Will Brexit kill you? An assessment of health risks related to no deal

On 28th October 2019, the deadline to achieve a Brexit agreement was postponed to 31st January 2020. Under the Withdrawal Act, not reaching an agreement on that date will result in a no-deal Brexit. This would be the worst-case scenario as the UK would automatically leave the EU without legal arrangements and it would be formally recognized as a third country (i.e. non-EU country without any special rights or privileges). The UK government is preparing for a no-deal Brexit with the so-called Operation Yellowhammer – a contingency plan to face the possible consequences of an exit without a withdrawal agreement. However, the adequacy of the preparations has been questioned by many economists and professionals in the healthcare sector.

The implications for the healthcare sector, both the direct and the indirect ones, are particularly concerning. Some of these effects are already visible, from the relocation of the formerly London-based European Medicines Agency (EMA) to Amsterdam, to the decision of the pharmaceutical research company Recardio to terminate its clinical trials in Britain. The aftermath of Brexit is extremely uncertain as many of its consequences have yet to materialize.

The Department of Health and Social Care (DHSC), in collaboration with the National Health Service (NHS), proposed a procedure to alleviate the health impact in the event of a no-deal Brexit, but little is known about this plan as the DHSC is preventing any disclosure of information.

The British Medical Journal summarizes in a simple infographic the concomitance of the already existing issues in the country and new ones caused by Brexit and explains how they will impact healthcare in the UK both in the short and in the long run.

To understand how healthcare will be affected under a no-deal scenario, it is useful to identify a series of losses, from the most straightforward such as the loss of funding, medical supplies and the loss of European privileges (i.e. free movement and access to common European institutions), to the less obvious ones such as the loss of social norms, the loss of trust in government and the loss of workforce. Inspired by the WHO Health System Framework, this article will summarize the plausible changes in the core components of healthcare caused by a no-deal Brexit. Furthermore, a rapid analysis of the consequences on food system will follow as it involves potential losses in the social care and healthcare spheres.

Healthcare funding

Although the economic consequences of Brexit are unclear, estimates show that a no-deal Brexit could reduce growth by £30 billion per year and government borrowing could almost double approaching £100 billion. While it is true that public health is not directly affected by economic fluctuations, the NHS funding depends on government subsidies; an underperforming economic environment could lead the government to cut spending on healthcare and social care.

Furthermore, a potential recession would imply a rise in unemployment with consequent rises in suicides, alcohol-related deaths and cases of depression, especially in vulnerable groups. This would lead to an unexpected rise in healthcare expenditure.

Looking at the long run perspective, the increase in bureaucracy and regulations, caused by the absence of a properly structured deal, will decrease the efficiency of pharmaceutical companies leading to a rise in drug prices. Considering the relative inelasticity of the medical products, customers will have to give up other goods because of higher medical expenses, contributing to the already expected poor economic performance.

Healthcare staffing and migration

A consistent immigrant labour supply is of paramount importance for the British healthcare system as it faces a shortage of approximately 100,000 professionals (9% of the posts). In fact, the UK relies heavily on international labour supply in the medical and social care sectors – respectively 5.5% and 9% of the workforce in the given fields comes from the Continent. A restrictive change in migration policies resulting from a no deal would complicate the recruitment of workers from other European countries. Furthermore, the sterling devaluation would result, once again, in a loss of competitiveness of the British labour market, disincentivizing work migrations.

Another problem arises if we consider the professionals from other European countries who are already working in the UK. What is their incentive to continue working in a country after their wage dropped below the competitive level and they are no longer protected by an adequate legal framework? The EU tried to ensure the position of its citizens currently living and working in the UK through the EU Settlement Scheme, but these arrangements are extremely complex and any technical problem could result in ambiguous legal status for many Europeans.

Healthcare Rights and Access to Essential Care Abroad

Another important issue concerns the future of healthcare rights. Up to now, the EU legislation provided a European Health Insurance Card (EHIC) to its citizens granting them the right to necessary public healthcare during a temporary stay in other EEA countries.