The exit of Britain from the European Union could prove disastrous for the nation's largest employer, its national healthcare system.
Eight percent, or 10,000 of the physicians practicing in the National Health Service and more than 18,000 of its nurses are natives of other European countries. A breakup with the EU could end the agreement that allows EU citizens to live and work in other member states without immigration restrictions.
Experts predict that everything from medical professional staffing to regulations on drugs and devices will most certainly change, and most, for the worse.
If the UK imposes tougher immigration policies, which was one of the issues supported by “leave” supporters, NHS could find it difficult to recruit health professionals. While they might not be sent home immediately after the official breakup, healthcare professionals' work requirements are certainly be threatened.
EU policies have also limited physicians' work schedules to 48 hours a week and that, British healthcare experts writing for BMJ agree, could fatigue doctors and endanger patients.
That possibility comes at a time when the U.K. faces an exodus of doctors already concerned about proposed government changes to work hours and pay rates. The U.K. is also seeing an increased demand to care for its growing elderly population.
“Either the Europeans who want to work in the UK will not be able to, or will decide not to in order to find opportunities in their own countries,” said Roz Lawson, an associate principal with ZS Associates, a global sales marketing firm. “That is clearly a threat.”
In the days following the vote, Dr. Mark Porter, council chair for the British Medical Association, appealed to NHS workers to unify.
“If you are a European doctor or nurse you might not feel too welcome at the moment,” Porter was quoted as saying. “The essence of delivering high-quality care is dependent on a workforce that feels valued and secure.”
And those sentiments might be aggravated if another prediction becomes reality.
Lawson believes a likely scenario will be an increase in privatization of certain segments of healthcare in the UK.
A number of U.S. healthcare firms, including Nashville-based, HCA Healthcare, and Dallas-based Tenet Healthcare subsidiary Aspen Healthcare, run private acute-care hospitals throughout Britain. But perhaps the largest opportunities lie in behavioral health. The NHS already has outsourced about 30% of those services to contractors.
Fewer U.S. companies have a larger foothold in that sector than Franklin Tenn.-based Acadia Healthcare, which in 2014 acquired UK behavioral health provider Partnerships in Care. In January, the company expanded by purchasing London-based Priory Group for about $2.2 billion, bringing the total number of facilities it operates in the UK to more than 350.
“They see NHS outsourcing mental healthcare more in the same way that in the U.S. back in the 60s, 70s and 80s we had around 5,000 mental health hospitals owned by the government and now we're down to 400, 40 years later,” said Brian Tanquilut, senior vice president of Healthcare Services Equity Research at Jefferies & Company, Inc. “I think it's the same sort of trajectory.”
That would especially be the case if Brexit led the UK into a recession. Former British Shadow Secretary of the State of Health Heidi Alexander, who recently resigned from her position, estimated Brexit could create a $14 billion gap in the NHS budget by 2019.
The NHS already has targeted $22 billion in cost savings by 2020.
Jeff Benton, senior managing director at FTI Consulting, in Washington D.C. says Brexit would result in more costly and lower quality healthcare services.
The world's pharmaceutical and medical device industries are not immune to negative predictions after Brexit. Some of the world's largest firms have U.K. headquarters and now face an uncertain regulatory landscape since separation from the EU will most likely mean relocation of the European Medicines Agency, which is currently based in London, and approves all drugs and medical devices for entry in the European market.
In a June 8 interview at Goldman Sachs' 37th annual Global Healthcare Conference, GlaxoSmithKline Chief Financial Officer Simon Dingemans urged the UK to stay.
“It is a very emotional issue in the UK, but it would be clearly very disruptive,” he said.
Brexit could make Britain a less attractive place for foreign investors, both as a partner with British firms in research and development ventures and as an acquisition target, according to Lawson.
