Brexit Health Alliance

‘Worst case scenario’ Brexit could cost NHS £500m a year

UK and EU flag

Patients could suffer if a ‘worst case scenario’ Brexit ended healthcare arrangements between the UK and the EU – costing up to £500 million a year.

Travel insurance for visiting Europe could become unaffordable for British citizens with existing health problems and additional pressure could be placed on the health service if British people abroad were no longer able to access reciprocal healthcare, a new publication warns, citing analysis from think tank the Nuffield Trust.

The alliance, which includes patient groups, charities, NHS bodies and medical research organisations, is calling on Brexit negotiators on both sides to take steps to make sure this ‘worst case scenario’ does not come about.

“Patients stand to lose out dramatically if UK nationals travelling to and living in the EU are no longer able to benefit from free healthcare and EU citizens will also lose out by not being able to get free healthcare here,” Niall Dickson, co-chair of the Brexit Health Alliance, said on Monday.  

“This is simply not acceptable. We want to see a Brexit settlement that will allow existing or similar arrangements to continue to benefit patients and those who provide their care.”

Publishing a new briefing on Monday, the alliance has launched the start of a week-long campaign on preserving reciprocal healthcare arrangements post-Brexit.

No deal

In the publication, the Brexit Health Alliance considers what might happen to patients if a satisfactory Brexit deal is not reached.

Maintaining reciprocal healthcare for patients after Brexit warns that travel insurance to the continent could become unaffordable for British citizens with existing health problems if they could no longer use the European Health Insurance Card (EHIC).

The EHIC currently entitles British citizens (and EU citizens in the UK) to urgent and emergency care without paying up-front costs for insurance. 

“With Brexit looming, I am really worried about what is going to happen to the EHIC card,” said Nicola Hawkins, a kidney dialysis patient. 

“It works brilliantly, I get the cost of my dialysis covered in Europe, everyone understands how it works and it means I don’t have to pay out over £1,000 a week to stay alive.”

Uninsured holidaymakers or people travelling on business could also face big bills if they fall ill or have an accident requiring emergency care.


But the potential ramifications of a ‘no deal’ go much wider – an unknown proportion of the 190,000 UK pensioners currently living in the EU could have little choice but to return to the UK.

According to the Nuffield Trust, if they all returned home after reciprocal healthcare arrangements stopped, then an extra 190,000 people could require hospital beds and 1,600 nurses, as well as doctors, other health professionals, and support staff.

Under current reciprocal arrangements, these UK citizens have the right to receive healthcare on the same terms as the local population. If they were discontinued the NHS would have to fund their care.

It would also lead to more red tape, as the current system for EU citizens is much more streamlined than the way we manage payments and administration for people from other countries. 

The alliance points out that if British people abroad could no longer get reciprocal healthcare rights it could cost the NHS up to £500 million a year. This is based on Nuffield Trust analysis, which puts the cost of caring for everyone who could return to the UK at £1 billion a year, minus £500 million which we would no longer have to pay to European health systems under the current scheme. 

This does not take into account the additional income we would receive from EU citizens having to pay for NHS care.


To protect the interests of patients and the healthcare sector, the alliance is calling for:

  • Straightforward and appropriate access to reciprocal healthcare for both UK and EU patients, preferably by preserving current arrangements
  • If this is not possible, provisions made domestically for the planning and funding of healthcare for UK nationals currently in the EU and vice versa.
  • No increased burden for both UK and EU health providers if they are required to handle new, more complex administrative and funding processes, should current arrangements be discontinued.
Launched in June 2017, the Brexit Health Alliance brings together the NHS, medical research, the pharmaceutical and healthcare devices industries, patients and public health organisations to safeguard the interests of patients and the healthcare and research they rely on.

It is co-chaired by Niall Dickson and Sir Hugh Taylor, former permanent secretary of the Department of Health.

Find out more

Download Maintaining reciprocal healthcare arrangements for patients after Brexit and join the conversation on Twitter #BrexitHealthAlliance

Read Nicola Hawkins', a kidney dialysis patient for 11 years, view on why it is vitally important that the EHIC is preserved: Please don't take away my EHIC card.

Listen to a podcast on why reciprocal healthcare arrangements post-Brexit matter for patients.

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