Brexit has brought a lot of new for the UK. A new Prime Minister is set to be appointed, a new relationship with the continent needs to be carved out and, potentially, a new, smaller UK is set to emerge. However, the ability to suitably fund and staff the NHS has remained a certainty, a security, even, for nearly 70 years.
The impact on the NHS of the UK’s membership of the European Union was a regular feature throughout the campaign. However, as the dust settles on the public’s decision to leave the EU, commitments made by the Brexiteers on what now happens to our health service will need to be either substantiated or quickly clarified.
New money recouped from the EU and made available for domestic spending was one of the hinge points of the Leave campaign’s economic argument for Brexit, and nowhere has the argument for increased Government spending been fiercer than over the NHS. Over recent months, the Leave campaign made promises that as much as £350 million per week of extra funding could be put towards the NHS, which they said could be diverted from money currently paid into the EU budget.
However, barely an hour after the result of the Referendum was announced, UKIP Leader Nigel Farage has claimed it was a “mistake” to plaster the Brexit battle buses with the £350 million figure. This admission somewhat justifies NHS England Chief Executive Simon Stevens, who argued that more realistic net savings from leaving the EU would only afford the NHS a total of 19 extra days of funding per year.
Any projected gains in funding for the NHS made by diverting money paid to the EU always came with the caveat that the impact of Brexit on the UK’s economic health could see a drop in the Government’s overall spending power, at least in the short term. We may not see the benefit of new money for the NHS for several years and the immediate aftermath of Brexit has seen huge market uncertainty and the pound at its lowest rate against the dollar since 1985.
Therefore, in the period between the outcome of the Referendum and the UK eventually leaving the EU and potentially unlocking new money for the NHS, there is a big question about how the health service will be able to maintain care standards amid economic and political uncertainty.
It leaves an even bigger question mark over whether the Five Year Forward View, the strategy by which the NHS has outlined it can reach sustainability, will be realistic or achievable should there be uncertainty over staffing or future funding.
As well as these questions, lengthy discussions are already taking place about the impact of EU migration on the NHS in a post-Brexit environment.
With nearly 130,000 EU staff working in the NHS today, the principle of free movement was credited by senior NHS leadership and Remain campaigners as an important mechanism for ensuring that domestic skills deficits can be offset and that services are sufficiently staffed to provide high-quality, consistent care.
Leave campaigners instead suggested throughout the campaign that “health tourism”, whereby visiting EU nationals are able to access free treatment on the NHS without paying UK tax, is responsible for a significant increase in demand on the NHS, with net migration from the EU standing at +184,000 in 2015 alone.
However, as the saying goes, “with change comes opportunity.” Balanced against any uncertainty of how a Government under a new Conservative Prime Minister will secure the long term future of the NHS, we have opportunity to sculpt a more agile and flexible health system. An opportunity to accelerate patient access to the newest and most innovative technologies and finally the opportunity to pause, look beyond EU borders and work with policymakers to shape what the system will look like for the future to come.