According to the King’s Fund the Brexit vote could have implications for health and social care in Britain. They pointed to: staffing, access to treatment when abroad, certain areas of EU regulation, (for instance the working time directive, procurement and competition law, regulations of medicines and medical devices and professional standards), cross border co-operation in public health and funding and finance of health care.
With regard to the foreign workers working for the NHS and social services, the document indicates that 135,000 workers of EU origin make up 5% of the 2.6 million working in the health and social care sector. However the NHS has a 25% yearly staffing turnover; better terms and conditions of service should reduce this, as could a properly funded training system.
The trade union perspective on Brexit is that workers should not lose out which implies that the working time regulations should stay in place. Long before the 1973 accession to the Common Market, British trade unionists fought hard for a shorter working week and day, for breaks and longer holidays. These rights existed in agreements and were also enshrined in law. Also in place were the regulation of medicines, medical devices and healthcare professions. These aspects existed before Britain was part of the EU and can continue after we leave. Reciprocal arrangements can be made with other countries over the health care of our citizens abroad and of course countries can co-operate on issues of public health.
Two areas pointed to by the King’s Fund that we can readily dispense with, are those of procurement and competition rules, and of rules on finance and funding of Health Services. While a member of the EU, new projects in healthcare, whether buildings or services, have had to be put out to tender. Since the 1980s this has led to wave after wave of privatisation to the benefit of private multi-nationals.
First in the mid 80s, there was an assault on ancillary services such as cleaning, catering, partnering etc, and since the nineties clinical services been fair game too. In 1989 GP surgeries and some specialist mental health services were almost alone in being in private hands yet paid for by the NHS. Now GP out of hours and walk in services, minor injuries and A&E units and even whole hospitals are privately run; ambulance, mental health and prison health, diagnostic and pathology services and a whole host of community services have been given over to a small number of multi-national corporations.
For example Virgin Care gains profit from various community services in the Southeast and Southwest, elderly care in East Staffordshire and a number of smaller contracts around England. SERCO is one of the world’s largest privatisers in health care and its out of hour contract in Cornwall ran into problems when it replaced clinicians with call handlers, leading to a massive increase in ambulance call outs. The company was also found to have falsified records. Care UK was exposed in 2015 for making use of tax havens along with nine other companies including Virgin Care.
A review of TED (Tenders Electronic Daily) will show the continued haemorrhaging of health and social care jobs and services bleeding into the private sector. Delays in leaving the EU are jeopardising our publically provided NHS. By being out of the EU we no longer have to follow competition rules or restrict public spending in line with Stability Pacts: our services no longer have to be privatised, health services can have a policy of buying from British companies and hospitals no longer have to be built with private finance.