Author: Philippa Simmonds
Many British people who voted to leave the EU did so in the belief that it would mean more funds for the National Health Service (NHS). Unfortunately, this was one of the first promises to be broken after the referendum results came in. During my time working as a junior doctor in one of the UK’s large post-industrial cities, I encountered many of the problems facing the NHS; challenges that require evidence-based investment and new ideas which are unlikely to be delivered by Brexit.
Like many high-income countries, the UK has an ageing population. Factors such as improved living conditions, improved childhood nutrition, reduced smoking prevalence and advancements in medical technology have resulted in a steady increase in life expectancy over the past 50 years. This demographic shift should be celebrated, but also requires careful planning and investment.
Unfortunately, forward-thinking investment has been limited by the government’s increasingly strict austerity measures in response to the 2008 global financial crisis. A study published in the BMJ last year showed an association between the cuts to health and social care budgets since 2010 and an increase in mortality, particularly among the elderly and those in care homes. When I worked in hospitals, a daily challenge was to handle the backlog of elderly people who were medically fit for discharge, but who couldn’t go home until their social care arrangements were ready- a process that could take weeks. This contributed to a shortage of available hospital beds which in turn led to increased waiting times for new patients. Accident and Emergency (A+E) waiting times in the UK have increased over the past ten years, a trend that is multifactorial but is in part due to this “backlog” effect.
Another challenge is that austerity measures indirectly burden the health service by affecting the social determinants of health. A recent report by the Equality and Human Rights Commission found that new tax “reforms” would have the biggest negative impact on the most vulnerable in society, including single parent households in the lowest income quintile, and people with disabilities. Another recent report by the Child Poverty Action Group found that more schools now supply anti-poverty measures such as food banks and clothing banks, in response to children arriving to school hungry and without clean uniforms.
This increasing pressure on the health system from demographic and policy factors is also being exacerbated by a human resources crisis. The UK General Medical Council says the medical workforce is not increasing in line with demand. Approaches by the Ministry of Health, such as enforcement of the unpopular new junior doctor contract, have alienated medical staff. In my experience it’s become increasingly popular for junior doctors to leave the UK, at least temporarily, to seek better working conditions in Australia and New Zealand.
It’s challenging to predict the future when the political situation changes week by week. At the time of writing, no agreement has been reached between the UK and the EU; preparations are being made on both sides for a no-deal Brexit. Regardless of the outcome, further budget cuts to health and social care look likely, as the government’s own analysis showed the UK will be financially worse off in any Brexit scenario.
Another trend likely to continue post-Brexit is the wave of privatisation occurring throughout the public sector. Virgin Care has become one of the UK’s biggest healthcare providers after being awarded almost £2 billion of NHS contracts. They have courted controversy at facilities across the UK: with technical issues, deteriorating quality of care, and a heavily criticised case in which the corporation sued the NHS after losing a contract to provide children’s services.
Last week, a right wing think tank with ties to UK and US politicians unveiled a plan for a trade deal that includes gradually opening the NHS to competition from private US healthcare companies- a potential Brexit outcome that has been a source of concern in the UK for some time. When the WHO ranked its member states’ healthcare systems back in 2000- the most methodologically sound ranking of this sort produced to date- the US healthcare system came in at number 37 globally. Despite a lower healthcare expenditure, the NHS ranked at number 18, 19 places ahead of the US. It also ranked first globally in the 2015 Quality of Death Index, which examines the quality of palliative care; the US came in 9th place. These types of rankings don’t give the full picture, but do imply that the NHS’ “free at the point of use” model is doing many things right, and achieving better outcomes than the heavily privatised US system.
A final concerning trend is that the number of EU nationals leaving the UK has been increasing since the Brexit referendum; this group comprises almost 10% of doctors and 7% of nurses. In response to many non-EU medics being refused visas, the UK government recently removed doctors and nurses from the Tier 2 visa cap on skilled migrants. This change should make it easier to recruit doctors and nurses from places such as India, however the UK remains at risk of becoming a less attractive place for non-UK doctors to work.
The UK has made incredible progress in improving in the health of its population over the past century. Brexit threatens to slow the rate of this progress, and could even reverse it altogether; as we are seeing in some US counties, where mortality for the poorest is increasing. In my opinion, preventing Brexit via a second referendum is essential if the UK wishes to retain and upgrade the NHS. With evidence-based planning and funding, it’s the best chance we have to meet the health challenges of the next century.