Alastair Whitington, Consultant Editor for Specialised Commissioning, breaks down Brexit’s impact on the NHS now and in the future
Brexit (or otherwise) has now been set for Halloween. Whether it will be trick or treat, or an outcome that will come to haunt us, is yet to be seen. There is still great uncertainty over whether any deal will be realised and the significant implications this may have for both the NHS and wider healthcare.
Preparing for Brexit has come at an eye-watering cost. So far, based on the government’s own figures, £3.5 billion has been committed. The potential long-term impact on the economy and cost to the NHS in implementation is less certain. Recurrent NHS debts and a capital backlog (as reflected in our feature on NHS financial sustainability, page 19) have first call on the £20.5 billion 5-year settlement. Public‑sector funding depends upon a thriving economy.
Preparing for Brexit has come at an eye-watering cost
Uncertainty over what Brexit deal may, or may not, be agreed is impacting on confidence in the UK economy. If Brexit results in lower growth in public spending,1 this will impact upon future funding for public health and social care, on which successful implementation of the NHS long‑term plan will rely. Three areas of particular concern relate to workforce, medicines/devices, and research and development.
The NHS and social care organisations currently both have vacancy levels of 9%, with 100,000 vacancies and 110,000 vacancies respectively, including nurses, doctors, social workers, allied healthcare professionals, and care workers.2 Freedom of movement under the EU has over the years increased the number of European Union (EU) nationals working in healthcare, who now make up 5.2% (62,000) of the English NHS workforce and 8% (104,000) of those working in adult social care. However, since the Brexit referendum, the recruitment and retention of NHS professionals from EU countries has not kept pace with those exiting these shores.
The NHS and social care organisations currently both have vacancy levels of 9%
The current level of vacancies and number of EU nationals working in the healthcare sector suggest that, even with government efforts to increase the domestic workforce, it will take some time, if ever, for this to meet the current and future demands in healthcare. It is therefore imperative that the government supports international recruitment and changes current proposals that will prevent the NHS and social care recruiting lower‑skilled workers from outside the UK.
Medicines and devices
Approximately three-quarters of medicines and half of the devices used by the NHS come via the EU.
The EU has a harmonised approach to medicines regulation, with the European Medicines Agency (EMA) responsible for the scientific evaluation of medicines developed for use in the EU. This enables pharmaceutical companies to submit a single application to obtain a marketing authorisation that is valid across EU, European Economic Area, and European Free Trade Association countries.
In the UK, the Medicines and Healthcare products Regulatory Agency approves drugs for the UK as a decentralised drug-approval process. However, many medicines marketed in the UK are subject to approval by the EMA, and all paediatric medicines and orphan drugs used to treat rare diseases have to go through this centralised process. Without a special deal, the UK would no longer be part of this EU pharmaceutical regulatory structure. It would be excluded from access to the centralised EU database, no longer seen by pharmaceutical companies as a first-launch priority market, with the consequence of drugs being launched later in the UK as in Switzerland and Canada, who both have separate approval systems.3
European and UK supply chains for medicines and devices are interlinked, and any new tariff arrangements or inspections could significantly disrupt this and cause delay to medicines that are time- and temperature- sensitive, such as cell and gene therapies, or those which the UK doesn’t produce (e.g. human insulin).
The Government has also indicated that Brexit will result in the UK leaving Euratom, which regulates Europe’s nuclear industry, including the supply of medical isotopes used in the diagnosis and treatment of cancer. Despite government assurances that it wishes a smooth and orderly exit,4 concern remains around future supply and cost of provision.
… the government has indicated that the UK will continue to recognise medical devices approved by the EU …
To overcome this risk, the government has indicated that the UK will continue to recognise medical devices approved by the EU, and encouraged the pharmaceutical industry to stockpile 6 weeks’ supply of medicines. Products with a limited shelf life will have to be flown in at considerable extra expense to the NHS.
Impact on research and development funding and collaboration
The UK’s scientific research has historically benefited through EU collaboration, both in terms of access to scientists and researchers, and because the UK is a net gainer in research funding. As with healthcare workers, restrictions on the movement of researchers will have a significant effect, with three-quarters of researchers having spent some of their career in a non-UK institution and 28% of university academics coming from outside the UK.5
… three quarters of researchers … spent some of their career in a non‑UK institution …
Between 2007 and 2013, the UK received 8.8 billion euros for its research, development, and innovation, while contributing only 5.4 billion euros to the EU research and development budget.6 Although the government has agreed to honour funding for European Structural Investment Fund projects signed before the Autumn statement of 2016, longer-term arrangements remain unclear.
The trick for 31 October will be to ensure workforce stability, support crucial supply chains, and maintain the UKs prominent position in research and development so that the NHS continues to be the country’s favourite treat.
- Organisation for Economic Co-operation and Development. United Kingdom–Economic forecast summary (November 2018). OECD, 2018. www.oecd.org/eco/outlook/united-kingdom-economic-forecast-summary.htm (accessed April 2019).
- The King’s Fund. Brexit: the implications for health and social care. February 2019. www.kingsfund.org.uk/publications/articles/brexit-implications-health-social-care (accessed April 2019).
- Fahy N, Hervey T, Greer S et al. How will Brexit affect health and health services in the UK? Evaluating three possible scenarios. Lancet 2017; 390 (10107): 2110–2118.
- HM Government. Nuclear materials and safeguards issues–position paper. Department for Exiting the European Union, July 2017. Available at: www.gov.uk/government/publications/nuclear-materials-and-safeguards-issues-position-paper
- The Royal Society. The role of the EU in international research collaboration and researcher mobility. The Royal Society, 2016. Available at: royalsociety.org/topics-policy/projects/uk-research-and-european-union/role-of-eu-researcher-collaboration-and-mobility/
- The Royal Society. UK Research and the European Union. The Royal Society, 2015. Available at: royalsociety.org/-/media/policy/projects/eu-uk-funding/uk-membership-of-eu.pdf