Theresa May failed to secure the mandate for Brexit that she was seeking in the General Election. As it transpired, the election was not just about Brexit but about a much wider set of issues. In the run-up to the vote, polls showed that despite the profile and prominence of Brexit, the NHS remained on equal terms or was even a much higher priority for the electorate than our leaving the EU. The NHS is always a high priority for voters but this time the challenges for social care were also a key issue, not least because of the so-called ‘dementia tax’. Jeremy Hunt remains as Secretary of State for Health, ensuring overall stability to the system. Brexit negotiations began on 19th June. A convincing majority government would not have simplified the issues. It might have made for an easier ‘clean’ rather than a ‘messy’ Brexit.
What might Brexit mean for health and care?
Brexit has huge implications for health and care
The issues are wide ranging and include:
- Investment in research - the UK receives EU research funding that the Government, prior to the election, pledged to match
- A Manifesto promise of investment to maintain the UK's position as the leading European Hub for research in the life sciences
- The relocation of the European Medicines Agency from London (and the subject of a blog by my colleague Joe Sunderland)
- The potential loss of reciprocal health care arrangements for UK nationals in the EU and EU nationals here, including a £500m annual bill if those UK nationals returned
- Cross border collaboration on health; potential impacts on procurement...there's a long list
Here I am focusing 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 as a system it 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 a wide range of long term conditions are creating huge pressures on resources. The Five Year Forward View sets out the NHS strategic plan and the integration of health and social care is at its core. The House of Commons Health Committee is exploring the potential impacts of Brexit on the system. They argue that the Department of Health needs to create a set of priorities for the Brexit negotiations. They also raise concerns about the knowledge within the Brexit negotiating team about the complexities of health and social care.
Health and care in the UK rely on EU nationals
The Conservative Manifesto recognised the ‘vital contribution’ that the 140,000 staff from the EU make to the NHS and social care system, pledging to make the security of their place here a priority in the Brexit negotiations. After the Brexit White Paper mentioned health four times but the NHS not at all, this brings welcome reassurance for them and their employers. Nonetheless, the workforce challenges are 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. Leaked Department of Health modelling indicated a potential 20,000 short fall in jobs in the NHS and a gap of 7% of all staff in social care, post-Brexit. The week after the result, figures obtained by The Health Foundation through Freedom of Information requests 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 didn’t address the issue of falling nursing numbers nor social care staff. It isn’t known whether the tax on the employment of migrants proposed in the Manifesto will exclude the NHS or social care.
Brexit – however negotiated and by whom – heightens the challenges in recruiting, retaining and getting the best out of a hugely committed workforce; and delivering improved outcomes across health and social care.