Brexit's Impact on the NHS

NHS Underfunding

Our NHS is in crisis. Much of this is attributed to chronic underfunding, directly and indirectly, in addition to poor management, service fragmentation and creeping NHS privatisation.

Underfunding:

Direct - we currently spend around 9.3% of GDP on our health service compared to Germany, at 11.3%, and France, at 11%, equivalent to around £30 billion less per year.

Indirect - cuts to social care which causes medically fit patients to be stuck in hospital ‘bed blocking’ whilst waiting for care funding and provision in the community, by the removal of the nursing bursary and the junior doctor’s contract dispute which has exacerbated the staffing crisis leading to dependency on expensive agency staff, reductions in the number of hospital beds and PFI debt.

Other factors contributing to the NHS crisis include expensive over management, NHS restructuring and increasing privatisation which has fragmented service provision and increased costs through profiteering. Our ageing and growing population is also contributing; however, this could and should be addressed by scaling NHS funding and services appropriately to cater for the increase in service demand.

We discuss the impact of immigration on the NHS later on below.

https://fullfact.org/health/spending-english-nhs/

https://www.nhsconfed.org/media-centre/2018/06/ifs-country-comparisons

https://www.independent.co.uk/news/uk/politics/nhs-deficit-crisis-one-chart-that-shows-how-the-nhs-is-headed-for-financial-ruin-a6687926.html

https://www.independent.co.uk/life-style/health-and-families/health-news/nhs-funding-cuts-100-deaths-per-day-public-spending-squeeze-british-medical-journal-a8058101.html

Less money for the NHS after Brexit

Brexit has damaged our economy and will lead to a reduction in public finances:

“In all three scenarios, Britain's economic growth is predicted to be lower over the next 15 years than current expectations. With no deal, growth would be reduced by 8%; with a free trade agreement, it would be 5%; and 2% if the UK remained a member of the European Economic Area.”

http://uk.businessinsider.com/leaked-government-analysis-brexit-britain-worse-off-2018-1

The UK economy is already 2.5 per cent smaller than it would be if the UK had voted to remain in the European Union. The latest update of the Centre for European Reform’s calculation of the cost of Brexit in the second quarter of 2018 shows the damage is growing even though the UK has yet to leave the bloc. The knock-on hit to the public finances is now £26 billion per annum – or £500 million a week. This far outweighs the U.K.’s contribution to the EU budget, £250 million a week.

https://www.cer.eu/insights/cost-brexit-june-2018

https://www.economist.com/britain/2018/06/21/the-economy-has-slowed-to-a-standstill-largely-because-of-brexit

New research revealed [Theresa May’s Brexit] agreement could hit the UK’s economy by £100bn a year by 2030, equating to an average of £1,090 per person.

https://www.independent.co.uk/news/uk/politics/philip-hammond-brexit-no-deal-austerity-economy-growth-spring-statement-a8820966.html

NHS and social care funding after Brexit (Kings Fund report):

“The NHS would also be affected by other consequences of economic instability. For example, a prolonged decline in the value of sterling would increase inflation, leading to higher prices for some drugs and other goods and services the NHS purchases. Even if the health budget continues to be protected, any further cuts to social care funding would have a significant knock-on effect on the NHS, as well as exacerbating the social care funding gap.

We have argued that the NHS needs additional funding over and above that announced in the Spending Review, particularly from 2018/19. We have also argued that additional funding is needed for social care, which has already suffered cuts resulting in around 400,000 fewer people receiving publicly funded social care. If additional funding is not forthcoming, or if promised spending increases do not materialise, the government must be honest with the public about how access to care and standards of care will be affected.

While the immediate focus will be on negotiating favourable terms for trading and working with the EU after Brexit, the impact on health and social care should not be forgotten. If an economic shock materialises, the implications for patients and service users could be profound.”

https://www.kingsfund.org.uk/publications/articles/brexit-and-nhs

Continuing austerity in a no-deal Brexit:

“Philip Hammond has admitted telling ministers to prepare to make cuts if the UK crashes out of the EU with no agreement.”

https://www.independent.co.uk/topic/philip-hammond-0

“Mr Hammond has previously warned of a near-8 per cent hit to GDP from a no-deal Brexit, which would blow an £80bn hole in the public finances.”

https://www.independent.co.uk/news/uk/politics/brexit-no-deal-cuts-operation-yellowhammer-eu-philip-hammond-latest-photo-chancellor-a8526046.html§

The chancellor Philip Hammond slashed the UK’s growth forecast for this year, as he warned MPs no-deal Brexit would destroy pledge to end austerity.

https://www.independent.co.uk/news/uk/politics/theresa-may-brexit-deal-latest-100-billion-poorer-eu-withdrawal-agreement-a8651146.html

“Health and social care spending cuts since 2010 are linked to nearly 120,000 excess deaths in England, with the over 60s and care home residents most affected, finds new UCL research.”

http://www.ucl.ac.uk/news/news-articles/1117/161117-austerity-deaths-england

NHS Privatisation

The Conservative Party are covertly privatising our NHS. This is explained fully in the book ‘How To Dismantle The NHS In 10 Easy Steps’ by Dr Youssef El-Gingihy.

https://www.independent.co.uk/voices/how-the-nhs-is-being-dismantled-in-10-easy-steps-10474075.html

Other references regarding NHS privatisation are collated on our website:

https://www.getthetruth.org.uk/the-nhs

Yes, privatisation was started by New Labour but it has advanced at a greater rate and intent by our current government. The NHS was recently restructured into Clinical Commisioning Groups which was modelled on America’s private health provision and providers like Kaiser Permanente.

https://www.independent.co.uk/life-style/health-and-families/health-news/nhs-health-service-healthcare-privatisation-a7160771.html

https://www.independent.co.uk/news/health/nhs-latest-senior-doctors-hospitals-underfunding-accelerate-privatisation-agenda-conservative-a7808591.html?fbclid=IwAR3VceTcV3gH6w57AtA49Hho5YntCQBsfVnx1-weQOJiRsXngmsuX_yZ-X0

https://www.independent.co.uk/news/uk/politics/nhs-humanitarian-crisis-private-health-insurance-cuts-privatisation-a7523941.html

The of NHS privatisation by a U.S. trade deal

1) A radical blueprint for a free trade deal between the UK and the US that would see the NHS opened to foreign competition:

https://object.cato.org/sites/cato.org/files/pubs/pdf/ideal-us-uk-free-trade-agreement-executive-summary-update.pdf

“Summing up, the ideal FTA is one that removes all barriers to trade in goods and services, opens up all sectors of the economy to investment, and, ultimately, goes as far as possible to remove all administrative impediments to integration of the economies of the parties without encroaching on the sovereignty of governments to pass laws and regulate in the public interest in ways that do not discriminate against foreign goods, services, and companies.

In practical terms, that means that the ideal agreement will result in the following:

- Zero restrictions on competition for government procurement;

- Zero restrictions on foreign direct investment in the economy;”

(Procurement is the process of finding, agreeing terms, and acquiring goods, services, or works from an external source, often via a tendering or competitive bidding process.)

2) Trump says NHS must be 'on the table' in post-Brexit trade deal:

https://www.independent.co.uk/news/uk/politics/trump-nhs-brexit-trade-deal-talks-theresa-may-press-conference-uk-a8943656.html

3) Woody Johnson, the US ambassador to the UK, said the "entire economy" would be included in transatlantic negotiations, which could include allowing American private firms to bid for NHS contracts.

https://www.independent.co.uk/news/uk/politics/donald-trump-nhs-trade-deal-woody-johnson-matt-hancock-a8940861.html

4) Theresa May suggests UK health services could be part of US trade deal:

https://www.independent.co.uk/news/uk/politics/theresa-may-donald-trump-nhs-us-trade-deal-brexit-torture-a7548156.html

“Theresa May has stoked fears that the NHS will be “for sale” in a trade deal with the US after Brexit, after refusing to say it will be excluded from the talks. The Prime Minister was warned that a “key objective” for Washington would be gaining access to the health service, which is being opened up to more private firms.”

https://www.independent.co.uk/news/uk/politics/theresa-may-nhs-us-trade-deal-talks-privatisation-healthcare-trump-a8198871.html

5) Britain leaving the European Union could lead to the “break-up” of the NHS, one of the world’s leading Brexit experts has told The Independent.

Professor Alex de Ruyter, director of the Centre for Brexit Studies at Birmingham City University (BCU), warned any future trade deal with the US would mean American pharmaceutical companies looking to access the health service.

https://www.independent.co.uk/news/uk/politics/brexit-uk-us-trade-deal-nhs-trump-theresa-may-alex-de-ruyter-a8390021.html

NHS staffing crisis now and after Brexit

We have a staffing crisis. Currently, our NHS is short of 45,000 nurses and 12,000 doctors and because of Brexit we are losing thousands more staff, both EU nationals and British. Since the referendum, we’ve seen a 96% drop in nursing applications from the EU and unfortunately we just don’t have the British staff to replace them. There are a number of reasons for this:

NHS staff have been demoralised for years by government decision making. We are overworked due to staff shortages (caused by poor government planning), underpaid / pay capped, and the junior doctors contract dispute saw the government impose an unsafe, unfair contract on our junior doctors which has lead to many doctors leaving the NHS and the U.K. to work in other countries like Australia and New Zealand.

The removal of the nursing bursary, funding that was essential for nursing students to live off whilst studying as nurse training is equivalent to a full time job. Many nursing students are also mature students with families who are unable to get student loans and need an income to support their family. As a result, we have seen a large drop in nursing applications since the removal of this bursary (-12% of undergraduate and -40% of mature students).

The GP exodus. Many of our older, more experienced GPs are retiring early due to being overworked and burdened by new administrative hurdles, government targets and health service restructuring.

https://www.theguardian.com/society/2018/apr/25/brexit-blamed-record-number-eu-nurses-give-up-britain

https://www.theguardian.com/society/2017/jun/12/96-drop-in-eu-nurses-registering-to-work-in-britain-since-brexit-vote

https://www.rcn.org.uk/news-and-events/news/removing-the-student-nurse-bursary-has-been-a-disaster

There has been a drop of 96% in the number of nurses and midwives from the EU registering to practice in the UK since July last year [since the referendum].

https://www.rcm.org.uk/news-views-and-analysis/news/eu-nurse-and-midwife-applicants-plummet

Warnings from the BMA on the damage Brexit will cause to the NHS

The BMA is keen to stress that no section of the health service will go unaffected by Brexit. “The only thing that is certain, is how disastrous leaving the EU will be for the NHS, its workforce, its patients and the health of the country as a whole – and that no type of Brexit can ever offer the same benefits we currently have."

https://www.bma.org.uk/news/media-centre/press-releases/2018/december/100-days-until-brexit-and-the-risk-to-britains-health-is-clearer-than-ever-says-bma

“The British Medical Association (BMA) is today warning that a no-deal Brexit could have could have potentially catastrophic consequences for patients, the health workforce, services and the nation’s health.”

https://www.bma.org.uk/news/media-centre/press-releases/2018/august/no-deal-brexit-could-be-catastrophic-for-health

Neurologist and government advisor Dr David Nicholl took to the streets to discuss the consequences, and his personal concerns, of the impact a no-deal Brexit will have on the NHS.

https://www.facebook.com/watch/?v=1052859608397091

The government's ‘Operation Yellowhammer’ paper outlines the ‘reasonable worst case’ plans for a no-deal Brexit. Disruption of medicines could last ‘up to six months’ and, while some medical products could be stockpiled, it would not be possible for others due to ‘short shelf lives’. This would include drugs, such as insulin and those containing radioisotopes, which are used by patients to maintain life. 

https://www.gponline.com/governments-yellowhammer-plan-no-deal-brexit-confirms-nhs-fears/article/1596478

Health union leaders have issued a stark warning that a no-deal Brexit could “devastate” the NHS and cause fatal medicine shortages.

https://www.independent.co.uk/news/health/no-deal-brexit-nhs-crisis-staff-medicine-shortages-bma-unison-a9082186.html?fbclid=IwAR0ghRhS7jlXGwN5ketrIKyD5QdCo4_ZGKzXFkr9bu6WnXhYz0ufNg1cx4o

The BMA and RCN support a People's Vote

BMA demands public vote on Brexit deal:

‘The reality is that a Brexit at any cost is not a price our NHS can afford, and it is a price that will ultimately be paid by those who staff our health service and the patients we care for. Brexit is bad for health, bad for patients and bad for the NHS. Let’s give the people a final say.’ 

https://www.bma.org.uk/news/2018/october/bma-demands-public-vote-on-brexit-deal

The Royal College of Nursing support a People's Vote:

The RCN has written to nine Westminster party leaders calling on them to support a second referendum on the final Brexit deal.

The letter states that Brexit poses an immediate risk to the provision of safe and effective care and explains some of the challenges posed by the UK’s withdrawal from the European Union, including the exacerbation of long-standing problems such as workforce sustainability. 

The UK’s membership of the European Medicines Agency, access to medicines, and participation in clinical trials and research projects are crucial in the delivery of the person-centred, innovative treatments patients deserve and are all at risk because of Brexit.

Brexit also has particular implications for nursing staff who provide care to patients in both Northern Ireland and the Republic of Ireland.

https://www.rcn.org.uk/news-and-events/news/rcn-calls-for-referendum-on-final-brexit-deal

Immigration and public services

Immigrants are net contributors to the U.K. economy and public finances. This money should be reinvested into our NHS to scale the services for the increase in usage. Although, it is important to note that immigrants are generally young and healthy and therefore are infrequent and light users of the NHS. It is our ageing elderly population that are the highest users of our health service.

https://www.theguardian.com/uk-news/2014/nov/05/eu-migrants-uk-gains-20bn-ucl-study

Our public services continue to have funding cuts and that is because of austerity, the economic policy chosen by our government which is proven to be detrimental to economic growth and leads to an increase in wealth inequality. That is the problem, not immigration. But the popular media (like the Daily Mail, The Sun, The Express, The Daily Star and The Telegraph) like to blame immigrants as a scapegoat and distraction, rather than telling us the truth. Why? Because they support the Conservative Party. And the truth, it is our government, austerity and the tax-avoiding super rich and mega corporations who are really taking advantage of us. We should be angry at them, not immigrants who contribute to society, who become our friends and family, and who work for our NHS. Now we’re not saying that there shouldn’t be sensible controls/limits on immigration but we are saying that the blame for the problems of our society has been pointed in the wrong direction.

https://www.theguardian.com/business/2016/may/27/austerity-policies-do-more-harm-than-good-imf-study-concludes

Does the EU force/encourage health service privatisation?

No, it does not. Firstly, it’s official EU policy that they are agnostic about forms of ownership (public/private). Secondly, can anyone give any example of when the EU has blocked a private-to-public transition? Over 28 countries and 40 years? Thirdly, even John McDonnell recently admitted that Single Market membership doesn’t stop GE2017 manifesto plans for renationalisation. Fourthly, NHS Scotland is fully public within the EU - NHS England should drop PFI, internal market and do the same.

Health Tourism

Health tourism accounts for only 0.3% of NHS spending so it is not contributing to the NHS crisis.

https://fullfact.org/health/health-tourism-whats-cost/

PFI debt

PFI (Private Finance Initiative) debt currently stands at £300bn and costing the country and NHS hugely. PFI deals were introduced by John Major's Conservative government and continued by New Labour and subsequent Conservative government's until 2018. It would certainly help for this to be paid off at a greater pace. The government could have chosen to prioritise clearing PFI debt over other less important projects such as the renewal of Trident at a cost of £205bn.

https://www.independent.co.uk/voices/nhs-funding-pfi-contracts-hospitals-debts-what-is-it-rbs-a7134881.html

https://tradingeconomics.com/united-kingdom/government-spending-to-gdp

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