The future for health after Brexit (Nuffield Trust, 18 April 2024)

Summary

The Nuffield Trust's Health and International Relations Monitor project, supported by the Health Foundation, tracks issues that are important for the delivery of health and care in the UK. It aims to understand how our changing relationship with Europe is changing the picture for the NHS and health more generally, and what the prospects are for the future. This latest report shows that global medicine shortages are being felt particularly acutely in the UK, and the country's reliance on migration as a source of health and social care staff is intensifying.

Content

Key findings

• Multiple indicators show that the past two years have seen constantly elevated medicines shortages, in a new normal of frequent disruption to crucial products, which if anything worsened in 2023. This has placed a significant burden on pharmacists, and has affected the medicines available to patients. The English NHS had to increase medicine prices to deal with supply problems on a scale which cost £220 million more in one year than the same products would have at their previous costs.
• These shortages reflect significant problems in the global medicine market, which are also having a serious impact in EU countries. However, Brexit has also contributed to difficulties by lowering the value of sterling and removing the UK from EU supply chains. In future it will pose the additional risk of being left out of EU measures to respond by shifting medicine between member states, buying products jointly, and trying to bring manufacturing back to Europe.
• The UK has intensified its reliance on migration following Brexit as a source for both health and social care workers. An expansion in social care workers in England is entirely due to migration from outside the EU; more EU and UK staff have left than joined the social care workforce. 
• Health care migration draws heavily on countries placed on the World Health Organization’s ‘red list’, which applies to countries judged to have too few trained clinicians for employers and recruiters from other countries to be allowed to recruit them. There are now 45,000 staff from red list countries in the English NHS, a 30% increase in just one year. One in five nurses trained outside the UK or EU who joined the UK register came from these countries in 2022/23. 
• Heavy reliance on migration without the underpinning of EU free movement of labour means a permanent risk of political choices suddenly affecting staffing availability. The recent decision to end the rights of social care workers to bring their dependants to the UK illustrates that the sector’s access to migration is subject to unpredictable change. 
• Life science and medicine regulation in Great Britain is now often lagging behind such regulation in the EU, caught between the strategies involved in trying to diverge and the demand from industry to align. The EU’s new law on artificial intelligence opens up a significant point of divergence from the UK and risks dividing off markets for medical devices. This could create a difficult situation in Northern Ireland, which has to align with EU rules on devices, but potentially with UK rules on artificial intelligence. In most other cases, the UK has moved towards realigning with the EU, but in a way that the life sciences industry has found unpredictable. 
• There is a similar pattern across both the movement of people and products, with the UK rapidly moving away from initial efforts to take a different course after Brexit and returning to strategies used during the period of EU membership, but with additional frictions. 
• Medicine authorisations for products that the EU approves centrally are typically slower in Great Britain than they would be if it were still a member state. From December 2022 to December 2023, four drugs authorised by the European Commission had been approved faster in Great Britain than in the EU; 56 had been approved later in Great Britain; and 8 had not been approved at all in Great Britain as of March 2024.
• Despite some recovery in relations between the EU and the UK, rebuilding the EU–UK health relationship at a formal level is not currently a priority for EU institutions and representative bodies, which have gone through an exhausting and at times bitter negotiation process with London, and are faced with many ambitious health reforms in train in Brussels.