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Funding of the NHS after the UK leaves the EU
Adjournment debate, House of Commons
Tuesday 15 November 2016
About the BMA
The British Medical Association (BMA) is an apolitical professional association and independent
trade union, representing doctors and medical students from all branches of medicine across the
UK and supporting them to deliver the highest standards of patient care. We have a membership
in the region of 170 000, which has been growing year on year.
Introduction
The NHS is facing unprecedented demand across almost all services, an ageing population
coupled with increasingly complex patient illnesses and a drastic funding shortfall. Doctors are
increasingly being asked to work longer in an overstretched, under-resourced health service.
This funding crisis facing the NHS risks being worsened by the UK’s decision to leave the EU.
Current economic predictions suggest that Brexit may result in a domestic economic downturn,
or in the very least, economic uncertainty. If these predictions are proven to be correct, this
downturn is likely to reduce public spending in general and, specifically, the level of funding which
is available to the NHS.
We share the views of the 41 politicians who wrote to the Chancellor, Phillip Hammond, on 24
October 2016, urging him to uphold the ‘single most visible promise of the Leave campaign’ to
give the NHS an extra £350 million a week in the forthcoming autumn statement 1 . The
government must deliver upon this funding promise made by Brexit campaigners, which proved
to be so persuasive at the ballot box, so that patients get the health service they deserve.
NHS funding crisis
The unprecedented demand currently facing the NHS must be matched with increasing
investment, which is based on a realistic assessment of what is needed to meet the health needs
of current and future generations.
The Westminster government has made a commitment to invest £10billion to deliver on
commitments in the Five Year Forward View. Much of this funding has however been made
available through cuts in other areas including public health, education and training, capital
spend and national bodies such as the NICE (National Institute for Health and Care Excellence).
Spending in these areas is being cut by more than £3 billion over the next five years, meaning the
funding made available is in fact £4.5 billion, falling far short of what is needed2. Furthermore,
this does not take into account funding for commitments for seven day services. The result will
be a 6.7% reduction in health spending as a proportion of GDP by 2020/21, creating a significant
1
The Guardian (2016) MPs urge chancellor to honour leave campaign's £350m NHS promise
BMA NHS funding and efficiency savings, pp. 4-5, https://www.bma.org.uk/collective-voice/influence/key-negotiations/nhsfunding/nhs-funding-and-efficiency-savings
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funding gap that will make it more difficult to provide high quality, safe, sustainable health
services.
We are deeply concerned by the pressures on the NHS and the disparity between what the
government claims it is investing in the NHS and what is actually being made available. Following
repeated claims by the health secretary, Jeremy Hunt, that NHS investment will increase by
£10bn during this parliament, we have written to the UK Statistics Authority (UKSA) to ‘advise on
the validity of these statements’ 3 making reference to the health select committee’s recent
analysis that found the use of the £10 billion figure was incorrect, creating a false impression that
the NHS was well funded.
Instead, frontline services are increasingly under increasing pressure and this is preventing
doctors from being able to provide their patients with the health service they deserve. General
practice is in crisis, with the proportion of NHS funding spent on general practice falling from
10.4% in 2005/6 to 8.1% in 2015/16. General practice needs a sustained, year-on-year increase
in the proportion of NHS funding going to general practice. In secondary care, the aggregate NHS
provider and commissioner deficit increased from £554 million in 2014/15 to £1.85 billion in
2015/16. In the provider sector alone, deficits stood at £2.45 billion at the end of 2015/16.
Potential impact of Brexit on NHS funding
Economic predictions suggest that the UK’s decision to leave the EU may result in a domestic
economic downturn, reducing public spending in general and leading to, potentially, further
reductions in the level of funding available to the NHS. The Health Foundation has suggested that
the NHS budget will be £2.8 billion lower than currently planned for 2019/2020 if the UK leaves
the EU due to a predicted fall in economic growth and other factors. The National Institute of
Economic and Social Research reinforces this view, suggesting the UK economy would be
approximately 2.5% smaller two years after a decision to leave the EU.4
The Department of Health (DH) has also admitted that the ‘UK economy is experiencing some
turbulence following the decision to leave the EU’5 stating in its evidence to the Doctors and
Dentists Review Body that ‘following the outcome of the EU referendum, the UK economy is
entering a new phase which will pose new challenges to the public finances’. The DH’s own
analysis suggests that the rate of economic growth will fall from 2.1%to less than 1%next month.
If these predictions regarding an economic downturn are proved to be correct, this could mean
that in the longer term, and assuming that the UK is able to remain part of the European Economic
Area (EEA), the NHS funding shortfall could be at least £19 billion by 2030/2031– equivalent to
£365 million a week. Should the UK not retain access to the EEA, the shortfall caused by the
domestic economic downturn and consequent loss of income is predicted to be as high £28 billion
– equivalent to £540 million a week.6 Furthermore, given the weak tax receipts reported in the
UK, which will slow efforts to reduce deficits, and the recent fall in Sterling, which will have a
3
BMA (2016): BMA seeks NHS funding figure clarity
Baker J, Carreras O, Kirby S, Meaning J, Piggott R. Modelling events: the short-term economic impact of leaving the EU. NIESR,
2016.
5The Review Body on Doctors' and Dentists' Remuneration (DDRB) Review for 2017 Written Evidence from the Health Department
for England, October 2016
6 Health Foundation (2016) Briefing: NHS finances outside the EU
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significant effect on the cost of medicines and other health products, the outlook for NHS
finances following the UK’s decision to leave the EU is deeply alarming.
An extra £350m a week for the NHS- Leave campaign
Given these dire predictions, we are dismayed by reports that the Chancellor’s Autumn
Statement on 23 November 2016 will contain no new money for the NHS7, despite calls from
leading NHS organisations for extra health spending following the UK’s decision to leave the EU.
Instead, we are calling on the Chancellor to deliver upon the promise made to the British people
to give the NHS an extra £350 million a week as we withdraw from the EU.
The BMA wrote to then Prime Minister David Cameron after the vote to leave the EU to urge the
Government to keep this promise8, which undoubtedly influenced the referendum result. The
public’s desire to see increased funding for the NHS is beyond dispute. This view has been
reinforced by a number of MPs, who wrote to the government last week urging the Chancellor
to give the NHS the extra £350 million a week promised by Brexit campaigners in next month’s
autumn statement. The government must now deliver the additional funding for the NHS that it
desperately needs.
November, 2016
For further information, please contact:
Susan Bahl, Senior Public Affairs Officer
T: 020 3058 7457|E [email protected]
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8
The Guardian, Friday 14 October 2016 No extra money for NHS, Theresa May tells health chief
BMA: Dr Mark Porter writes to the Prime Minister about Brexit
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