Brexit and Health

‘No-one takes much notice of doctors, least of all politicians, but all the doctors MD has spoken to are in favour of the UK staying in the EU. Indeed, MD cannot trace one prominent national medical, research, or health organisation that has sided with Brexit. This is partly because of the un-evidence based fantasy bollocks of the Brexit camp and partly because, on balance, doctors and scientists overwhelmingly believe the UK is better off, healthier and safer in Europe.’ So wrote MD before the referendum in 2016, and detailed the risks of Brexit to health and healthcare (Eye 1421 ). As predicted, no one took much notice. Voters reduce complex decisions to simple metaphors. You either feel safe in the arms of the EU or strangled by its tentacles. Facts and risk analyses rarely cut much ice.

But here goes anyway. The 881 days since the referendum have not been kind to the NHS, with growing delays in treatment and alarming staffing shortfalls. There are 12,000 non-UK EU health and social care staff in Scotland and 60,000 such NHS staff in England. The question is not just whether they are allowed to stay – as Theresa May belatedly promised – but whether they want to, having being used as political pawns since June 2016. May’s noisy declaration that EU citizens will no longer be able to ‘jump the queue’ to sort out NHS queues is unlikely to help. And a no deal Brexit could reverse their right to stay. Many aren’t hanging around to find out.  Fertility expert Lord Winston told the BBC how he has lost nearly all his EU laboratory workers over the last few years.In 2015, the UK had a net gain of 3,000 nurses from the EU, but by 2017 this had dropped to a net loss of more than 1,000 nurses per year. Given the NHS has 100,000 staff vacancies and the number of UK trained nurses are declining by 1000 a year, it’s hard to see how Brexit will help solve the manpower crisis and reduce the high agency costs for staff. The bill for agency nurses alone in 2017 was £1.46 billion. As a senior manager in Scotland told MD. ‘Recruitment and retention is tough….we don’t pay enough and we’re competing globally. Brexit is a fucking disaster. There are four anaesthetists in the Western Isles, all Europeans. Scotland’s rural service relies very heavily on European staff.’

There shortfall in health professionals is indeed global, predicted to be 15 million by 2030, which is why Japan is investing heavily in robotic carers for dementia and health secretary Matt Hancock is so enthused by the remote monitoring of patients by new technology.  Hancock is also trying to ‘move upstream’ to stop people getting sick in the first place but – as the recent UN report pointed out – there are 14 million people living in poverty in the UK, including 4 million children and 1.5 million people so poor as to be destitute. Poverty is the strongest predictor of future ill-health, particularly if it starts in childhood. The solution requires more that offering Bingo and Zumba classes on social prescription, but Brexit has diverted attention from the parlous state of public health, and funds away from addressing inequalities. The opportunity cost has been huge. And a no deal Brexit that threatens even more jobs could be catastrophic for public health and the NHS.

Hancock has said he ‘cannot guarantee’ people would not die after a no deal Brexit and he may even be right. Stockpiling of vital medicines such as insulin, 99% of which is manufactured abroad, may not be sufficient. Medical radio isotopes which are needed for 700,000 diagnostic tests a year can’t be stockpiled, and none of them are manufactured here. Quite what Brexit ends up doing to your health depends on how you define it. In 1948, the year the NHS was founded, the World Health Organization came up with a two stage definition. Step one is ‘an absence of disease or infirmity’ which fails just about everyone (we all have a spot of dandruff and dental decay). Step two is equally unreachable – ‘a state of complete physical, mental and social well-being’ – which may fleetingly be reached by orgasm or opium, but probably not by joining the European Research Group.

In 2011, a Dutch conference of medical experts proposed a more Darwinian definition of health – the ability to adapt and self-manage in the face of social, physical and emotional challenges (e.g. Brexit.) MD’s favoured definition of health is via the economist and philosopher Amartya Sen. Health is ‘the freedom to live a life you have reason to value’. Very rarely do NHS and social care have the time to ask and listen to patients about what they really value, which is why so many people end up as slaves to over-medicalisation and unpleasant high-tech death. But at least medicine tries to offer informed consent, allows patients to change their minds as the facts change, and places no obligation on doctors to perform any procedure a patient is demanding if the weight of evidence suggests it would not be in his or her best interests. So it should be with Brexit. Our politicians need to step up.