With the NHS approaching crisis point like never before, and social care suffering from this Government’s chronic under-funding, there are many important concerns about the UK’s exit from the EU.
Issues such as medicine regulations, reciprocal healthcare and competition rules, which are currently dealt with at European level, will all have to be painstakingly scrutinised. But among these issues, two stand out as by far the most prominent for health and care services: the state of the economy (and therefore the sector’s finances), and its workforce.
If a strong economy makes for a stronger NHS, then the recent report commissioned by the Mayor of London to Cambridge Econometrics bears some bad news. The report, “Preparing for Brexit”, examines five scenarios, going from soft to hard Brexit, with the fourth being the closest to the current state of negotiations – that is, no single market or customs union deal and a two-year transition from March 2019.
The projections for the economy get progressively worse with the more severe types of Brexit. According to the report, Brexit will not only reduce the size of the UK economy, but the cumulative change in Gross Value Added (GVA) over time will keep increasing in the long-term.
Compared to what would happen if the UK remained in the single market and customs union, the UK is expected to have a loss of 2.7% (£49.1bn) in GVA by 2030, 13.8% (£41.6bn) in investment and 1.4% (468,000 people) in employment under scenario 4.
However, for example under scenario 2 (two-year transition followed by single market membership without customs union) the loss would be 1.0% (£18.6bn) in GVA, 6.7% (20.2bn) in investment and 0.5% (176,000 people) in employment.
While London is likely to fare somewhat better in terms of economic output, the impacts on population (and so employment) will be noticeably stronger there than in the rest of the UK.
This is due to the higher number of non-UK residents and workers in the capital, who will potentially leave or never come to the UK after Brexit, and also to the potential departure or non-arrival of their dependents (children and elderly parents).
Population growth under scenario two is predicted as 0.78%pa from 2019 to 2030, whereas under scenario four and five the projection is 0.54%.
The health and social care relies heavily on non-UK staff, of which a significant percentage are from the EU. Given this, it is concerning to already see a change in recruitment and retention of NHS and social care staff coming from the EU.
For example, the number of EU nurses and midwives leaving the Nursing and Midwifery Council’s register between October 2016 and September 2017 increased by 67% compared to the 12 months before, while the number joining it fell by 89%.
Moreover, a recent British Medical Association survey of EU doctors working in the UK has found that 45% are considering leaving following the EU referendum result, with 18% already having plans to relocate elsewhere.
It’s clear that the Government needs to be doing much more to reassure EU citizens that their rights to live and work in the UK will be protected after Brexit.
The health and social care sectors could face a considerable loss of staff if EU migration is limited after Brexit. Modelling from Department of Health projects a shortage in the UK of between 26,000 to 42,000 nurses by 2025/26. Estimates from the Nuffield Trust suggest a shortfall in England of as many as 70,000 social care workers by the same date.
The way Brexit negotiations are currently being conducted is jeopardizing the health and care sector. With the Government pursuing a needless, damaging and extremely hard Brexit, and looking prepared to possibly leave the EU without a deal, they are putting the entire health and social care sector at risk.
By Dr Onkar Sahota, London Assembly Member and Labour’s spokesperson for Health, chairing the Health Committee.