The run up to the Brexit referendum saw Leave campaigners such as Boris Johnson claiming that uncontrolled immigration puts “unsustainable pressure on our vital public services” including the NHS. But the evidence suggests that people from abroad are not heavy users of NHS services and that the costs of their care can be recovered anyway.

Now that the UK has decided to leave the EU, there are likely to be adverse impacts for the NHS. UK residents are likely to suffer the consequences, mainly because the NHS will struggle to deliver the level of care to which we have been accustomed. There are three potential fallouts. First, UK residents may have to pay more if they need treatment while on holiday in Europe. Second, it will be more difficult to recruit NHS staff. Third, the NHS is less likely to receive the funding it needs.

Exiting the EU might mean that we have to give up the European Health Insurance Card. If we fall ill while on holiday on the continent, the EHIC gives us the right to receive medically necessary healthcare. Treatment should be provided to UK holiday-makers just as it would be to a resident of the country they’re visiting. And it should be provided at a reduced cost or for free, as it would be under the NHS. The country that provides the treatment then sends a bill to the UK to recover the costs of treatment. And the UK does the same for holiday-makers that use the NHS while here. The EHIC means that we don’t have to worry about these financial arrangements. But by leaving the EU, we might have to worry.

If we have to give up our EHICs, the price of holiday insurance will increase to cover the risk of needing treatment while abroad, we’ll have to claim for the costs of care we receive and we might have to pay part of these costs ourselves. People who go on holiday without insurance will have to pay the full price themselves.

But we might be able to hang onto our EHICs. The arrangements currently apply to other countries in the European Economic Area and Switzerland. So if the UK becomes an EEA member, EHICs may be part of the package. This should be a key element of our negotiated settlement.

Foreign staff keeps NHS going

The NHS is more reliant on foreign-trained staff than are other EU countries – 11% of doctors and 4% of nurses working in the NHS are from other EEA countries, and recruitment from these countries has increased over the last few years because the Home Office has made it more difficult to recruit from outside the EEA. By exiting the EU, the costs of recruiting staff from the continent will increase further and staff will find it less appealing to move to the UK for work.

The NHS will have to respond in two ways. First, it will be necessary to train more staff in the UK. But our historical record in training sufficient NHS staff has been poor, and the NHS is already struggling with staff shortages. Medical training takes seven years and nursing training takes three years, so it won’t be possible to fill a widening staffing gap with home-trained recruits any time soon.

The second option is to increase wages, so as to retain existing staff and to attract back to the NHS those that have left to work elsewhere. There has been low growth in NHS wages over the last few years. This has made permanent NHS contracts less attractive than agency or locum work, which helps explain why agency costs have been rising. But the government is hoping to restrain NHS wage growth to just 1% a year to 2019/20, well below forecasts for earnings growth in the economy as a whole. Continued wage restraint is going to make it more difficult to retain existing staff and to attract new people into the profession.

Recession on the way

But without wage restraint the NHS is going to struggle to balance the books. Some projections suggest the NHS budget needs to increase by an extra £30 billion in 2020-21 compared with 2015-16. But the government has promised only an extra £4.5 billion. But even this extra funding will be under threat if, as most analyses suggest, the UK suffers a short-term economic hit as a result of Brexit. A deeper recession will reduce tax receipts and, consequently, the money available to be spent on the NHS.

This funding gap is unlikely to plugged from our current EU contribution. The Brexiters “promise” to spend an extra £350m a week on the NHS instead of the EU was withdrawn within an hour of the referendum results being announced.

Older people are more likely to suffer the consequences of NHS underfunding and staff shortages, as they are also most likely to use the NHS. Ironically, the elderly were also most likely to vote for Brexit.

Disclosure

Andrew Street has recived project funding from the National Institute of Health Research, the Department of Health's Policy Research Programme, and the European Union. The views expressed are his own.

Andrew Street, Professor, Centre for Health Economics, University of York

This article was originally published on The Conversation. Read the original article.