Hello. I'm going to be talking about the
potential and possible impact of the
Brexit, but in some ways the changes are
starting to take place and they're being
implemented into a period of time that
is probably one of the most challenging
that the NHS has faced in its 69 and a
half years of existence. So probably the
most famous picture from the Brexit
campaign was this one - I guess you
remember it, who can forget it, and it
immediately connects Brexit with the NHS.
And what I want to do today is just show
you how it's connected in a number of
different ways and how that might impact
upon us. So we tend to think of the NHS
as a national competency for each
country, for the UK particularly, so we
tend to think of it as not an EU issue
and yet there are many issues here on
this slide that point this out. I should
point out that I haven't received any EU
research, but what to do - EU funded research - but what I do want to do is focus on
two aspects: one is patients and and one
is staff. So in terms of patients
first of all, the EHIC card - 27 million people
in the UK have an EHIC card that's
about 40% of the population. I was going
to ask if I could have a hands up and
how many had one but I can't really see
you I'm afraid
with the lights... some, some, yeah, a few
maybe not 40% as such...But this is
one of the main ways in which we have a
relationship in terms of patients. Some
of the highlights has been that we have
the UK has paid out 650 million pounds
to European countries but we've only got
50 million pounds back in return. Now,
most of this money is associated with
pensioners, but others point out that
it's actually a very small amount. Brexit,
will this lead to the end of the
EHIC? Well, potentially there's an
agreement in principle but if it was
lost there's a danger as Kelly was
pointing out that 190,000 pensioners
might come back we would need 1,600 more
clinical staff at a cost of five
hundred million pounds. So the NHS has
launched an overseas visitor and migrant
cost recovery program (snappy title) but
so far it hasn't recovered anything like
the amount that the government thought
that it would do. Some £97 million. The
second aspect I want to look at is
staffing and certainly the referendum
generated a lot of interest and this
classic photo of the multinational
nature of NHS staff points this out. But
just to highlight this really, the NHS
staff is made up of many other different
countries yes the EU is is important but
many other parts of the world are
represented so if we take out a
proportion of EU staff from the NHS what
impact will this have? Potentially
quite serious impacts. At the moment,
about one in ten doctors come from the
European Economic Union, slightly larger
than the EU, and currently seven percent
of nurses come from the EU, so we're
quite heavily dependent on our European
clinical colleagues. But we have to
understand that this is being put in
place at a time when the NHS is
particularly short of many key workers;
GPs and nurses particularly. One in ten
nursing posts are vacant. Added to that,
the tweet on the right-hand side from
Bournemouth: 28 workers - EU workers - have
left Poole Hospital and 44 the Royal
Bournemouth. And this is generating a
change which is a kind of a perfect
storm really, the red line pointing out
the number of workers leaving the NHS
and versus the number of people joining
and we see one
leaving at that a greater rate than the
other. The other issue that relates to
this is nursing workforce, and we've seen
a dramatic drop in the number of nurse
registrations per month from over a
thousand last year to 46 this year. So
we've got tremendous pressure being put
on the NHS. But how will this play out in
terms of the broader impact upon you and
me and our an our clinical care? Where
where will the NHS sit? And I thought
this would be quite useful just to put
in terms of our spending, and clearly our
economic fortunes are going to be
closely tied up with government revenue.
At the moment we spend about the
European average in terms of our health
spending. More than Spain, but less than
France and Germany. This might have a
serious effect upon our future to be
able to fund healthcare at that sort of
level. So in terms of what we get for our
spending generally speaking according to
the Commonwealth Fund we seem to do very
well, we're a good, high-performing health
system. But this is particularly under
threat as we move into the period closer
to the Brexit day and beyond, and this is
particularly important when we consider
the current deficit that we're facing in
the NHS: £5.9 billion, six out of ten
trusts in in deficit, half are planning
to cancel or delay spending because of
financial pressures. If we add in
staffing issues particularly, we're going
to be facing a terrible situation so if
we add in the issues that I've been
talking about the mix of EHIC issues,
staffing issues, financial issues, we
could see a situation of worse access,
possibly lower spending and poorer
quality as a result. So the decision of
Brexit will have far-reaching
implications upon the NHS. So although a
lot of uncertainty exists, how we respond
and how we as a country respond and how
we address that in terms of the NHS will
say a lot  - not
just about the EU, but will say a
lot about our attitude towards the NHS
as we approach its 70th birthday. Thank
you.
