"Brexit means Brexit," a strong and catchy soundbite that has been banded around by politicians for months but it is still not entirely clear what it actually means. The issues that seem to attract the most interest and have centre stage in press coverage are the anticipated effects on the economy, namely access to the single market and the impact on immigration through the principal of free movement of people.
There will no doubt be far reaching ramifications regardless of the "firmness" of the Brexit that is ultimately reached, most of which will have been unforeseen. Most worryingly from our perspective as Clinical Negligence specialists is the potential impact on the NHS and the specialist care that it provides.
Unintended consequences on our personal health
You can easily be forgiven for being sceptical of the view that Brexit will directly make us less healthy and live shorter lives. How could leaving a political and trade union possible have that deep an impact I hear you ask? The risk is that it will happen indirectly like a shadowy spectre through the impact on our slowing economy. The value of sterling has already taken a, roughly, 10% hit since the result of the referendum was announced last year. This has left many households poorer meaning they may well have to make less healthy decisions when it comes to what they eat.
Less money in the economy also has an impact on key social factors such as education, employment, working conditions and poverty. All these factors affect life expectancy by influencing lifestyles. Therefore Brexit has the potential, albeit indirectly, through impacting the economy and the knock on effects on social factors, to mean we may live shorter lives.
Euratom and unintended consequences on cancer care
Euratom is the pan-European regulator that oversees everything nuclear-related in the UK from plutonium stockpiles to imports of radiotherapy treatments for cancer. The impact of leaving this organisation on cancer care is surprisingly unexpected.
The reason we are potentially leaving Euratom is because it is governed by EU institutions, including the European Court of Justice (ECJ) and the Prime Minister has committed to severing all ties with the ECJ.
The potential consequence of leaving Euratom however is that a disorganised departure, without a new UK regulatory system in place with agreements with the EU, will lead to the disruption of imports of radiotherapy cancer treatments. In turn this could have a devastating impact on thousands of patients who will need this life saving treatment and may even lead to rationing of care. This is clearly an unacceptable position but another example of how intrinsically linked the UK is with the EU in almost every aspect of our lives.
Impact directly on the NHS
In more direct terms Brexit will have a huge impact on how the NHS is staffed and funded. A recent report by the Nuffield trust suggests that if we are not able to negotiate secured status for British nationals abroad then tens of thousand will come home to use the NHS as they will not be entitled to treatment abroad. This will raise the cost of healthcare paid for these people by the UK government to £1bn a year.
If Brexit brings an end to the principal of free movement of people, then the NHS will suffer in terms of recruitment. There are an estimated 57,000 EU nationals working for the NHS, including 10,000 doctors and 20,000 nurses. The number of EU nationals registering as nurses in England has dropped by 92% since the Brexit referendum in June 2016, and a record number are quitting the NHS altogether.
This leads to the question of even if we find the funding to replace these doctors and nurses who would take up these jobs? Potentially we just train more British nurses and doctors. A novel idea but it remains a question if the incentives are there to bring people into the profession.
It remains to be seen how Brexit will pan out, but at the moment we're looking at a picture which potentially sees our patients and NHS impacted adversely.