Brexit talks carry important implications for healthcare. NHS European Office director Elisabetta Zanon considers what the negotiation phase could spell for the health and social care sector on matters including workforce supply and reciprocal healthcare arrangements.
Brexit negotiations between the UK government and European Commission started on 19 June in Brussels – a year after the EU referendum took place.
The start of formal talks was welcomed by the EU, which was becoming increasingly impatient and anxious that the UK would need more time to define its negotiating position in the aftermath of the general election.
Over the last few months, the mood in Brussels has indeed been one of urgency to start discussing the terms of the UK’s withdrawal with time rushing by and the 29 March 2019 deadline, the date by which the UK is due to leave the EU, presenting an unprecedented task.
Looking at the approach to be taken for the talks, at the first meeting on 19 June it was agreed that negotiating meetings at political level will take place every four weeks with three issues to be addressed first: resolving the issue of citizens’ rights, agreeing the financial settlement, and finding a creative solution to avoid a hard border between Northern Ireland and the Republic of Ireland.
Only when, and if, sufficient progress is made on these issues, discussions about a Free Trade Agreement, which will regulate the new relationship, can start.
Turning now to implications of Brexit for the NHS, they could be wide-ranging and will ultimately depend on the outcomes of negotiations. There could be a notable impact on:
- workforce supply
- access to EU collaborative medical research
- participation in EU networks
- continuous supply of medicines and other medical technologies
- early access to innovation
- participation in EU clinical trials
- reciprocal healthcare arrangements.
Some of these issues will be discussed early on and others later in the negotiation process.
Resolving the issue of citizens’ rights will be addressed at the beginning of the talks. This will imply agreeing that the 3.2m EU citizens legally residing in the UK, and the 1.2m UK nationals in the EU, can remain residents after withdrawal.
But the right to residence is only one aspect among many others to be clarified. The agreement should also resolve issues concerning rights to work, social benefits, pensions, healthcare, and the recognition of diplomas and qualifications, among others.
This is of the greatest importance for the NHS which has called for reassurance to be given as a matter of urgency to the 160,000 EU nationals working in our combined health and social care sector, who face uncertainty over whether they will be able to remain in the UK in the future, and under which conditions.
A decision on citizens’ rights is also important for the planning and funding of NHS services. There are currently 190,000 UK pensioners living in the EU who have the right to receive healthcare on the same terms as the local population, thanks to EU reciprocal healthcare arrangements.
If these arrangements were to be discontinued, this would mean that planning and funding provisions should be made in the NHS for these citizens. This would probably bring an increase in costs. A Health Select Committee report cites that the average cost of a UK-insured pensioner in the EU is lower than the cost in the UK under existing arrangements – around £2,300 per pensioner, compared to an average cost of £4,500 to treat a pensioner in the UK.
A separate recent report from the Nuffield Trust states that finding the staff and beds these people might need could be even more difficult:
“Looking at relative hospital demand by age group, we might expect 190,000 people to require 900 more hospital beds and 1,600 nurses, as well as doctors, other health professionals, and support staff, such as porters. This number of additional beds would be the equivalent to two new hospitals the size of St Mary’s Hospital in London”.
The issue of the relocation of the European Medicines Agency is also one that will be decided soon, with criteria for the relocation having been agreed and bids to become the agency’s new host city to be submitted by the end of July, followed by a decision on the new location to be made in November 2017.
With regard to finding a solution for the Irish border, which will also be prioritised in the talks, it should be stressed that maintaining shared clinical services, ensuring adequate supply of safe and qualified healthcare staff, mutual recognition of professional qualifications and consistency in professional regulation across the border have allowed patient outcomes to improve and all efforts should be made for these to continue.
A telling example is the network for children’s heart disease that links specialist cardiology services and diagnostics across the entire island, ensuring that all children in Ireland have access to the highest standard of cardiac care.
Other important issues for the NHS, such as the shape of the future collaboration in the area of the authorisation of medicines and clinical trials, future possible participation in the EU programme for research, and cooperation on public health will be discussed at a later stage, as part of the negotiations of a future Free Trade Agreement, and will largely depend on what access to the EU internal market the UK will be able to secure.
Brexit talks carry important implications for healthcare. It is therefore crucial for the NHS and the health sector more generally to inform the debate and to bring evidence to the negotiators of the impact their decisions could have on patient care.
This is why we have established the Brexit Health Alliance, a coalition bringing together the NHS, medical research, industry, patients and public health organisations to ensure that the health sector can speak with a coordinated voice on Brexit.
We look forward to working closely with the members of the Alliance over the coming months to make the strongest possible case for our sector as the negotiations unfold.
Elisabetta Zanon is director of the NHS European Office. Follow the organisation on Twitter @NHSConfed_EU
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