“Perilously uncertain” future for UK health sector despite Brexit deal, expert analysis reveals

The perilously uncertain future facing the UK at the end of the Brexit transition period could put the UK’s health and care system at risk.

New barriers to migration, an unknown level of disruption to medicines and devices, a prolonged economic slowdown and barriers to investment in science will impact the health sector almost immediately and into the future.

That’s according to the most comprehensive study to date looking at the issues remaining for health in the UK after the country cuts its ties with the EU in January. The research, Understanding the impact of Brexit on health in the UK, has been carried out by the Nuffield Trust and academics from the Universities of Oxford, Sheffield and Michigan, and funded by the Health Foundation [1].

The study examines several areas of impact for health in the UK, including access to medical supplies, ensuring enough staffing for health and care services and public health capacity [2]. It identifies the short, medium and longer-term issues that may present the sector as the UK goes its own way after January.

Key findings include:

• While extensive planning to monitor and respond to the disruption of medical supplies has been carried out by the government and NHS England, it is not clear exactly what scenario has been prepared for and what the impact will be if disruption is longer or broader than expected.
• Plans will not have anticipated the effect of the current border restrictions brought in as a result of the new Covid-19 variant.
• The Covid-19 pandemic has already slowed migration dramatically even before Brexit takes effect, with serious questions about how quickly the health sector can recover. National Insurance Number registrations both for EU and non-EU applicants, decreased by 70.1% (from 190,509 to 55,428) between the fourth quarter of 2019 and the second quarter of 2020.
• The vulnerable social care sector will immediately find itself blocked from recruiting staff from the EU because of a new unilateral migration policy, exacerbating dire workforce shortages.
• In the longer-term, senior Government and industry figures believed the UK will face a loss of investment for medical research and life sciences, and a permanent increase in the cost and difficulty of accessing supplies. There is no clear policy yet to respond to this and restore competitiveness.  
• The health of the public could be directly worsened by a prolonged economic slowdown that leads to lower living standards and a squeeze on public spending, as well as the possibility of less effective regulation of determinants of health like air pollution. These risks could hit the most vulnerable hardest.
• The controversial Internal Markets Bill risks jeopardising devolved countries’ plans to introduce new public health measures, like further pricing measures for alcohol, tobacco packaging and e-cigarettes, calorie labelling and high-fat foods in Scotland, and in banning hormone-injected beef in Wales.

The report also highlights concerns about how medicines, supplies, and staff will enter Northern Ireland after transition, with interviewees suggesting the lack of clarity threatens provision and access to health services.

Commenting on the report, Mark Dayan, Brexit Programme lead at the Nuffield Trust said:

“Despite Covid-19 pushing health and healthcare to the top of the domestic agenda, there are so many serious questions that remain unanswered about the future of the sector after the UK leaves the Single Market on January 1 2021.

“A lack of transparency over the planning for the disruption ahead has fed into a sense of uncertainty for the sector – both in the short and long term.

“There are a particular set of fairly immediate issues which should be in sharp focus – from the double whammy of Covid-19 and Brexit related workforce shortages and economic fallout to the very real danger of supply chains of medicines and medical devices being disrupted.

“But it doesn’t end there. There are some deeply concerning and unresolved issues that may affect health in the UK over many years to come and potentially risks the health of the UK population.”

Tamara Hervey, lead of a project on Health Governance after Brexit said:

“Health was always in people’s sights during the EU referendum and the subsequent debates on the UK’s future relationship with the EU. The UK government reassured us that Brexit would ‘do no harm’ to health. It’s crucial that we are able to track what happens next: the UK has an opportunity to lead in health policy, as it forges a new path. But for that to be a reality, major investment will be necessary, and the unintended effects of other policies, like on migration, trade, and research, will have to be mitigated.”