Health in the UK after Brexit: Moving apart or stuck together?

The Health and International Relations Monitor project, supported by the Health Foundation, explores how the dramatic changes to the UK’s international relations following Brexit have affected health – from the rupture in trading and institutions, to the new ability of the UK to regulate everything from medicine to migration in a way that differs from its neighbours. 

This report, the last in the series, provides updates based on data and legal analysis for the issues of medicines supply, the migration of staff, and procurement, where the new reality after exiting the single market continues to be linked to rapid change. 

It also looks at four less-studied areas of crucial importance to health where Brexit has meant a new course for the UK: artificial intelligence (AI), funding, professional qualifications and patients moving across borders. We held roundtables in London and Austria with industry, regulators and experts to explore AI regulation in depth.

Key points

NHS and social care professionals

• Following Brexit, the UK has continued to rely heavily on very high migration of health care staff from outside the EU – rather than to rely more on training and retaining staff domestically. In England, two thirds of the increase in registered nurses since the exit from the single market as 2020 ended has come from staff trained outside the UK or European Economic Area (EEA).
• By November 2024, one in 11 (9%) of all NHS doctors in England held a nationality from one of the countries listed by the World Health Organization (WHO) as having such a shortage of staff that other countries should not recruit from them.
• A recent collapse in inward migration of social care workers following a sudden tightening of policy illustrates how unstable this approach is without the stability of EU rights.
• The UK is on course to diverge meaningfully by cutting the number of hours of clinical training it requires for nurses to qualify, well below what EU law demands. While this is not outside the range that other comparable countries require, it will likely preclude any possibility of re-establishing the mutual recognition of nursing qualifications with the EU.

Procurement and the supply of medicines

• The elevated and troubling level of medicine shortages we noted in earlier reports in this series is continuing, with no sign of improvement in key indicators. We have previously concluded that this is not primarily due to Brexit, with other EU countries also suffering significant shortages. However, data now confirm the UK to have had the lowest import growth in medicines of any G7 country, driven by a reduction in EU imports. This does illustrate the particular impacts of leaving the EU.
• The UK’s 2023 Procurement Act moves procurement away from EU law. A carve-out frees the English NHS from the requirement to go through as many full procurement processes – a requirement created originally by its unique attempt to run a market inside the public service since the 1990s.
• It also creates somewhat more space to prioritise local businesses, and social and environmental goals, rather than simply going with the lowest offer. However, it does not go as far as some had hoped in limiting space for corruption and exploitation by suppliers. 

The UK is diverging from the EU on its approach to AI regulation

• Against the AI Act passed by the EU last year, the UK has taken a fundamentally different approach to regulating AI. While the EU Act creates a system to classify and assess all uses of AI, the UK has told regulators in each sector to take their own approach based on shared principles.
• Rhetorically, the EU has emphasised safety and the protection of rights, while the previous UK government emphasised its openness to innovation and a desire to attract investors. But the reality is that for AI systems intended to treat or diagnose as medical devices, the UK and EU systems largely share technical standards, meaning differences in what is actually required can be minimal.
• The costs to business of having to follow two systems, even where they are similar, will remain a problem for the UK in AI medical devices. If divergence grows over time because of the different principles of EU regulation, AI firms will feel pressure to prioritise standards in the much larger EU market – the ‘Brussels effect’ – even if at least some see its rules
  as more burdensome than UK regulation.
• If the UK follows through on its plan to stop recognising EU medical device approvals in 2030, this will confront firms producing new products with the sharp choice of accepting the costs of an extra regulatory system, or not serving the market in Great Britain.
• Because it is based on separate types of products, the UK system has no obvious way to deal with AI systems that were never intended for health care being used in this way – something increasingly prevalent as generative systems are used across society, including by health professionals. Open AI’s GPT-4.5 is not sold as a medical device, but it is
  beyond doubt that both patients and professionals have at times used it to inform diagnosis.

The UK has no single strategy for health and Brexit

• Five years on from leaving the EU, the UK is taking a very variable approach to divergence in law and regulation. In many areas, it has been sticking with the EU law it inherited, or even actively mimicking its larger neighbour. But in procurement, staff training and AI, it has taken different choices – though the extent of difference is often overstated. For migration, medicines and funding, meanwhile, the UK has struggled to find a new equilibrium.
• In all these areas, constant change in technology and in EU law and policy means that Brexit is not a policy issue that can be resolved but an ongoing source of tension and pressure. For sectors that often involve international trade, including AI, divergence will create an intrinsic cost from companies complying twice. This creates a standing disadvantage set against any intrinsic benefits.
• The UK’s different strategies in important areas of health policy would complicate any fundamental move to realign with the EU, even as this is a preferred approach in other policy areas.