Brexit: Rob Whiteman's thoughts


Following the EU referendum result, Rob Whiteman wrote an opinion piece for the Health Service Journal (HSJ). In the article, he summarised the effect a Brexit could have on the health and social care sector. That article is reproduced below.

We must uphold the positive impacts of EU membership

The dust has not yet settled on the announcement that the UK is to leave the EU, but already many in the health sector have raised significant concerns about the future of health and social care services.

That comes as Ian Duncan Smith and Nigel Farage have both backtracked on the official Leave campaign’s claim that a Brexit will free up an extra £350m per week to be spend on the NHS. The leading campaigners have stated this cannot be guaranteed. 

That should have come as no surprise to anyone who was following the debate: any money freed up has been committed by Leave supporters several times, even if it doesn’t disappear in a worsening economy. I am, though, deeply concerned that this is the start of the unravelling of the claims and counter claims made by both sides of the debate.  Now, as we close a 40-year chapter and begin a new one, it is crucial that the change process is executed in a far more objective manner than we witnessed during the campaigns.

If there’s no extra funding, then in terms of the future of the day-to-day running of the NHS and social care, and the integration of these two sectors, there may little change. This is because the UK has always been responsible for such decisions. 

Beyond that, however, one of the first things that will need to be addressed is whether the Freedom of Movement policy continues. According to the TUC around 50,000 (4.5%) workers from the European Economic Area (EEA) work for the NHS. Without these professionals, taxpayers would have to fund agency and locum staff to provide cover.  This is a significant concern considering the Public Accounts Committee (PAC) suggest that the NHS are already struggling to cope with a shortage of 50,000 clinical staff – the problem could double. In light of this, the rights of EU nationals working for the NHS to remain in the UK must be clarified. Hopefully, Jeremy Hunt’s reassurances will prove well founded.

Another priority will be to protect the collaborative relationships formed between those leading the health sector in the UK and their European counterparts. These have powered research and have allowed for the exchange of ideas to improve best practice.

In the run up to the referendum, CIPFA commissioned independent interviews with health sector leaders, including CEOs and CFOs. They cited these collaborative relationships as one of the key benefits of being in the EU. Indeed, they greatly valued the opportunity to learn from how the sector is managed in other member states. They claimed this had led to improvements to UK governance, funding and delivery models. 

Those interviewed also acknowledged that these collaborative relationships have improved public health research. Indeed, the Coalition government in 2011 claimed cooperation between EU countries had helped the UK tackle alcohol addiction, health inequalities and alcohol abuse.
Before this momentous decision was made, the UK was going to play a part in the EU’s efforts to try and alleviate the pressures caused by the obesity crisis. Given that the NHS is estimated to have spent £6.3bn to treat obesity related illnesses in 2015, the EU’s help in seeking to reduce this burden may be sorely missed. 

Here too, though, a balanced view is in order, for as set out in its health strategy, ‘Together for Health’ issued in 2007, the EU positioned itself as more of a health promoter than an active decision maker.  The mid-term review of the EU strategy for 2008-2014, sees its value as a ‘guiding framework’ and a ‘catalyst’ for actions, such as in health promotion.

While cooperation brings many benefits and must, where possible, continue. It is important that we focus on the opportunities that may be gained. Public service leaders have also told us that onerous regulation can stifle innovation. It will be important that NHS leaders get to grips with what changes they want to see and make a clear case as the negotiations progress. 

Greater influence and responsiveness of the regulatory system, particularly in terms of procurement, may change significantly the range of delivery options available to day in a very positive way. For example, I hope we will be able to explore more fully of social value in public sector contracting that would enable more integrated and strategic use of all public budgets.

Of course, it remains to be seen what will the new relationship between the UK and the EU will look like. We can only speculate as to what will happen to the co-operative research programmes and networks. But as conjecture turns into reality, the government must acknowledge and seek to continue the benefits this kind of EU influence has brought.

There is, then, no reason for health and social care professionals to despair. But it is important to recognise, and proactively seek to maintain wherever possible, the positive impacts of EU membership on areas such as workforce, research monies, cross-border care and collaborative relationships.