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Decisions regarding the day-to-day running of the NHS and social care, and indeed the integration of these, are made by individual members of the EU. As set out in the EU’s overarching health strategy Together for Health which was issued in 2007, health expenditure is viewed by the EU as being of great value in itself and in its ability to promote economic growth.
The EU’s health strategy also cited solutions to the joint challenges member states are facing and the major health inequalities that remain between countries. It is unclear what influence these solutions have had on the UK, as they closely align to strategies the health sector would have implemented without the EU. Indeed, the Mid-Term Evaluation of the EU Health Strategy 2008-2013 found that health policies within member states that reflect EU policy are due to aligned priorities rather than significant influence. The EU’s evaluation found that the EU’s health strategy main value is as a guiding framework and ‘as a catalyst for actions at the EU level’.
10% of health and social care professionals in the NHS are from countries within the European Economic Area (EEA). EU membership means that European medical qualifications must be recognised across member states, which makes it easier for practitioners from Europe to work in the NHS.
According to the last government’s 2012 Balance of Competences report, nursing in particular has benefited enormously from the free movement of professionals.
Research by Oxford University claimed migrant workers add great value to the sector, significantly in social care. The research suggested that there is greater flexibility amongst non-UK workers, particularly to work the unsocial hours required to provide 24/7 cover.
Changes to legislation have significantly closed off opportunities for non-EU care workers, increasing the UK’s reliance on support staff from within the EU. Other EU legislation, such as the Working Time Directive (WTD) and the Agency Workers Directive (AWD), has a great impact on the health sector’s workforce.
The WTD is an EU social law that regulates working time and rest periods to ensure a workforce is not too tired to undertake duties safely. This policy has been widely criticised for leading to a lack of flexibility and reduced hours.
If the UK were to leave the EU then there would be an opportunity to remove policies that influence workers’ rights, such as the WTD, from UK contracts. However, Jeremy Corbyn, leader of the Labour party, in 2016 claimed this means that other policies, such as equal pay, annual leave and maternity pay rights could also be put at risk.
The UK is a global centre for pharmaceutical research, and UK-based scientists are at the forefront of global public health research, including efforts to tackle Ebola and Zika.
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). The successor policy, Horizon 2020, offers an even greater level of research funding and wider access over seven key themes, of which the largest (€7.5bn) is health, demographic change and well-being.
Given the structure of the NHS and its close links with academia, the UK is well placed to put forward successful bids in the future, particularly following the development of Academic Health Science Networks. A particular stream of research funding has been identified for the integration of services.
The Balance of Competences report specifically praised public health research and cited the benefits it has had tackling issues such as alcohol abuse.
The report recognised that preventative action will hopefully decrease the significant burden so called ‘lifestyle’ diseases are having on the NHS.
However, it did also raise concerns that ‘outcomes and application from the research could be greatly improved and that the process of funding research could become more transparent’.
There are various formal and informal networks within the EU that have a positive effect on service provision, as they provide an opportunity to see how services operate in other jurisdictions. Such co-operation may also benefit public health measures. Through collaboration, there has been a joint effort to reduce alcohol misuse, tobacco addiction and health inequalities.
Obesity, which is estimated by the Government to have cost the NHS £6.3bn in 2015, is one of the areas which the EU is attempting to tackle. In 2012, in the Balance of Competences report, the Coalition government said voluntary co-operation on obesity policy is likely to ease the problem at a European level.
Much has been made of the financial burden this issue has on the NHS. In 2014 Department of Health figures showed the UK was only able to recoup £49.3m for EU nationals that have been treated in Britain. However, at an EU-wide level the costs and numbers involved are very low overall.
EU figures suggest total cross-border healthcare accounts for 1% of all healthcare spend and, as this includes dealing with emergencies, the costs associated with planned cross-border care are lower. Although the flows are not evenly distributed.
Health tourism has even been blamed for the NHS’s £3bn deficit. Doctor and UKIP member, Angus Dalgleish argued that the thousands of health tourists attracted to the UK are partly to blame for the sector’s difficult financial situation.
Research carried out by the LSHTM (the London School of Hygiene and Tropical Medicine) and University of York suggested that whilst numbers seeking treatment in the UK from abroad have always been fairly high, they have remained stable.
Since 2010, the number of health tourists has been overtaken by the numbers leaving the UK to seek health treatments abroad- an estimated 52,000 came to the UK for treatment and 63,000 UK citizens went abroad.
They state that ‘UK residents most commonly travel for medical treatment to north, west, and southern Europe with France being the most visited country over the decade’.
They also cite the more positive economic impacts of health tourism, with circa £220m being spent on hotel costs per annum alone. Indeed, in 2010, figures from LSTM and York University show 18 British hospitals received an income of £42m from people coming to the UK for treatment.
Transatlantic Trade and Investment Partnership (TTIP) is a series of trade negotiations being carried between the EU and US. As a bi-lateral trade agreement, TTIP is to reduce regulation and thereby increase trade.
The introduction of TTIP means public services will be opened up to US companies, as they will be able to bid for public contracts.
There has been speculation that this will threaten the NHS as deals could lead to privatisation of some services. The European Commission has stated that public services will not be involved in TTIP. Although, UK Trade Minister Lord Ian Livingston has admitted that talks over the NHS are still ongoing.
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