For public and private providers alike working in health and social care, there are significant issues to deal with in the post-Brexit world. Business leaders need to stay ahead of the curve in terms of remaining informed of changing trends and priorities and then planning accordingly with the right staffing, healthcare training, business organisation, service provision and strategic positioning to meet future patient’s needs.
It’s important to know that on an EU wide basis, healthcare provision is not a marked and significant competence. In fact, the UK is just one European country that relies heavily on incoming talent from across the world in order to train its specialists, to implement cutting-edge healthcare practices and to deliver advanced services across the NHS and private provision space. However, the Brexit vote does have significant implications for health and social care, particularly as the NHS is facing tremendous NHS and operational pressures. The degree of the anticipated impacts is impossible to quantify at this stage, but it is clear that a number of issues will have to be carefully considered and addressed by policymakers. For example:
Currently, many of the healthcare workers who are employed in the UK are from other countries in the EU and beyond. These include 55,000 NHS workers from the EU and 80,000 adult social care workers, according to figures from Skills for Care. The NHS is particularly struggling to attract and retain quality permanent staff, and in 2014 a 5.9pc shortfall in permanent resource equated to a gap of around 50,000 full-time roles. Areas which are particularly struggling include health visitors, midwives and nurses according to the National Audit Office 2016 figures. A similar situation can be seen in the social care sector, which has a high turnover of over 25pc (representing around 300,000 staff leaving their roles annually).
Until the details of the UK’s employment and migration policy with the EU is clarified, the existing freedom of movement regulations remains in place. The government has publicly reassured EU staff working in the NHS that they will be supported in their right to remain and work in the UK, however many healthcare providers would like to see the retained right to recruit EU staff when resident equivalents are not available. This could be done by adding key health and social care roles to the shortage occupation list maintained by the Migration Advisory Committee, which currently allows employers to recruit midwives and nurses from beyond the EEA.
The impact of immigration and treatment access on the NHS is another hot issue, and where immigration to the UK grows, the pressure on public health and social care services tends to grow with it.
The current European Health Insurance Card is an important measure for guaranteeing reciprocal care within EU countries for EU nationals, and arrangements for the future will need to be defined. Around three million EU migrants currently live in the UK and around 1.2 million British migrants live in EU countries, and they will need the reassurance of their ability to continue to access healthcare on a similar basis to the existing EHIC scheme. This will need to be agreed as part of the ‘divorce’ settlement. Already, there are some reciprocal healthcare arrangements that exist with certain non-EU countries which could be used as a model.
The government will need to decide whether it continues to abide by existing EU regulations on areas such as working hours, competition and procurement law, the regulation of medical devices and medicines, and professional standards regulations and medical education. These areas are absolutely crucial to the healthcare industry and could affect the way that training is delivered and accredited. Clinical trials could also be heavily impacted and the UK may seek to rework the way that new drugs are developed and brought to the market.
It’s important to note too that the EU has a heavy governance role when it comes to public health. It has systems that detect and warn about communicable diseases, which are overseen by the European Centre for Disease Prevention and Control. This currently allows for cross-border cooperation on health threats and possible pandemics. Recent examples include collaboration on efforts to overcome resistant to antimicrobials (AMR) and the response to the H1N1 pandemic.
This EU wide cooperation also has allowed the UK to enjoy a strongly successful record of scientific research thanks to its ability to access key funding sources and EU-wide research talent. In 2015, the ONS found that the UK accessed over 8.8 billion EUR for R&D and contributed 5.4 billion EUR to R&D. The medical and academic communities have already flagged up their concerns about leaving the EU within the context of medical research and science. It is hoped that the issues of access to research talent and funding for specialist scientific investigations should be prioritised as part of the Brexit discussions.
Finance and funding
The Vote Leave campaign before the referendum claimed that the money the UK puts into the EU’s membership pot could instead be directly pumped into the NHS. This was one of the most contentious aspects of the campaign and then rapidly refuted by many Leave politicians. The campaign said that EU membership cost £350 million a week to the UK and that a Brexit decision could lead to £100 million extra a week instead of going to the NHS, in excess of the amounts agreed by the Spending Review.
The NHS is certainly facing huge pressure in the wake of limited finance and dwindling performance against more challenging targets. Ultimately, the UK’s economic performance will help to influence the NHS and its funding. A strong economy means healthy tax receipts and the ability to fund public spending campaigns, so ongoing stability will be key to public health services. Many NHS leaders have also called on the government to provide extra funding for social care which has already experienced heavy cuts and resulted in around 400,000 fewer Britons receiving public social care sources.
With Brexit negotiations still in full swing and the detail now being worked through in lengthy and complex negotiations, the health and social care industries will continue to work hard to ensure that their voices are heard and that the government gives these key strategic areas the necessary priority and focus to ensure a healthy, happy and adequately funded post-Brexit world of health and social care provision, where the right staff can be found, where training can be properly accredited and where specialist research activities and funding access can continue unabated, for the good of patients across the UK and beyond.