Forget the election: whoever wins, 2017 will go down in history as the year Brexit began. Negotiations will start in earnest within the next few weeks, considering the difficult issues of the UK’s divorce settlements and rights for European citizens here and British citizens in the EU. By winter, discussions will begin on our future trading arrangements with our largest market.
These negotiations will touch on every area of government in Britain. The Financial Timesreports that we will have to negotiate no less than 759 international treaties, governing everything from crucial components for our nuclear reactors to the wellbeing of swordfish in Chile.
But in the eyes of Britain’s electorate, only one other issue competes in importance with Brexit itself: the state of the National Health Service. Our analysis suggests many of its supporting pillars could be strengthened or weakened by the deal we get—and one of the most alarming statistics relates to the potential post-Brexit cost of healthcare for expats living in the EU.
NHS funding unexpectedly became a major and contentious issue in last year’s EU referendum. The accuracy of the famous claim that we could give the NHS £350m a week currently sent to Europe was questionable, but there is a reason the health service’s finances came into play. Across the UK, services are struggling to cope with years of relative austerity, a fact contributing to difficulties in staffing and waiting times.
"European migrants made up almost a third of newly registered nurses in the UK last year"Read the small print of the Leave campaign, and their specific suggestion was to spend an additional £100m a week on the NHS. That amount really could be freed up by cancelling our EU membership fees. But on the other hand, the long-term economic costs of Brexit threaten to take even more money out of the Treasury. The OBR estimates that the hit to the public finances could be £15bn by 2020. That would mean significantly less money for the NHS, not to mention services like housing and social care which its patients rely on.
Perhaps an even bigger issue is the end of free movement of labour, which both Labour and the Conservatives say will be part of their Brexit deal. Here, there is more downside than upside for the NHS. EU migrants using the NHS as patients more or less cover their costs through the taxes they pay. A reduction in migration might free up some bed space initially, but it would leave the NHS financially no better off than it started.
On the other hand, though, the NHS and social care have become chronically dependent on staff from the EU and the wider European Economic Area (which includes Norway, Liechtenstein and Iceland). European migrants made up almost a third of newly registered nurses in the UK last year. The NHS is already facing a serious nursing shortage. Figures leaked from the Department of Health suggest that without this lifeline unfilled posts could rise by 20,000 or even more by 2025, on top of the vacancies that already exist.
Social care services, like care homes and workers who support frail older people in their houses, are also relying on European migration to keep up with our aging population. Our research suggests that if these often relatively unskilled migrants were unable to keep coming under a new migration system, a shortage of 70,000 could open up by 2025.
"The Brexit negotiations will coincide with one of the trickiest periods in NHS history"Many of the rules and regulations which govern the NHS also come from Brussels. Some the service will hope can be kept—for example when it comes to European medicines licensing. This keeps the UK part of a large market where pharmaceutical companies launch new drugs early, and means we can shop around for a good deal. Others, like the Working Time Directive, are unpopular in at least parts of the NHS. Many medical royal colleges argue that the Directive’s restrictions on working hours get in the way of teamwork and training for junior doctors. Even though healthcare is very much a domestic industry, we need British negotiators to be constantly aware of the implications of their deals for the NHS.
Then there is the matter of what happens to the healthcare arrangements which cover European citizens in the UK, and British citizens in Europe. Some have suggested we get a bad deal here: we send the EU far more money than we receive under these programmes. But in fact, our estimates suggest that if pensioners living in the EU under the S1 health scheme had to return to the UK for treatment it could cost up to £1bn—double the amount we pay out at the moment for their care abroad.
The Brexit negotiations will coincide with one of the trickiest periods in NHS history. With an ageing population needing more care every year, there is a serious shortage of both funding and staff. The right deal could help the NHS to cope with the pressures it faces. But unless negotiations are carried out with the health service clearly in mind, Brexit has the potential to make a difficult situation worse.
