What does the public think about the NHS and Brexit?

Since 1983, NatCen’s British Social Attitudes (BSA) survey has asked a representative sample of adults in England, Scotland and Wales about their views on the NHS and health and care issues.

The King’s Fund sponsors a selection of questions in the survey, and in last year’s survey, conducted between July and October 2018, we included questions on the potential impact of Brexit on the NHS. While much has changed since the survey was conducted, the findings are nonetheless interesting, giving a picture of where people’s views were at that point.

The survey asked respondents whether they thought leaving the EU would be a good or bad thing for the NHS. A higher proportion of respondents thought it would be a bad thing for the NHS (38 per cent said it would be either 'bad' or 'very bad') than a good thing (26 per cent said it would be 'good' or 'very good') (Figure 1). A large proportion of respondents gave a neutral answer (31 per cent said 'neither').

n=973. The King’s Fund analysis of NatCen Social Research’s BSA survey data, 2018

People aged 65 and older were more likely to say that leaving the EU will be a good thing for the NHS (38 per cent) than those aged 18 to 64 (22 per cent). Respondents in lower income brackets were more likely to say it would be a good thing than those in higher income brackets; and Conservative supporters and those who consider themselves to be 'leavers' were more likely to think it would be a good thing than Labour supporters and those who consider themselves to be 'remainers'.

We particularly wanted to know why people gave the answers they did, so the survey also asked a follow up question where respondents could select as many choices as they wanted from a list of possible reasons. The lists of reasons were developed using answers to an open-ended question about why respondents thought leaving the EU would be either ‘good’ or ‘bad’ for the NHS . The most frequently cited reason for Brexit being a bad thing for the NHS was that it would be more difficult to get NHS staff from the European Union (Figure 2). Our work suggests that Brexit does have the potential to compound the already significant workforce shortages in the NHS. About  five per cent of the NHS workforce and eight per cent of the social care workforce have come from other EU countries, and this proportion has been growing. The government’s proposals for the immigration system after Brexit are likely to impact on the ability of the health and care system to access the staff it needs, particularly in the short term. While there are efforts to increase the domestic workforce, these will take a long time to result in more staff on the ground.

Respondents could select multiple reasons. Base = respondents who said they thought leaving the EU would be a 'bad' or 'very bad' thing for the NHS, n=344. The King’s Fund analysis of NatCen Social Research’s BSA survey data, 2018

The other top reasons given by people who thought leaving the EU  would be a bad thing for the NHS were financial: goods like medicines and equipment will cost more; less funding would be available for medical research; and there would be less money for the NHS.

The most frequently cited reason for leaving the EU being a good thing for the NHS was that they thought more money would be available for the NHS (Figure 3).

The second most popular reason people gave for feeling that Brexit would be a good thing for the NHS is that fewer non-British people would be using the NHS (figure 3). Under EU rules, people who come from elsewhere in the European Union to live in the United Kingdom, or who leave the United Kingdom to live in another EU country, have access to health care on the same basis as nationals of that country. That may not be the case after Brexit. It’s estimated that there are about 3 million EU migrants living in the United Kingdom and around 1 million British migrants living in other EU countries. EU citizens living in the United Kingdom tend to be younger and therefore less likely to use health and care services than UK citizens living abroad, who are often older. If Brexit means that many older UK citizens currently living in the European Union return to the United Kingdom this could have major implications for health and care services.

Respondents could select multiple reasons. Base = respondents who said they thought leaving the EU would be a ‘good’  or ‘very good’ thing for the NHS  n=268. The King’s Fund analysis of NatCen Social Research’s BSA survey data, 2018.

The third most common reason for people feeling leaving the EU would be good for the NHS is that there would be fewer EU rules and regulations. Competition law has been particularly contentious in the NHS and leaving the European Union could provide the government with the impetus to align competition law more with the NHS’s ambitions around integration, but this would need significant further legislation.

In many ways these results show the divisions of public opinion on the wider impact of Brexit, not just on the NHS, particularly around the potential financial impacts. In the end, the amount of spending on public services is a political decision, and whether or not more would be spent on public services after Brexit depends on decisions taken by future governments.