2016 has been a turbulent year for health care in the United Kingdom. Aside from repeated strikes held by junior doctors in light of the government’s decision to enforce a new employment contract, the more recent widespread political discord resulting from Britain’s decision to leave the European Union (EU) — now notoriously known as “Brexit.” These changes have left the National Health Service (NHS) in a questionable position.
Junior doctors — an umbrella term encompassing the equivalent of interns and residents in the United States — voted with a 58 percent majority against the employment contract, which was enforced nonetheless in July. For the uninitiated, the new working contract effectively means that junior doctors will be required to work longer hours and for less cumulative pay than they currently receive, though the primary argument on the doctors’ side has been that such working practices would be unsafe for patients. This revelation had been somewhat dwarfed, however, by the June 23 announcement that Britain had voted to leave the EU, with a similarly narrow (although national) margin of 52 percent. The latter event has wide-ranging implications, and not least for UK health care. The NHS has long been utilized as a political tool for many ends, and the EU referendum was no different: Brexit campaigners repeatedly cited that the £350 million saved per week were Britain to leave the EU could instead be flooded directly into NHS funds. However, in light of the referendum result, the remark was quickly disclosed to be a “mistake” — an about-turn that has enraged many Brexit voters. Adding salt to the wound, a more recent report from the UK Health Foundation has projected that funding for the NHS could instead fall by up to £2.8 billion following the Brexit decision, and by up to £28 billion by 2030 if the United Kingdom does not join the European Economic Area.
A shortfall in UK staffing and training has led to a heavy dependence from an overseas workforce, which has left the NHS in a precarious position as far as the Brexit issue is concerned. The NHS is the largest employer in the United Kingdom, and more than 10 percent of its workforce is currently employed from within the EU. It has been strongly suggested that the Brexit decision will render recruitment from the EU a much more difficult prospect (and vice versa for UK staff looking to seek work elsewhere in Europe). Though officials have been quick to quell rumors that EU-derived NHS workers will face difficulties regarding employment rights in the future, guarantees are in short supply in light of the confusion that has since arisen over Brexit. Professor Jane Dacre, president of the Royal College of Physicians, has also spoken out, claiming that “health care professionals from Europe and around the world … are feeling anxious and confused about how welcome they are and will be in the future.”
Not much is known in turn about how work contracts in the NHS will be affected directly, as, until the referendum, working hours for health care staff in particular fell under the 2003 EU Working Time Directive. This directive stipulates that EU employees are restricted to a working week of no more than 48 hours — though they can “opt-out” if they choose — which was considered an important landmark at the time for maintaining patient safety. Prior to this, working hours for doctors, in particular in the United Kingdom, were largely unregulated, and were coupled with staff shortages and low training numbers. Those in favor of Brexit have argued that lifting these restrictions will allow surgeons to undergo up to 3,000 hours of extra training. However, it is unclear how this will be factored into existing training programs, and whether it will result in a return to overworked and overtired health care staff.
Furthermore, it is now thought that the Transatlantic Trade and Investment Partnership (TTIP), which is also affected by the Brexit decision, may have implications for the NHS’ future: UK health care may potentially
be led down the path of privatization, as Britain now looks to secure new business ties with countries independently of single-market EU regulations. In theory, therefore, the NHS could be up for grabs — for sale to the highest bidder.
In reality, it will take at least two years before Britain has completely severed its ties to the EU, and much of the current turmoil is hoped t0 die down during this period. Arguments in favor of Brexit supporting the NHS’ future have also been publicized in the media. Others have still argued, however, that the Brexit decision has opened the floodgates for the NHS to be targeted by overseas investors, should it continue to suffer crippling shortages in staffing and funding over the coming years. As it stands, the future of the NHS is currently a bleak one. As Professor Martin McKee from the London School of Hygiene & Tropical Medicine told The Lancet, “The question is not if there will be a crisis … but how deep that crisis will be … We must now anticipate the worst including, potentially, significant loss of life.”