Leaving the EU brings large risks but also opportunities for health and the NHS, according to a new study.
It found that staffing, finance and access to drugs and technology are all at risk depending on the terms agreed for Brexit. But regulation and training could benefit.
Nick Fahy, lead researcher from the University of Oxford and formerly employed by the European Commission, said that there will be wide-ranging impacts on health and the NHS.
”These must be addressed now if the consequences of Brexit are not to be borne by the sick and the vulnerable.”
The study, published in The Lancet by a group of researchers – some of whom campaigned for the UK to remain in the EU – looked at the effects of three possible scenarios termed soft, hard, and failed Brexit. The UK Government has until March 2019 to reach a deal to leave the EU.
The researchers define a soft Brexit as representing the closest continuing relationship with the EU, retaining a high degree of integration with the single market, but with some restrictions on the free movement of citizens.
A hard Brexit means the UK leaving the single market and the end of freedom of movement, and involves a free trade agreement, without tariffs on products or other restrictions.
A failed Brexit would be a lack of agreement between the UK and EU, and the two fall back on World Trade Organisation rules, which would be more restrictive.
The researchers concluded that each poses “substantial threats”.
Emma Greenwood, Cancer Research UK’s director of policy, said: “A migration system that attracts global scientific talent and supports collaboration, as well as regulatory alignment for clinical trials and drug licensing are crucial to bring research forward and beat cancer sooner across Europe and beyond.”
All three scenarios involve some restriction on freedom of movement of EU citizens, and the study states that “it will be very difficult for the UK to be self-sufficient in the NHS or social care workforce in the foreseeable future.”
Around 60,000 people from EU countries work in the NHS and 90,000 in adult social care, meaning staffing of the NHS and social care is a major issue.
There are already staff shortages with 1 in 10 posts in diagnostic services, including those that diagnose cancer, empty.
Some estimates have put the extra cost of recruitment at more than £7 billion a year.
The UK stands to lose out on direct funding that the European Investment Bank provides the NHS. And the researchers state that any negative impact from Brexit on the wider economy would greatly impact on the NHS as the largest part of the UK’s public expenditure.
Similar issues affect research. An estimated 16% of scientists in the UK are from other parts of the EU and the UK receives £40 million a year for cancer research from the EU. Access to EU programmes also allows vital research and collaborations
EU laws underpin collaboration and allow research and clinical trials to take place and treatments to be licenced. Public health issues such as tobacco control and air pollution are regulated by EU law, and will need to be addressed before Brexit is finalised.
But it is also on laws and regulation that the researchers see opportunities from Brexit, as they say competition laws, such as those which limit state intervention, could be replaced by ones that benefit the NHS.
Costs and administrative burdens might also be reduced for the NHS, they conclude. But the researchers say that these improvements are far from guaranteed and would need action from the Government to ensure they are introduced.
“As the UK and the European Union negotiate their new relationship, Cancer Research UK is actively engaging with decision-makers on both sides to make sure we ensure the best possible deal for research and patients,” said Greenwood. “We will continue to work to keep science strong.”
Professor Martin McKee, one of the researchers from the London School of Hygiene & Tropical Medicine, and member of the advisory board of Healthier In (a NGO which campaigned to remain in the EU) said: “The EU has shown that it recognises many of these threats, and we hope that our paper encourages the UK negotiating team to make health issues a priority.”