Brexit: the end of the NHS?
This article was first published in 2017.
The National Health Service (NHS), the public healthcare system offered to all UK residents established in 1948, is generally considered one of the world’s best public healthcare systems in terms of efficiency, cost, and safe care. Additionally, it employs one of the UK’s largest workforces — 1.5 million people. However, going into Brexit, uncertainty has arisen about the future of the NHS. Questions have been raised regarding the areas of budget, employment, and international healthcare recognition between countries as ‘the influence and impact of EU affairs on the NHS has significantly increased over time, with various aspects of domestic health policy intrinsically linked with EU policy.’ EU law currently does not affect the way the UK manages and runs the NHS. However, economic, political, and social outcomes resulting from the departure of the United Kingdom from the European Union would have a rippling effect on the health service.
With the details of legal agreements between the UK and EU called into question, certain previous givens would no longer be readily available — such as reciprocal health privileges with other EU countries. As a member of the European Union, the UK is legally required to treat EU citizens through the NHS. However, looking at the statistics on the number of EU citizens treated by the NHS — those visiting versus those who live there — one can see that the majority are tax-paying citizens of the UK whose taxes contribute to the running and sustaining of the NHS. Additionally, the EU has a reciprocal arrangement on healthcare which compels the NHS to treat some EU and EEA citizens and non-permanent residents whilst also entitling UK citizens to free healthcare elsewhere in the EU when traveling abroad. When the UK leaves the EU, this arrangement will dissolve, forcing many UK citizens to purchase expensive travel health insurance when traveling or, in the case of UK citizens living in abroad in an EU country, purchase long-term EU health insurance.
Post-Brexit funding for the NHS is another major worry. The NHS receives funding by regions within the UK, and with Brexit, it is anticipated that there may be less funding for all or some regions. According to a report by the Office for Budget Responsibility (OBR), health expenditure (in particular) and social care costs are both projected to rise. Additionally, the Institute for Public Policy Research (IPPR) reports that there will be a dramatic increase in the demand for health care due to the increasing percentage of the elderly (over 65 years of age) — projected to rise to 33 percent by 2030 — in the overall UK population. This resultant need for increasingly more money and more caregivers will consequently put a strain on the NHS. Less funding impacts both actual patient care (in-patient and out-patient services) but also research allocations, new treatments, expansion of novel treatments. Labor costs are the largest expense for hospitals and there will most likely be notable cuts in that department. For example, earlier closing hours, reduction of home care allocations, shorter in-patient stays, fewer referrals to specialists, longer wait times for elective procedures, etc. There will also most likely be a significant reduction in the innovation and research funding in the NHS, putting the NHS behind that of other countries regarding the efficiency and modernisation of the program. Mitigating this, however, the “Vote Leave” party promised — as part of their lists of goals — to take the money which the UK is forced to spend on its EU membership and invest it with the NHS, promising specifically a ‘£100 million per week cash injection.’
The biggest and most easily quantifiable fear, however, for a post-Brexit NHS is the threat of lack of staffing — particularly when added to the threat of lack of funding. According to research, the UK’s health care system is significantly more reliant on foreign staffing than other countries — in 2008, 27.8 per cent of UK health care professionals were immigrants. Analysts worry that, after Brexit, the future of the NHS will be uncertain, and that this uncertainty will prompt many health care professionals to leave thus creating staffing shortages. Even the NHS’s Chief Executive, Danny Mortimer, has verbalised these worries, explicitly citing evidence of foreign staff who are considering very seriously leaving the NHS and returning home. In fact, understaffing already constitutes a serious problem for the NHS. Stephanie Aiken, Royal College of Nursing (RNC) Deputy Director of Nursing, has flagged a distressing 20 per cent decrease in the number of applications which the NHS is receiving for advertised positions. This trend, when added to the future threat of staff leaving following Brexit, creates ‘a very worrying situation that could cause the staffing crisis to deteriorate past the point of no return.’ Operations Director of TFS Healthcare, Olivia Spruce, explained how uncertainty about Brexit has exacerbated the strain of staffing shortages for the NHS since December 2016, placing patients at risk:
‘This coupled with more and more existing NHS workers leaving the system, is creating a very worrying staffing crisis on the horizon for the NHS unless the government acts quickly and provides clarity.’
Overall, Brexit would have rippling negative economic and social effects on the NHS — many of which are already starting to manifest themselves because of the lack of clarity about Brexit conditions supplied by the British Government. Without a clear idea of what lies ahead for the future of the NHS, the increasing difficulties which it is experiencing threaten to propel the organisation into a downward spiral of problems — from staffing shortages to economic difficulties — that the UK will find difficult to solve.
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