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How will a No Deal Brexit affect healthcare in the UK?

Last week saw the British House of Commons reject a proposed deal to withdraw from the European Union, with Theresa May’s government losing the vote on the prospective agreement by an unprecedentedly large margin. With the UK parliament riven with divisions between those wanting a hard Brexit, a soft Brexit and no Brexit at all, the only current certainty is that, should no deal be agreed by March 29th, the country will leave the European Union and revert to World Trade Organization rules regarding trade, with no trade deals with any other nations in Europe or with the European Union as a whole.

Here at Xpomet, we pride ourselves on bringing together the best medical minds in the European Union and beyond to discuss the future of medicine and healthcare. With such a huge uncertainty ahead, it is worth considering the implications of crashing out of Europe on healthcare in the UK. The National Health Service (NHS) is the biggest single-payer healthcare system in the world, not to mention one of the world’s largest employers period, with an estimated 1.7m people working for the NHS. Beyond that, it is regularly cited as one of the things of which British people are most proud, with an unknowable – though undisputably large – value to the population.

So what happens to the NHS if Britain crashes out of Europe without a deal? Let’s deep dive the 5 things that you need to know before March 29th.

  1. The NHS is dependent on EU migrants to function

This much is obvious. It is estimated that one in 20 NHS workers is an EU migrant and around one in ten are non-British. If the current immigration rules were applied, a substantial portion of those would not qualify for work visas, unless a special category was made that specifically referred to healthcare staff. This seems unlikely to be enacted by March 29th. The NHS is also suffering hugely from staff shortages even with the current levels of foreign labour, so if that were to drop, then it would naturally only worsen.

Xpomet spoke to Claire Maguire, a thirty-year veteran of the NHS’ mental health services in the North West of England, who spelled out just how bad the situation is. “We are already hitting a workplace crisis because we can’t recruit enough doctors and healthcare professions,” she told us. “We have a real crisis in terms of vacancies and we are having to be very creative to fill them. If people are less willing to come here and less able to come here, then this only gets harder. There is only a finite number of people that we can employ and we’re trying to make the jobs seem attractive, but it is not easy, especially in particular areas – rural areas such Cumbria or Cornwall for example.”

These problems would arise before considering, for example, the inevitable decline in value of the pound – at least in the short term – against the euro, which would make the UK a less desirable option for potential migrants. A trained nurse from a less wealthy EU nation may choose to work in the UK because the strength of the pound against the euro or their home currency means that their remittances back to their country of origin are worth more. Without that advantage, then these people may simply choose to go elsewhere.

  1. Regulatory alignment for staff would become much more difficult

Let’s imagine that the flow of migrant workers into the NHS continues despite Brexit and the NHS chooses to keep hiring staff from abroad. The principal factor in the hiring process is competency, which is proved by qualifications – nobody wants their surgery done by an unqualified surgeon, obviously – and this presents a problem. Currently, the UK accepts EU qualifications, but without an agreement post-Brexit, there is nothing to suggest that they will continue to do so.

Claire Maguire again: “The NHS has an aging workforce, which has been happening for a long time. Because of that, we have had to employ a range of different strategies to entice workers from other parts of Europe and beyond to work here. Previously, we could employ those with an EU passport easily, but now that may involve a very different set of rules to check that their qualifications are comparable to British ones. Currently, it is very easy to compare someone from say, Spain, and the UK, but difficult for someone from, for example, South Africa.”

The UK would, theoretically, have to scope all 27 member states’ health qualification standards and compare them against their own and, indeed, against those of every other nation in the world. Is a Latvian nurse better qualified than a Thai nurse? They might have to go and find out.

  1. People are one thing, but medicines are another

It has been fairly widely reported that the British government is stockpiling medicines ahead of a potential No Deal situation. Drugs are currently imported to the UK seamlessly as part of the EU customs union, but there is absolutely no guarantee that that will continue post-Brexit, or what form any replacement might take. The only certainty is that, in the event of nothing being agreed before March 29th, all drugs will have no legal validity in the UK. Cancer-treating radioisotopes and insulin for diabetics are among the most vital pharma supplies that will likely go short.

Ireland has already begun planning for No Deal situation as well, with over half of the 4,000 medical products used in the country arriving via the UK. The Oireachtas, the Irish Parliament, will soon vote on motions relating to stockpiling drugs in the event of No Deal, though the Irish government itself was quick to add that this was just a precautionary measure.

  1. Research will grind to a halt if there is a No Deal Brexit

Here at Xpomet, we are all about the future of medicine – and that is something that stands to be heavily affected by a No Deal Brexit. The Royal Society, the UK’s leading scientific body, has spoken publically regarding what it would like to see in any deal, especially regarding regulatory alignment on medicines and technologies. Without a deal, there can be little movement forwards that involves British science, as nobody will have defined the parameters in which they would hope to work.

The effect is already being felt, with some UK scientists reporting their feeling that they are left behind while their European counterparts march ahead. “I’ve noticed that since the vote, UK scientists can’t play as prominent a role in European projects,” said Paris-based epigeneticist Edith Heard to Nature magazine late last year. “They can be part of them, but have drawn back from leadership roles because of the risk that proposals could be compromised in the future, when it’s not clear what’s going to happen. That’s stunting science.”

  1. British people abroad could lose healthcare access

While much of the focus has fallen on the rights of EU citizens living in the UK, there are also substantial numbers of British citizens resident in other EU countries for whom No Deal could be potentially catastrophic. Spain, for example, is home to over 200,000 British citizens, a large proportion of whom are elderly retirees. France also has a similarly large population of retired Brits. Older people are among the most regular users of the healthcare service and, in the event of Britain leaving abruptly, there is no guarantee that the current reciprocal system operated between EU nations would continue to exist.

Britain has reciprocal health agreements with non-EU countries – Australia and New Zealand, for example – but they had to be negotiated and signed off on. Again, the UK would have to do that 27 times to protect its citizens abroad, which seems unlikely to happen by March 29th.