The impact that Brexit could have on the National Health Service (NHS) in England has been long awaited since the EU referendum two years ago where Boris Johnson’s ‘Vote Leave’ bus campaign confidently claimed that £350M could go to the NHS instead. On 24th June 2016, following referendum, Britain declared that it would be leaving the EU, since then the salience of healthcare has continued to rise. NHS A&E staff received more than ten million emergency calls in June, this increased pressure on workforce resulted in implementing healthcare system which favoured life threatening situations rather minor injuries and non fatal injuries. How did the Brexit decision effect the NHS, its finances, its staff and its patients?

The NHS Financial Burden

Firstly, Due to increase of demand and costs, budget responsible for NHS would need to be increased by 5% which is equivalent to £100, higher patient demand will account for a chunk of the money each year, leaving a limited amount for new initiatives. This increase in cost pressures include ageing population, new technologies and advanced treatments. With this, NHS spending which rose from about 3% of GDP in the 1950s to about 8% in 2009-10, but would be far above those of the past seven years. Since 2009-10, real growth in NHS spending has averaged only 1.1% a year. These increases in demand world create longer waiting lines, less in-time treatments and higher cancelation of operations.

So, what does this mean?

In short, the NHS budget may continue to rise in real terms. However, it is more likely than not that lower economic growth will take away funds that would otherwise have been available for additional spending increases. Indeed, even without Brexit, tending to the weights on NHS financing would almost certainly have required critical tax increases, extra borrowing or diverting more money away from other services. Brexit will make reacting to these challenges significantly difficult.

The Nuffield Trust (from this report) estimates that the ageing and growing population alone could mean we need another 17,000 hospital beds by 2022 — and that’s just hospital beds. The number of doctors, nurses, other staff and equipment all have to meet demand.

Staff Wanted

Since the referendum, there has been huge drop in number of staff registrations in Britain. This recruitment of nurses and staff from the EU would cause an increase in costs and retention. According to recent findings, EU nationals make up 17% of dentists, 10% of doctors and 7% of social care workers, physiotherapists, care workers and nurses. The UK has never trained doctors for their own need, some 28,000 doctors are non-UK nationals, which is quarter of the total. NHS England alone depends on some 11,000 doctors from the EU27, which amount to about 10% of all doctors. Add in the further 20,000 NHS England nurses and around 100,000 social care staff from the EU27 and the sheer scale of reliance on EU migrant workers becomes clear.

The “Brexit effect” this year caused NHS to recruit 10,000 contract doctors and workforce from overseas.  As stated by the CBI report: ‘Workers from both the EU and the rest of the world play an invaluable role in supporting [the health sector] from a leading brain surgeon from India through to home care assistants from Portugal.’

With the British government idea to focus on skilled migrants, lower-skilled positions such as assistants, caterers, launderers and cleaners could all face severe shortages. These roles are key contributions of health care system function, which has been impacted due to complex system created due to demand and cost pressures.

Seven day NHS for patients

Due to understaffing and poor service on weekend, many deaths were caused in past two years. Currently, experts and health care organization have raised their voice against poor services in hospitals. Some polls have suggested that the public is in favour of seven-day access to NHS services, but many (48%) think these services aren’t possible with the levels of funding and staffing at the moment. 42% thought it was possible.The government admits that the money is already going to NHS during this parliament.

The Welsh government has already published a long-term plan for health and social care. This includes promises of a “person-centred approach” with more services closer to people’s homes and outside of hospitals. Like the planned Green Paper in England, there will be discussions about how to pay for social care including increasing taxes.

The Scottish government says it wants to increase the pace with which the health and social care systems are integrated in 2019, following the creation in 2016 of joint boards responsible for funding local services. There will be investment in a drive to reduce NHS waiting times.

With the assembly and executive suspended in Northern Ireland it is hard to identify priorities and long-term strategic plans. The NHS plods on with civil servants doing the best they can in the absence of political leadership. Waiting times for routine surgery and in A&E continue to exceed those in the rest of the UK.

There are some big decisions to be made in 2019 about how the NHS and social care cope with the care needs of more older and sicker patients.

More care away from hospitals is what everyone wants, but finding the money to keep up with patients’ needs gets harder, leaving political and health leaders at Westminster and the devolved administrations with a lot to think about in the year ahead.

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