Impact of Brexit on health and care in Scotland

At this morning’s Holyrood Brexit and Health seminar, I was asked what my immediate response to the Brexit vote was. Well of course I was elated at the thought of the promised £350m extra spending on the NHS. I had quickly calculated the Barnett consequentials and drafted UNISON’s shopping list to the health minister. Then I woke up and realised that this pig had not flown by my window!

In the real world, health is like so many other sectors, avidly awaiting any semblance of a strategy from the UK government. It remains unclear if this is because of civil service unpreparedness or cabinet divisions. However, it shouldn’t stop us in Scotland, identifying the risks and the opportunities and preparing our own position.

An early priority should be the economy. There are some positive signs of recovery except for the currency, and crucially for health, the public finances. We should be concerned that the Autumn Statement does not use Brexit as an excuse for a new round of austerity in order to achieve the ideological goal of reducing the state. In the alternative, if the Chancellor accepts the need to boost the economy, we should be increasing revenue spending as well as capital. NHS Scotland needs revenue funding more than it needs capital.

The big issue that focused most minds at today’s seminar is migration.  A right to stay for EU nationals is crucial to health sector. It may be legally possible to deport people, but there would be huge political and practical difficulties. I suspect the UK government’s unwillingness to make a declaration on this, is more to avoid a pre-Brexit migration surge than as a realistic bargaining chip.

There are various estimates of how many EU nationals work in the health and care sector in Scotland, but none are reliable. Audit Scotland’s report today on the social care sector used a 2008 survey that showed 6.1% of the social care workforce in Scottish care homes for older people were EU – non-UK workers, and a further 7.3% were employed under work permits. Most of those employed from within the EU came from Poland and the Czech Republic and those from outside the EU were from the Philippines, India and China. The NHS staff survey on ethnicity is published annually, but is voluntary and equally unreliable.

What we do know is that staffing levels are already under pressure. NHS Scotland had 2207 nurse vacancies in March of this year and the social care sector is struggling to recruit and retain staff.  If we are struggling with EU nationals, we need to ask how we will recruit the additional 65,000 additional health and care staff the sector will need in Scotland by 2022.

Recruiting more care staff from the indigenous workforce is going to be challenging given the numbers involved. We will need to really value care workers for the great job they do. That means fair pay, training, and time to care. We also need to break down gender segregation in the sector. Unless significant numbers of male staff are attracted to the sector, something like one-third of all female school leavers will need to work in care – and that simply isn’t going to happen.

While these are the immediate concerns, we should start to plan for other issues that will impact on the health sector. These include the common EU standards in professional regulation and employment law, particularly the working time directive. There may also be some opportunities in Brexit to address the limitations European procurement law has had on the sector, in particular, state aid and the posted workers directive.

There are wider public health impacts of EU environment and food regulation. Not to mention the loss of research funding and opportunities for collaboration over research. We should also be concerned about a UK approach to trade deals given the lack of expertise and ideological approaches. If we think the EU has made a mess of TTIP, CETA etc. – imagine what ministers like Liam Fox will do! Private healthcare predators could have a field day in a post-Brexit environment.

In conclusion, Brexit creates a wide range of potential issues for the health and care sector. The threats are obvious, although we shouldn’t lose sight of opportunities. Most people at today’s seminar recognised that we should move on from despair at the outcome and focus on what we need to do to protect these crucial services.