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What will be the impact on health and wellbeing of a decision by the UK to leave the EU? It’s not a question with an easy answer. Decisions regarding the day-to-day running of health and social care are made by individual members of the EU, with the EU’s health strategy being simply a guiding framework which is ‘a catalyst for actions at the EU level’. Whilst working in NHS finance, the main ways in which the EU was visible to me was via policies such as OJEU procurement rules and ensuring compliance with the European Working Time Directive.
So when I was asked to take part in a debate about the impact of Brexit on health and wellbeing I felt I had to look more deeply. To inform its publication on the impact of EU membership on public services, CIPFA commissioned ComRes to undertake a survey of 1,000 British adults in late March 2016. Not only did the survey ask whether the UK would be better out or in (36% felt the EU was net detrimental, 31% net beneficial), they also questioned the extent to which areas of the public sector felt EU membership puts pressure on individual public services. Of the areas probed, health received the largest ‘better out’ vote (31%) and the lowest ‘better in’ (20%, joint with education). It is likely that debates over the TTIP trade agreement and health tourism, which have received the most media attention in this area, have contributed to this view.
On funding, it is difficult to find a credible source which doesn’t suggest there will be an element of economic shock following a Brexit, even if this is temporary. Health and social care funding is already highly stretched (see separate article on More Medicine Needed) so it’s hard to see how any further deterioration in the economy with its consequent impact on taxation and government spending could be dealt with without further cuts, higher taxes or relaxation of the deficit reduction pledges. This argument has been well-rehearsed, but is summarised well in the recent IFS report suggesting Brexit will add two further years of austerity, a prospect which doesn't sit comfortably with anyone working in public services.
The impact on the health and care workforce could also be significant. According to the Balance of Care Competencies report (2012), all areas of healthcare, particularly nursing, benefits from the impact of net inward migration of professionals. Research by Oxford University found that migrant workers add great value to the sector, particularly in social care suggesting there is greater flexibility amongst non-UK workers to work the unsocial hours required to provide 24-7 cover. The TUC estimates the numbers of EU workers in health who might be unsettled by a Brexit at approximately 50,000 (4.5% of the workforce), a figure which is broadly in line with the current level of vacancies. As agency staffing costs were one of the most significant causes of the unprecedented provider overspend reported for 2015/16 (£2.45bn), avoiding any further pressure on staffing levels which could result from a ‘Brexit’ will help to protect both services and finances.
The relatively large share of EU research funding received by the UK is another important element. In 2013, the NHS Confederation demonstrated that UK organisations are the largest beneficiary of EU health research funds, having secured more than €670m from the Seventh Framework Programme (FP7). Opportunities to access further monies from the successor policy, Horizon 2020, are coming soon offering an even greater level of research funding over seven key themes, of which the largest (€7.5bn) is health, demographic change and wellbeing.
Other members of the panel included Lord Andrew Lansley, former Health Secretary, who also felt that a decision to leave the EU would be detrimental to health and wellbeing. He spoke in detail about the access to research funding and the impact on ex-pats living in Europe. Craig Bennett, Chief Executive of Friends of the Earth, argued that 40-50,000 people per annum are dying prematurely due to air pollution and that the UK cannot work in isolation on these issues. EU membership has contributed significantly to initiatives including cleaner beaches and eliminating chemicals from consumer cleaning produces - he could not see how those advocating Brexit would do anything to push forward the important environmental agenda.
The discussion concluded by considering the immediate impact of a Brexit. After explaining the ins and outs of TTIP Tamara Hervey, Professor in EU Law at Sheffield University, spoke about how unravelling 30+ years of intertwined UK and EU law would be ‘good news for lawyers’, a phrase which makes a former NHS Finance Director shudder. The panel also worried about the likely chaos resulting for the Civil Service, and for the country as a whole if it brought about another national leadership campaign.
I think it’s fair to say that the panel felt strongly that despite the shortcomings of the EU, the best way forward for health and wellbeing was a vote to remain. This concurred with the CIPFA ComRes research, where the public service leaders surveyed, while recognising that day-to-day awareness of the EU and its institutions is generally low, were almost unanimous (19-1) in their view that public services are better off as a result of the UK being in the EU.
See CIPFA’s publication Treuble and strife: an uneasy marriage (PDF, 1.9MB)