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The Impact of Brexit on NHS
As part of our NHS Hot Topics series of blogs, we are aiming to educate you in a series of areas relevant to the health service which you may be asked to discuss in your medical school interview. The aim is to help you with your expert interview preparation, whether it be for a panel interview of multiple mini interview (MMI). At MMI circuits, it is extremely likely that one station will be focused on your insight into medicine, so it is critical that you prepare.
We’ve discussed a number of other NHS hot topics so far, but this one focuses on how Britain exiting the European Union will affect the National Health Service (NHS). We don’t know for sure what’s going to happen, but the majority of doctors and nurses think that Brexit will have a negative effect on the NHS.
WHAT IS BREXIT?
Brexit is the word people use when referring to the United Kingdom’s exit from the European Union (EU). The EU is a political and economic union of 28 countries, who trade with each other. It was set up to allow citizens to easily move between EU countries for living and working. The UK has been a member of the EU for the past 45 years, having joined in 1973.
In June 2016, a referendum was held where members of the UK government were asked whether the UK should leave the EU or not. The leave campaign won, taking in 52% of the votes, and thus the government began to formulate plans for the official exit, due in March 2019.
PM May's Brexit deal setting out the terms of Britain's exit from the EU and negotiated with the other EU 27 member states was rejected on 15/01/2019 by the UK chamber. Uncertainty remains at this stage on what will happen next. In the event of a no deal (i.e. if no Brexit deal is accepted by the British Chamber before 29th March 2019, consequences for the UK, the NHS and its patients are rather grim.
THE NHS AND BREXIT
The NHS is responsible for the public health services in the UK and was established in 1948. It promises services which are comprehensive, universal and free at the point of delivery. A series of NHS trusts govern local areas and decide what needs changing. The EU is not involved in governing the NHS but some of its decisions can affect the UK and the NHS.
One of the main claims of the leave campaign was that Brexit would result in ‘an additional £350million per week to be spent on the NHS'. This was one of the reasons why many people voted to leave the EU. As soon as Brexit had occurred, this claim was proven to be false. Doctors and nurses have joined public health campaigns in saying that Brexit is bad for the nation’s health. The fall of the pound has resulted in an economic squeeze, with cuts and closures throughout NHS trusts resulting in staff losses and poorer treatment.
Additionally, many European doctors and nurses cross borders to work in the UK There are over 160,000 EU nationals working in the UK today. Leaving the EU will impact the free movement of people, especially health and social care workers. Since the Brexit result, we have seen a profound drop in the number of nurses from EU countries signing up to the professional nursing register, placing yet more pressure on the NHS. Part of the leave campaign’s manifesto was that they wanted to tighten borders. It is likely that in the event of Brexit the workforce from outside of the UK would be reduced in the short term. Longer term is it is likely that the UK will offer improved conditions to try attracting both EU and non EU staff.
EU citizens are also entitled to a European Health Insurance Card (EHIC) when travelling abroad. This provides insurance so that they can access healthcare for free or reduced cost in EU member states. This means people have access to medicines and can be treated in a&e departments etc without having to worry about the financial burden. In the event of Brexit, it is highly likely that this EHIC card will be disbanded, and UK residents will have to purchase expensive travel insurance. This could be difficult for people with complex disorders, who may not be able to travel due to the high costs of obtaining insurance.
The European medicines agency (EMA), an EU body, must approve most medicines marketed in the UK. Post-Brexit, drugs would need to be approved in the UK, but additional approval would be needed before they are marketed elsewhere.
The EU regulation adopted by all member states including the UK also controls the hours that public can work, capping it at 48h a week through the working time directive. This protects both the workers and patients. Some people are concerned that post-Brexit these laws may be relaxed, which could be dangerous. There is a worry that health and social care may be affected. On the other hand, the working time directive is quite stringent and being able to interpret it in a more flexible way in the UK could better fit local needs and be a positive.
WHAT DOES THIS MEAN FOR RESEARCH?
The UK is the largest beneficiary of EU health research funds in Europe. Public health and the NHS has benefited greatly from these research funds, with much being injected into clinical trials. Many professional researchers may no longer wish to travel to the UK to participate in research and clinical trials. Since the UK decided it wanted to leave the EU, we have already seen a drop in EU funded collaborative research in the UK. This will inevitably affect new treatments arriving into the UK and impact patient care and well-being.
Additionally, the EU is developing a new system of monitoring clinical trials, but there is a concern the UK may not have access to these databases post Brexit. This makes it hard for the UK to take part in international clinical trials, and thus may affect the health of NHS patients as there will be fewer opportunities for them to participate in clinical trials. People are also concerned about the UK having to remove itself from the reference network for rare and complex diseases. In the event of a new epidemic, it is possible that those living in the UK may experience delayed treatments due to a lack of information sharing.
The biggest threat to all of the above is uncertainty. If a Brexit deal is not reached and plans for leaving the EU do not fall into place, issues the NHS will face won't be about whether the UK has enough staff to treat patients, but whether needles, ECG machines, beds, medicines etc can actually enter the UK soil without too much delay. Brexit will restore the customs border between the UK and the EU implying additional lengthy formalities, customs and non-customs controls (sanitary and phytosanitary controls) and additional duty costs.
IS THE EFFECT OF BREXIT ON NHS ALL BAD?
There are some positives that could come from leaving the EU. Although it is unlikely that there will be an additional £350million available per week, it is possible that some of the money the UK saves on EU membership could be injected into the NHS. Additionally, it may mean that more medical students can be educated at home, reducing competition for the extremely popular degree course. Finally Brexit may lead to an increase in demand for UK based private practices as they face less competition from similar organisations in the EU.
In all honesty, no one really knows what is going to happen, and the plans for leaving the EU are yet to be finalised. Make sure you keep updated with the news and see how the story develops!
We hope that this was a helpful overview of this NHS issue and you feel more confident tackling it if it comes up as a question. Don't hesitate to send us any questions or comments by email at hello@theMSAG.com. Good luck in your interview!
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