Mark Dayan, Brexit programme lead at the Nuffield Trust – ‘Any change on this scale creates winners as well as losers’
So while in general, Brexit was an added burden on the NHS at the worst possible time – bringing lost tax revenue after a decade of austerity, and separation from its neighbours as a wave of medicine shortages crashed across the continent – there were silver linings.
It was the prospect of mass disruption in a "no-deal" departure that caused the UK to force companies to warn it about incoming medicine shortages, and ejection from the EU that caused it to demand more consistency from suppliers. The country was braced before the storm of disruption from Covid and the war in Ukraine hit, with dire effects on patients.
Brexit cut off and deterred EU migrants from working in the NHS, with worrying results. But UK governments felt they had political permission to allow far more staff to join from Africa and Asia. Migration filled tens of thousands of vacancies – though the political pressure to unravel this is already having an effect.
Outside EU rules, nursing degrees can now be granted with fewer hours of clinical training. A review we conducted suggests fewer hours, but more real experience with patients, could work better.
Brexit also allowed the UK to accept medicines approvals across the world – becoming a rule-taker in a way which saved time and money. It is also overhauling regulations on the medical use of AI: while the EU has an updated system too, there is real scope for the UK to design safer and better rules.
For major areas such as medicines trade and research, there is a strong argument in the coming years to move back towards Europe - cautiously through health agreements, or dramatically through a return to the Single Market. After the bad blood of Brexit, the UK government will need to be realistic that this is not going to be easy. The UK will need to make concessions: addressing the problems of Brexit for health might mean losing some of these silver linings.
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Dr Holly Smith, resident doctor – ‘Brexit destroyed one of the main reasons the NHS worked so well’
I am an NHS doctor, and I sadly do not know anything other than the difficult conditions we work in every day. Being a doctor has always been a hard job, yes, but it is harder still when services are persistently understaffed and delivered in the shadow of a post-Brexit settlement in which promised funding never materialised. The £350 million a week slogan once emblazoned on buses across the country is a difficult claim to reconcile with the sustained pressures the NHS continues to face. Whatever one’s view of Brexit ten years ago however, the implication was clear: the NHS would emerge stronger.
It has not. Appeals for “sovereignty” and “taking back control” of our health policy may still resonate in political soundbites, but on the hospital floor the reality is starker: staffing gaps that do not close, rotas that do not balance, and a workforce under increasing pressure to sustain a system already stretched to capacity.
Workforce research shows what many clinicians already see following Brexit: rising staff instability and ongoing uncertainty around regulation and roles. Roles that once moved easily across shared European systems have become more fragmented. These pressures are not separate problems; they show up in the way we deliver care every day.
This is most obvious across our wards. The NHS has never been built on structures alone. It is built on people. The service that patients know, and trust, has been built by people who came here from across Europe and around the world. The multicultural nature of the service is not an addition to the system – it is one of the reasons it works at all.
That reality has become more fragile since the referendum. Many healthcare professionals across Europe describe uncertainty about residency, recognition and their future in the UK, alongside reduced morale and growing intentions to leave. Patients ultimately bear the cost: longer waits, delayed diagnoses, and a health service increasingly forced to react rather than plan.
This impact extends beyond staffing. There are growing barriers to research collaboration, regulation and access to innovation following Brexit. Patients feel this too. Delays to clinical trials and slow adoption of new treatments mean longer waits for medical progress.
Ten years on, the question is not whether Brexit delivered greater sovereignty or control, but whether it delivered a stronger NHS for the patients it was supposed to serve.
‘£350 million a week’ once travelled the country on the side of a bus, destined for our hospitals. Ten years on, that bus is yet to arrive.
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