Martin McKee, CBE, is professor of European public health at the London School of Hygiene and Tropical Medicine. He was president of the British Medical Association (BMA) from 2022-23.
Among the stranger features of the Soviet Union were the photographs from which individuals, such as Trotsky, were airbrushed out. They, and their acts, were erased from history. Everyone knew they had existed. They just didn’t speak openly about them.
These images came to mind recently when I was reading the latest of many reports on the problems facing Britain. Lord Darzi, the eminent surgeon, has compiled a detailed assessment of the parlous state of the NHS and how what had been, only 12 years ago, among the best-performing health systems in the world, had got into this state.
His list of reasons held no surprises. More than a decade of austerity. The catastrophic Lansley reforms of 2012. A failure to engage with staff and patients. And, of course, the pandemic, now cited along with the war in Ukraine, as an excuse for everything that doesn’t work in Britain, even though the United Kingdom is unique among rich countries in failing to recover. But where was Brexit? Not a single mention. Airbrushed out of history.
I’ve been researching health systems across the world for 35 years. So, when David Cameron called the referendum, while I expected the Leave campaign to exploit fears about free movement of people and the vague concept of sovereignty, I never imagined that they would use the NHS as an issue. A service that had long depended on health workers from abroad, who diagnosed patients using imported technology and medicines, was always going to be vulnerable to anything that erected barriers to these flows.
When we looked into the details, as we did in a series of articles in The Lancet, we could see that the problems were even worse than we had first thought. There were the short half-life radioisotopes that we got from The Netherlands, the cooperation on diseases so rare that there may only be under 100 patients across the EU, and our involvement in the research that had driven so much progress in areas such as cancer. Why would anyone want to give all that up?
We didn’t expect the blatant dishonesty of those behind the Leave campaign. As an American colleague said, “the bus lied”. The NHS would never get the promised £350 million a week.
We did try to counter this nonsense. I joined Mike Galsworthy in creating Healthier in the EU to make the case for Remain. We organised letters from leading health professionals, which was easy as virtually none supported Leave. We explained the problems to those who would listen. But we could never compete with the huge sums available to the Leave campaign or the media attention they attracted. Now, eight years after the referendum, we can see what has happened.
We can start with the money. As the Chancellor struggles to fill the £22 billion “black hole” she has inherited, we should recall that virtually every economic analysis suggests that Brexit has cost the UK taxpayer over £30 billion per year, money that could make a sizeable dent in the massive backlog of underinvestment. Lord Darzi doesn’t just describe how we lag far behind other similar countries in technology like scanners. He reports how the roof had collapsed just before he visited one health facility.
The goal of any health system should be to get the right mix of staff in the right place, with the right tools, at the right time, to help the patient along their journey. As the latest in a series of reports by the Nuffield Trust reveals, Brexit makes all of this more difficult.
As expected, there was a dramatic reduction in health workers coming from the EU, with particular shortages in some specialised areas such as anaesthesia and cardiac surgery. Many of the resulting shortages have been alleviated by recruiting from other parts of the world. This has worked so far, but the decision by the last government to restrict the ability of family members to join those recruited is likely to have severe consequences, especially in social care
Innovative medicines are transforming many aspects of health care. Boris Johnson made much of the UK’s rapid approval of Covid vaccines, overlooking how this was achieved using EU rules. Now we can see what happens when we go it on our own. In the year to December 2023, Great Britain approved four drugs more quickly than the EU, but approval of another 56 was slower, and 8 approved in the EU had still not been approved at all in Great Britain by March 2024.
Meanwhile, patients with long-term conditions need regular supplies of existing medicines but, increasingly, have faced shortages. While these problems are not unique to the UK, as the Nuffield Trust reports, Brexit makes it more difficult to resolve them.
Artificial intelligence is another rapidly advancing area that has considerable potential to enhance medical technology. Yet there is a real risk that Great Britain will be excluded from some of these developments if it fails to align with the EU’s changing regulatory regime.
Fortunately, there are a few areas where our worst fears were not confirmed. A fix has been developed for the supply of radioisotopes. Some supply chain problems have not yet materialized because of the failure to “get Brexit done” as the introduction of incoming border checks slips ever further into the future. And the UK has reached a deal to participate in health research, albeit on far worse terms than before.
Lord Darzi paints a picture of an NHS in which some parts are in “an awful state”. Yet it can be fixed, but only by addressing why it got into this situation. This means that politicians need to be honest with a population that now overwhelmingly accepts that Brexit was a mistake.
For more on this, see our breakdown of 10 ways that Brexit has been a disaster for our NHS and our video, Brexit Dead Ringer.
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