No-deal Brexit 'Worst Possible Scenario for UK Health'

Peter Russell

February 26, 2019

The NHS would be worse off after Brexit but leaving the European Union (EU) without a deal would be by far the worst scenario, a report found.

The analysis in The Lancet said that a 'no-deal' Brexit would have a negative impact on the health care workforce, NHS financing, availability of medicines and vaccines, and medical research.

The study, led by the Universities of Oxford and Sheffield, and the London School of Hygiene & Tropical Medicine, looked at four possible outcomes: a no-deal Brexit, the withdrawal agreement yet to be agreed by parliament which provided a transition period until December 2020, the Northern Ireland 'backstop', or the PoliticalDeclaration on the Future Relationship between the UK and EU, centred on a free-trade agreement.

The analysis did not include the possibility of remaining in the EU. That scenario was outlined in a previous paper in 2017 by the same authors, and in the same journal, which concluded that continued membership would be better overall for the nation's health than any form of Brexit.

Four Possible Scenarios for Exiting the EU

In the new analysis, the authors, who are leading experts in public health and law, drew on available legal and political texts to assess the impact of the four alternative scenarios on 15 specific aspects of the UK health service.

They concluded that under either the backstop or political declaration scenarios, the impact of Brexit on the NHS would be only slightly less harmful than a no-deal outcome.

"Leaving the European Union will be the biggest challenge to this country's governance and policy making that it has faced in peacetime," co-author Nick Fahy, from the Department of Primary Care at the University of Oxford, told Medscape News UK.

The report found that specific areas where leaving without a deal would be a particularly bad option for the NHS and healthcare in general would be:

  • Recruitment and retention of EU nationals

  • Mutual recognition of professional qualifications

  • Reciprocal health-care arrangements

  • NHS financing

  • Disruption to the supply chain for pharmaceuticals and other medical products

The NHS and the Long-term Plan

Nick Fahy said the authors hoped their updated evaluation would help decision makers understand the consequences of their political actions. "The capital financing from the EU is important but not absolutely central to the NHS, and it is predominantly still staffed by UK staff," he said.

"But as we all know, and as we can all see, the NHS is already under extreme pressure, and even the additional, relatively limited but nevertheless significant pressures from Brexit are coming into a service which is already struggling to cope. And for that reason I think it's appropriate for us to be concerned about this."

Mr Fahy, who has 20 years of experience at a senior level in European health policy, said the manner in which the UK left the EU could have drastic consequences for the Government's much vaunted long-term plan for the NHS.

"Brexit is barely mentioned in the 10-year plan and there is no particular sign within that plan of strategies to manage the consequences of Brexit," he said. "That, I think, is an assumption that is going to have to change unless we have the softest possible form of Brexit.

"If the consequences of Brexit are, as we analyse here, going to be making life somewhere between more difficult and really very much more difficult for the NHS, surely that will have to have an impact on the scale and the ambition of what the NHS is trying to achieve over the next 10 years.

"It is possible for the United Kingdom to get to a stage where we manage just fine outside the European Union but the point is there is an enormous amount of transitional effort to be done to get us there from here, and that will take decades and a huge amount of work and will have an inevitable impact on our ability to achieve the ambitions for what we would want to do if Brexit were not happening."

Mr Fahy said he was often asked why the UK could not maintain an effective healthcare system outside EU membership when this was the experience of many other nations, including the island nation of Japan.

He said: "Japan has spent, like the UK, the last 50 years of globalisation putting in place trading arrangements, links, deals, including its free trade deal with the European Union.

"The whole world has been engaged in building its infrastructure of how you exist within a globalised world that has been created in the last decades.

"And we can do that too. The point is we have done it – we've spent 50 years doing it, and it has been built around our membership of the European Union.

"We can rebuild that separately as a country – that option is open to us – but it's an option that has consequences, and in the short-term it has enormous costs and difficulties."

How will Brexit affect health services in the UK? An updated evaluation. Lancet. Online First. DOI:

COI: Several of the authors have links with the EU.


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