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In your Med School Interview, you should aim to have one or two key points in your mind about the impact of Brexit on the NHS, as it’s such a hot interview topic. This guide outlines the key points to be aware of, and how you can use this information in your answers.

Background: Brexit & The NHS

The UK officially left the EU on 31st January 2020, with a transition period until 31st December 2020. Brexit negotiations were agreed on 24th December 2020, with effects on healthcare and scientific research unfolding as the transition period concludes.

Extra £350m For The NHS

If there is one move on the Leave campaign’s side that could be said to have swayed the public’s opinion, it was the incorrect claim that leaving the EU would free up £350m per week to 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.

In 2018, the government promised a £20 billion increase to the NHS budget per year for the next five years, starting in 2019/20. They said it would be partly paid for through the ‘Brexit dividend’ but there is no guaranteed extra money from leaving the EU, as it is expected that costs associated with leaving will outweigh those that are being saved.

Health experts have said this money will ‘help stem further decline in the health service, but it’s simply not enough to address the fundamental challenges facing the NHS, or fund essential improvements to services that are flagging.’

In 2019, the Conservative manifesto stated an increase in the NHS budget by £33.9 billion by 2023/24, and an immediate injection of £6.2 billion. Stricter immigration laws, such as the new ‘settled status’ for EU citizens, may slow the UK’s population growth, and ‘Leave’ campaigners in the referendum argued that the fewer people who are eligible to access NHS services, the greater the government spend per capita.

In March 2020 Spring Budget, the government provided a boost to capital spending and £5.4 billion of revenue funding until the end of this parliament to support manifesto commitments to more clinical staff, GP surgery appointments, free hospital car parking for some groups as well as more community-based care for those with autism or learning disabilities.

Due to these changes, the Department of Health and Social Care budget between 2020/21 and 2021/22 will be greater than originally planned. £20.9 billion of Covid-19-related funding has been allocated for 2021/22, with likely additional funding being designated to respond to the pandemic – which could include further procurement and distribution of vaccines. This extra Covid-19 funding will not be maintained in budgets allocated to the Department after the pandemic ends.

Staffing Crisis

Figures from the Nursing and Midwifery Council (NMC) show almost 5,000 nurses and midwives from EU countries have left the NHS in the last three years, with many identifying Brexit as the reason. However, there has been an increase in the number of nurses and midwives coming from countries outside of the EU to work in the UK.

In 2017, it was recorded that NHS England faced a shortage of over 40,000 nurses, putting a large strain on the existing workforce. The number of European workers in the NHS is expected to fall further due to the following:

  • harsher immigration laws will be implemented
  • the value of sterling and UK salaries will decrease
  • the recent ‘seven-day NHS’ initiative deters EU staff from signing up for longer hours

There was concern a no-deal Brexit would end the mutual recognition of professional qualifications so fewer doctors from the EU would be able or want to work in the UK. However, a Health And Care Worker Visa is available, which enables medical professionals to do an eligible job with the NHS, an NHS supplier or in adult social care. This must be renewed every 5 years and involves several criteria being met in order to be eligible.

There was also concern that the 207,300 British ex-pats living in the EU would lose their rights as EU citizens and return to the UK. This would increase the burden of an already ageing population on the struggling health service – although this wasn’t seen before the coronavirus pandemic.

Whilst Home Office delivers a new immigration system, it will also need to tie up the Settled Status scheme. The result of this could mean the NHS, already facing staff shortage, will not have enough people to fill crucial roles in a time where Covid-19 vaccinations commence, on top of winter pressures.

Days prior to the negotiations being finalised, NHS Confederation members urged the Prime Minister to extend the transition period, warning of severe disruptions to the NHS.

The letter outlines particular concern in the South East, where ambulances could face delay in reaching patients and clinicians due to congestion on Kent roads. It states “They will face these barriers to their critical work while facing some of the highest levels of Covid-19 infections and the additional risks that the increased traffic, lorry parks and congestion could increase the demand for NHS services in the area.”

Stockpiling Medicine

In anticipation of Brexit negotiation deals, the UK has built a stockpile of drugs and medical supplies – but these have been used up during the coronavirus pandemic. Members of the pharmaceutical industry are warning that rebuilding stockpiles could become an issue during the post-transition period. For example, we may see border disruptions and delays. However, drugmakers are anticipating this and planning alternative means around the Dover to Calais route to avoid delays.

However, there is also the issue of safety checks being carried out before being sold in the EU and vice versa. Consequently, this could cause delays of up to several weeks. This will have a serious impact on the pharmaceutical industry that depends heavily on an “in time” supply chain in order to ensure the efficiency of short shelf-life ingredients. Ultimately, Brexit will see the impact on medicine delivery, and this will affect a large proportion of medication such as radioisotopes for treating cancer and insulin for diabetes.

There had also been concern that a no-deal could’ve caused delays to the importation of Covid-19 vaccines, but the Government stating that there are contingency plans in place to prevent this. This is being enabled by a £100m freight contract, which is act as a backup to ensure Category 1 goods (including vaccines) will be imported with ease.

The director-general of the British Generic Manufacturers Association’s director-general stated that about 20-25% of generic medicines used by the NHS are made in the UK, whilst 40% is manufactured in the EU. The majority of active pharmaceutical ingredients come from India and China, which inevitably caused problems during the first lockdown due to factory shutdowns and closed borders.

Scientific Research

If the UK can’t retain its EU funding, scientific research could also suffer. Between 2007 and 2013, the UK contributed €5.4bn to the EU science budget but received over €8.8bn –that’s a €3.4bn EU-sourced surplus to fund research.

The UK had been receiving €1.28bn each year from Horizon 2020, which is the EU’s science and innovation funding programme. However, the EU-UK trade deal text that was published states that the UK can apply for top-tier membership of the forthcoming EU Horizon research initiative, it will not be given access to funding for new technology projects. However, the text does state that UK researchers can apply for “associate” status, which means will then allow them to apply for and receive EU funding, similarly to EU researchers.

Professor David Lomas of University College London has revealed that British scientists are being removed from EU grant applications by European colleagues, as the new ambiguous status of the UK makes the associated applications weaker. Similarly, the free movement of specialists both into and out of EU member states that the UK currently enjoys may be revoked, or more heavily sanctioned.

Figures from the Higher Education Statistics Agency show EU nationals currently make up 17% of academic researchers in UK universities and 15% of postgraduate research students – whilst 72% of UK researchers have trained or worked as researchers abroad.

One in three UK research papers are co-authored with EU scientists, and these links could potentially be lost with Brexit. In the year following the result of the Brexit referendum, 2,300 EU academics resigned from British universities.

The president of the Royal Society had previously voiced concerned that a bad or no-deal Brexit will ‘stop valuable research in its tracks’. One of the reasons for this is that many international scientists may choose to not work in the UK as the visa costs would make it a more expensive place to work than other leading scientific nations.

As negotiations are finalised, the president of the Royal Society states that it is imperative “the focus must now be on ensuring a fair and effective means to deliver appropriate association to EU science funding programmes, such as Horizon Europe, outlined in the agreement. Any delay in delivering such association will damage UK science and, in the event of any delay, the Government must take quick action to protect and stabilise the world class asset that is our science base.”

Furthermore, Brexit may deter some UK researchers from joining international projects. The loss of mobility will increase the time and financial cost of moving workers to the EU, and many fear that UK-based scientists will no longer have a significant hand in larger, EU-wide projects such as the regulation of new drugs.

Student Fees

Brexit is set to cause two significant changes for students from the EU/EEA. Up until now, EU/EEA students applying to study at UK universities have been eligible for the same loans and grants as home students. EU/EEA nationals who started their studies before the end of the transition period will remain eligible for the student loans and grants for the duration of their course, even if it ends after the end of the transition period.

In the future, students coming from the EU/EEA will be subject to the higher international tuition fees. The reverse of this is that its likely students from the UK will no longer benefit from the cheap or even free tuition available at many universities across the EU to EU/EEA nationals.

The UK will launch a new programme called the Turing Scheme, to replace participation in ERASMUS+. The programme will be backed by over £100 million and will enable funding for roughly 35,000 students in universities, colleges and schools to undertake placements and exchanges overseas. This scheme will roll out in September 2021.

Brexit Interview Questions

You may be asked about how Brexit will impact the NHS, and how that could shape your career as a Doctor. If you’re not directly asked about Brexit, mentioning a key issue is a good way of demonstrating your depth and breadth of interest in Medicine.

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