Clare Marx is the President of the Royal College of Surgeons.

The NHS took centre stage during the EU referendum campaign, with both sides pledging to protect our health service. Regardless of whether Vote Leave’s proposed extra £350 million a week to the NHS is deliverable, it’s clear from the referendum campaign that the British public expect us to use Brexit to help, not hinder, the health service.

This Thursday, the Lords will debate the impact of Brexit on the NHS. Many have already aired concerns about the risks to the workforce. This is particularly the case in my speciality: surgery. Twenty-two per cent of registered surgeons trained in European countries, with a further 20 per cent from outside the EU. Such a statistic should serve as a stark reminder that we need to do far more to train our own workforce, which is why Jeremy Hunt’s recent announcement to boost UK medical school places by 25 per cent from 2018 is so welcome. . However, the main risk of any changes to migration rules is not to highly qualified medical professionals – which the Government has already pledged to protect – but to the tens of thousands of administrative, clerical, and support staff from overseas that the NHS and social care fundamentally rely on for delivery of the service.

Much less has been said by the health service about the significant opportunities that Brexit brings for improving a number of areas of healthcare safety. Along with all EU countries, the UK has often been required to accept the lowest common denominator of standards across Europe. These have sometimes posed risks to patients.
Testing the language skills of non-UK staff is one such area that can now be prioritised for change. Since 2014, the General Medical Council (GMC) has been able to ask doctors from the EU to demonstrate their English language proficiency before they practise in the UK. According to recent figures, the GMC has prevented a thousand doctors from practising due to poor English language proficiency.

But while EU rules recently permitted regulators such as the GMC to ask applicants to demonstrate their language skills, the EU prohibits the UK from insisting on how this is demonstrated. As a result, most doctors from the EU demonstrate their proficiency through the academic International English Language Test System (IELTS) test. This test poses everyday questions – such as asking a candidate to relay their experience about the importance of maintaining old buildings. IELTS does not include questions more relevant to the NHS such as describing the side effects of a drug or understanding a patient’s diagnosis.

At present, regulators such as the GMC do ask doctors from the rest of the world, where EU rules don’t apply, to sit tougher and more relevant tests which examine language skills in a clinical setting. The current two-tier system is blatantly unfair and not sufficiently protective for patients.

Some doctors, especially surgeons, have also had long standing concerns about the impact of the European Working Time Directive (EWTD) on time for training. Surgeons need as much time to train in theatre as possible. We learn by doing. It’s not sufficient for surgeons to learn their craft from books and academic papers; we need hands-on experience to operate safely on patients. Unfortunately, the EWTD limits the amount of time junior doctors can work, and therefore the amount they spend in training.

In 2014, the EWTD taskforce, commissioned by the coalition government and which represented a broad range of health organisations including the British Medical Association, concluded that we need greater flexibility for training hours while ensuring we never go back to a culture of excessive hours that can only harm patient care. Surgical trainees have suggested that the EWTD should be slightly relaxed to a maximum of 56 hours a week. However, many of the EWTD rules have been written into the recent junior doctors’ contract – so any changes will now require legislation for specific groups of doctors, such as surgeons, who want to see more flexibility. It is of course important to stress that EWTD is not the only problem with medical training; there are many broader issues that still need to be addressed.

A third area we can seek positive change is in medical device safety. Under current European legislation, it is possible for some devices to find their way into the UK having been approved in European countries with lower safety standards. There is an opportunity now to toughen those laws. However, by removing ourselves from such European legislation, we may risk slowing the entry of new devices to the UK market so, we will also have to work harder to attract international innovators in healthcare.

The Government is clear that we are leaving the European Union. The NHS has been great at adapting to changes in technology and medicine, often being the first in the world to innovate. For the sake of our patients, we must now show that same resolve as we deal with the opportunities and challenges posed by Brexit.