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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 concluded.

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.’

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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 had been allocated for 2021/22.

Staffing Crisis

Figures from the Nursing and Midwifery Council (NMC) show almost 5,000 nurses and midwives from EU countries have left the NHS from 2017 – 2019, 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

In October 2021, it was reported that up to one in five nursing vacancies on some wards remain unfilled. The staffing crisis has been made worse by a drop in recruits from Europe, including Spain and Italy. Furthermore, the number of nurses from the European Economic Area joining the Nursing and Midwifery Council register has fallen more than 90%.

“There just aren’t enough staff to deliver the care that is needed, and we now have a nursing workforce crisis”, said Patricia Marquis, England director for the Royal College of Nursing (RCN). “We should never have got into a position where we were so dependent on international nurses. We are on a knife-edge.”

However, applications to study nursing and midwifery were up 21% this year, the Department of Health and Social Care explained. The government has pledged to add 50,000 nurses to the NHS workforce before the end of parliament.

Stockpiling Medicines

In anticipation of Brexit negotiation deals, the UK built a stockpile of drugs and medical supplies – but these were used up during the coronavirus pandemic. Members of the pharmaceutical industry warned that rebuilding stockpiles could become an issue during the post-transition period, when we saw border disruptions and delays.

In September 2021 the issue of importing medicines after Brexit was still an issue. The Guardian reported that pharmacists had raised concerns about supply issues due to driver shortages, with deliveries to pharmacies being reduced.

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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 stated that the UK can apply for top-tier membership of the forthcoming EU Horizon research initiative, but 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 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 were being removed from EU grant applications by European colleagues, as the ambiguous status of the UK made the associated applications weaker.

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 was 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 stated 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 it’s 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 has launched a new programme called the Turing Scheme, to replace participation in ERASMUS+. The programme is 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 is rolling out for the 2021/2022 academic year.

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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