How the Brexit Decision Might Affect Healthcare

Peter Russell

June 24, 2016

LONDON — The world is reeling from the United Kingdom's (UK) historic vote on Thursday to leave the European Union (EU). The ramifications will be felt in all aspects of life, from economic, to travel and immigration, to national security, and not the least, to health.

The future of the UK's National Health Service (NHS) featured prominently in the run-up to yesterday's referendum, and will figure prominently in the changes brought about by the decision.

While the "Leave" camp claimed the cash that the UK currently gives to the central leadership of the EU in Brussels, Belgium could now be ploughed back into health services, the "Remain" camp warned that economic turmoil from the British Exit (Brexit) threatened the fragile finances of the NHS.

But the bell has been rung. Now that 51.9% of the UK's citizens chose to get out of the EU, while 48.1% backed remaining part of the club of 28 nations, what might the impending exit mean for the future of health and social care in the UK?

Timing

Firstly, nothing significant is going to change today or tomorrow.

Soon after the result was declared, Prime Minister David Cameron announced he would stand down in the autumn, by which time another member of the conservative party will be chosen to be the new leader in the UK.

It will be up to the next prime minister to decide when to pull the lever to leave the EU, known as Article 50 of the Lisbon Treaty, which would give the UK 2 years to negotiate withdrawal terms.

Will There Be More Cash for the NHS?

Supporters of Leave originally claimed that quitting the EU would give the UK an additional £350 million a week to spend on health and other public services.

However, an analysis this month by the Institute for Fiscal Studies (IFS) disputed this figure, saying that after taking into account money received back from the EU, the UK's net contribution was £150 million a week.

However, this takes no account of any financial turmoil that could hit government finances.

The IFS analysis predicted that Brexit will add an additional 2 years of austerity to the UK's economy. Carl Emmerson, IFS deputy director and an author of the report, said: "the overwhelming weight of analysis suggests that the economy would shrink by more than enough to offset the positive effect on the public finances of the reduced financial contribution to the EU budget."

Will Containing Immigration Cut NHS Costs?

Immigration and its effect on health and other public services was a key topic during the referendum campaign.

A recent analysis by the Nuffield Trust estimated that in 2014, migration from the EU added £160 million in additional costs for the NHS across the UK.

However, it says this was a relatively small sum when set against the £1.4 billion in additional costs caused by other factors such as treating an ageing population and migrants from outside the EU.

The report also pointed out that immigrants are taxpayers as well as patients and that they could even be making a net contribution to available resources.

Will Health Insurance Cards Still Work in the EU?

British travellers to EU and European Economic Area (EEA) countries can carry a European Health Insurance Card (EHIC) giving them the right to access state-provided healthcare on temporary stays at a reduced cost or, in many cases, for free.

But once the UK leaves the EU, and if it also left the EEA, British tourists and retirees abroad would have to cover health care costs from their own pockets or from travel insurance in these countries.

However, it is possible that the UK could negotiate specific agreements with EU and EEA countries for EHIC to remain valid.

What About the NHS Staff?

A total of 55,000 out of the 1.2 million staff in the NHS in England are citizens of other EU countries — equivalent to 5% of NHS workers.

That is close to the 4.7% of the UK population who were born in other EU countries.

According to the Nuffield Trust, 10% of physicians and 4% of nurses are from other EU countries.

The NHS's most senior physician, Sir Bruce Keogh, MD, has called on NHS leaders to send out a message to European staff working in the health service that they are valued and welcome in the wake of the referendum result. Sir Bruce told the Health Service Journal: "It is really important we make them feel welcome.

"If you are a European doctor or nurse you might not feel too welcome at the moment."

The British Medical Association (BMA) urged politicians not to play games with the UK's health services. BMA council chief, Mark Porter, MD, said in a statement: "We stand together as one profession with our colleagues from Europe and across the world, with whom we live, work and study and on whom the NHS depends."

What About Medical Research?

UK medical science has benefited from EU funding for decades.

In the wake of the result, several leading experts issued statements about what it could mean for research.

Nobel Laureate Sir Paul Nurse, PhD, director of the Francis Crick Institute, said: "This is a poor outcome for British science and so is bad for Britain.

"Science thrives on the permeability of ideas and people, and flourishes in environments that pool intelligence, minimise barriers, and are open to free exchange and collaboration.

"British scientists will have to work hard in the future to counter the isolationism of BREXIT if our science is to continue to thrive."

Professor Anne Glover, PhD, vice-principal external affairs and dean for Europe at the University of Aberdeen, said: "I am personally heartbroken and I have great concern for the future of British science, engineering and technology.

"Our success in research and resulting impact relies heavily on our ability to be a full part of European Union science arrangements and it is hard to see how they can be maintained upon a Brexit."

Could the Exit Affect Access to Medicines?

Leading figures from the life sciences industry recently expressed their fears that Brexit could jeopardise the UK's central role in the European pharmaceutical industry and call into question the country's access to innovative medicines.

Following the result, Mike Thompson, the head of the Association of the British Pharmaceutical Industry (ABPI), said in a news releases that leaving the EU would create "immediate challenges for future investment, research and jobs in our industry in the UK."

Meanwhile, the BioIndustry Association (BIA) said in a statement that "key questions about the regulation of medicine, access to the single market and talent, intellectual property and the precise nature of the future relationship of the UK are now upon us."

Before the vote, the ABPI, BIA, and business leaders and organizations for the life-sciences industry, had signed a letter warning that the UK leaving the EU would put access to cutting-edge medicines at risk, according to the ABPI release.

An early sign of the threat posed to the UK's position came as the association representing Germany's pharmaceutical industry, Beraten Analysieren Handeln, called for the European Medicines Agency (EMA), the UK's equivalent to the US Food and Drug Administration, to be relocated from its central seat in London to Bonn, Germany following the UK's departure from the EU.

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