On 31 January 2020, the UK officially left the European Union, although it remains a de facto member and beneficiary of its constituent structures until the end of the agreed transition period on 31 December 2020.
From this date, the impacts of exiting European frameworks in practice will be momentous. Nowhere is this more relevant than health and the NHS, which is concurrently battling with the largest public health crisis in a century – the Covid-19 pandemic. Tracking these impacts, positive or negative, will be a vital task.
This report, commissioned by the Health Foundation, maps out the health areas that will be affected by exiting the EU, identifies both well-known and often overlooked policy issues and dilemmas, lays out their possible impacts, and describes how they could be tracked over time.
Our research confirms the well-known issues Brexit raises in many areas, from medicine supplies to data flows. It has also uncovered the following less widely discussed impacts, which deserve urgent attention:
- The short-term supply of medicines and medical devices to the UK after the transition period is a serious concern, with levels of uncertainty very high. The UK government is predicting disruption and planning mitigation, but with little transparency.
- Beyond this short-term picture, our interviewees and roundtable participants believed the UK will face a lack of competitiveness in terms of investment in health-related industries, a permanent increase in the cost of supplies for health and social care, and difficulties in accessing them. Yet there seems to be no detailed plan for how the UK will regulate medicines and medical devices after we leave the single market and EU institutions.
- The end of the free movement of labour is likely to make it more difficult for the NHS and social care to access the growing number of workers they need. Our data analysis shows that the Covid-19 pandemic has also slowed migration dramatically – from the EU and the rest of the world – even before Brexit changes take effect, with a 70% drop in migrants entering the labour market. The pandemic has therefore raised the bar still higher: the UK now needs to dramatically accelerate migration from 2021 to meet government commitments on nursing and on providing more social care.
- Industry representatives and government officials described uncertainty around how medicines, supplies and staff will enter Northern Ireland after the transition period, and what this would mean for access to health services and medical products in the future. While the recent decision of the joint committee has set out short-term allowances, longer-term decisions have yet to be taken and there is an expectation of widespread accidental failure to comply with the law.
While food safety issues such as chlorinated chicken have received significant media attention, the most important question for public health will be how the UK government regulates causes of ill-health such as poor air quality, tobacco and unhealthy food. There has been little discussion of plans for this after Brexit.
Slower economic growth and decreasing spending capacity following Brexit may worsen wider determinants of health, such as unemployment and access to health services. It will be possible to track indicators of these changes – such as healthy life expectancy or child poverty – over the long term. However, there will be a challenge in disentangling the impact of Brexit from the effects of the recession brought about by the Covid-19 pandemic.
There was significant uncertainty regarding powers returned and redistributed through the Internal Market Bill (IMB), with respect to the UK's four constituent nations. Officials in Scotland, Wales and Northern Ireland are concerned the Act could curtail their ability to regulate in the future to improve public health, tying them to unclear Westminster plans, and depriving the UK the opportunity to learn from regulatory experimentation, such as Scottish measures on smoking in public places and alcohol pricing. The Internal Market Act, approved on 17 December, partly addresses these fears, by including amendments that permit regulatory divergence from UK-wide rules, where the four constituent governments have agreed on a common approach. This mechanism has been set out in principle, but remains to be monitored in practice.