Brexit and Healthcare – The Naked Truth

The UK’s decision to leave the European Union has come as a shock for the whole world.
The impact on the economic stability of the country will involve a range of areas, but what seems to be certain is that healthcare will be deeply involved.
Some of the main actors involved in the pro-Brexit campaign initially gave an indication that the quality of care provision could be improved by recovering and using funds sent to the EU and investing them on the NHS instead. However, even only hours after the vote, this possibility was retreated and the facts are now actually telling us that, as predicted by many experts, there are many reasons for concern for the stability and progression of healthcare in the UK..

Exclusion from Research Funds

The UK is today one of the main contributors to world health and medical research.
This has become possible mainly thanks to the arrival of a substantial portion of EU research funds.
In simple maths, the UK has been receiving more research funds (16% of the whole of EU budget) than it has actually payed (11%).
Unless special agreements are made, one of the first results of Brexit will be a substantial slow down of UK health research and an increase in time necessary for the development of new treatments and medicines.
Being part of the EU has also allowed the UK to become the centre of the pharmaceutical industry. London is home to the European Medicines Agency , which is the centralised EU pharmaceutical licensing system for new products. With Brexit, this is clearly going to change as the agency is likely to be moved to another European country, taking most of our pharmaceutical firms with it.
The results of Brexit have already been seen in the first months after the vote, with the UK’s removal from many research projects since its uncertain position is inhibiting the assignment of funds.

Less Scientists for research

But the advacement of research is not only determined by funds. It is part of a bigger, complex puzzle of components, so paradoxly the freedom of movement, which has been one of the major determinants in people’s vote for Brexit, turns out to be essential for the survival of the country’s advancement in research.
Indeed, free movement of labour is what has allowed the best scientists in Europe to easily move to UK, work in its research centres and relevantly contribute to its current position as a focal point for world research.
It should not be forgotten that researchers follow money, as funding is essential to research progression, and companies providing that money traditionally prefer settings that allow simplified scientist recruitment processes.

Loss of Indirect reasearch-related benefits

The effects of the research industry on the UK’s economy are huge and as we all know, the quality of healthcare strongly depends on the country’s economy.
Within the current European Regional Development Fund (ERDF) budget, €5bn have been exlusively channelled to the development of health and health services.
Research follows money, and money makes money. And so it goes that many areas of south-east England and cities such as London and Liverpool have hugely benefitted from the arrival of these massive budgets (ERDF).
The arrival of pharmaceutical company headquarters in these areas has indeed provided thousands of jobs, not only in the scientific and academic areas, but also in the many administrative and auxillary service areas.
Furthermore, research budgets and the arrival of many European top-scientists have provided enormous benefits to Universities and allowed to build Hospitals. For example Altnagelvin, one of the major hospital complexes in Northern Ireland, has been developed thanks to EU funds.
The UK, which currently gains disproportionately from funding streams for medical research, risks incurring in significant losses.

Less International Participation

The improvement of healthcare is strongly dependent on the development of clinical trials. Larger clinical trials are more reliable, and in many cases it is necessary to join forces with the participation of many countries so as to have a large enough population to provide significant and secure data.
Let’s think, for example of what happens when a company is developing a medicine to treat a rare metabolic disease. It is highly probable that the affected population in one country is not enough to ensure the results of the trial can be reliable.
This is the reason for which the union of many countries, with a common regulation and simplified processes in the involvement of trials has had profound effects on the advancement of clinical research in the EU.

A separate drug licensing system

Companies seeking to conduct clinical trials for new drugs across the EU can today easily run multi-country studies by registering on a single EU clinical trial database.
In the after Brexit scenario, UK companies seeking to conduct multi-country clinical trials could be forced to apply individually to each country, resulting in a huge administrative and cost burden. On the other hand multi-country EU clinical trials will tend to exclude the UK from innovative and multi-country development projects for the same reasons.
From a regulatory standpoint, the UK will lose influence over the European Medicines Agency, the organization that approves drugs for use within the EU.
In practical terms, this means that the UK will be required to maintain a separate database on pharmaceutical products in the market and carry out its own tests. Useless to say, this will require more spending, contributing to the NHS’s budgetary problems.

No more Free healthcare in Europe

Until today, any healthcare treatment for UK citizens in all EU country has been guaranteed thanks to the European health insurance cards.
With Brexit, the UK government will need to negotiate new arrangements with each.
It is now not unusual for UK residents to choose to have hip replacements in France, or to travel to Belgium for spectacles, or to Budapest for dental treatment, all paid for (as according to EU legislation) by the local UK “purchaser”.
This is so common that the NHS had started placing special arrangements with some major overseas hospitals for highly specialistic care. An example of this is the NHS’s referral for proton beam therapy to overseas treatment centers.
These arrangements have advantages both for patients and the NHS. On the one hand patients have free access to some services that they could not otherwise undergo, and on the other hand these arrangements mean huge advantages in terms of savings for the NHS.
Indeed, outsourcing has a role in healthcare too. The maintenance of highly specialised wards for the benefit of a small portion of the population is sometimes neither cost-effective nor beneficial to patients and their healthcare system.
For this reason many healthcare systems around the world have been centralising highly specialised healthcare within fewer, more advanced centers, in which shared expenses and investments result in quicker progress and higher quality of care.
The recent changes towards a more shared and “open” structure of European Healthcare are the gateway to a European healthcare system in which the “joint forces” of many medically advanced countries will relevantly boost highly specialised reference centers to which all EU citizens will have free access.
The UK will now have to contract its terms of use in this system.

NHS staff

4,5% of the NHS workforce is made up of citizens from other EU countries. They include doctors, nurses, paramedics, pharmacists and othe health professionals, as well as administrative staff, and they are vital for the NHS’s functioning.
NHS is in shortage as is, and this gap has been increasing in time, so that we are now expecting a 16,000 Physician and 100,000 nurse shortage within the next 4-6 years.
The UK has been struggling to fill in the gap by recruiting both doctors and nurses from foreign countries, especially from other EU countries, where freedom of movement has ensured an easier migration process.
The guarantee of free movement and stable, long-term contracts is a huge advantage to care providers within all EU countries, and among these, it must be said that the UK is currently one of the countries who’s healthcare system most depends on the import of doctors trained abroad.
The UK’s vote to leave the European Union, with immigration cited as one of the key reasons, and the Govermnent’s lack of reassurance towards the millions of EU healthcare workers in the UK, threatens devastating effects on the NHS.
Qualified workforce is highly requested worldwide and qualified workers are in the position of choosing among a range of alternatives on where to go to work. Fears of uncertainty for the future and a growing anti-immigration attitude will inevitably result in people choosing other destinations than the UK.
The risk is not only for the future, but also for the very present. There have already been reports of a relevant decrease in EU recruitment since Brexit and initial hints of a “brain drain” of EU scientists and healthcare workers since the 23rd of June.

Less Home Care

The biggest impact on the NHS workforce is expected to be in social care provision.
Primary and long term care, which currently account for around 20% of the total health budget, have been a key point in the UK’s efforts to reduce expenses, and major emphasis has been placed in their development in the last years.
The NHS is seeking to bring about efficiency savings of £22 billion over the next few years by transitioning care away from hospitals and towards long-term care based managed care models.
social care workers are the center of this development as they help manage chronically ill and elderly patients outside hospital settings. As part of the program, the NHS has therefore been seeking to recruit 100,000 social care workers.
Recent changes to overseas immigration laws bringing the minimum yearly income to staggering levels of 35.000£/year have already been a cause of major concern for lower-income immigrants entering or living in the UK.
Even though some professions have been excluded from these new rules and it is probable that social care workers, as nurses, will be among them, the insecurity of what could happen in the future and the possibility of not being able to settle down long-term if rules were to change are bound to have immediate effects.
Most of UK social workers are currently recruited from the EU thanks to the advantages of free movement of labour.
But now Brexit seems to be set to guarantee continued and growing vacancies for social care jobs. Indeed, some reports are anticipating an exodus on existing social care workers back to their native countries, thereby making a bad situation worse.

The risk of an exodus of NHS staff is so relevant that even Stephen Dalton, chief executive of NHS Confederation, stepped in to say “We need to move on from just telling people that they’re valued to giving them some security at the end of that two-year period,” he said, “that actually they will have some legal safety to remain in this country”.

Pandemics control

With an ever globalising world, and the very recent and current issue of spreading infections such as Ebola and Zika virus, another major challenge after Brexit is the future coordination between the UK and the EU in dealing with pandemics, as well as other health threats. Close coordination with the EU has been and will remain critical in reducing spread of potential new outbreaks. In the future, the UK will need to coordinate controls with the creation of a new EU-UK joint coordination, but this process could take a few years and will imply a further administrative burden.

In conclusion, there are many issues that require the government’s urgent attention. The impact of Brexit on health and social care could have profound implications for patients and service users and should be adressed as soon as possible.