Quit the Brexit scaremonging, how the landmark EU referendum will impact healthcare is what patients truly need to know.
The voices for and against Brexit continue to multiply and people are united in fear of uncertainty. How can we vote to leave, when we have no idea what’s to come? How will it affect our health services?
We recently spoke to Labour MPs Jamie Reed and Keith Vaz about how Britain leaving the EU could affect diabetes healthcare, and examined the prevailing ambiguity that appears to be entrenched in most, if not all of the issues.
There are so many questions, but so little factual answers. In this article, we drill down to the facts, figures, and concrete examples of how either outcome will impact the healthcare system as people living with diabetes know it.
We investigate four questions:
- Would public health services suffer from a Brexit?
- Should British healthcare industries be pro-European to attract and retain talent?
- In what ways is the EU membership benefiting people with chronic diseases like diabetes?
- How will leaving the EU impact diabetes research?
Would public health services suffer from a Brexit?
According to public health experts, staying in the European Union will be the best option for the British public’s wellbeing.
A recent report by the Faculty of Public Health (FPH) found that the EU’s ‘free movement of person and goods’ rules largely benefits the UK.
Net migration from the EU is at historically high levels – over two million nationals of other EU countries currently work in the UK. Of these, approximately 10 per cent of the health and social care workforce, including some 10,000 doctors and 19,000 nurses, are coming from countries in the European Economic Area (EEA).
It is not certain that EEA workers would be asked to leave if the UK votes for Brexit, but their tenure would become more uncertain. However, there are numerous political reasons and legal dispositions that would almost certainly stand in the way of mass expulsions of citizens from another developed country.
According to the Telegraph, the Vienna Convention of 1969 ensures expats – who already exercised their right to live in another EU state prior to Brexit – legal protection.
This means that, in the event of Brexit, these 10,000+ doctors and 19,000+ nurses would still face protection from leaving the UK. This is one positive because, in the short-term, people with diabetes in the UK would at least receive a similar level of treatment from NHS staff.
Another argument in favour of maintaining a bilateral cooperation is that workers who are in this situation would become harder to replace if they did leave, which isn’t totally true.
In the case of NHS trusts like the London Ambulance Services, for example, recruiting new staff wouldn’t necessarily become more difficult or more expensive.
In the past, whenever the LAS has had to recruit foreign paramedics due to shortages – either because universities cannot replace every departing paramedic or as a result of exodus over rising workloads and work pressure – it has turned to countries like Australia or New Zealand, where comparable training programmes are ru, and even though the Commonwealth doesn’t have a EU-style freedom of movement.
Last year, for example, a team of 12 senior managers from LAS reviewed 202 candidates’ applications from Victoria, Sydney, Brisbane and Auckland in 15 days, hoping to sign up 250 recruits to meet UK growing demand.
Brexit might have an impact on migration to the UK, but the efficiency of services won’t be put under threat as its workforce is easily replaceable.
The recruitment trip, which cost LAS £86,000 was a success. Figures released at the time indicate that the 177 posts on average offered annually to Australians and New Zealanders represent a saving of £8.85 million in training costs – it costs £50,000 to train a single paramedic in the UK.
A career in central London, with nearly 2 million calls per year, will always be very attractive to prospective paramedics. Working in London gives foreign paramedics opportunities to embark on interventions that they might not see back home.
That said, recruiting firms also offer convincing incentives to tempt Australian paramedics. They can expect an average salary of $75,000 a year, $30,000 more than in Victoria, according to the Ambulance Employees Association. The UK Border Agency also offers £8,000 for visa applications and relocation costs for each candidate.
In conclusio, Brexit might have an impact on migration to the UK, but the efficiency of services won’t be put under threat as its workforce is easily replaceable. Its effectiveness, however, may be affected without a pool of good EU candidates.
Should British healthcare industries be pro-European to attract and retain talent?
According to a 2015 executive summary by the General Medical Council – looking at the numbers of UK doctors in training and whether they are graduates of UK medical schools, graduates from the rest of the European Economic Area, or international medical graduates – there is an increasing and high reliance on non-UK graduates.
With a rise of accelerated four-year medical graduate entry courses on offer, the UK attracts a large proportion of international (EU and non-EU) students globally. The number of non-UK graduates grew much faster than that of UK graduates during 2010-2014, particularly among medicine (33% vs 20%) and emergency medicine (46% vs 35%) specialists.
If the UK exits the EU, the NHS could miss out on top talent and they’ll go somewhere else.
In 2013, more EEA graduates – with a third of them from Southern Europen, and a fifth from Italy and Greece – joined the medical register than IMGs. And 2014 saw a 64 per cent increase in the number of EEA non-licensed doctors.
Being part of the European family promises far greater prosperity for the healthcare sector in the UK. If the UK exits the EU, the NHS could miss out on top talent and they’ll go somewhere else.
To put that in some context, UK pharmaceutical and biotechnology companies will have to capitalise on the opportunity promised by the digital economy.
It has been estimated that UK businesses will need an additional 2.3 million digitally skilled workers by 2020. If Britain was to leave the EU, British businesses simply wouldn’t get access to the same high-tech European skills and elite computer scientists as its competitors, which would put them at a competitive disadvantage.
Therefore, if the UK exits the EU, British healthcare industries will miss out on top talent and the NHS won’t be able to keep improving performance and boosting efficiency.
In what ways is the EU membership benefiting people with chronic diseases like diabetes?
A recent report commissioned by The Richmond Group, a coalition of 12 leading health and social care organisations including Diabetes UK and The British Heart Foundatio, suggests that 250,000 people across the UK could die from preventable conditions by 2025 unless significant national action is taken.
The researchers, who examined future trends for health conditions including coronary heart disease, type 2 diabetes, cancer, chronic lung disease, arthritis and dementia, drafted a series of potential public health initiatives that could cut early death from these debilitating diseases by a quarter.
These actionable measures, like preventing smoking and poor diet, curbing harmful alcohol consumptio, and tackling physical inactivity, include laws for further restriction on unhealthy food and alcohol marketing, the reformulation of packaged food and portion size control labelling.
Staying a team player within Europe allows the UK to benefit from shared intelligence, response and action.
The FPH report mentioned at the beginning of this article argues that a cessation of EU membership could significantly slow down the implementation of these interventions. The UK has a strong leadership role for public health in Europe and, inversely, European legislation on the environment, consumer safety, food quality and human rights has contributed to better UK overall health and wellbeing.
On the other hand, the decision making process within the 28-member bloc can be cumbersome and slow, and a post-Brexit UK could act in a more streamlined and efficient way to tackle a health crisis, like the one we’re facing with drug resistance in a post-antibiotic world for instance. Overall though, staying a team player within Europe allows the UK to benefit from shared intelligence, response and action.
The UK is also a net beneficiary from EU funding for public health practice. However, it is not inconceivable for the UK to find an ad hoc solution and cut reciprocal deals with a number of EU countries in the same fashion as the arrangements made with non-EU countries for emergency care costs of UK expats abroad.
In the event of a Brexit, the UK could lose the benefit of co-operation and information sharing with other EU member states including enforcement initiatives such as uniform product safety laws and various health policies.
How will leaving the EU impact diabetes research?
Funding agencies have often been accused of promoting top-down approaches to science efforts by throwing money at “big science” types of research projects that work on the same problems with little coordination between them.
Using government funding for science smartly requires instead the development of a collection of European projects and organising distributed science. This would suggest more cooperation between researchers all over Europe.
The upcoming application of EU Clinical Trials would, for example, modernise the current framework for clinical trials and ensure a greater level of harmonisation within the EU.
Experts argue that the UK exiting the European Union would break-up cross-border collaborations and cut off vital subsidies.
The new regulation provides, among other things, an access to an associated EU wide database which reduces administrative burdens on applicants and allows for a simplified process for companies wishing to conduct both multi-centre clinical trials in the EU and the UK, where different authorisation procedures would need to be followed.
Research funding, that UK scientists currently benefit from, is also a cause for concern. Experts argue that the UK exiting the European Union would break-up cross-border collaborations and cut off vital subsidies.
From a scientific point of view, a Brexit could halt many experiments, although the UK could opt to selectively buy into European research programs, as some non-EU nations like Switzerland have done. But such a process can take years and would be far down the list of negotiations that the government will need to complete following a Brexit vote.
Is the answer to this referendum self-evident?
As far as the healthcare sphere go, and although leaders haven’t actively contributed to the “fact-pack” of a properly informed debate, it is my hope that people can draw on some of the issues mentioned previously to inform their voting decision.
It is for each individual to decide where Britain’s future lies. At any rate, Brexit or no Brexit, it is crucial that what positives we’ve managed to achieve as a Union aren’t going to change in the aftermath of this landmark day for Britain and Europe.
