The impact of Brexit on the NHS has been a source of debate and controversy since the figure of £350million appeared on the side of a bus during the EU referendum in 2016. As we get closer to 29th March 2019 – the official date the UK is due to leave the EU – what will the impact of Brexit really look like for the NHS, its staff and its patients?
There's a long list of concerns.
Firstly, there's the future recruitment and retention of NHS professionals from EU member states, and notably nurses. Since the referendum, there has been a huge drop in the number of nurses from EU countries on the nursing professional register.
Just yesterday, the Royal College of Nursing warned that Brexit could particularly affect nursing staff based near the border to the Republic of Ireland, and that this poses a big threat to patient care.Important challenges relate to the impact of Brexit on healthcare delivery in Northern Ireland; cross-border collaboration and co-operation currently facilitates the provision of care in a range of areas.
For example, children’s cardiac surgery is no longer undertaken in Northern Ireland and children are instead transferred to a hospital in Dublin.
With this, as with many other questions, clarity on the position of the Irish border is vital.
If a withdrawal agreement with the EU is not finalised and the UK moves into a no-deal situation, UK patients will no longer be able to rely on their European Health Insurance Cards (EHIC) which currently give access to free or reduced cost for necessary medical care in EU member states.
The withdrawal agreement provides current UK citizens abroad, such as retirees in Spain, with rights to access healthcare under existing reciprocal EU rights – without it, they may be subject to considerable costs for treatment if they fall ill.
Those travelling at that time would be well-advised to ensure they have full travel insurance. Some patients with complex disorders, who are unable to obtain affordable travel insurance, may even decide they cannot take the risk of travelling.
Even if there is a withdrawal agreement and transition period until December 2020, there is as yet no agreement as to whether the EHIC insurance will continue in the future.
But what about the people in the UK? What impact will Brexit have on the supply of and access to medicines, for example?
Concerns have been expressed over possible new customs delays in a no-deal scenario.
The UK government has indicated that stockpiling of six weeks supply of medicines will take place. In the case of products that have a limited shelf life, such as medical isotopes used by radiographers, specific arrangements will be in place for these to be airlifted to the UK.
But such arrangements come at considerable additional costs to the NHS.
As things currently stand, without a specific deal made with the EU concerning medicines, post Brexit the UK will also no longer be part of the EU’s regulatory regime.
So, what does this mean?
Currently some, though not all, medicines marketed in the UK are subject to approval by an EU body, the European Medicines Agency (EMA), and certain drugs such as paediatric medicines have to go through this centralised process.
If approved by the EMA, the authorisation is valid across the EU.
The government has stated there will be consultations in the autumn regarding changes needed to UK legislation in this area, including new regulation for medicines currently approved by the EMA.
While this would regularise the situation in the UK, manufacturers would need to get additional approval if they intended to market the drugs elsewhere.
The government has also indicated it wants to continue aligning itself with EU law regulating clinical trials on drugs; there's a new regulation due to come into force in 2019, but after the March cut-off point.
Without a special deal, the UK will then be excluded from other aspects of the approval process for these trials, such as a new centralised EU database.
Once no longer part of the EU pharmaceutical regulatory structure, the UK may no longer be seen by drug companies as a first priority launch market.
This would mean that new drugs may be launched later in the UK than other EU countries, and patients could suffer as a result.
There is still uncertainty as to whether the withdrawal agreement and transition period will be agreed in the autumn and the vital issue of the Irish border remains to be resolved.
The prospect of a no-deal, cliff-edge Brexit to an already cash-strapped NHS, desperately concerned with maximising resources and staff, is a very real concern – and the clock is ticking.
Professor Jean McHale was co-author to the report, Cost of No Deal Revisited from the The UK in a Changing Europe.