Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
School of Law, University of Sheffield, Sheffield, UK.
Lancet. 2017 Nov 4;390(10107):2110-2118. doi: 10.1016/S0140-6736(17)31926-8. Epub 2017 Sep 28.
The process of leaving the European Union (EU) will have profound consequences for health and the National Health Service (NHS) in the UK. In this paper, we use the WHO health system building blocks framework to assess the likely effects of three scenarios we term soft Brexit, hard Brexit, and failed Brexit. We conclude that each scenario poses substantial threats. The workforce of the NHS is heavily reliant on EU staff. Financing of health care for UK citizens in the EU and vice versa is threatened, as is access to some capital funds, while Brexit threatens overall economic performance. Access to pharmaceuticals, technology, blood, and organs for transplant is jeopardised. Information used for international comparisons is threatened, as is service delivery, especially in Northern Ireland. Governance concerns relate to public health, competition and trade law, and research. However, we identified a few potential opportunities for improvement in areas such as competition law and flexibility of training, should the UK Government take them. Overall, a soft version of Brexit would minimise health threats whereas failed Brexit would be the riskiest outcome. Effective parliamentary scrutiny of policy and legal changes will be essential, but the scale of the task risks overwhelming parliament and the civil service.
英国脱欧将对英国的健康和国民保健制度（NHS）产生深远影响。本文使用世界卫生组织的卫生系统构建模块框架来评估我们称之为软脱欧、硬脱欧和脱欧失败的三种情景的可能影响。我们的结论是，每种情景都构成了重大威胁。NHS 的劳动力严重依赖欧盟工作人员。为在欧盟的英国公民和在英国的欧盟公民提供医疗保健的融资受到威胁，获取一些资金的机会也受到威胁，而脱欧则威胁到整体经济表现。获取药品、技术、血液和移植器官的机会受到威胁。用于国际比较的信息受到威胁，服务提供也受到威胁，尤其是在北爱尔兰。治理方面的关切涉及公共卫生、竞争和贸易法以及研究。但是，如果英国政府采取行动，我们发现了一些在竞争法和培训灵活性等领域改善的潜在机会。总体而言，软脱欧版本将最小化健康威胁，而脱欧失败则是风险最大的结果。对政策和法律变化进行有效的议会审查至关重要，但任务的规模有可能使议会和公务员制度不堪重负。
