Will Brexit Affect the NHS

We all remember Boris’s epitaph on the side of the Out-campaign bus saying “Let’s fund our NHS instead”. This related to the £350 million a week that we supposedly pay to the Europe Union (the net figure was of course significantly less). The question is, is the NHS going to be worse off because of Brexit?

Currently, we don’t know how the negotiations are going to end. The government talks about leaving without a deal suggests that they can start trading with the EU on World Trade Organisation tariffs or the complicated agreement implied by May’s Florence speech. With no overall majority will this government even be able to complete the negotiations.

Most commentators highlight four factors that will determine the impact on the NHS following Brexit (If and when we leave EU). The state of the economy will determine general taxation, and that will determine the level of NHS funding. In recent years the NHS had protected status although many NHS Trusts are financially very vulnerable. The pressure on the NHS will be further exasperated by an ageing population and plans for a `seven-day service.’ The EU membership costs, £8.6 billion net, will not all be used to support the NHS as there are other priorities (the government has promised some sectors that after Brexit they will be protected, at least for a while). The NHS will certainly not get the £350 million a week. The budget for the NHS for 2017/18 is £122 billion. If the full amount of £8.6 billion were given to the NHS, it would be used up in 26 days.

NHS is reliant on migrant staff to deliver services. Currently, around 11,000 doctors are working in England from the EU27 and 20,000 nurses. There are already staff shortages in nursing, with a 92 percent drop in the registration of EU nurses from the EU27 as of March 2017. Because we still don’t know what immigration regime the government will introduce post-Brexit, there is a considerable resource risk of specialist medical skills for the NHS.

For UK citizens, already resident in the EU there will be little change for them. However, the millions of UK nationals who annually travel to the EU in the future will have to purchase private health insurance. To bust a myth 52,000 patients came to the UK for treatment while 63,000 patients left the UK for treatment in Europe.

The NHS will also be affected by the availability of pharmaceutical drugs in Britain. EU law underpins the regulation of pharmaceuticals in the UK, and even though Theresa May has said she wants Britain to remain part of the European Medicines Agency, by coming out of the EU, UK will lose access to facilities that allow these goods to flow freely between the UK and the rest of the EU.

It is difficult to see what will happen to the NHS after the Brexit negotiations have been completed and just as difficult to convey these doubts to a public that is becoming weary by the entire Brexit debate.

 

 

 

 

 

* Tahir Maher is the Wednesday editor and a member of the LDV editorial team

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14 Comments

  • “NHS is reliant on migrant staff to deliver services”

    Whilst that is correct, The NHS is more reliant on staff from the Row than it is the EU
    Out of 1.2 Million staff members
    139,000 are Non British, equating to 12.5% of all NHS staff
    Of these 5.6% come from EU Member states and 6.9% come from (ROW) Rest of World
    Therefore the NHS is more reliant from migrant workers from “outside the EU”

    For comparison there are 2040 Australians working within the NHS, that is more than
    Slovenia, Switzerland, Norway, Croatia, Malta, Austria, Belgium and Denmark combined

    If the NHS is reliant on non uk staff it is Indian Doctors whose numbers are equal to that of 23 EU states combined and for Filpino Nurses whose numbers equate to 24 EU states combined.

    It is more than plausible that the drop in EU nurses is nothing to do with Brexit but more to do with EU countries that were experiencing recession and redundancies within their health services are now starting to recruit again.

    Our NHS is not going to collapse because of Brexit, there is a worldwide pool of medical professionals out there to be tapped into including Europeans .

  • @Matt the total number of doctors that are qualified not in UK is 25% overall all. The norm I believe is 9% in many countries. I agree that the EU27 number is small but I wanted to still show the reliance of a significant number of EU medical practitioners who will be very difficult to replace and it will take time to replace them. Hence not a collapse but certainly a body blow, as it were.

    I didn’t mention non-British EU nationals working in the UK’s social care system which has shot up by more than 40%. A question by MP Tom Brake, in parliamentary shows the total increased from 65,000 in December 2013 to 92,000 by September last year, the most recent date for which figures are available. They will also have an impact on care.

    After the Windrush scandal, how easy will it be to get doctors/nurses from the Indian sub-continent, West Indies and other places?

  • @Tahir

    I believe the latest stats show that 36% of Hospital Doctors gained their primary medical qualification outside of the UK of which 9% qualified in the EU, which suggests to me that the UK is reliant on a pool of “international” medical professional from the Row and not just the EU

    “I didn’t mention non-British EU nationals working in the UK’s social care system which has shot up by more than 40%. A question by MP Tom Brake, in parliamentary shows the total increased from 65,000 in December 2013 to 92,000 by September last year”
    I thought the argument that since the referendum and brexit was EU nationals are leaving in large numbers and our care system will not cope, but those statistics you quote seem to quash that and show number are increasing since the referendum

    “After the Windrush scandal, how easy will it be to get doctors/nurses from the Indian sub-continent, West Indies and other places?”
    Quite easily I would have thought, after all they will be given a skilled migrant visa, after which a period of 5 years, they would be able to apply for permanent residency, if they so wish.

  • As you say, Tahir, “is, is the NHS going to be worse off because of Brexit ? Currently, we don’t know how the negotiations are going to end”. Exactly, we don’t know.

    I benefited from a transplant seven years ago under the brilliant Scottish NHS – performed by Turkish and Argentinian surgeons who (after representing my late great Aunt at the Millicent Fawcett statue unveiling yesterday) I’m delighted to report was a brilliant young woman. I don’t suppose either would be affected by Brexit.

    As to the UK Social Care System, yes, it’s in crisis. As a former Convener of Social Care I confirm local authorities are under enormous pressure to reduce the cost of contracts with outsourced care providers – who try to undercut each other. Result ? They pay ridiculously low wages attracting only the persons you mention. Allied Healthcare’s CVA this week is the latest example of a crumbling service (which, don’t forget, goes back to Coalition austerity local government cuts !!). The ‘market’ doesn’t work for recipients of elderly social care.

    PS Disappointed with LDV not featuring the unveiling of the Fawcett statue – tho’ I saw Jo Swinson in the crowd. Was it because Asquith said “I suppose so” when Millicent told him ‘women are people too’ ?

  • A recent survey of Slovaks abroad found that most would return if they were able to find jobs at home paying around 60% of what they earn abroad I imagine you’d get similar figures for most Eastern European countries (you would get a certain gap even for northern English people to leave the south).

    Given one of the aims of the EU is to bring poorer regions to equality and given average wages there (Slovakia) are now nosing at 1000 euros a month (up from 770 euros at the end of 2012) we are getting close to the exodus point anyway – hence the reported difficulties in getting people to come to the UK for 3 months and harvest rather than stay home and harvest their own crops. Regardless of Brexit, the UK was soon going to have to prepare for a situation where, for the first time, it was no longer very near any massively poorer countries. It was never going to be sustainable for the UK to keep freeloading off those EU countries with free university education. The solution is the same as for any non-disaster-hit country – train the medical staff you need for the jobs you have – which should be part of a general process of better gearing education to the demand for skills.

    Brexit just means the UK decides – the govt should say now, that regardless of the negotiations they will keep free movement for healthcare workers and the Lib Dems should make it clear that they would do that as part of their post Brexit policies.

  • The debate below the line is rather simplistic as it treats each NHS worker as an individual with no partner, no children etc which is often not the case. Whether a person works in UK or not is not merely driven by whether they personally can get a visa but also how their partners and children are treated and the partner may not be a healthworker and may not be the same nationality and subject to the same restrictions. Ie a nurse whose partner is a builder may have come to work in UK before but might not in the future. Whether we need workers or not – the message that Brexit sends out internationally and daily is that foreigners are unwelcome. A trained healthworker has options about where they work – Britain is increasingly unwelcoming and unattractive.

  • William Fowler 26th Apr '18 - 7:26am

    Recruitment of overseas staff has a relationship to the value of sterling, too, its current ruined state not helping matters and if Labour gets in plus really hard Brexit you may be looking at 0.5 to the Euro and 0.7 to the dollar (don’t laugh, these are the worst case figures doing the rounds in financial circles) so a huge increase in cost for staff recruitment (and if you are paying foreigners more you have to match that to local rates).

  • Andrew Daer 26th Apr '18 - 8:07am

    Tahir’s question is fundamental to the Brexit debate; it was claimed leaving would be easy, and that the only noticeable effect would be the saving of the cash spent on our membership fee. This wonderfully simplistic view was exemplified by the claim made by the red bus, that the saving could be ‘earmarked’ for the NHS.
    In the real world, leaving the EU has hundreds of other implications, but on the narrow question of the economic impact, there is still a surprisingly simple question to be answered; leaving will obviously damage our economy, but is the loss in tax revenues going to be greater than the £8bn gain from ending our contribution to the EU?
    The problem with discussing the £350 a week for the NHS is that the red bus message was never meant to be taken literally, and was just a way of saying the EU is draining the UK of cash, and that we’d be better off out of it. That claim seems absurd now, but stagnation in real wage growth over many years had left many people feeling something is not right, and when they were offered a simple solution they clutched at it.
    When you talk to leave voters, most (not all) don’t want to discuss NHS staffing issues, or even future funding of the NHS; they will tell you they never believed the red bus lie. They assume that their own and their families healthcare needs will be met, somehow, and if you believe the British are specially gifted (look at our glorious past) why would you worry?
    Hospital doctors lament the loss of EU recruits, but privately – they don’t walk down the A&E corridors shouting “you wouldn’t be waiting on a trolley if you’d voted remain”. We are all constrained by having to avoid resurrecting project fear, and would gain more from concentrating on the positive benefits of EU membership, rather than the trying to convince leave voters they were wrong.

  • @Alistair

    If the main visa applicant is a health worker i.e Nurse or doctor then their partner is also given leave to remain also to work in whatever job they chose. They are not required to also be in a position where there are skills shortages.
    The entire family is assessed on the application of the main applicant.
    The Children if any are all permitted to attend school and all receive health health care etc.
    Then after a period of 2-3 years, they can apply for “Indefinite leave to remain” which basically gives them the right to continue to reside and work in the UK for however long they wish and after 5 years they can apply for permanent residency

    @William Fowler

    The UK will always be able to attract overseas workers to professions like nursing, even from the EU after we have left.
    Take Portugal, where the average nurse takes home a dismal £750 a month, compared to a new qualified nurse in the uk taking home £1,500 a month ( To be clear, I am not saying that UK Nurses are well paid)
    While European countries are paying abysmal wages to their medically train staff, the UK will always be able to tap into that resource and attract people to come and work here.

    And as someone pointed out earlier. It is quite possible for the UK to leave the EU, single market and customs union, but still have a policy of freedom of movement for ALL healthcare workers from around the globe.

  • The NHS has planned expenditure of £124 bn for 2017/18 according to the NHS Confederation.

    PWC estimated that financial services contributed taxes of £72 bn in the year to March 2017 which is 11% of total UK Government tax receipts.

    So, ignoring the slight mismatch in time periods covered, financial services contribute 58% of the cost of the NHS.

    Theresa May & Co are NOT going to get a deal that preserves access for UK financial services to the EU27 except perhaps transitionally while the EU27 build up their capacity which will take time. Nor will they get access to other substantial markets even if they get the highly advantageous Free Trade agreements they fondly (but wrongly) imagine they will get. That’s because, apart from the EU’s Single Market, other trade agreements do not include financial services except marginally.

    Also, it’s a very obvious strategy for the EU27 to require financial services firms to relocate into the EU27 as a way of plugging the hole in Brussel’s coffers left by the end of the UK contribution. Individual EU27 countries will share Brussels interest in increasing their tax base.

    Nor is it likely the hole in UK government finances can be plugged by manufacturing or other exports. UK based manufacturers will see the cost and difficulty of exporting to their major market – for the great majority the EU – go through the roof compounded by the fact there will be a great shortage of expertise in the complexities involved. So, most will find their costs soar; some will probably fail. To compound exporters’ difficulties they will find, that, like the NHS, key skills are in short supply because of the failure to train enough engineers etc.

    So, manufacturing profits will be down and so will the personal taxes of their employees and spending taxes. They will not be able to plug the hole left by financial services.

    I really don’t see how the NHS can continue except as a skeleton service. Perhaps Brexiteers can explain.

  • Arnold Kiel 27th Apr '18 - 8:22am

    I find this debate surreal. No leading Brexiter is pursuing his goal because he/she wants to expand any social service. The exact opposite is evident. They want to destroy the social state. As there is no direct majority for their perfidious plan, they sold you a Brexit based on a NHS-lie that will make its abolishment inevitable and irreversible.

  • Andrew Daer 27th Apr '18 - 9:01am

    This has nothing to do with the NHS. EU membership is far too complex for anyone to understand, so the Leave campaign said “when we leave we will be £350m a week better off. There is no downside. Do you want to be £350m a week better off? If so vote Leave.” The way to make the ‘gain’ from not paying the EU membership fee seem slightly more real was to align it in people’s minds with the dear old NHS.
    What Tahir is pointing out is that the stupidity of such simplistic thinking is now much easier to see – when all the other effects of Brexit are becoming clearer. The trouble is, however, that although the claim that we’d be £350m a week better off was what many leave voters latched onto, even that was only a proxy for their real reasons, which were fear of immigration, which they had been primed to suppose was connected with EU membership, and the ability to give a “stuff you” message to the political elite.

  • Peter Martin 28th Apr '18 - 6:37am

    @Arnold Kiel,

    “They [Brexiteers] want to destroy the social state.”

    This is a bit rich coming from someone who supports a system which creates mass unemployment. Getting on for 20 million throughout the EU. Mass unemployment is a weapon used by the ruling classes, if you’ll excuse the Marxist terminolgy, against the working classes to keep wages suppressed and increase their share of national income. What other possible reason can there be for allowing it?

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