Day Two of our series on the 70th anniversary of Scotland's NHS

TWO weeks after the EU referendum result, the NHS Confederation issued this statement: “The Leave vote will certainly have far-reaching implications for the NHS.”

One of the biggest areas of concern is in relation to the NHS workforce. Even before Brexit, the NHS in Scotland has already been struggling to recruit and retain health and social care staff. But the relative lack of borders within the EU also plays an important role in the larger public health picture. Institutions such as the European Centre for Disease Prevention and Control coordinate surveillance systems for communicable diseases such as influenza or HIV and are intimately involved in helping tackle challenges such as antimicrobial resistance.

Such “cross-border co-operation” is also vital to medical and scientific research. Sir Paul Nurse, the Nobel Prize winner and former president of the Royal Society, has warned that Brexit amounted to “the biggest threat” facing UK research in living memory and that it could “jeopardise” the world-class medical research for which Scotland is renowned. Scotland’s Auditor General, Caroline Gardner, has suggested Brexit could cost medical research in Scotland millions of pounds in funding.

At present, almost one in four research scientists working in the UK is from another EU country. Brexit could make the UK a far less attractive place for these scientists to work. In addition, the loss of EU-wide collaboration may see vital clinical research trials pulled out of the UK. As Simon Wessely, president of the Royal College of Psychiatrists, put it: “There will be less money for the NHS and for science. I cannot hide my anger – there never was £350 million a week for the NHS. Will we be able to attract the best doctors and scientists in the future?”

Another major area of concern for health and social care workers is what will happen to the European Working Time Directive (WTD). In the 1980s, junior doctors were working an average of about 90 hours per week. A new contract for junior doctors introduced in 1991 brought this figure down to about 72 hours per week.

While such long working hours almost certainly improved the continuity of care, this came at the expense of exhausted doctors and increased risks to patient safety. The WTD sought to ensure maximum working hours of 48 hours per week as well as regular breaks between shifts. If Brexit leads to an “opting out” of the WTD, it will have massive implications for contracts and initiatives such as the Agenda for Change as well as risking a return to the dark days of exhausted young doctors with patients being harmed as a consequence. At a more profound level, Brexit may affect the health and well-being of our society across the board. According to Professor Sir Michael Marmot of the UCL Institute of Health Equity: “About 90% of economists predict that, with Brexit, we would be a poorer country in the short and medium term. A poorer country will have less money to spend on social services, healthcare, education and research. This will damage health.”

So we have to accept that when Brexit occurs and Scotland is pulled out of the EU, and if the warnings for the provision of health and social care come to pass, this will have profound, potentially negative implications for the health and wellbeing of us all.

Dr Stephen McCabe has been GP Principal on Skye for 20 years and is a passionate advocate for rural healthcare