The referendum result could have a major impact on hospital doctors and the NHS as a whole. We look at some of the implications.
The Brexit result on 24th June has sent shockwaves around the world. In the wake of a Yes vote for withdrawal from the European Union, attention now turns to the negotiations expected to begin in the new year.
These two-year talks will finalise the scope and direction of the United Kingdom’s future relationship with the EU.
At the same time the government has signalled its intention to seek bilateral deals with potential trading partners across the globe as part of its post-EU strategy.
Depending on the outcome of these negotiations, UK hospital doctors could, like many other professions, feel the impact of changes to employment rights, a weaker pound, reduced EU funding and additional budgetary pressures in a lower-growth economy. So, what are the main areas that could affect NHS hospital doctors following the referendum result?
1 Hospital Doctors from other EU Countries
The Brexit result has sent an extremely negative message to colleagues from across the EU. The referendum could also impact on retention, recruitment and those benefiting from EU-wide professional standards.
Status of EU Health Workers
Major uncertainty currently surrounds the final status of EU citizens from abroad living in the UK. Prime Minister Theresa May has failed to guarantee their future status, meaning they must wait for the outcome of talks.
There is a possibility that many may not wait to find out the result – and that future possible recruits from the EU will now turn their backs on the UK.
A similar impact is predicted on the recruitment and retention of nurses and other healthcare professionals from EU countries.
EU-wide Professional Standards
The EU makes sure that healthcare workers comply with a common set of professional standards. The European Specialists Medical Qualifications Order is an EU/EEA-wide order and was brought into UK regulations in the enactment of EU Council Directive 93/16/EEC of 5th April 1993.
Its aim is the free movement of doctors. Post-referendum it could be an endangered species, threatening to place a barrier between UK and Commonwealth doctors and the NHS, on the one hand, and their EU counterparts and health systems on the other.
2 Employment Law
Some key areas of UK employment law have been adopted as a result of EU directives. Their future is not currently guaranteed.
European Working Time Directive
The EWTD’s adoption in the UK, enshrined as the Working Time Regulations, restricts the working week to an average of 48 hours and guarantees 11 hours’ rest a day and a right to a day off a week, a right to a rest break where days are longer than six hours, and 5.6 weeks’ paid leave per year.
Although the UK negotiated an opt-out to the hours limit, meaning that if workers “volunteer” to do so they may work for longer, the directive as a whole has had a positive impact for hospital doctors and is reflected in NHS contracts.
An end to its application in the UK could pose a significant challenge to doctors who have benefited from important guarantees against the kind of long-hours cultures that used to plague UK medical staff.
The Transfer of Undertakings (Protection of Employment) Regulations 1981 may take on even more significance for hospital doctors as the NHS faces ongoing widespread restructuring.
It protects the terms and conditions of employees who are transferred from one employer to another, yet is derived from EU Directive 2001/23/EC.
3 A weaker pound
A weaker pound will have a serious impact on the purchase of medicines and equipment from non-UK companies, pushing up spending and reducing budgets elsewhere in the health service.
And hospital doctors, alongside all employees, will likely find that their incomes will not go as far as the cost of imports into the economy rises.
Currently the proposal is for continued “restraint” across the health pay bill capped at 1 per cent a year.
4 NHS budgets
The financial impact of the vote on the NHS is still being calculated. The suggestion that an additional £350 million a week could be found for the health service in the event of Brexit has been widely discredited since the vote, and politicians have poured cold water on the suggestion.
Possible lower-than-expected growth, or even a bigger slowdown, would result in lower tax receipts and will put further pressure on Treasury calculations and, by extension, health budgets.
5 Return of the “Ex-pats”
Tens of thousands of “ex-pat” British residents could return to the UK from their current homes in other EU countries.
Currently there are 319,000 living in Spain and another 171,000 in France.
If a deal cannot be struck to secure their status abroad then this could mean rapidly rising pressure on health services back home – not least because of the ageing profile of many British ex-pats.
6 Healthcare research
The UK may also lose indirectly in terms of improving healthcare quality and innovation in a post-Brexit environment. For example companies seeking to conduct clinical trials for new drugs across the EU can run multi-country studies by registering on a single EU clinical trial database.
UK universities are estimated to receive around £1.2 billion in funding – 10 per cent – from the EU, on top of other grants and support for scientists.
Some universities have already reported their exclusion from multi-country bidding for EU research grants.
The UK also risks losing its influence over the European Medicines Agency, the regulator that approves drugs for use within the EU.
Prior to the Brexit vote the government and EU Commission had sought to guarantee that publicly run health services would not be threatened by the secretive EU-US free trade agreement, which includes controversial terms for private companies to take nation states to court for damages.
Some uncertainties remained pending the outcome of negotiations, though these have reportedly slowed to a standstill amid resistance from France and with the US presidential elections around the corner.
That said, if the UK as a non-EU member sought its own bilateral deal with the United States, the concerns raised around TTIP could reappear in a new form.