A prolonged economic fallout as a result of Brexit could have a chilling effect on the NHS budget, writes the head of the NHS European Office.
The organisation and delivery of health services and medical care are not areas of EU competence as member states have exclusive responsibility in these areas. Nevertheless, the reach of EU policy on our healthcare system is very significant and a withdrawal of the UK from the EU would have important implications for NHS patients from different perspectives.
With the appointment of a new Prime Minister this week and the newly created role of Secretary of State for Exiting the European Union, we can now expect substantive work to design a negotiating strategy to kick off soon. It will be crucial that the potential implications of Brexit on the NHS and our patients are duly taken into account in this process and fully reflected in the UK negotiating priorities.
First and foremost, there could be an economic impact. Much discussion has taken place about possible additional funding for the NHS as a result of leaving the EU. But it has also become clear that if economic growth slows as predicted, funding no longer being paid to the EU would be more than cancelled out by the negative economic consequences of leaving.
While it is difficult to quantify the possible financial impact of an economic downturn on the NHS, some predictions have been made. The Health Foundation has estimated that the NHS budget could be £2.8bn lower than currently planned in 2019/20, and the Economist Intelligence Unit has stated that by 2020 the NHS will spend £135 less per head if the UK leaves the EU.
A prolonged economic fallout could indeed have a chilling effect on the NHS budget, which in turn could impact on patient care. It could potentially lead to longer waiting times, or reduced access to innovative, expensive medicines and health technologies, or in a lowering of quality.
Patient care could also be hit in the event that it becomes more difficult to attract EU nationals to work in the NHS in the future, given the staff shortages we already face and our high dependence on EU health professionals.
There could also be consequences for NHS patients in terms of the ability to access treatment in other EU countries, in the event that the set of EU mechanisms and rules which facilitate cross-border healthcare were no longer applicable.
This means that, in the future, British citizens on holiday in Europe might no longer be able to use the European Health Insurance Card. Known as an EHIC, the card allows British citizens to receive emergency or immediately necessary healthcare on the same terms as the residents of that country.
EU law also allows Britons who are abroad for a longer period of time – such as pensioners living abroad, or UK citizens who work in another EU country – to be entitled to receive healthcare in the country where they live. These rules are extremely complex, but the key principle on which they are built is that Britons are entitled to healthcare just as the local population, thanks to a system of reimbursement of costs between the UK and the host country.
In the future, this system might no longer apply unless bilateral agreements are negotiated between the UK and each individual EU country. This could mean that our citizens might have to purchase private health insurance and/or come back to the UK when in need of healthcare.
There is also uncertainty over whether NHS patients could in future benefit from EU rules which allow them to receive elective healthcare in other EU member states when, for example, a specific treatment is not available in the UK, or when the waiting time is long and the patient could be treated more quickly abroad.
It should be stressed that these EU rules are reciprocal and therefore uncertainty also exists on whether EU citizens will be entitled to receive healthcare in the UK following Brexit. Selfishly, we may believe that this could potentially help alleviate pressure on our stretched healthcare system, as there are currently around double the number of EU citizens living in the UK, compared with UK nationals living in the EU. But this is far from being true, as UK nationals living abroad are often older and in greater need of care, compared with the younger and healthier EU citizens who work or study in the UK.
Another challenge from a public health perspective is whether, in the future, the UK will continue to be able to benefit from EU coordination when responding to cross-border health threats, such as pandemics.
Similarly, uncertainty has arisen over UK participation in EU clinical research projects and collaborations in the years ahead. The European Commission has funded projects that have enrolled over 340,000 people into clinical trials, developing new treatments for a range of conditions, including cancer, diabetes, heart diseases, and rare diseases. If this involvement was no longer possible, patients’ access to innovation could be slowed down, as EU collaborative research studies have helped to improve the speed at which innovation in medical science is incorporated into healthcare provision.
It is important to clarify that the UK government has not yet notified the European institutions that they wish to withdraw from the EU. Therefore, the UK is still a member of the EU and the range of EU rules and collaborative initiatives outlined above will continue to apply, probably for at least another two years.
After that, however, and especially if a decision is taken that the UK does not wish to maintain access to the EU single market, we would be in uncharted waters, with potentially significant implications for patients in all the areas described above.
Elisabetta Zanon is director of the NHS European Office, part of the NHS Confederation. Follow the organisation on Twitter @NHSConfed_EU
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