A ‘no deal’ Brexit would do serious damage to an already overstretched NHS, the Nuffield Trust warns today. Without deals in place to guarantee the rights of EU staff, secure vital cross border treatment in Northern Ireland and safeguard access to lifesaving drugs, equipment and vital medical products, patients could bear the brunt of a chaotic exit from the European Union.
The warning comes in a new briefing, which looks at the priorities for the NHS as attention turns to a possible trade deal with the EU. The briefing explores five key areas  where the deals the UK government reaches with the EU – or lack of them – will impact upon health and social care. It also examines where the NHS might have greater freedoms and flexibility once the UK has left the European Union and what benefits these could bring.
The report finds that even with an exit deal on money, citizens’ rights and Northern Ireland, trade and co-operation deals would be needed so that:
· Delays or charges at the border do not drive up prices of the supplies the NHS relies upon, or risk the loss of vital products with a limited shelf life like radioisotopes;
· British scientists and doctors can keep working as much as possible with European programmes, like Horizon 2020 which has funnelled €420 million into British health research;
· British patients do not face slower access to life saving drugs, and British and European taxpayers do not have to pay more for duplicate regulation in medicines.
The report argues that an exit deal will be needed to make sure:
· The rights of tens of thousands of EU doctors and nurses are guaranteed, minimising the chances of an exodus making already concerning staff shortages across the NHS worse;
· A hard border does not obstruct Northern Irish people who need to go to the Irish Republic for vital care and vice versa;
· A sudden legal vacuum does not risk supplies of already approved medicines, and human substances like blood plasma;
· Expat pensioners who access healthcare under EU schemes do not feel forced to return, potentially requiring up to £500 million more in annual spending, and 1000 extra hospital beds.
The report also highlights areas where the NHS could have greater flexibility after Brexit. One such area is the opportunity to loosen the restrictions on the hours doctors work under the Working Time Directive, which could free up time for training. However, a return to the long hours of the past would risk driving staff away. Another is in removing elements of competition law currently restricting collaboration between NHS organisations. But the report concludes that the scope for more flexibility here after Brexit may in fact be limited.
Commenting on the report, author Mark Dayan said:
“Many different parts of EU law and EU institutions play an important role in enabling healthcare to be delivered to the standards we see today. Suddenly ending them with no replacement would do serious damage to an already strained NHS.
“For many things – from medicine regulation to the rights of NHS staff – there is a way through if deals can be secured. But if negotiations collapse entirely or if political red lines get in the way of future co-operation, patient care will suffer.”