The NHS-EU debate is not over. It was one of the main factors during the EU referendum, and it is also a top point in the Brexit negotiations.
There is a consensus that leaving the bloc will impact on the British health system, and, according to the think tank The UK in a Changing Europe, the decision "is likely to exacerbate" the funding pressures on the NHS.
In its last report “Brexit and the NHS,” the institution warns that if the funding pressure becomes acuter “there will be a direct knock-on effect on waiting times, and thus recovery rates, as well as the quality of care that can be delivered.”
And the amount of money available for total public spending would drop by £262m less per week in 2033 in the best of the four Brexit scenarios, says the think tank Global Future in its last analysis.
But not everyone agrees. Both studies were released a couple of months after the Foreign Secretary, Boris Johnson, went back again to one of his key arguments during the Vote Leave campaign.
In an interview with The Guardian early this year, Johnson said that they “grossly underestimated the sum over which we would be able to take back control.” He raised his “£350 million per week” up to £438 for the period 2020-2021.
“When the cash becomes available,” said Johnson, “the NHS should be at the very top of the list” getting up to £100 million per week, as it was revealed to the media before a Government Committee.
Johnson's new plea was not well received by the Government nor the Prime Minister. Theresa May’s spokesperson asked for privacy in cabinet decisions, and Chancellor Philip Hammond told that Johnson is “the Foreign Secretary” not the Health Secretary.
Hold on a second. I hardly remember the NHS controversy, could you refresh me that?
Yes, of course. Here is a timeline.
Is the impact on the NHS only a matter of money?
No, it isn't, although it is one of the leading elements.
According to the report "Brexit and the NHS," patients, staff, and access to medical technology and products might also be affected after December 2019, when the transition period finishes.
“The EU has limited direct competence over health policy,” states the report, therefore “the effect of Brexit (…) will mostly be indirect”.
Here you could know the think tank’s main arguments regarding the Brexit impact on the NHS, the opinion of the two sides in the EU referendum and some official data.
And, what do the experts say?
In an open letter, the NHS England Chief Executive, Simon Stevens, congratulated the Government's decision of ensuring the rights of the EU citizens living in the UK. But that is not enough.
The Chief Executive of NHS Employers, Danny Mortimer, reminded that "in the short to medium term, it's simply not feasible or realistic to meet our needs through domestic recruitment alone." A "flexible" immigration system must be ensured to “quickly recruit the skills required,” he added.
In fact, the Royal College of nursing has already raised the voice with a shortage of 40,000 nurses, and not enough home nurses to fill the gaps.
“Patient care must not be compromised,” the institution has warned.
But patients could face “severe” consequences in a 'no deal’ scenario, stated the Brexit Health Alliance, an institution which brings together the NHS, medical research, industry, patients, and public health organisations.
There are 1.2 million British living in another EU country, which make 53 million visits to the EU health services each year. And, if the 190.000 pensioners in the EU returned, the UK would “require 900 more hospital beds and 1,600 nurses, as well as doctors, other health professionals, and support staff,” stated the Brexit Health Alliance.
The supply of new drugs and medical technologies to the UK and the collaboration between medical researchers are others of the main concerns.
"Certain medicines and medical technologies may be delayed in reaching patients or may even become unavailable to patients if no solution for medicines and medical devices is found during the Brexit negotiations," says the Alliance.
A report released in the medical journal The Lancet at the end of last year warned about the “profound consequences for health” in the UK due to the Brexit.
“Access to pharmaceuticals, technology, blood, and organs for transplant is jeopardised. Information used for international comparisons is threatened,” said the article.
The British Medical Association have claimed in a manifesto for participating in the European Reference Networks and the alert systems, as well as in the regulatory framework for Clinical Trials. They also call for an agreement between the UK and the European Medicines Agency.
But, what is the main problem to keep that relationship between the NHS and the European health schemes?
"The most critical factor will be whether the UK will remain, or not, in the EU's internal market," says the director of the NHS European Office, Elisabetta Zanon.
The Health and Social Care Committee stated in their last report in March that although the European Council "has reiterated its wish to have the UK as a close partner," the Single Market “excludes participation.”
Being in the Single Market would mean what is called a soft Brexit.
Will there be consequences for Europe?
"Undoubtedly," says the president of the European Public Health Association (EUPHA), Dr Natasha Azzopardi, although this will vary depending on the agreement.
Ireland and Malta will be the most likely affected, due to the close relationship with Britain.
"These two countries still refer complex cases for specialised treatment in the United Kingdom," Azzopardi explains, and they also “share the same English language package as the UK"
A Britain exit of the European Medicine Market could, therefore, mean problems in the supply of medicines, due to a loss in “the economies of scale they currently achieved through the British market.”
According to the president of the EUPHA, the consequences for public health “has not been captivated completely.”
The UK has contributed “immensely” to the development of the public health policy in Europe, and Britain “currently leads several of the European Reference Networks for rare diseases, and it is active in important researchers,” she adds.
What do British people think? Have we changed our minds?
Yes. According to a survey by YouGov released in March, the only "trackers that have changed substantially since the referendum is the NHS."
Another recent survey, this one carried out by The King's Fund, points out that people are pessimistic about the standards of care in the NHS. Half of the respondents expected a worsening in the next five years, an increase of 21 percentage points since 2014.
Regarding the funding crisis, four out of five considered the institution is facing "a major or severe" problem, 14 points higher than in 2014.
Has Brexit created the NHS funding crisis?
Medical institutions and think tanks have been warning that the NHS needs more funding to cope with the ageing population even before the EU referendum or the last election.
In a letter published in The Times in June 2017, three of the main think tanks, The King's Fund, Nuffield Trust, and Health Foundation, said that "politicians must come up with a long-term answer to rising health spending or (they will) be forced into wasteful emergency bailouts."
The UK in a Changing Europe also thinks that "the UK's decision to leave the EU has not created the funding pressures on the NHS, but it is likely to exacerbate them."
What is the situation of the NHS?
According to the Kings Fund institution, the Department of Health budget will grow by 1.2% between 2009/10 and 2020/21. "This is far below the long-term average increases in health spending of approximately 4% a year," the organisation says.
As for the Office for Budget Responsibility, the NHS budget will have to increase from £140 billion in 2020/21 to 228 billion pounds by 2066-67. That means £88 billion yearly to face the pressure demand.
Data from the NHS England shows the pressure due to the 'winter crisis' whose consequences will last until summer, says the British Medical Association.
What measures are the authorities taking?
Theresa May announced at the end of March "a long-term plan for the NHS and then ensure that that is properly resourced" this year.
Days before, the Government funded 40 NHS hospitals and community services with £760 million, and last year.
But the NHS will need more. In an interview with ITV, the Health Secretary, Jeremy Hunt, said that "to get more resources into the NHS and social care system, it will have to come through the tax system and also through growth in the economy."
Is rising citizens' tax necessary to solve the NHS funding crisis?
Almost 98.8% of the NHS funding comes from general taxation and the National Insurance, according to The King's Fund charity, and only 1.2% come from patient charges.
A survey from the same organisation concludes that two-thirds of the respondents are willing to have their taxes raised to fund the NHS, either by paying more or having a special fee.
But whether a specific tax for the NHS is needed or not is another controversial topic in which experts do not agree, and telling their reasons would give for another article like this one.
