The costs of Brexit make severe challenges even harder for the NHS and social care

The seismic changes to the relationship with our nearest neighbours and the impact of Brexit have only added fuel to the fire of severe challenges facing health and social care in the UK today, making people less healthy and widening health inequalities.

The warning comes from the Nuffield Trust think tank, which has published the most up to date look at the impact of Brexit on the UK’s health and care services. The ongoing monitoring work, funded by the Health Foundation, covers the impact on the NHS and social care workforce, medicine and medical devices supply and the economic cost, and reveals negative effects across these areas.

Shutting off the ‘relief valve’ of EU migration has put additional pressure on staffing challenges in a health and care system which has relied heavily on EU and international recruitment and without an effective domestic training and retention plan. The impact has been felt most on efforts to recruit care workers, dentists, and specialist doctors.  

Meanwhile, pressures on the supply of medicines and medical devices have steadily increased since the EU referendum. While other countries have also seen shortages, this seems to be especially prolonged in the UK, likely because of the currency depreciation and trade barriers associated with Brexit.

Health and Brexit: six years on finds:

• Recruitment of dentists and social care workers from the EU has been left ‘uncompensated’ by increased recruitment drives from the rest of the world. The number of dentists joining the UK register has halved since the EU referendum vote and since the introduction of more stringent English language testing, and has not recovered. There has been no marked uptick in care worker recruitment with international recruitment of care workers virtually stopping in spring 2020.
• Brexit has made longstanding recruitment challenges for specialist doctors worse in several specialities facing ongoing shortages, including anaesthetists and heart and lung specialists.
• The UK saw a 100% increase in cardiothoracic surgeons across the five years leading up to the EU referendum. This yearly increase has fallen to 5%, while the rise in anaesthetists is down to 5% yearly compared to 20% before the pandemic.
• The rapid increase in recruitment of doctors and nurses from the rest of the world is not sufficient to address ongoing shortages, and should not be seen as a replacement for proper workforce planning and efforts to recruit and retain staff domestically.
• Since the end of the transitional period, recruitment from World Health Organisation designated ‘red list’ countries has expanded rapidly. Between October 2019 and March 2022, there were sharp increases in staff from red list countries, including Nigeria, Ghana and Pakistan. This suggests an increase in active recruitment drives raising ethical questions and opening the system to abuse.
• While the government and pharmaceutical industry averted immediate disruption to patient care from difficulties in the supply of medicines after leaving the single market, there have been a greater level of shortages across the board since the UK’s departure and indeed before it. Serious Shortage Protocols allowing pharmacists to dispense a different product were intended to be a rare emergency response, but in fact more than five have been in effect for most months since the UK left the single market.
• The government has had to accept more increases in price on medicines, such as Prozac, as pharmacists have been unable to find them at the usual price. The number of concessions granted has on occasion risen fivefold to over 100, up from below 20 before the pandemic. While similar increases have been seen in other countries, including France and Germany, instances have been unusually sustained in the UK and proceed the pandemic.
• Due to the Northern Ireland Protocol, a growing number of medicines are being approved only in Northern Ireland or only in the rest of the UK. This is gradually splitting off the Northern Irish medicines market from Scotland, England and Wales.
• There is a strong correlation between livings standards and health which will be impacted by falling living standards driven by rising inflation and the fall in the value of sterling. Brexit risks particular economic consequences for areas of the country where industries are more affected by trade barriers, and may worsen embedded health inequalities following austerity.

Brexit has compounded the already severe difficulties faced by the NHS and social care confronting recovery from the pandemic and the economic shocks of the cost-of-living crisis and the Truss government mini-budget.

However, there are some levers within the UK’s power to help address Brexit challenges. The government should do more to ramp up domestic training and supply of health and care workers, and use narrow opportunities for competitive advantage to counter fluctuations in availability of medical devices and medicines.

Nuffield Trust Brexit Programme Lead, Mark Dayan, said:

“It is undeniable that the NHS has faced three of the most difficult years in its history. The health and care sector is still reeling from the effects of a global pandemic and is now grappling with rising cost pressures. The effects of Brexit appear to have added to the severe challenges and problems the NHS currently faces.

“The economic hit of Brexit combined with the worst cost of living crisis for a generation is reducing living standards creating additional need for health and care. Meanwhile a slowdown in EU and EFTA recruitment is making shortages of urgently needed care workers, dentists and specialist doctors even worse.

“The UK has also apparently taken the worst of a period of medicines shortages which has swept across Europe. The fall in the value of sterling around the EU referendum, and the trade barriers erected since, are probably major factors in our unusually consistent and longstanding problems supplying vital products.”

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

“We urgently need an honest national conversation about the post-Brexit context for medicines, equipment and devices supply and NHS staffing. The health sector, generally speaking, would like a closer relationship with the EU’s standards. There are potential benefits from a looser relationship with the EU but capitalising on them would involve courageous political decisions. Instead, we have drift and fantasies.

The position in Northern Ireland is particularly worrying, where political game-playing seems to be put ahead of the health of the population.”

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*For an interview or further information, please contact simon.keen@nuffieldtrust.org.uk