This section outlines the latest on the Brexit negotiations between London and Brussels and their possible impact on health and care.
Remember to view also our latest updates section for more on Brexit and health.
UK and EU agree Brexit delay
At a specially-convened EU Council meeting on 10 April, the UK and EU agreed to delay the UK's exit from the EU until 31 October, giving the UK Parliament more time to agree the Withdrawal Agreement (WA). The "flexible" extension still allows the UK to leave the EU if the UK Parliament agrees the WA before this date. Should Parliament fail to agree the WA by 22 May, then the UK must take part in elections to the EU Parliament. Read the Council text.
Responding to the extension, Niall Dickson, Brexit Health Alliance (BHA) co-chair and NHS Confederation chief executive said that no deal still remains a "potential outcome which means everyone involved in healthcare must continue to prepare for this possibility". Read the BHA response in full.
No-deal Contingency Action Plan
On 19 December, the European Commission published a series of notices (Contingency Action Plan) to help EU27 citizens prepare in the event of a no-deal Brexit.
The notices cover a limited range of sectors that will be affected, including transport, citizens' rights, customs and financial services.
The notices will be temporary in nature, having affect only until the end of 2019 and are designed to ensure that certain aspects of Union life can continue as normal in the event that the UK leaves the EU on 29 March 2019 without a deal in place.
Among the proposals put forward by the Commission, several have implications for the health sector:
- Customs Checks - all relevant EU legislation on imported and exported goods will apply as of the withdrawal date. This includes the levying of duties and taxes and respect of the formalities and controls required by the current legal framework, in order to ensure a level playing field. This means that customs checks will be applied on goods which move between the UK and the EU.
- Right to stay - UK nationals will not need a visa for short stays (up to 90 days in a 180 day-period). A residence permit from the member state will be required for stays longer than this. Member States should take measures to ensure that UK citizens legally residing in the EU on the date of withdrawal will continue to be considered legal residents.
- Social security coordination - Union rules on social security coordination (which includes reciprocal healthcare arrangements) will no longer apply to the United Kingdom. The Commission is urging member states to address the concerns of those affected by taking steps "to ensure legal certainty and protection of the social security entitlements acquired by citizens who exercised their right to free movement prior to 30 March 2019". Further guidance will be published in due course.
- Road haulage - the Commission will allow temporarily, for 9 months, access for road haulage operators licensed in the United Kingdom to the carriage of goods by road between the territory of the latter and the EU27 Member States.
- Air transport - The EU Commission will ensure temporarily (for 12 months) the provision of certain air services between the UK and the EU.
- PEACE programme - given its importance, a Regulation will be put in place that will allow the continuation of the PEACE programme in Northern Ireland until the end of 2020
The Commission has prepared a question and answer text on the some of the consequences of a no-deal Brexit. Download it here.
Read more on the Contingency Action Plan on the EU Commission website.
On 25 November, leaders of the EU27 approved the texts of the Withdrawal Agreement setting out the terms of the divorce deal, and the political declaration setting out the framework for the future relationship between the EU and the UK. The UK Parliament was expected to vote on the deal on 11 December, but the Government has now postponed the vote until later date, yet to be confirmed.
Many of the key issues which the Brexit Health Alliance has raised are addressed at least to a degree in the Withdrawal Agreement, and this is welcome. The headline messages for the health and social care sector are as follows:
- The agreement avoids a no-deal cliff-edge, confirming that a transition period will be in place until the end of 2020, during which time the details of the future relationship will be finalised.
- It guarantees the rights of UK citizens (including reciprocal and cross-border healthcare) in the EU and vice-versa during transition, but without guarantees as to what will happen after the transition period ends.
- Free movement will end, the UK government has stated that the future immigration system will based on skills, not on where the person comes from.
- There will be appropriate arrangements in the future relationship for reciprocal professional qualifications.
- In terms of supply chains of medicines and medical equipment, there will be a single customs territory between the EU and UK, no tariffs on goods, and deep regulatory co-operation during the transition period. This should avoid Brexit-related shortages and supply chain difficulties after 29 March 2019.
- Goods licensed / authorised before the transition period can continue to be circulated in the EU.
- Data sharing will continue during the transition, with an intention to have a future agreement in place by the end of the transition period.
- The political declaration talks about continued co-operation on health security and participation in programmes such as science and innovation.
- The backstop of the UK and Northern Ireland remaining in a single customs territory will persist until an alternative arrangement, agreed by an independent panel from both the UK and EU, is in place.
Once approved by both the UK and EU Parliaments, the Withdrawal Agreement would then allow negotiations to begin in earnest on the details of the future relationship. Until then, the possibility of a no-deal remains, with concerning consequences for patients.
Following agreement between the EU and the UK on the terms of the Withdrawal Agreement (WA) - which remains to be ratified by both parties - the European Commission has published a Question and Answer text on the rights of EU and UK citizens as they are outlined in the WA.
The text includes information on:
- who will be covered by the Agreement, with real-life examples
- what residency conditions must be met to be covered by the Withdrawal Agreement
- how will family members be treated
- how will citizens' rights contained within the Withdrawal Agreement be monitored post-Brexit - will the European Court of Justice have competence
- how will freedom of movement be handled during the transition period
- will the mutual recognition of professional qualifications continue under the Withdrawal Agreement
- how will social security rules be handled under the Withdrawal Agreement and what will be the status of the European Health Insurance Card (EHIC)
Technical notices from UK government
The government has published several in a series of papers setting out how the UK plans to deal with a range of issues, including health, in the event that we leave the EU in March 2019 without an agreement.
The papers stress that both the UK and EU are working hard to negotiate a positive deal and that no-deal is unlikely. However they recognise that until they can be certain of the outcome of negotiations, they have a duty to prepare for all eventualities, however unlikely, to ensure business continuity.
Here we examine at the papers in more detail. Responding to the guidance, Niall Dickson, co-chair of the Brexit Health Alliance, said:
"What we need is a categorical assurance that patients will continue to get the medicines and treatment they need, no matter what happens in the negotiations. This guidance is a first step, but only a first step, towards that". Read the full response from the Brexit Health Alliance.
Government publishes its white paper on future relationship
The government has published its long-awaited white paper on how it sees the future relationship between the UK and the EU post-Brexit. Read our analysis of the white paper.
In response, Niall Dickson, co-chair of the Brexit Health Alliance, welcomed the government's commitment to maintaining the highest standards of health protection after the UK leaves the EU, but pointed out that "we should be under no illusions of the consequences for patients if we fail to plan properly and do not reach a good agreement". Read the full response from the Brexit Health Alliance.