Nuffield Trust: Slow decisions and vague trade slogans leave NHS uncertain of post-Brexit future

Our report published today looks at six key areas of health and social care that are being impacted by Brexit.

Press release

Published: 20/12/2021

The government’s response to Brexit and its failure to iron out key agreements after nearly a year outside of the Single Market and Customs Union are fuelling constant uncertainty over many aspects of health and social care in the UK.

A new report from the Nuffield Trust, first reported by the Financial Times, warns that pledges to keep the NHS and medicine prices “off the table” in new trade agreements carry little clear meaning while key details remain unknown, and that processes have been secretive with little engagement to ensure that negotiations with the rest of the world benefit the UK health sector.

Going it alone: health and Brexit in the UK explains how delayed decisions and negotiating brinksmanship across six key areas including regulations around medicine and devices, international trade agreements, and the situation in Northern Ireland are leading to direct impacts on health including restricted access to EU science funding and on staffing pressures, felt particularly acutely in social care. 

The report, which collates findings from interviews, roundtables, data and analysis, and is funded by the Health Foundation, finds:

  • Pledges to keep the NHS and medicine prices “off the table” in trade negotiations mean little without specific commitments on key areas such as patent protections and investment rules. It also remains unclear that the government has a positive agenda to bring benefits to the UK health sector through trade negotiations.
  • Staffing in health and social care services is the most pressing concern following the introduction of new immigration rules, adding to the burden the health system has been grappling with capacity for many years. The situation in social care is the most urgent where new immigration rules effectively halt immigration from the EEA.
  • There is a deep sense of uncertainty in the medical science and life sciences industry which impacts on medicines and medical devices, making the UK unattractive to investment.
  • Northern Ireland faces a serious risk to medicines and devices supply at the start of 2022, and it is still undecided exactly what measures might be implemented by the EU and UK to help.
  • Access to the flagship EU science funding programme has been used as a bargaining chip throughout negotiations, and uncertainty over access to the programme is endangering future plans for collaboration and projects.
  • Among the few areas where there are clearer plans to use the ability to diverge from the EU are the changes to procuring health goods and services which aim to reduce bureaucracy, but similar policies would have been allowed within EU law.

While the government and pharmaceutical industry put in measures at the end of the transition period to stop immediate medicine or medical device shortages, this was achieved in part by simply sticking to old EU rules and accepting EU approvals. How the industry will be regulated and how the UK might remain competitive remains unclear. 

The authors call for more decisive action to address the effects being felt right now on workforce numbers, access to scientific funding and Northern Ireland’s access to medicines. The government must address the lack of transparency in order to provide more clarity on trade, workforce, and investment in medicines through the provision of better data.

Mark Dayan, Senior Policy Analyst and Brexit lead at the Nuffield Trust, and a co-author of the report, said:

“The protracted struggle of negotiating a Brexit deal was supposed to provide clarity and some certainty to the UK health and care sector, but nearly a year on, the impact is only beginning to filter through, at times masked by the severe shocks to the health service and economy of the Covid-19 pandemic.

“The government’s approach to the effects of Brexit on health and care has fuelled uncertainty with the UK heath sector. The lack of answers to key decisions, ongoing brinkmanship between the UK and EU and a secretive process lacking in engagement with health and care has already had direct impacts including reducing competitiveness for medical supplies, restricting access to important EU science funding and fuelling a staffing crisis in social care.

“While the government has set about securing a flurry of trade deals, there appears to be no plan to bring benefits to the UK health sector. Missing details have made the promise that the NHS and medicine prices will be off the table in any negotiation all but meaningless.”

Jean Monnet Professor of EU Law ad personam at City University of London, Professor Tamara Hervey said:

“The position of the NHS in Northern Ireland is becoming critical, as ‘grace periods’ cannot go on forever. Northern Ireland is in effect within the internal market for goods, but outside of the European Union. The supply of products to the comparatively small Northern Irish NHS is in jeopardy, as market actors take rational decisions about whether to supply that market, looking at the costs associated with different possible trade routes. The position of frontier workers on the island, in terms of their access to health care, but also as members of the health and social care workforce, is worryingly unclear.

The mosaic of different overlapping rules (common travel area, Withdrawal Agreement, retained EU law, Trade and Cooperation Agreement) urgently needs to be better understood, effectively implemented, and communicated clearly in ways which people can understand.”

Notes to editors

About the Nuffield Trust:

The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.

For all queries or to arrange an interview, contact Simon Keen: 07780 475571/; or Meesha Patel: 07920 043676 /