‘A Healthy Brexit’? How a Split From EU Could Affect UK Health System
When the UK leaves the EU, there are likely to be far more consequences than opportunities for its health system, some predict.
From implications on research funding to the cost and availability of pharmaceuticals, the looming Brexit—no matter the shape it eventually takes—will have substantial effects on health services in the United Kingdom, according to authors of a new health policy review.
“First, the effects of Brexit are wide ranging, touching every building block of a health system as described in the [World Health Organization] Health System Framework. Second, these effects on health range from somewhat negative to very negative, with few opportunities. Third, the effects depend on what type of Brexit is pursued; the harder the Brexit, the worse the effects, with no deal being the worst of all,” write Nick Fahy, BSc (University of Oxford, England), and colleagues.
Their paper, published online September 28, 2017, ahead of print in the Lancet, addresses three possible scenarios that could come from the United Kingdom leaving the European Union (EU) as a result of the June 2016 referendum colloquially referred to as Brexit.
The first, what they term a “soft Brexit,” would give the UK access to the European market but restrict the free movement of its citizens and would “[minimize] health threats” the most. The second situation, what Fahy and colleagues call a “hard Brexit,” would be similar to the current relationship between the UK and Canada. Lastly, a “failed Brexit” would happen if the UK and EU cannot reach agreement and the former falls back on World Trade Organization rules for trade—the “riskiest outcome” for the UK according to the authors.
Regardless of what happens, Fahy and colleagues insinuate that there are many more consequences than opportunities for the UK’s health system going forward.
They estimate that more than 60,000 people from non-UK EU countries are employed by the National Health Service (NHS) and 90,000 work in adult social care. These people might not opt to stay in the United Kingdom since Brexit “could undermine their legal entitlements and those of their families (whether their families are EU citizens or not),” the authors write.
Next, financing for both individuals and the NHS will suffer, they predict. The healthcare coverage of UK citizens who travel outside the UK will be jeopardized, but the “most profound impact is likely to be on UK nationals who live elsewhere in the EU.” Given that British pensions are being paid to almost 200,000 people who live in other EU countries, it’s probable that they “depend on [the current] arrangements for healthcare,” Fahy and colleagues say.
Another “key concern” will be cost of and accessibility to pharmaceuticals, medical devices, and other medical products. The European Medicines Agency (EMA), which regulates pharmaceuticals for the entire European Union, has been headquartered in London. It could be possible that the UK continues paying to participate in EMA endeavors if a “soft” or potentially even “hard” Brexit ensues, but would likely lose any sort of control over decision-making, the authors write.
And for medical devices specifically, “the UK has the choice of either passively accepting EU regulatory standards, deregulating the sector substantially, with all that entails for patient safety, or developing a new framework, which risks making the UK unattractive for companies because of extra costs,” Fahy et al explain.
Risky for ‘Almost Every Part of the NHS’
On the public health forefront, the UK has lagged behind a series of EU directives to improve air quality in recent years, and when a Brexit happens, it’s likely that “in the absence of EU legislation, UK environmental standards could slip further,” they write, adding that the UK could also potentially be an aggressive target for the tobacco industry once the country leaves the shelter of certain EU policies.
One area for benefit, the authors note, is in competition. “The UK could have an opportunity to improve the policy environment for the NHS post-Brexit, should it choose to do so,” they say. “The EU has a strong regulatory structure designed to prevent states from implementing industrial policies that might impede competition within the internal market. . . . These bodies of law all create inconveniences and even some threats to the NHS.”
Lastly, Fahy and colleagues list six issues of direct relevance to health related to Brexit’s potential effects on research: funding, mobility of researchers, harmonization of regulations, intellectual property, collaboration, and science policy. “The scientific community was one of the most vocal against Brexit in the referendum campaign, reflecting the enormous importance of EU membership for British research, and the leading role of British universities within the EU,” they write.
In a press release, senior author Martin McKee, DSc (London School of Hygiene & Tropical Medicine, England), said, “our analysis of how Brexit will affect the NHS, although the UK's desired outcome remains unclear, is that Brexit in any form poses major risks to almost every part of the NHS, with a ‘no deal’ scenario potentially catastrophic. The EU has shown that it [recognizes] many of these threats, and we hope that our paper encourages the UK negotiating team to make health issues a priority.”
Also in the press release, co-author Tamara Hervey, PhD (University of Sheffield, England), commented: “I remain deeply concerned about the effects of leaving the EU on all aspects of the UK's economic, social and cultural life, including health. If we must leave the EU, I hope this analysis will help interested stakeholders and our elected representatives to hold our government to account to deliver a 'healthy Brexit'.”
Fahy N, Hervey T, Greer S, et al. How will Brexit affect health and health services in the UK? Evaluating three possible scenarios. Lancet. 2017;Epub ahead of print.
- Fahy reports acting as an adviser to the House of Commons Health Committee, serving as a former employee of the European Commission, and receiving support from the National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom.