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Brexit shockwaves hit the NHS


LONDON — After Brexit, prepare for the next U.K. revolution — in Britain’s cherished public healthcare system.

With health leaders this winter all but admitting their inability to cope — making an unprecedented call for hospitals to postpone all non-urgent operations in January — momentum is building for major reform of the country’s £125 billion-a-year National Health Service.

The NHS has been struggling to reconcile increased demand from an aging population with tightened public spending for years and calls for an overhaul aren’t directly linked with Brexit. But for some policymakers, the U.K.’s departure from the EU is serving as a moment for self-reflection: to examine what the British truly value.

One of the institutions in the spotlight is the NHS.

“To heal the divisions of the Brexit referendum it is vital that we recast Brexit as an inspiring moment of electrifying and comprehensive national renewal — economic, cultural, political,” said George Freeman, chair of the Conservative Party’s policy forum. He believes it can be a moment for “re-energizing our approach to domestic issues even if they have nothing to do with Europe” — including the NHS and social care.

“The closest thing the British have to religion is the national health care system,” said Robert Colvile, director of the Centre for Policy Studies, a British think tank that has called for a cross-party government advisory committee to look into revamping the NHS.

“One of the powerful things about Brexit is it forces you to look at yourself in the mirror,” he added. “Even if Brexit and the NHS don’t have [much] to do with each other, you don’t have any excuses anymore. After Brexit, they [the problems] are your fault; it’s up to you to fix them.”

Spending restraint

Prime Minister Theresa May has precious little time or political capital for a major reform of the NHS funding model. But a growing chorus of her political allies say there could be no project more likely to galvanize a divided British population than saving the NHS.

Currently funded almost entirely from taxation, the NHS stands apart from healthcare systems in most rich European countries where services are more often funded through a mix of the state and the individual, via personal or employee insurance.

But after years of spending restraint since the 2008 economic downturn, and with Brexit set to put a dampener on future economic growth, policymakers are beginning to question how long the current system can last without major new streams of funding.

“The prime minister also needs to set out more clearly why Brexit will be a moment of domestic renewal” — George Freeman, chair of the Conservative party’s policy forum

Calls for a cross-party commission to consider how to fund the NHS and the country’s struggling care system were given a huge boost last week when Theresa May’s former chief of staff, Nick Timothy (who still has the ear of the prime minister), backed the idea, endorsing a tax increase on the over 40s to cover some of the funding gap.

Norman Lamb, a former health minister in the coalition government of 2010 to 2015, who has long backed a cross-party commission, said Brexit isn’t the linchpin for overhauling the NHS, but it does impact the NHS in major ways.

The first is money.

Brexiteers campaigned on the idea that leaving the EU would provide the U.K. with extra money that could be injected into the NHS — the notorious and discredited £350 million a week claim on the side of their battle bus. The real impact of Brexit is likely to be less money, said Lamb. If Brexit “undermines our economic performance, then it undermines our ability to fund our public services, including the NHS,” he said.

Second is staffing. Figures released by the U.K.’s Nursing and Midwifery Council in November suggest that the number of EU nurses and midwives coming to work in Britain from Europe has dropped by 89 percent since the referendum. A significant proportion of NHS stuff — 62,000 or 5.6 percent — are EU27 nationals so if the U.K. continues to be a less attractive location for healthcare workers as Brexit unfolds, that could spell serious staffing problems for the NHS.

Despite the problems, Freeman, who was formerly head of May’s Downing Street policy board and is now the fulcrum between Tory policymaking and grassroots activists, told POLITICO that big new ideas on the NHS are an opportunity to “carry with us” those who fear Brexit will be a distraction from issues they care about.

“Whilst ministers negotiate Brexit over the next 15 months, the prime minister also needs to set out more clearly why Brexit will be a moment of domestic renewal,” he said.

In the same way that Michael Gove, the environment secretary and prominent Leave campaigner, has won plaudits for his promise of a “green Brexit,” May could revitalize the Tory brand by championing an NHS and care revolution, Freeman believes.

Brexiteers campaigned on the idea that leaving the EU would provide the U.K. with extra money that could be injected into the NHS | Oli Scarff/AFP via Getty Images

Contrary to more traditional strands of Conservative thought, that doesn’t mean boosting NHS internal market forces further, he says, but taking lessons from European neighbors on alternative funding models — including the highly controversial idea (in the U.K.) of co-payments by individuals.

“We need to be less parochial and look at how other countries fund their healthcare systems. With an aging population we should aspire to be amongst the world’s leaders in health spending as a percent of GDP … Nobody wants an American style insurance-based system … but there’s a huge range of different models across Europe which we should look at in designing the right system for a modern U.K.”

Crystal ball

With the NHS held in high public esteem, such a reform would prove very politically challenging, and Freeman agrees with Timothy and Lamb’s call for a cross-party approach.

Backing from the likes of Timothy makes it all the more likely that May will give the green light to some kind of review. But also key will be the Health and Social Care Secretary Jeremy Hunt, who was reappointed with an expanded brief in this week’s Cabinet reshuffle.

Hunt will also take over responsibility for a major reform of social care, due in the summer, which was going to be led by May’s former deputy Damian Green, before his resignation before Christmas.

Britain’s Health and Social Care Secretary Jeremy Hunt | Daniel Leal-Olivas/AFP via Getty Images

Senior figures, including Tory MP Sarah Wollaston, chair of the House of Commons health select committee, believe that a review that looks just at care, and not health, won’t get to the heart of the matter. “[It] will miss the point that these two systems cannot be considered in isolation,” she wrote in the Financial Times.

Hunt seems to agree. “How we treat the elderly is the litmus test of a civilised [sic] society,” he tweeted Tuesday, “The health and social care systems are umbilically linked, so putting leadership in one govt department makes sense as a first step ahead of a vital green paper.”

Tipped for promotion and widely thought to have leadership ambitions, Hunt fought against being moved on from the health brief by May, according to reports of her Cabinet reshuffle. If there is to be a major push to revitalize the NHS, he may fancy himself as the man to lead it.

A vocal advocate of increasing the NHS budget, Hunt said in 2015 that while he was “confident” the service can remain taxpayer funded for the next generation, he did not have a “crystal ball.”

That was before Brexit. After Brexit, change is in the air.

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