The European Union has never experienced the withdrawal of one of its member states and the EU treaty does not provide much detail on the process to be followed. Here we take a look at what we know about the process and clarify what it means for the NHS.
What is Article 50 of the EU treaty?
Article 50 of the EU treaty says that if a member decides to leave the EU, there will be a period of two years for the leave agreement to be conducted, starting from the moment a formal notification is submitted from the government of the member state to the EU. If required, this period of time can be extended.
Negotiations will be long and complex, and the EU has made clear that the UK cannot cherry-pick the terms of its new relationship with the EU after Brexit, stressing that the EU's four principles – free movement of goods, services, people and capital – cannot be split up.
Now Article 50 has been triggered, what is the process and timescale for the UK withdrawing from the European Union?
On 29 March 2017, Theresa May, the Prime Minister of the UK, sent a letter to President of the Council of the European Union to inform him of the UK’s intention to leave the EU, and to invoke Article 50.
Until the moment the UK formally leaves the EU, it remains a full member and all EU policy and law will continue to apply.
The rights of EU citizens working in the NHS will be unaffected during this period and NHS employers can continue as before to recruit staff from EU countries. The UK will continue to receive EU funding and be able to participate as partners in the different EU funding programmes.
This European Commission factsheet on the Article 50 process gives an indication of timescales and key milestones in the process. We have also produced an infographic on key decisions for the NHS during the exit negotiations.
Conduct of negotiations
On 19 June 2017, both the European Commission and the UK government agreed the terms of reference, which set out the guiding principles for the conduct of the Brexit negotiations.
Negotiations have been following the sequence set out by the EU 27, with terms of the divorce being addressed first, namely citizens rights, agreement on the financial settlement and the border separating Northern Ireland and the Republic of Ireland, followed by negotiations on the UK's future relationship with the EU.
You can keep up to date with the negotiations via the European Commission's dedicated Article 50 Task Force website.
What sort of future relationship is the UK government seeking with the EU post-Brexit and what are the main priorities for the EU?
The Prime Minister set out the 12 principles which will guide the UK government during its negotiations with the EU on leaving the union. This announcement was followed up by a government white paper. Read our article on potential implications for the NHS.
The EU's main priorities are revealed in the negotiating directives.
As of mid-August 2017, both the EU and the UK government have published a series of position papers which provide more detail on their respective priorities for the Brexit negotiations and how they envisage their future relationship with each other post-Brexit.
In terms of the future relationship, the Article 50 taskforce has also produced a number of presentations and papers on the basis of the UK’s ‘red lines’ to indicate the type of future relationship that can be proposed.
The UK also set out some ambitions for negotiations in the Prime Minister’s speech at Mansion House on 2 March 2018 and more recently, the Government has published a series of presentations on the negotiation process, including on the future economic partnership and the partnership on science, research and innovation.
What will be the impact of the UK’s plans to leave the EU on the NHS?
The NHS played a central part in the Remain and Leave campaigns before the EU referendum. In this blog article, the director of the NHS European Office has considered what lies ahead for the NHS as the UK plans to exit the EU.
We have produced an infographic on the top issues for the NHS related to Brexit and one on the key decisions for the NHS in the Brexit negotiations.
In October 2016, the NHS Confederation issued a response to the Health Select Committee (Commons) inquiry on Brexit and health and social care, where we discuss the key potential impacts and make some recommendations on how to mitigate risks and take advantage of opportunities.
Take a look at some of our other blogs and articles on the potential impact for the NHS:
In July 2017, the Brexit Health Alliance was formed to ensure that patients and the healthcare sector that supports them are in the strongest possible position once the UK leaves the EU.
What will be the impact on the NHS EU workforce and on recruiting and retaining staff from outside the UK?
Kate Ling from the European Office has produced a blog article on immediate implications for the workforce and what may happen next. There is a highlight on issues such as education, training and employment regulation, and the Working Time Directive.
The NHS European Office is a member of the Cavendish Coalition, a coalition of 29 health and social care organisations created to ensure that standards of care are maintained as Britain prepares to withdraw from the EU.
What will be the impact on EU grants for NHS organisations currently involved in EU funding bids?
The UK government has recently updated its guidance (Oct 2019) to UK organisations on continued Horizon 2020 participation, in light of the continued uncertainty related to Brexit.
In the context of Horizon 2020, the situation remains largely unchanged:
- If a deal is agreed, under the terms of any transition period Horizon 2020 participation shall continue as normal
- If the UK leaves the EU without a deal, the UK should be able to participate in Horizon 2020 as a non-EU country, supported by the UK government underwrite guarantee (to be delivered by UK Research and Innovation); noting that UK organisations will not be able to access schemes that are not open to third countries.
For more on the government's underwrite guarantee, see the UK Research and Innovation page.
UK participants are therefore encouraged to continue applying for Horizon 2020 funding and participating in Horizon 2020 projects. Participants should also reassure their international partners about their capacity to fulfil the roles and assume the involvement which best fit proposed projects.
Will I still be able to use my European Health Insurance Card (EHIC) to access healthcare in the EU?
Until the UK formally leaves the EU, EU law will continue to apply to and within the UK. So there is no immediate impact on UK citizens travelling and living abroad and using the EHIC or for European citizens living in the UK.
What will happen to the European Medicines Agency (EMA) which is based in London?
For two decades, the EMA has overseen medicines regulation across the EU and has granted pharmaceutical companies a single marketing authorisation that provides access across the whole of the EU market.
With the UK's withdrawal from the European Union, the EU began preparations to relocate the EMA from its London home to Amsterdam.
The EMA has developed a business continuity plan prioritising the agency’s activities in order ensure that the assessment of medicines is not disrupted and that patients in Europe continue to have access to high quality, safe and effective medicines after the UK’s withdrawal from the EU. It has also produced a questions and answers document related to the United Kingdom's withdrawal from the European Union with regard to the medicinal products for human and veterinary use. Both documents can be found on the EMA’s dedicated Article 50 page.
The Prime Minister in her Mansion House speech on 3 March 2018 indicated that despite leaving the centralised licensing system for medicines, the UK will seek associate membership of the EMA.