What Brexit Means for the UK’s National Health Service; What We Americans Might Learn

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The United Kingdom’s decision to leave the European Union registered a magnitude 9 on the Richter scale across the world as far as I can judge. The economic fallout is widely expected to result in a recession in the UK along with reduced GDP growth across several European countries.

The United Kingdom Independent Party (UKIP), which has championed the cause for “Brexit,” has indicated that funds sent to the EU can be recovered and used to invest in the National Health Service (NHS), thereby improving quality of care provision.

But the facts, however, say otherwise, according to a prescient piece by Reenita Das in Forbes last week. By 2020, UK’s NHS is expected to face a shortage of around 16,000 primary care physicians. By 2022, nurse shortages are expected to be in the vicinity of 100,000.

The UK has traditionally tried to fill the gap by recruiting both doctors and nurses from foreign countries, especially other EU countries. The guarantee of stable, long-term contracts is a huge draw for a broad range of care providers across different EU countries. With the UK voting to leave the European Union, citing immigration as one of the key reasons, the NHS will struggle in recruiting manpower from these countries.

The biggest impact on manpower is expected to be in social care provision. The NHS has sought to recruit 100,000 social care workers to help manage chronically ill and elderly patients outside hospital settings.

This is considered a critical aspect of healthcare transition as the UK seeks to reduce the spending on secondary care, which accounts for 78% of the total health budget, and place greater emphasis on primary and long term care, which currently account for around 22% of the total health budget.

Most of these social workers are recruited from the EU, and the Brexit is set to guarantee continued vacancies for social care jobs. Some experts predict an exodus on existing social care workers back to their native countries, thereby making a bad situation worse.

To make matters worse, presently, 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. In a post-Brexit environment, companies in the UK seeking to conduct multi-country clinical trials will be forced to apply individually to each country, resulting in a huge administrative and cost burden.

From a regulatory standpoint, the UK would lose influence over the European Medicines Agency, the organization that approves drugs for use within the EU. This would mean that the UK and the EU would be required to maintain separate databases on pharmaceutical products in the market.

As a result, this would entail more spending by the UK, contributing to the NHS’s budgetary woes. The UK, which also currently gains disproportionately from current funding streams for medical research, will incur significant losses. A major challenge would be future coordination between the UK and the EU in dealing with pandemics, as well as other health threats.

Close coordination with the EU is critical in reducing spread of potential new outbreaks. Going forward, the UK will need to coordinate with individual countries within in the EU, which will be a huge administrative burden (translation: big hit to the bottom line). While frameworks could eventually be put in place for the creation of a new EU-UK joint coordination mechanism, this process could take up to 10 years, according to some observers.

Steve’s Take: Victory by the “Out” faction in the UK is causing secessionists across the United States to take heart. The historic vote to leave the European Union last month has sparked interest in the mind-bending, far-fetched idea that the American states might win independence from Washington, DC.

In an opinion piece by Clare Foran in the Atlantic, she notes that separatist groups are especially optimistic that Americans will be open to the idea of secession given that it looks all but certain that we will have to choose between two extremely unpopular candidates–Donald Trump and Hillary Clinton.

“Rational people are scared of Trump and what he represents. His racism, his intolerance, his lack of vision, his wall building,” said Rob Williams, publisher of the Vermont Independent, a news website that he describes as “devoted to exploring Vermont independence, broadly defined.”

That doesn’t mean secession will actually happen in the U.S. “There is zero chance of any states seceding from the union,” said Douglas Brinkley, a history professor at Rice University.

I agree with Foran that as much of a fringe idea as secession may be, to dismiss separatist movements as a complete anomaly would be to miss the point. Support for secession is ultimately an extreme version of a viewpoint that many Americans share: dissatisfaction with the way things work in Washington, coupled with the conviction that local governments know best. Remind you of any other nation in the news recently?

As I contemplate the mountain of incredibly complex issues that have to be dealt with–let alone the associated costs incurred—by the UK just in the healthcare sector alone, this whole notion of secession here in the U.S., with Trump applauding Brexit, saying, “It’s a good thing…they’re taking their country back,” I swallow hard and say it couldn’t happen here.

We’re too smart… Right, but how many of us, I above all, gave Trump a snowball’s chance when the GOP primaries kicked off with the Iowa Caucus back on Feb. 1?

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