The impact of a no deal Brexit on health care

With the increasing possibility of the United Kingdom leaving the European Union (EU) without a deal, what are the major areas in which the impact of a no deal Brexit could be felt most sharply in the NHS?

A risk of intensifying the staffing crisis

The NHS already has serious workforce shortages, with nearly 100,000 vacancies in NHS trusts in England. Our research has shown that the NHS needs an additional 5,000 overseas nurses each year to stop the situation worsening: a migration system which made this more difficult would have serious implications, even if current staff could all be persuaded to stay.

With 116,000 EU nationals working in health care, even a small trend towards European migrants leaving the United Kingdom due to a fall in the pound or uncertainty around their ability to stay in the UK will worsen this situation. The lack of clarity about the deadline for applications for residency, and the very large proportion of EU nationals yet to apply, are a concern. A 2018 survey of doctors from the EU has found nearly a third would consider leaving the country.

Shortages and price rises for vital supplies

Despite plans for stockpiling and creating new routes for transporting supplies, it is likely that a no deal Brexit would increase short-term shortages of some vital medicines and medical devices. This would be due to the large amount of new paperwork and regulatory hurdles that a no deal Brexit would create. Although it is difficult to judge the size of the problem, a leaked government document emphasised the vulnerability of supply chains in the sector.

As a result of this, companies would face higher costs to get their products into the UK – costs that would ultimately be passed on to the NHS. It has been estimated that this might add up to £2.3 billion in extra costs for the NHS. This money will have to come out of other services and supplies that patients use, unless the overall budget increases. In the short term, higher costs would risk shortages of non-branded medicines even if supply chains remain unbroken.

The need to care for returning emigrants

A no deal Brexit will mean UK citizens living in the EU will not have guaranteed rights, and they may have to return to the UK to live and receive treatment if they become ill. Around 200,000 people using the special EU scheme that guarantees health care rights to retirees abroad would face losing that protection. It is unclear how many of the roughly 800,000 other UK citizens in Europe might also be unable to access or afford care. While we would have a duty to help these individuals, it would add considerably to the already high demand pressures on the NHS and social care.

Funding shortages at a time when health care services need it most

Although an extra £20.5 billion has been pledged to the day-to-day budget of the NHS in England, this does not cover other areas of spending such as investment in buildings, equipment and staff training budgets, which have been reduced in recent years. Creating real improvements for patients will also require repairs and upgrades to buildings and equipment, increased public health funding, and a stable social care system.

The Office for Budget Responsibility has estimated that the UK’s public finances would be around £30 billion worse off each year in a no deal scenario of medium disruptiveness. This sum is more than the total spent on adult social care plus investment in NHS buildings and equipment across the whole of the UK in 2017/18.

Health care services are already struggling to meet rising demand for services and maintain standards of care; these pressures would be exacerbated in the event of a difficult winter with high rates of flu. The potential consequences of a no deal Brexit could significantly impede services’ ability to meet the needs of the individual patients and service users who rely on them.

This article is based on The impact of a no deal Brexit on health and care: an open letter to MPs, The King’s Fund, Nuffield Trust and The Health Foundation.