By: Yeeun Lee

Brexit has been a topic of discussion since the June 2016 referendum. While the political, social, and economic consequences are often discussed, the decision would also have a lasting impact on health. On October 31st, the UK is due to leave the European Union (EU). As the date approaches, the possibility of a no-deal Brexit poses several health implications. Issues specifically related to the workforce, financing, and the food system seem to be the most pressing. However, other areas, such as research and information sharing, will also be affected. 

In the UK, healthcare is provided by a single entity: the National Health Service (NHS). Funded by taxpayer money and provided by the British government, the NHS provides free treatment to all UK citizens. Nonetheless, this system has benefited immensely from collaborative work with the European Union. 

One of the biggest challenges that the NHS currently faces is workforce shortages. A no-deal Brexit would only worsen this situation because it would make it harder to recruit staff from outside the UK. In 2018, there were about “94,000 full-time equivalent”  health-related vacancies advertised between July and September, which is about 1 in 12 posts.

Compared to other developing nations, the UK appears to lack key staff members such as nurses and doctors. For example, the UK has 7.86 nurses per 1000 individuals, compared to Norway that has 17.73 nurses per 1000 individuals. Most of these vacancies are filled temporarily, which may indicate that the labor shortage is actually worse than these statistics show.

In a no-deal Brexit situation, EU citizens will face the same immigration restrictions and laws as non-EU citizens, making it harder for them to work in the UK. In theory, the UK will be more autonomous because it will be able to set its own healthcare regulations and have control over training times and employment standards. However, in practice, this will exacerbate the existing labor shortage. Stricter immigration laws alongside an end to the Freedom of Movement, which allows “EU citizens to live and work anywhere within [the] EU,” will make it harder for the NHS to employ staff from EU countries.[1] 

Furthermore, an end to the European Health Insurance Card (EHIC) would mean that UK citizens visiting EU countries will need separate medical insurance. A more serious consequence is that patients that receive care in other member states will not be able to do so anymore. Such populations include patients on dialysis as well as older residents that have serious conditions that can be treated for less in EU countries. A no-deal Brexit means that these individuals will have to receive care in the UK, which will be extremely expensive – for them and for the NHS.

There are questions of whether or not the government will be able to maintain its current funding to public healthcare.

Since the UK economy will also be affected, this will affect how much the government can spend on the NHS. There are questions of whether or not the government will be able to maintain its current funding to public healthcare. Moreover, the 190,000 UK pensioners living in EU states would no longer be able to access health services in those countries. Thus, they would have to receive care in the UK, adding an extra £500 million per year to the costs of the NHS.[2] 

Additionally, food system will also be disrupted because the UK relies heavily on imported goods. From wine and cheese to spinach and tomatoes, the UK imports several food items from countries across Europe. Prices are expected to rise about 10% because of tariffs, transport costs, and a shortage of migrant workers who help with harvesting and manufacturing.[3] Tariffs will likely be highest on short shelf life foods such as fruits and vegetables, posing a barrier to accessing nutritious food. For instance, according to the British Tomato Growers’ Association, only one fifth of all tomatoes in the UK are produced domestically.

The price surge will especially affect those on low incomes, leading to more people relying on food banks, which will also face supply chain shortages. Hypothetical economic models were conducted at Imperial College London that predicted an increase in cardiovascular disease deaths due to these price surges in fruits and vegetables.[4] An increase in paperwork and health safety certifications that were previously covered by the EU will add extra costs as well. 

Similarly, medical products will also face a shock to their supply chain. UK-led but EU-funded networks and projects will face severe consequences. Unless the EU accepts British data protection laws, all of these shared collaborations will lose legal status. Thus, sharing data and information across borders will be impossible. This would not only apply to medical research but to disease surveillance, clinical trials, and patient monitoring.

The UK will lose influence in the scientific field because it will no longer be a member of the European Medicines Agency, through which it conducts significant biomedical research.[5] Shortages and delays on medicines are expected; thus, on August 15th, the UK government signed a contract that transported “time sensitive shipments” from the EU. Nonetheless, the uncertainty around the supply of medical products has prompted “one in three generics manufacturers” to make their separate plans.

The reality of what people are currently facing is best exemplified through Angela Boyd’s encounter with her physician: “As a cancer patient with chronic lymphocytic leukaemia on second-line treatment, I asked my consultant haematologist whether the Imbruvica capsules I am taking, which are manufactured in Belgium, would still be available after a no-deal Brexit. She had no answer.”

All in all, this is a fraction of the problems the UK will face were it to leave the European Union without a deal. As political tensions rise, the fast approaching decision day has made members of parliament adamant about delaying the Brexit date. While the UK would not be the first country to leave the EU, it is certainly the most influential one to leave thus far. The government’s response will ultimately determine the severity of these outcomes. However, any decision made on October 31st will indefinitely change the course of history. 

References
[1] Read, R, Fenge, L‐A. “What does Brexit mean for the UK social care workforce? Perspectives from the recruitment and retention frontline.” Health Soc Care Community. 2019; 27: 676– 682. https://doi.org/10.1111/hsc.12684

[2] “BREXIT BRIEFING: Reciprocal healthcare between the UK and the EU.” British Medical Association [PDF File].

[3] Van Schalkwyk, May C I, et al. “Assessing the health effects of a no deal Brexit.” BMJ 2019; 366 :l5300

[4] Seferidi P, Laverty AA, et al. “Impacts of Brexit on fruit and vegetable intake and cardiovascular disease in England: a modelling study.” BMJ Open 2019;9:e026966. doi: 10.1136/bmjopen-2018-026966

[5] Fahy, Nick, et al. “How Will Brexit Affect Health Services in the UK? An Updated Evaluation.” The Lancet, vol. 393, no. 10174, 2019, pp. 949–958., doi:10.1016/s0140-6736(19)30425-8.

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