Quora Question: How Will Brexit Affect the National Health Service?

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Brexit supporters form a counter demonstration as Pro-Europe demonstrators protest during a "March for Europe" against the Brexit vote, in London, Britain, September 3. Luke MacGregor/Reuters

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Answer from Bruno Ping, NHS molecular diagnostics lab manager:

Are you a glass half-full or glass half-empty type of person? I am a foreigner that has been working for the British National Health Service (NHS) for the past eleven years. Hopefully I can give a double perspective on the issue of how Brexit will affect the NHS.

As I address the question, I will have to address a few misconceptions. I will also have to pick up on a few points raised previously:

  1. There is no such thing as cheap labor in the NHS. Substantive staff are on pay bands linked to their job description. You might get an uplift in salary if you live in London or close to it (London allowances). Your nationality does not impact on your earnings at all.
  2. The bigger issue linked to the above is recruitment. As an example, a lot of nurses are being recruited from abroad due to lack of training at a national level and associated failed policies. To meet short supply, hospitals also have to employ locums. In my hospital, this has led to a deficit of millions of pounds.
  3. Worldwide recruitment. With the same Brexit rules in place for everyone, hospitals might feel more justified to do global scans of talent rather than within the EU. There might be an increase in numbers arriving from English-speaking countries.
  4. It is estimated that around 30 percent of staff working for the NHS are not British. Assuming that this figure is right, any policy that will negatively impact their stay in the country will be extremely detrimental to the running of the NHS. The government and every senior manager in the NHS knows this. They will do everything to keep their staff. Just because the media and emotional thinkers paint an extreme scenario, it does not mean that it is a logical step to be taking.
  5. The other scenario regarding staff is a mass exodus due to a feeling of "unwelcomness" that is being portrayed by certain people. Will this happen? I very much doubt it. The Brexit vote has not made me feel uncomfortable with any of my colleagues at work; my feelings and thinking about the NHS as my workplace has not changed overnight as the result of the vote. It took many years to develop.
  6. Hike in prices due to the "falling" pound—my experience with multinational companies is that they will always try to find an excuse to increase prices—inflation, exchange rates, Brexit, etc. I have seen three different pricing strategies at play: Increase in prices linked to exchange rate; quoting supplies in Euros rather pounds—similar to above but less sensitive to fluctuations in exchange rate; and fixed prices in pounds—the company absorbs the fluctuations in exchange.

In the end, it is a company decision. The only companies that really have a grip on the NHS are the ones that are selling "unique" products e.g certain non-generic drugs. The risk is that these companies might end end up pricing themselves out if a cost-benefit rule is applied.

The much bigger issueis that the NHS does not have a really centralized procurement policy. For example, a hip replacement product price varies between hundreds and thousands of pounds depending of where you are in the country.

People are living longer, the drug regimens are getting more complex and expensive, the population numbers are increasing and health tourism is a reality. Hard questions need to be asked e.g.what are the conditions for access? Do we need new ones?

Will Brexit help with the steady increase in population numbers and the health tourism aspect? Probably but I'm not sure to what extent.

Summing up, the main issueis that we have a healthcare system that was devised many decades ago and will need major 21st century re-thinking and re-structuring. Even if it was possible to throw £350 million at it, the reality is that we would still have an inefficient and old-fashioned system. A lot more needs to be done in terms of health prevention and education and this should be the focus and not any shortterm or headline capturing relating to Brexit. Unfortunately, the NHS is a political football because it is a national institution and everyone is looking to score points to further their own agendas and views.

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Quora Question: How Will Brexit Affect the National Health Service? | Opinion