The deep structural change required dwarfs the Brexit challenge for the health serviceby Nigel Crisp / September 25, 2017 / Leave a comment
There are significant risks to the NHS from Brexit. A brief discussion of them illustrates three points.
The risks include uncertainty about staffing with an estimated 155,000 EU citizens from outside the UK working in our health and care system; threats to continued research funding from the EU and to collaboration with European colleagues on vital research topics; concern about whether we can still access the radio-isotopes we need on the same terms as we do now; and worry about whether other institutions may follow the European Medicines Agency in leaving the UK.
That’s not all. There are reciprocal health care arrangements between EU countries which entitle us all to the same treatment in any EU country as a citizen of the country would get. This applies to Britons working in another EU country, to tourists who have obtained a European Health Insurance Card, and to British pensioners abroad. There are very large numbers of people involved. It is estimated that there are about 480,000 British pensioners living in other EU countries but only about 6,000 European ones living here. If the system is disrupted and pensioners decide to return home we will not only pick up costs estimated of up to £1 billion (depending on how many people come) but, even more problematically, the NHS and care system will need to expand staffing and facilities to cope. This expansion will probably prove even more difficult than finding the money which, while a huge sum, is much less than 1 per cent of NHS turnover.
This summary makes clear three things. Firstly, there are very significant risks but, secondly, nobody knows what will happen—the margins of uncertainty are enormous. Thirdly, while government can seek to mitigate risks, ultimately it is people making their own decisions who will determine how much or how little of this risk materialises. The government is seeking to minimise the risks and has also tried to reassure people about the health consequences of Brexit. In the end, this comes down to issues of trust and confidence. Why should an EU nurse stay in the UK when she may feel more secure elsewhere? Does a British pensioner want to be anxious about what will happen as s/he ages?
People will not just be making their own judgements about the success of negotiations, they will also be considering the likely economic impact of Brexit. If the UK becomes poorer EU citizens may do better elsewhere—they have already been hit by the fall in the pound—but UK pensioners, on the other hand, may feel they will fare better in a more prosperous country.
We mustn’t just concentrate on the risks
These risks are real and the government must do everything it can to reduce their likelihood, minimise their scale and mitigate their impact. However, it is important that we also build for the future.
The UK is a world leader in health with outstanding academic institutions and more than 4,800 biotech companies turning over more than £55 billion. The recent report to government on the life sciences industry is very welcome with its emphasis on how we can strengthen it as part of a refreshed industrial strategy. It is a reminder that it will not be new trade deals that will really matter to our future prosperity as a country—nor even whether or not we stay in the EU—but the creativity and enterprise of our people and institutions.
This is a rare example of longer term thinking in a political world currently dominated even more than usual by short termism. It should also serve to remind us that the biggest risk to the NHS doesn’t come from Brexit but from failure to have a clear vision for the future of the service and a carefully prepared set of strategies and plans for getting there. We still have a hospital, physician and illness based service when all the evidence suggests we need a community, person and health based one. This will be a problem long after Brexit is completed and would be a problem even if Brexit weren’t happening. It dwarfs Brexit in its scale and implications.
An optimist could see Brexit as the crisis that forces change. A pessimist may see it stalling progress because of the short-term focus. Realistically, this last may be the biggest Brexit risk of all.