On the 20th February 2016, in one of the most divisive and dangerous political moves this century, the then-Prime Minister David Cameron announced that the British public would vote on if the United Kingdom should remain a member of the European Union – and the effect of Brexit on the NHS has been a hot topic.
On 24th June, following that referendum, Britain declared that it would be leaving the EU. The process of the departure is still ongoing, and the effect it is unexpected to have on healthcare and scientific research in the UK is still, for the most part, uncertain.
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Labour leader Jeremy Corbyn called a vote of no confidence, which May won by 325 votes to 306. However, there are still divisions within the Conservative party over the best way to move forward with Brexit.
“Sadly, I have not been able to do so. I tried three times. I believe it was right to persevere, even when the odds against success seemed high. But it is now clear to me that it is in the best interests of the country for a new Prime Minister to lead that effort.”
It will be up to the newly elected Prime Minister to continue to negotiate a deal that will see Britain exit the EU.
The deadline for doing this has been extended to 31st October 2019, but what are the concerns going forward for the new Prime Minister to consider?
Brexit: Are Patients Stockpiling Drugs?
The Royal College of Physicians has urged the government to be more ‘transparent about national stockpiles, particularly for things that are already in short supply or need refrigeration, such as insulin’.
Professor Helen Stokes-Lampard, the chair of the Royal College of GPs, said: ‘We … would ask them [patients] not to take it upon themselves to stockpile, or put their prescribing healthcare professional in a difficult position by asking them to help them to do so, and look to the government to reassure the public’.
According to the BBC, ‘Ministers and NHS leaders say every effort is being made to ensure there will be enough medicines and clinical equipment available in the event of delays to imports caused by traffic chaos near the Channel ports.
‘The Whitehall line is that everything that can be done is being done.’
Others argue that this is an unprecedented situation and nobody can guess the impact leaving the EU without an agreement will have on the UK’s healthcare sector.
The public need to be reassured and panic stockpiling of medicines should be avoided, as this would only exacerbate supply shortages. However, senior hospital executives need to be able to identify any risks to their organisations, patient care and foresee any gaps in planning that could occur.
On 12th June 2019, a confidential cabinet note was seen by the Financial Times, which undermined Tory Prime Minister candidate, Boris Johnson’s promise to remove Britain from the EU with or without a deal on the scheduled Brexit date of 31st October.
The note claims that the government will need six to eight months of engagement with the pharmaceutical industry, in order “to ensure adequate arrangements are in place to build stockpiles of medicines by October 31.”
Brexit: What Does This Mean for the Economy?
One of the more prominent questions about the effect of Brexit on the NHS is the issue of how the UK Pharmaceutical Industry, and more importantly, the economy will be affected by the Brexit deal. A seemingly compelling element of the ‘Leave’ campaign’s side was the claim that leaving the EU would free up £350m per week that could then be spent on the NHS.
The cross-party campaign couldn’t dictate how any funds were to be spent, nor had they quoted an accurate figure. The Financial Times calculated the UK’s contribution to the EU as £137m per week and predicted that the bulk of the so-called savings would be distributed amongst a variety of public sectors – and used to pay for the lengthy settlement with the EU itself.
Theresa May stated that the UK would not remain in the customs union under any circumstances. However, it will be up to the new Prime Minister to settle this issue. If May’s previous statement is correct, it could lead to border disruptions, as well as delays. This could jeopardise pharmaceutical supply chains and affect a large proportion of medication, such as radioisotopes for treating cancer and insulin for diabetes.
The government is said to be looking to stockpile medicines as the solution. However, this is expected to cost the NHS millions of pounds instead of improving its funding.
It was announced in June 2018 that the NHS in England would receive a funding increase totalling £20.5 billion by the year 2023/24. This equals an average increase of around 3.4% in spending a year, starting from 2019/20 and once inflation is accounted for.
Stricter immigration laws, such as the new “settled status” for EU citizens, could lead to a slower population growth rate in the UK. However, ‘Leave’ campaigners have argued that the fewer people who are eligible to access NHS services, the greater the government spend per capita.
Brexit: What Does This Mean for the NHS’ Staffing Crisis?
Following the result of the referendum, the number of European Economic Area (EEA) staff who have left the Nursing and Midwifery Council (NMC) has tripled, with almost 4,000 staff members leaving between 2017 and 2018.
However, within the same time frame, only 805 members registered with the NMC, which is just 13% of the 6,382 staff that entered the UK in 2016-17. There are over 60,000 European workers currently in the NHS, however the lack of new migrant workers has left the NHS with a real terms loss of around 40,000 nurses.
The amount of European workers in the NHS is expected to fall even further if Britain does leave the European Union. This would be due to stricter immigration laws, the currency exchange rate and a decrease in UK salaries. The “seven day” NHS initiative that deters EU staff from signing up to work longer hours could also have a significant impact too.
There is further worry that UK expatriates, of whom 430,000 are aged 50 or over, could lose their right as EU citizens and return, which would increase the burden of an already ageing population on an already struggling health service.
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Brexit: What Does This Mean For Scientific Research?
Scientific funding is another issue for concern, due to the impact it would have if the UK is unable to retain its EU funding.
Between 2007 and 2013, the UK contributed €5.4bn to the European science budget, however they received over €8.8bn. Part of this was a €3.4bn EU-sourced surplus far from the pro-independent rhetoric of the ‘Leave’ campaign.
According to university officials, an additional €1.4 billion has been allocated since then – the equivalent to another Research Council – and the UK has received 22% of all allocated EU scientific research funds since 2007.
The British Council has also calculated that 11% of UK university research funding comes from EU sources, excluding the significant income generated by EU student fees.
Financial costs and benefits are clearly at the forefront of commentators’ minds, however the human side shouldn’t be ignored either. Professor David Lomas of University College London has revealed that British scientists have been passed over as applicants to EU funds. This is due to the ambiguous status of the UK, which is seen to make British applications weaker.
Likewise, the free movement of scientific specialists both within and out of EU member states that the UK currently enjoys could be revoked, or they could face stricter sanctions if the UK were to leave the European Union.
Speaking to Health Europa, Dr Paul-Peter Tak explained the likely impact on research and development. “Brexit will have an impact on both scientific and academic research – for these it is vital to have an open environment as it is an international affair. Many of the great scientists in the UK are from other countries and more than 10% of employees at some of the UK’s top universities have an EU passport.
“It is critical that these people are provided long term safety and that they feel at home in the UK whilst also still having access to European funding, the European research agenda and networks.
“The continuous uncertainty we have been seeing in the last few years has already had a hugely negative impact on the NHS and I know that many people will be moving back to their respective EU homes – I cannot imagine that the government will be so irresponsible as to let this happen and so believe this issue would be resolved with at least short-term solutions.”
A number of politicians have remarked that highly-skilled workers who are commonly employed with scientific research are unlikely to be affected by any new restrictions. Immigration control is primarily used to cap mass, low-skilled migration.
In addition to capping net migration, the outcome of Brexit could lead to a decrease in UK researchers joining international projects.
Brexit: What Could This Mean for Universities?
According to the British Council, EU nationals currently make up 18% of academic staff in UK universities and 14% of postgraduate research students. 72% of all researchers in the UK have published abroad between 1996-2012.
However, since the Brexit referendum, approximately 2,300 EU academics have resigned from British universities. This loss of mobility could lead to an increase in the time and financial cost of relocating workers to the EU. It is feared that UK-based scientists will no longer have a significant hand in larger, EU-wide projects such as the regulation of new drugs.
Brexit: What Impact Could This Have on the Sale of Pharmaceutical Products
Implementing Article 50 means that the UK medical sector is still obliged to follow EU regulations, in order to sell pharmaceutical products in Europe. However, it will have no say in settling legislation for those regulations.
“In the event of a chaotic, no-deal exist, many NHS trusts could quickly run out of vital medical supplies,” Rosser wrote in a memo to the UHB board of directors that even if there were central stockpiling, then shortages could occur due to “unprecedented” distribution challenges.
Nations such as Australia and the US, who are not EU members, often have a six to twelve month wait before they are able to trade and access the same drugs as European Union members.
It is likely that the UK will experience a similar effect, however some pro-Brexit parties have highlighted that there are currently 16 associate EU members who do not receive funding and support from the EU, and that it would be wise for Britain to pursue a similar relationship.
Furthermore, there are concerns from the European Medical Agency that if the UK does leave the EU, and authorisation plans cannot be adapted in time, then 16% of pharmaceutical products (108 out of 694 affected) may no longer be available on the EU market. This could lead to supply disruptions to both the UK and EU countries in the future.
Secretary of State for Heath and Social Care, Matt Hancock, reassured relevant pharmaceutical companies and urged suppliers to increase their stock of medicines by at least six weeks on top of existing buffer stocks, in case of a no-deal scenario and transition period.
Ministers have also said planes will be available to be chartered in advance if needed to bring in vital medicines, if the ports were to become blocked. However, there are concerns that contingency planning for a hard Brexit aren’t as advanced as they should be.
Brexit: End of an Era
Brexit is an issue that raises more questions than it answers, particularly when it comes to the future of healthcare. As one of the most defining political events in modern UK political history, people are right to have concerns over the unprecedented impact of Brexit on the health sector.
Major concerns surround the loss of international talent and aid, whilst others and eagerly anticipating the additional control of funds and direction that the divorce bill could potentially allow.
Most medical practitioners and researchers condemn the decision, however this is not representative of general public opinion, as they are members of only one industry that could be affected.
The process of exiting the European Union is still currently underway. With politicians still to decide on a new Prime Minister, it could be years before we are able to fully understand the effect of David Cameron’s referendum. However, for the medical sector, concerns are set to continue for a very long time.
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