Last Word


Brexit: The only thing that hasn’t changed is people need support from the sector

Andrew McCrackenAndrew McCracken from National Voices, the leading coalition of 160 health and care charities, looks at the potential impact and ramifications of the UK’s Brexit decision on the sector.

It’s unprecedented, it’s blurry, and it’s fast-moving. Many are struggling to comprehend the implications of Brexit. 

What has now been set in train will, soon or eventually, have its effects on UK research, innovation and knowledge sharing, international co-operation on public health and health protection, human rights, health inequalities, social cohesion, and funding for charities and civil society. 

The list could go on, but there are two immediate and inter-dependent issues that are emerging as pivotal to the future of our health and care services: as the UK negotiates its exit from the EU, can we maintain economic stability and retain the ability to recruit overseas staff? 

The economy 

The Vote Leave campaign argued that membership of the EU was costing the UK £350m a week, a significant sum of money that could be better spent on public services, such as the NHS. Even more specifically, the Leave Camp pledged to invest an additional ‘£100m per week’ in the NHS, over and above the additional funding announced in the last Spending Review. 

At the same time, the Treasury warned that a vote to leave the EU would lead to the UK being ‘permanently poorer’.  NHS England chief executive Simon Stevens backed this up: “It would be very dangerous if at precisely the moment the NHS is going to need extra funding actually the economy goes into a tailspin and that funding is not there.” 

Britain’s economic future arguably hinges on our ability to retain access to the European single market. The price for retaining that access, according to Donald Tusk, president of the European Council, is the free movement of EU citizens. 

Freedom of movement 

For many, immigration became the key issue of the campaign, and the free movement of labour has a significant impact on health and care services. 

Staff shortages in the health and care sector are well documented. Earlier this year the House of Commons Public Accounts Committee warned that the frontline in England may be as many as 50,000 short of staff. The story is the same in social care, where there is an estimated vacancy rate of 5.4%, rising to 7.7% in domiciliary care services.

Many providers have looked overseas to plug the staffing gap. According to the NHS Confederation, 10% of doctors in the UK are from another EU country. The proportion of registered nurses and midwives from the EU is lower, at approximately 5%, but that figure represents a sharp increase at a time when the numbers of British-trained nurses has fallen. 

Regardless of your views on the referendum, it is clear that the NHS is currently heavily reliant on EU citizens to fill vacancies in the workforce. 

Have our cake and eat it? 

A majority of the electorate voted to leave the EU, and for many that was on the grounds of immigration. If the new government holds the Vote Leave line on restricting freedom of movement, it will have potentially bad effects on recruiting staff and – critically – retaining the existing EU workforce. 

Insisting on restrictions on the free movement of people may make it difficult, or impossible, for the UK to retain access to the single market. And if we don’t have that access it could harm the economy, with  a proportionate impact on health and care funding. 

So now the central issue is whether we can have our cake and eat it in the Brexit negotiations. 

The only thing that hasn’t changed 

It will take some time to digest the full implications of this historic vote and its political aftermath. A lot is uncertain, and some things will unfold slowly. At National Voices, as a coalition of health and care charities, we are preparing to defend the things that we hold dear, both in domestic policy and in the mandate for negotiations to redefine our relationship with Europe and the rest of the world. 

Pretty much the only thing that hasn’t changed since the referendum is that people and communities still need the support offered by health and care services, charities and community groups. Now is a time for us to provide the stability that many in society need.

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Hilary Burrage   20/07/2016 at 12:26

Thanks for this, and yes indeed. The only thing we must also note is that there was NOT a majority of the electorate in favour of #Brexit. Only 37.5% of those eligible to vote chose '#Leave' and it would seem sensible to assume that significant numbers of those preferring #RemaIN didn't actually vote, because unfortunately they had been told this would be the outcome anyway. Given also that #Brexit-ers have no idea what to do next (in other words, they were not even serious to start with) I see no reason to accept that leaving the EU is necessarily what must happen. It is not, for the reasons above and many others, in the UK's interests to be outside the EU, spending countless trillions - which could be more usefully invested in the NHS etc - trying to negotiate a pathway to that end. The Referendum was intentionally advisory, so now MPs must be persuaded to consider that very weakly expressed 'advice' carefully, and then find another way forward. Soon.

Rod King   20/07/2016 at 13:29

Yes, lets not forget that with under 18's barrred from voting in the EU referendum then it was only 26% of the population that signalled a desire to leave the EU. Of course MPs have a responsibility to all ages rather than just those voting and under 18s will be far more effected by the future if UK leaves the UK. Hence the "will of the people " is in fact "the will of 26% of the people". Referendums are usually held to endorse a policy by the government of the day which would result in constitutional change. In this case the government by an overwhelming majoity of MPs (75%) wanted to remain. Hence rather than a referendum endorsing policy it asks to government to rethink it. This means that whilst it should take the outcome into account, it is in no way mandated to reverse it previous considered position, especially if there was evidence that the referendum was badly conducted. Whilst it is entirely correct for health professionals in public and voluntary sectors to understand the consequences of a Brexit both positively and negatively, they should be very wary of a de-facto acceptance of Brexit happenning when due parliamentary processes to consider the outcome of the referendum have not even started. Should they consider that Brexit would have negative consequences then they hopefully will be putting their efforts into campaigning against its implementation as well as planning for its consequences.

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