When Theresa May failed to secure a Brexit mandate the June 2017 General Election, voters proved what the polls predicted: The election was not just about Brexit but a much wider set of issues. The National Health Service (NHS) was an equal or higher priority for the electorate than leaving the EU. The NHS is always a top priority for voters, but this time the challenges for social care were also a key issue, in part because of the so-called ‘dementia tax’. Jeremy Hunt remains as Secretary of State for Health, ensuring overall stability to the system. And while a convincing majority government would not necessarily have simplified matters, it might have made for an easier ‘clean’ Brexit rather than a messy one.
Huge Implications for Health and Care
The issues are wide ranging and include:
- Research funding from the EU that the government, prior to the election, pledged to match.
- A Conservative Manifesto promise of investment to maintain the UK's position as the leading European hub for research in the life sciences.
- Relocation of the European Medicines Agency from London (and the subject of a blog by my colleague, Joe Sunderland)
- Potential loss of reciprocal health care arrangements for UK/EU nationals, including a £500m annual bill if British retirees living in the EU return.
- Cross-border collaboration on health and procurement.
The list of potential impacts goes on, but I want to focus on just one: the challenges for the health and care workforce.
The NHS is the biggest employer in the UK and the fifth largest in the world. Social care is more disparate, but in total employs 200,000 more people than the NHS. Together, they employ one in ten of the working population. An ageing society and the potential of new treatments for many long-term conditions are creating huge pressures on resources. The Five Year Forward View sets out the NHS strategic plan—with the integration of health and social care at its core—but the House of Commons Health Committee argues that the Department of Health needs to create a set of priorities for the Brexit negotiations. The committee also raises concerns about the knowledge within the Brexit negotiating team about the complexities of health and social care.
Reliance on EU nationals
Following the Brexit white paper that mentioned health four times but not the NHS once, the Conservative Manifesto’s recognition of the “vital contribution” that 140,000 staff from the EU make to the NHS and social care system came as welcome reassurance for the workers and their employers. Despite the pledge to make security of their role a priority in Brexit negotiations, workforce challenges remain complex.
Social care relies heavily on migrant workers--one in five staff are from outside the UK and nearly 30% of those are from the EU. Department of Health data modelling shows the post-Brexit potential for 20,000 fewer nurses than needed and a shortfall of 7% for all staff in social care. More recent reports showed a 96% drop in EU nurses registering to work in Britain since the Brexit vote. The Conservative Manifesto committed to training more doctors, but it didn’t address plummeting nursing numbers or social care staff. We don’t know whether the tax on the employment of migrants proposed in the Manifesto will exclude the NHS and social care.
Brexit heightens the challenges in recruiting, retaining, and motivating a hugely committed workforce. No matter how and by whom it is negotiated, improved outcomes will depend on successfully addressing the many complex issues already emerging across the health and social care system.