Longer working hours, fewer staff available? The post-Brexit NHS
Edmund Stubbs, 28 June 2016
The first thing to be quite clear about is that the NHS is not going to get another £350 million a week to add to its budget. Such a figure ignores the money that the UK receives back from the EU in rebates, reducing the figure by at least £200 million. The balance would have to be shared by the NHS with other public services. The figure of £350 million was highlighted during the referendum campaign by many on both sides as being misleading, and even Nigel Farage admitted its implausibility on ‘Good Morning Britain’ on the morning of the result.
Finance aside, what other benefits or limitations might the NHS experience from Brexit? Importantly, the NHS will no longer find itself subject to EU competition law; regulations which concerned members of the public, and politicians such as Lord Owen believed might, in the future, force the NHS to contract out its services against its own best interests. However, as all reforms intended to introduce independent providers into the health system have to date been introduced by UK governments rather than the EU, the NHS is unlikely to see much change post-Brexit.
Two issues are, however, likely to cause difficulty for the NHS. The first is the likely abandonment of the European working time directive (EWTD) implemented by the European Commission to limit the number of working hours of European employees. In the NHS this has certainly helped to mitigate the danger to patients caused by extreme fatigue of doctors and other staff working up to 100 hour weeks. The EWTD, when applied to the NHS, was not however free of negative consequences.
As a result of the directive, with each staff member working fewer hours, rota gaps opened and many professionals who rely on hands on clinical involvement to gain experience received fewer hours of training before qualification. Nevertheless, there is no evidence of a desire to return to the ‘bad old days’ of 100 hour weeks, though Brexit could certainly mean that staff might work noticeably longer hours than at present. Indeed, there may be some professionals, such as surgeons who may be compelled to work many more hours as currently they are able to voluntarily waive the EWTD limitations but only if they so choose.
Another issue which has the potential to hit the NHS where it hurts most arises in relation to immigration. There is of course great uncertainty as to what form future UK immigration policy might take but it is quite clear that any government would be foolish not to formally recognise that most NHS specialisms are ‘shortage occupations’ and thus to protect immigrant staff already in them and encourage more to come to Britain.
Of course many nurses and doctors come not from the EU but from further overseas, for example from the Philippines, the Asian subcontinent and from many African countries. However, with some taking the Brexit vote as an indication of national sentiment against immigrants in this country, it could be that many EU and non-EU immigrants might consider working in remaining EU countries or might be discouraged from working for the NHS at all.
After Brexit there is a possibility that some politicians might call for stronger immigration controls affecting both EU and non-EU immigrants in the future. Whatever form the next government takes it would be well advised to think carefully of the effect that any new, harder line on immigration might have on the NHS. It is hoped that a new government will make every effort to make such groups both from inside and outside the EU feel welcome in this country. At present we do not train nearly enough medical staff in the NHS to run our health system efficiently and effectively. An ill-considered immigration policy might have the potential to damage or even cause the collapse of the NHS as we know it.
The impact that Brexit might have on material procurement and independent sector provision of healthcare services from EU based companies is unclear as the leave side has not yet presented any clear picture of what ‘Brexit’ might look like. As relevant negotiations have not begun it is impossible to predict whether Brexit might prove advantageous or not in this respect.
After Brexit the NHS may find it more or less expensive to get its supplies from the rest of the world. It might find it easier or harder to work with American, European or other international providers who want to become part of healthcare provision in the UK. Such provision may become an issue for the future depending on whether future governments want to expand or contract independent sector provision of NHS services. A lot of uncertainty lies in this area.
One final important issue affecting the NHS is the establishment of mutual agreements for healthcare treatment between EU member countries and the UK. New arrangements for how various countries’ citizens are treated should they become unwell while abroad need to be fixed. At the moment most EU citizens have European Health Insurance Cards. A choice post Brexit-Britain will be faced with is whether we will continue to work with EU member states to keep such a system of mutual entitlement, or whether we will require our, and their, citizens to take out private health insurance for access to healthcare services.
For the immediate present it would appear to be business as usual for the NHS. As a national healthcare service it never had much dependence on the EU and so there is likely to be no immediate systemic shock. There are therefore reasons to be optimistic. Nevertheless, post Brexit immigration policy might pose real danger in the long term to the effectiveness of the NHS as we have come to know and value it.
Edmund Stubbs is Healthcare Researcher at Civitas