The impact of Brexit on the NHS

Freshwater takes a look at the potential pressures facing healthcare services following the UK’s recent political change.

There can be no doubt that, if Britain exits the EU, the future of the NHS remains ambiguous. At a time of political turmoil, uncertainty has gripped the financial markets and public services alike, health leaders and thinkers are struggling to come to terms with Brexit as it becomes clearer than ever that the economy and the NHS are intrinsically linked.

The result of the referendum saw immediate animosity directed towards the Leave campaign for providing misleading information. One of the most appealing suggestions for those who voted to leave was the promise of ‘£350 million per week to the NHS’ – money which the Leave campaign claimed Britain currently pays to the EU. Whether or not this pledge is plausible sparked much discussion. Dr Sarah Wollaston, Chair of the Health Select Committee, defected from Vote Leave based on her assertion that the monetary pledge “simply isn’t true.” Michael Gove, former Conservative leadership candidate and prominent Leave campaigner, lowered the amount to £100 million per week during his Conservative leadership bid confirming misgivings that surround the initial figure. Nigel Farage, former UKIP Leader, declared the statement a “mistake” and distanced himself from it shortly after the referendum result was announced. Unpredictable events will come into play in the coming months and when a week is considered a long time in politics, it would be wise to think an hour is a long time in Britain’s currently febrile government.

The Leave camp focussed great attention on the effect of migration on the NHS, suggesting that increased migration due to the free movement of people placed increased strain on NHS services. Net migration from EU countries was recorded at around 184,000 last year and was similarly high in previous years, providing just below 50 per cent of overall migration to the UK. Questions arise when considering the facts behind this approach as roughly 130,000 EU citizens work in the health and care service.

Five per cent of the UK population are from other EU member states, compared to 10 per cent of the NHS workforce, and, at present, the NHS is struggling to recruit and retain permanent staff. In 2014, there was a shortfall of 5.9 per cent, equating to 50,000 full-time staff, between the numbers of staff that health and care services said were required and the figure employed. It is of little shock that in the run up to the referendum, 80 per cent of NHS chief executives and chairs who responded to a survey concluded that leaving the EU would have a negative impact on recruitment of the health and care workforce.

Arguably, Brexit could create a deterrent against migration for future generations, making us what could be described as a more inward looking nation. Last year the NHS looked abroad for almost a quarter of new recruits. Now, Brexit may deter possible migrants from accepting offers of employment based on the country’s position in a globalised world, leading to fears that staff shortages will worsen.

Further uncertainty surrounds the UK residence status of EU nationals when Brexit does come into effect. The new Prime Minister, Theresa May, wishes for EU exit negotiations to occur prior to guaranteeing the status of nationals from other EU countries in the UK. Politicians across the political spectrum have called for the residency of nationals of other EU countries to avoid further discontent. A somewhat overlooked element to migration is the prospect of approximately 1.2 million British expatriates returning to the UK, placing added pressure on NHS resources.

2016-17 was initially forecast to be a particularly challenging year for the NHS, with service leaders facing huge financial pressures, and performance against key targets deteriorating due to myriad reasons. In light of Brexit and its aftermath, a new Prime Minister increases the likelihood of a snap election prompting a fresh Budget and perhaps squeezing public service finances further, Brexit has left an indelible mark on the future of the NHS.

Freshwater’s healthcare team has significant experience of working with health and social care organisations and NHS trusts, offering services from integrated communications to crisis management, as well as delivering events and training.