It is not often that the NHS steers clear from the centre of the political fray, but Brexit might just be one of those occasions. This could be because the EU has few direct competencies over health.
That said, a new briefing published by SPICe and the Northern Ireland Assembly, explores the wide range of health issues which may be directly and indirectly affected by Brexit.
This includes familiar issues such as the NHS and social care workforce but it also looks in greater depth at more obscure domains such as:
- new medicines and medical devices
- clinical trials
- membership of EU agencies such as the European Centre for Disease Control
- reciprocal health care
- mutual recognition of professional qualifications
- public sector procurement
- blood, organs, tissues and cells
- food standards and labelling.
Some of these are reserved to the UK Parliament but others may come to the Scottish Parliament should the powers be repatriated.
Impact on the medical workforce
Despite the broad range of health issues affected by Brexit, we anticipate that the impact on the health and care workforce will dominate the agenda. The briefing explores this in some detail.
Attempts to gauge the extent to which these sectors rely on EU workers are hampered by large gaps in data. The briefing explores recent data from the General Medical Council which appears to show that Scotland is less reliant on doctors from the European Economic Area (EEA) than the rest of the UK.
However, non-UK EEA doctors do make up 5.9% of doctors in Scotland (total number = 1177), and about a fifth of them qualified in Ireland (21.3%, total number = 251). As a result, the details of the UK border with Ireland could be important for the future supply of medical staff.
The data also sheds some light on whether the feared exodus of doctors has occurred. For Scotland, it shows that the number of non-UK EEA doctors gaining a licence to practice fell between 2016 and 2017 (from 73 to 63), but it was still higher than previous years.
Scotland has also managed to keep a positive balance in the number of non-UK EEA doctors working here, with those gaining a licence to practice in Scotland outnumbering those leaving (+30 in 2016).
In this regard, Scotland also appears to fare better than the UK as a whole, where more non-UK EEA doctors have been leaving than gaining a licence to practice (-1504 in 2016).
Nevertheless, last year there was actually a small increase in those gaining a licence across the UK (from 2048 to 2057). Whether this trend continues remains to be seen, and the 2017 data on those leaving is eagerly awaited.
Impact on the social care workforce
While this might provide some comfort to the Scottish NHS, we need to remember the importance of the social care sector. For a long time now a well-functioning social care sector has been recognised as key for a well-functioning NHS.
This is reflected in the push towards integrated health and social care services and the Scottish Government’s focus around ‘flow’. Put simply – without somewhere for patients to be discharged to – hospital wards get full, A&E gets full, patients cannot be transferred from ambulances, ambulance response times get longer and planned operations get cancelled.
The authors of the briefing surveyed NHS boards and local authorities about non-UK EEA staff they employed. The main finding of this survey is a lack of local data on employee nationality. However, one interesting insight came from Perth & Kinross Council.
Because much of social care is provided by charities and private companies, there is little information on their employees and their nationality. However, Perth and Kinross Council surveyed their independent social care providers.
They found that 10% of care home employees were from EEA countries outwith the UK, as were 7.8% of staff in home care services. Overall, this amounted to 9.5% of social care staff in the independent sector.
Recruitment and retention in social care was scrutinised by the Health and Sport Committee in 2016. At this time, Scottish Care told the Committee that 55% of their new recruits in the preceding 18 months had been non-UK EU nationals.
The Committee was also told that an additional 60,000 workers will be needed to meet demand in social care in the coming years. Recruiting so many new staff could be challenging in the context of the recruitment difficulties already faced in the sector. Brexit could add another dimension to this challenge.
The UK Government has given assurances about the rights of EU nationals to remain in the UK. However, the shape of immigration policy in the future is likely to be pivotal in dealing with the challenges facing the NHS and social care.
Kathleen Robson, Senior Researcher, Health and Social Care