The future for health after Brexit

Following on from our 2022 report looking at the health landscape six years on from Brexit, this report aims to look deeper at key trends we identified in the supply of products needed for health, the life sciences, migration and the health and care workforce. It also looks at the options and priorities for addressing the issues raised. We also examine what the prospects are for enhanced cooperation with the EU and its institutions so that health in the UK can be improved.

The Health and International Relations Monitor project is supported by the Health Foundation, an independent charity committed to bringing about better health and health care for people in the UK.

Key findings

• Multiple indicators show that the past two years have seen constantly elevated medicines shortages, in a new normal of frequent disruption to crucial products, which if anything worsened in 2023. This has placed a significant burden on pharmacists, and has affected the medicines available to patients. The English NHS had to increase medicine prices to deal with supply problems on a scale which cost £220 million more in one year than the same products would have at their previous costs.
• These shortages reflect significant problems in the global medicine market, which are also having a serious impact in EU countries. However, Brexit has also contributed to difficulties by lowering the value of sterling and removing the UK from EU supply chains. In future it will pose the additional risk of being left out of EU measures to respond by shifting medicine between member states, buying products jointly, and trying to bring manufacturing back to Europe.
• The UK has intensified its reliance on migration following Brexit as a source for both health and social care workers. An expansion in social care workers in England is entirely due to migration from outside the EU; more EU and UK staff have left than joined the social care workforce. 
• Health care migration draws heavily on countries placed on the World Health Organization’s ‘red list’, which applies to countries judged to have too few trained clinicians for employers and recruiters from other countries to be allowed to recruit them. There are now 45,000 staff from red list countries in the English NHS, a 30% increase in just one year. One in five nurses trained outside the UK or EU who joined the UK register came from these countries in 2022/23. 
• Heavy reliance on migration without the underpinning of EU free movement of labour means a permanent risk of political choices suddenly affecting staffing availability. The recent decision to end the rights of social care workers to bring their dependants to the UK illustrates that the sector’s access to migration is subject to unpredictable change. 
• Life science and medicine regulation in Great Britain is now often lagging behind such regulation in the EU, caught between the strategies involved in trying to diverge and the demand from industry to align. The EU’s new law on artificial intelligence opens up a significant point of divergence from the UK and risks dividing off markets for medical devices. This could create a difficult situation in Northern Ireland, which has to align with EU rules on devices, but potentially with UK rules on artificial intelligence. In most other cases, the UK has moved towards realigning with the EU, but in a way that the life sciences industry has found unpredictable. 
• There is a similar pattern across both the movement of people and products, with the UK rapidly moving away from initial efforts to take a different course after Brexit and returning to strategies used during the period of EU membership, but with additional frictions. 
• Medicine authorisations for products that the EU approves centrally are typically slower in Great Britain than they would be if it were still a member state. From December 2022 to December 2023, four drugs authorised by the European Commission had been approved faster in Great Britain than in the EU; 56 had been approved later in Great Britain; and 8 had not been approved at all in Great Britain as of March 2024.
• Our research with stakeholders suggests that, despite some recovery in relations between the EU and the UK, rebuilding the EU–UK health relationship at a formal level is not currently a priority for EU institutions and representative bodies, which have gone through an exhausting and at times bitter negotiation process with London, and are faced with many ambitious health reforms in train in Brussels. 

Key recommendations 

• The health sector cannot rely on big formal changes to the EU–UK relationship any time soon. How much change is possible will depend on what the UK is willing to offer across all sectors. But UK organisations are already rebuilding and maintaining links to EU counterparts. Provisions in the EU–UK Trade and Cooperation Agreement already set out areas for the UK government and the EU to cooperate over, and there is more that could be achieved here. 
• If formal agreements between the EU and UK were reopened, which would require either real give and take across sectors or an ambitious framework to cooperate over health specifically, there are certain provisions that would be significantly positive for life sciences, medicine supply and other aspects of health security in the UK. These include mutual recognition of batch testing for medicines, and anything that is possible in smoothing clinical trials across the two jurisdictions. However, it is important not to assume that it will be possible to eliminate all or even most of the frictions that Brexit has caused through renegotiation within the confines of what would be essentially a trade agreement – far from a return to a single market. 
• There are steps well within the powers of the UK government to address these problems, which do not require renegotiating with the EU. Better anticipation of medicine shortages, more openness about shortages in line with other European countries, being careful that sudden squeezes on cost do not drive instability and having a plan for the EU’s stockpiling and medicine transfer schemes would all be positive steps which require no international negotiation.
• Building on the English NHS Long Term Workforce Plan and its equivalents in the other UK countries to create a sustainable domestic health care workforce, and expanding this to social care, could eliminate many of the underlying risks that leave the NHS and care sector so exposed to changes in migration policy and so dependent on sometimes ethically dubious international recruitment. Similarly, there is a credible policy agenda to improve the attractiveness of life sciences in the UK, which could help to balance losses in access to the EU’s clinical trials system, and previously science funding. 
• The UK government should be honest about the many areas where alignment has proven the best option, and where it has chosen to continue with rules and strategies developed during the period of single-market membership. Having to follow different regulatory processes in different countries is commercially unwelcome, and successive UK governments have often listened to the pleas of businesses to avoid this. Setting this out more clearly would help to avert uncertainty, which affects services and industries that deal with data regulation, medical devices and the migration of care workers.