News & Blog
Brexit, Clinical Commissioning Groups and Medical Devices
Tuesday 2nd August 2016
The impact of the UK's vote to leave the EU could have major implications on the commissioning of health and social care by the Clinical Commissioning Groups (CCGs) in England and Health Boards in Wales. The NHS is currently in deficit for the second year running; an analysis published in May by the regulator NHS Improvement showed the amount health trusts overspent by has gone from £0.85 billion in 2014/15 to £2.45 billion in 2015/16.
CCGsBefore the referendum, HM Treasury stated that a vote to leave the EU would result in 'an immediate and profound economic shock, creating instability and uncertainty' and that in the longer term the UK 'would be permanently poorer' (HM Treasury 2016a, 2016b). This economic and political uncertainty could lead to increased financial and operational pressures on the NHS, and a sustained fall in the value of the pound would mean increased costs, even if the NHS budget was protected, as any cuts to social care funding would increase pressure on the NHS.
Catherine Rees, Clinical Liaison Nurse at UK biotech JRBiomedical said, "Despite some of the negative sentiment arising from Brexit, and the subsequent increase in cost to importers of medical devices, suppliers will ensure that NHS commissioners and clinical staff receive the same high quality products and standards of service expected from the medical device industry. Nevertheless, some manufacturers may, as a result of these significant increased costs, need to review prices to safeguard supply and investment in R&D".
Economists have pointed out that the ability for us to fund the NHS is linked to our economic success. In a briefing report by academics from LSE and the Institute of Global Health Innovation at Imperial College London, the authors concluded that "withdrawal from the EU is likely to reduce NHS funding, lead to staffing shortages, and that the threat posed by Britain's exit from the EU is as critical as any the NHS has yet faced, and that once Britain's rebate and costs of access to European markets is accounted for, the available funds are not the £350 million a week claimed by the Leave campaign but £22 million a week or £1.4 billion a year. Even if diverted to the NHS, this amount would not cover its annual budget deficit."
Any cuts to the NHS budget would start to affect front line services. In a recently published briefing by The King's Fund, entitled "Deficits in the NHS 2016" the authors conclude that "Regardless of the impact of Brexit, the government must review its priorities for the NHS to ensure that they can be delivered within available resources."
Staffing is another issue that would be affected by Brexit. Currently there is freedom of movement and mutual recognition of professional qualifications within the EU, and 55,000 of the NHS's 1.3 million workforce and 80,000 of the 1.3 million workers in the adult social care sector come from other EU states (Health and Social Care Information Centre 2015; Skills for Care 2016).
The Impact of immigration on the NHS is an issue that the Leave campaign used to back their case.However, there is a lack of reliable data on the use of health services by immigrants and visitors.The average use of health services by immigrants and visitors appears to be lower than that of people born in the United Kingdom, which may be partly due to the fact that immigrants and visitors are, on average, younger (Steventon and Bardsley 2011). But many immigrants are working and paying taxes,which help fund the NHS. Another concern is that the uncertainty of future reciprocal healthcare arrangements in other EU states could lead to UK citizens currently living elsewhere in the EU, including many pensioners, to return, putting more pressure on healthcare services.
Also of importance following the referendum result is the issue of regulation. The government will need to decide whether its intention is to replace EU regulations with UK alternatives, or to retain them. These include the regulation of medicines and medical devices (the current EU regulations of which are undergoing a major revision anyway,) the working time directive, and procurement and competition law. This issue will be further explored in a future article.
Sources
https://improvement.nhs.uk/news-alerts/nhs-providers-working-hard-still-underpressure/
http://www.kingsfund.org.uk/publications/articles/brexit-and-nhs
http://www.lse.ac.uk/LSEHealthAndSocialCare/impacts/news/NHS-and-EU-Referendum-briefing.pdf
http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Deficits_in_the_NHS_Kings_Fund_July_2016_1.pdf