I spoke with Dayan this week as the Nuffield Trust published his blog looking at five ways Brexit has impacted the NHS.

What about the £350m?

The Leave campaign ran the notorious ‘Boris bus' advert claiming the UK would save £350m a week for the NHS by leaving the EU but just how much has gone to our health service in the 10 years since Brexit?

‘Essentially none of it,' Dayan put it bluntly. ‘Because of the net effect of Brexit was to lose money from the public finances and that's because although we did save some money from not having to make contributions to the EU that was completely outweighed by the size of the economic impact of Brexit, meaning less tax revenue. So there was actually less than no money freed up by Brexit.

‘The budget of the NHS obviously went up quite a bit anyway, but that was because they got the money from other places, from other public services, from higher taxes, not because any money was freed up by Brexit.'

Staffing

Dayan's blog highlights the big rise in non-EU workers in the NHS to compensate for the drop in the EU workforce post Brexit.

Much to the contradiction of Leavers claims that Brexit would result in a drop in migration, however, Dayan said the number of non-EU workers coming into the NHS was ‘much higher' than the number of those that had been coming from the EU.

For example, the number of nurses coming from the EU pre-Brexit was around 10,000 a year. Compare this with a peak of nearly 30,000 non-EU nurses in 2023-24 and above 20,000 for the past four years running.

What about the benefits of more UK recruitment? Dayan said there had not been a huge change in the number of UK nationals coming into the NHS post Brexit due to a lack of significant expansion in training.

Given the large number of non-EU nationals coming into the NHS, Dayan said he was ‘concerned' about the potential for a social care type visa ban being repeated in health.

‘I'm definitely concerned that eventually at some point the pendulum will swing the other way and now we are outside the EU, there won't be that free movement of labour with much of the rest of Europe to provide some kind of bedrock and some kind of stability,' the policy analyst noted.

‘Back of the queue'

Being outside the EU had made the UK ‘only a bit' more vulnerable to medicine shortages, Dayan argued, citing Europe-wide supply problems in the last four years.

However, he said the UK was ‘starting to get to a place right where increasingly Brexit is becoming more of a problem' as the EU had responded to shortages by progressively trying to manage them as one big bloc.

He highlighted the recent passage of the Critical Medicines Act which meant the bloc can subsidise medicine factories in the EU so that those businesses will then prefer the EU over other countries during shortages.

He said there were other EU measures where member states will prioritise other members in the event of a shortage.

‘All of these things do risk putting the UK at the back of the queue,' he argued.

Dayan also highlighted the increase in prices the NHS had to spend on medicines dispensed in community pharmacies in the aftermath of Brexit, largely due to the drop in the value of sterling.

The policy analyst cited a couple of examples of positive developments in terms of medicines access, however.

He said the setting up of a system of tracking medicine shortages before Brexit in 2018 had been beneficial.

‘If we hadn't done that we would have been a long way behind other countries when the big wave of shortages hit in 2022,' he noted.

The policy analyst acknowledged the UK had also begun speeding up medicines approvals by fast tracking ones approved in lots of countries around the world, while noting this was partly just to catch up with the EU.

He said medicine research had been another Brexit casualty.

‘Research has suffered from the uncertainty of whether or not the UK would be able to join the Horizon programmes, which are the EU's flagship science funding initiative,' Dayan added.

While the UK has subsequently joined Horizon, albeit on less favourable terms, he said there will always be the uncertainty over whether they will remain a member.

In addition, Dayan said Brexit had had a significant impact on the UK's ability to attract science researchers because of their tendency to work in teams across Europe.

Trade deals

When asked if Brexit had liberated the UK to clinch new trade deals on medicines with other markets, Dayan answered: ‘not really'.

He acknowledged the US zero-tariff trade deal but added the NHS was ‘paying a pretty large cost for that'.

The Nuffield Trust has taken the DHSC's refusal to reveal the actual cost of the deal to the Information Commissioner but estimates it could run into the billions.

In addition, there is a productivity cost to the deal, he noted, with the NHS forced to spend more on drugs which are less effective in saving the amount of healthy life compared with other NHS services.

Another negative impact was the deal's lowering of cost-effective standards which means that the deal includes more inefficient medicines than previously bought, he said.

Where to now?

Looking ahead, Dayan said an ‘immediate priority' for health should be an EU agreement on medicine shortages and to recognise testing of medicine batches on both sides.

‘Those things should be possible within a slightly closer relationship than we have now without opening any deep fundamental questions,' he observed. 

When asked what we can do to minimise the impact of being outside the EU, Dayan highlighted further co-operation on medicines and research along with ‘more planning and stability on the workforce'.

‘Some of the reasons the NHS is so reliant on migration is that it has not done a good job at all on lining up workforce numbers with its budgets,' Dayan said.

‘If we saw off some of the wild cycles in migration, we wouldn't necessarily be in this position,' he concluded.