Vote Leave claimed £350m a week extra could go to the NHS as a result of Brexit. That was never possible as the UK’s net contribution to the EU budget averaged about £200m a week, not £350m.
That contribution to the EU – lower per capita than many comparable countries – was the price of access to the single market, the loss of which is predicted to cause a 4-5% hit to GDP and at least a similar hit to the public finances (due to a fall in tax revenue) and to funds available for the NHS.
Leaving the EU also meant the UK had to spend more money on duplicating activities previously provided at EU level, including the regulation of medicines and the €13bn annual funding for the EU’s Horizon Europe research programme, of which the UK was a major beneficiary, not least for health research.
All in all, the government will - as a direct result of Brexit - have around £20 billion a year less available for public spending. That’s £385m less a week, not £350 million more.
So – while there has been an increase in spending on the NHS – that has come from higher taxes and cuts elsewhere, not from any ‘Brexit dividend’, which does not exist.
The UK is already outside key EU structures. Its exclusion from the Horizon research and innovation programme, with its huge health element, is a threat to UK’s leading position in medical research.
The EMA was based in London but left for Amsterdam in 2019, with the loss of 900 jobs in the UK. Evidence is emerging that, since Brexit, pharmaceutical companies have prioritised submitting new treatments to EMA and then undertaking clinical trials in the EU (and US), meaning they are likely to be rolled out in those jurisdictions before the UK.
The UK is now outside the European Centre for Disease Prevention and Control (ECDC) which has a key role in data collection and sharing and advising the EU Commission and national governments.
The EU is now setting up a body to prepare for and prevent future pandemics: the Health Emergency, Preparedness and Response Authority (HERA), which will also pursue further collective EU procurement of key treatments, after the success of the EU’s Covid vaccine procurement.
The EU has expressed a willingness for HERA to work with the UK, but the UK will be outside its decision-making structures and will have no voice in its policies.
In June 2022 94 000 full-time employment vacancies in the NHS, of which about 39 000 posts were for nurses and 8 000 for doctors. A survey published in November 2022 by the Nuffield Trust health think-tank estimated that Brexit had led to 4 000 fewer EU doctors working in the UK, with a particularly marked effect for anaesthetists, crucial for other doctors to be able to perform operations. Separate figures from the Nursing and Midwifery Council show that the number of nurses and midwives coming to work in the UK dropped by over 90% between 2015 and 2022.
Before Brexit, it was possible to fill vacancies quickly and flexibly thanks to free movement, with people from countries with strong health systems who could spare these staff. Now the government is trying to recruit nurses from Nepal…something which raises serious ethical questions.
UK medical staff have also lost the automatic right to work in the EU – whether long-term or short-term, for example to provide specific expertise or to give or receive training.
The initial rules post-Brexit led to a grave shortage of social care workers, who generally do not earn enough (£25 700) to qualify for work permits. Some short-term schemes have been implemented to mitigate this – but it is not enough. The whole sector is in crisis.
Brexit means there is no longer a single market for medical devices, which has created or exacerbated supply problems, including for personal protective equipment.
UK divergence from EU data protection rules – as proposed by the government – would present a significant threat to collaboration between the NHS, other UK health organisations and EU counterparts. Transfers of data – both individual (for example when a patient moves) and collective – are crucial to addressing cross-border health threats such as Covid-19, enabling the movement of professionals and facilitating research.
Any EU member state can choose to fast track new medicines or vaccines, without waiting for full approval from the European Medicines Agency (EMA). So, it is a fallacy promoted by Boris Johnson that Brexit allowed the UK to roll out Covid-19 vaccines before others in Europe.
It is also a fallacy that the UK has out-performed the EU in vaccination coverage. By late summer 2021, after a slow start, the EU had caught up with the UK in terms of proportion of the population fully vaccinated, despite low take-ups in some eastern Member States bringing down the average.
The vaccination rate in richer EU member states such as Spain, Italy, Germany and France is, as of November 2022, higher than in the UK.
The EU had by September 2021 delivered 700 million vaccine doses to its own citizens and another 700 million to neighbouring and poorer regions, making it by far the world’s biggest donor. It has launched partnerships with Africa, Latin America and the Caribbean to support local manufacture of vaccines.
The EU brought economies of scale and market power to bear in collectively buying vaccines mostly at cheaper rates than the UK
The EU – and especially its richer countries – have also performed better in preventing deaths from Covid, almost certainly partly through having introduced confinement/lockdown measures and mask mandates earlier than the UK. The cumulative estimated totals from the beginning of the pandemic until 27 November 2022 were 3,158 deaths with Covid per million people in the UK and 2,608 in the EU (France 2,340, Germany 1,889, Bulgaria 5,606).
All countries worldwide have had both achievements and failures in Covid policy – for example, neither the UK’s nor the EU’s test and trace systems had the impact hoped for, while both jurisdictions’ Covid certification schemes for travel were broadly successful.
But the EU has overall performed fairly well on a global scale – and certainly better than the UK, albeit not dramatically so. The suggestion otherwise still being spread by some prominent pro-Brexit politicians is a falsehood that they maintain for ideological reasons.
Looking to the future, both the UK and the EU have now authorised new versions of existing vaccines, adapted to tackle the Omicron strains.