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When the UK left the EU and the Single Market, it abandoned the application of European law and institutions that had formerly underpinned many elements of health and social care in the UK. Regulations on medicines and devices, laws on the buying and selling of care, trade agreements, and rules on migration which had previously worked across most of the continent, were repatriated to the UK.
More than three-and-a-half years on, these changes are still fuelling uncertainty in many aspects of our health and social care system.
Professionals have raised serious concerns about the impact of EU departure. Many believe that the failure to address these concerns would lead to serious consequences for the sector and the public.
Our new report summarises much of the work carried out on the effects of Brexit on the NHS, health and social care since 2016. Our purpose in writing it is to raise awareness of the challenges and difficulties created and the impact they are having on the nation’s health and care, and to draw attention to the need for a more ambitious UK-EU agreement which would serve the needs of the sector and, as a result, the UK population.
Concerns can be grouped around five main areas.
First, mobility. Across England, Scotland and Wales NHS workforce challenges are the most critical. Recruitment from countries outside the EU has increased, but the workforce gaps are still significant, and there is no credible plan to move to greater reliance on British staff. The situation in social care is the most urgent, where new immigration rules largely halt immigration from the EEA.
Second, the medicines, medical devices and life sciences industry in the UK faces great uncertainty. Border bureaucracy has increased dramatically. The current regime seems oblivious to the fact that product supply to the NHS relies on global trade. The NHS now regularly experiences delays in obtaining medical equipment and medicines from the EU, which puts patients at risk and limits treatment options.
Alignment with the EU, as has been chosen for medical devices and equipment for Northern Ireland, allows for cheaper supplies. This model could be followed for Britain should the Government so choose.
Third, trade negotiations have done nothing to help the NHS or social care. The Government once promised that the NHS and medicines prices would be kept “off the table” in trade negotiations, but this promise means little without specific commitments on key areas such as patent protections and investment rules. There does not appear to be a clear agenda to bring any benefits to health in the UK through trade agreements.
Fourth, the lack of clarity over the Government’s plans for regulatory divergence from the EU is causing harm to the sector. Regulatory divergence from the EU could be used to meet policy goals (greater patient safety, incentivise industry investment or early product launch, for example), but risks increased costs associated with being a smaller market.
There is a need for regulatory consistency and clarity. There is no ‘obvious right answer’, but the pros and cons of different positions should be acknowledged – as our report does – and debated.
Finally, the new settlement has harmed health and social care in the devolved nations. Governments in Scotland, Wales and Northern Ireland are concerned that they have lost some of their control over health protection, improvement of health outcomes and health-related funding.
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The special situation of Northern Ireland is perhaps the most critical. Both product supply and workforce remain fragile aspects of the NHS in Northern Ireland. The gains to peace made through the health aspects of ‘Cooperation and Working Together’, following the 1998 Agreement, are too precious to be lost.
What is needed now is a calm, evidence-led, realistic, and detailed discussion about where the UK (or rather, where Great Britain and Northern Ireland) wants to place itself in terms of our global relationships when it comes to health and the NHS.
The relationship with the EU will continue to be the most important one for the UK, which shares its only land border with the EU, and where dense trade relations still apply. The relative size of the UK (or Great Britain) is an important contextual factor.
There is no point in ideological statements about ‘Global Britain leading the world’: if we want to continue global health leadership we need to forge alliances through which to do this. Our most obvious partners remain our European neighbours. This isn’t ‘remain/rejoin ideology’ – it’s hard-headed and practical.
What we need now is political leadership to step up. Without it, health and social care will continue to suffer – needlessly causing harm to those in need of care.
Mike Buckley is the director of the Independent Commission on UK-EU Relations