Brexit burdens, not boosts, the NHS

A letter for all groups, activists, supporters, to send to their constituency representatives:

Dear MP and MSPs,

I’m writing to ask you, as a matter of urgency, to raise with the relevant Ministers a number of issues arising directly from our departure from the EU, and from the risk of the transition period elapsing without a deal.  

It’s increasingly clear that, despite the promises on the bus, leaving the EU will have a severe impact on both the health and social care sectors, for a number of reasons – all entirely avoidable, and all exacerbated still further by the fall-out from coronavirus.  These include the haemorrhaging of EU nationals from the workforce; the impact on medical supplies; the risk of medicine shortages; the potential impact on workers’ rights; the damage to medical research; the ending of reciprocal healthcare arrangements; and the barriers to cooperation over Covid-19 and other public health crises.  I’ve provided more detail on each of these below.

EU Workforce 

The Health and Social Care sectors are hugely dependent on EU nationals.  Even without Brexit, the NHS already has serious workforce shortages; the King’s Fund has identified a shortfall of 100,000 staff, including 41,000 nurses. The situation in Social Care is even worse, with 110,000 vacancies.  According to the Nuffield Trust – “a net inflow of nurses from the EU into the NHS has turned into a net outflow; between July 2017 and July 2018, 1,584 more EU nurses and health visitors left their roles in the NHS than joined”  The Nursing and Midwifery Council say they have seen a 90% fall in new EU registrations since 2016. In the words of the Royal College of Nurses (RCN): “a collapse of the EU workforce presents a huge challenge for the sustainability of our health and social care sector.” It is worth noting that “Scotland is also heavily reliant on an EU workforce, who make up between 6-8% of the total workforce and have nearly 12% of all nurses.” 

The RCN has also raised concerns about the Migration Advisory Committee’s recommendations on salary thresholds, and their implications for Social Care recruitment. They have made clear their view that the UK’s Shortage Occupation List (SOL) should cover all NHS and Social Care roles.  According to the British Medical Association (BMA): “any new immigration system (which facilitates the entry of doctors, nurses and other important Health and Social Care staff to the UK) must be flexible and responsive to the needs of the Health and Social Care systems – a system of mutual recognition of professional qualifications (MRPQ) must be maintained”

Medical supplies

Our future trading relationship with the EU will have huge implications for the affordability and supply of drugs and medical devices.  We urgently needa formal agreement which will enable continued participation in the European Medicines Agency (EMA), assessments for medicines approvals, and mutual recognition schemes for medical devices. At present the CE marking system regulates new products, but there is much uncertainty about device accreditation schemes after the transition period. Medical devices created in the UK may need to be accredited twice, and EU producers may not bother with the UK market if they have to comply with a UK-only scheme. This is likely to seriously damage patient care and act as a disincentive to innovative practice.

Medicine Shortages 

In the event of no deal, or even a “bare-bones deal”, existing drug shortages are likely to be exacerbated due to border delays, particularly at the very busy channel ports.  We need urgent assurances about the continuity of all medical supplies, in particular those with a short shelf-life, as well as environment-critical supplies such as insulin and dialysis suspensions. It’s also worth noting that the radio-isotopes which are so vital for many cancer treatments and diagnoses, and which will be adversely impacted by withdrawing from EURATOM, have a very short shelf life and are not currently manufactured in the UK.

Workers’ Rights

At present workers’ rights derive from EU Law; specifically, the European Working Time Directive defines the limit of a 48-hour working week, and provides for rest breaks and statutory paid leave. As the BMA has pointed out, this needs to be enshrined in UK Law to protect the wellbeing of staff and ensure that the NHS provides safe care to patients. 

Medical Research 

UK medical researchers have been at the forefront of EU research programmes for decades.  Now we have left the EU, those researchers will no longer have access to EU funding and will enjoy much less scope to take part in international collaborative research. An agreement is needed that will allow the UK to continue to take part in EU research programmes and also enable the UK’s Medical and Healthcare Products Regulatory Agency to take part in clinical trials that span both the EU and UK.

Reciprocal Health Care Arrangements 

It is vital that these arrangements, which we have enjoyed for decades, should continue.  Access to the EHIC card makes Europe accessible for many people who might otherwise be unable to holiday abroad, such as those undergoing dialysis or those with other chronic conditions.  Furthermore, without an EHIC card, UK nationals living in the EU will have to return to the UK to live and receive treatment if they become sick. A further 200,000 retirees abroad might lose their health cover and have to do the same, placing an intolerable burden on the NHS.  

Brexit + COVID19 

IF we fail to do a deal, it will weaken cross-border cooperation, which in turn will impact on public health initiatives that are so critical as we deal with the pandemic.  The UK has already withdrawn from the EU’s Emergency Coronavirus Fund, which seems very short-sighted.  I share the BMA’s concerns that a trade agreement might restrict “future Governments’ freedom to develop the NHS towards a more collaborative model and regulate to protect public health.” This must be avoided at all costs.

In conclusion, there are many pre-existing issues within the NHS and Social Care that need urgent attention, all of which will be worsened by an ideological approach to relations with the EU. I urge you to address these issues with the appropriate Ministers at your earliest convenience, and would be grateful to know the responses you receive.