The Brexit white paper published today provides some additional clarity about the Government’s intentions. But there remains considerable uncertainty about what Brexit means for health.
What is at stake? Here are five questions to ask from the patient’s point of view.
1. Will I still get access to my medicines?
In the UK, we are lucky that we can pretty much take the supply of medicines for granted. But the pills in our chemists and hospital pharmacies are there by courtesy of integrated supply chains, in turn dependent on frictionless European borders and seamless regulations. What happens if there is more friction in future? What if it results in extra costs and delays to the manufacturing, quality control and transport of medicines? What if some drug companies cease manufacturing in the UK? What if my vital medicine is impounded by customs officials? We have to hope that none of this comes to pass, but it could, and a “no deal” Brexit would make it more likely. No wonder that NHS England – as recently disclosed by CEO Simon Stevens – is carrying out contingency planning.
2. Will there be enough people to look after me and my loved ones?
The UK health and care system relies on overseas workers to plug gaps in skills and numbers. Many are from EU countries but future flows from Europe are uncertain. Reducing freedom of movement was a big part of the rationale for Brexit.
The UK could recruit and train more home-grown health and care workers and attract staff from outside the EU. But will the numbers add up? This is not just about highly skilled doctors but also about nurses and care staff – the linchpins of the NHS and of social care.
3. Will I still be able to benefit from the development of new treatments?
The UK is one of the world’s leading centres for life sciences. Much research and development is carried out here; a number of things make that possible. One is that health research is a global endeavour and the UK is involved in many international research collaborations. Another factor is that many scientists from EU countries work in our universities, hospitals and research institutes. A third factor is that we are part of Europe-wide networks for developing and supporting new treatments. These cross-border collaborations are of particular importance to people with rarer diseases, when there may only be a small number of patients with a particular condition in any one country. What happens to all of this after Brexit?
4. Will I still be able to get treatment in the European Union, paid for by the NHS?
The current reciprocal health agreement, symbolised by the familiar EHIC card, makes it possible for me to travel in Europe with the assurance that should I fall ill I will not be landed with an unaffordable bill for treatment. It also means that if I have a predictable treatment need, like kidney dialysis, I can still travel in Europe. And if I am a UK citizen living in Europe, I have similar protections. But the longer term future of these arrangements is not assured.
5. Will I be protected if Britain is hit by a Europe-wide public health crisis?
Disease is no respecter of borders. What if a virulent new strain of flu sweeps across Europe, risking the lives of thousands or millions? At present we have the assurance of European Union arrangements for public health protection. What happens after Brexit?
None of these five questions has a definitive answer. In each case, the answer is: we can’t be sure.
This is not a criticism of Government intentions. Indeed, the new white paper offers considerable reassurance, confirming that, through the “association agreement” it is seeking, the Government wants the closest possible alignment with the EU that is consistent with actually leaving it. For health that would mean, in effect, frictionless borders for trade in goods, continued regulatory alignment, and more besides.
But in a negotiation, intentions do not guarantee the outcome. And these negotiations are not a step by step process: with one matter nailed down before going on to the next one. Rather it is a case of “nothing is agreed until everything is agreed”. Furthermore, health matters are not a separate negotiating theme. What happens to health depends on what is agreed on other matters such as trade. Finally, as Ministers have been reminding us, there remains a real possibility of “no deal”.
In June 2016 nobody voted to dismantle the systems of Europe-wide collaboration and coordination that play such an important part in our health and healthcare. Yet that outcome, while not desired, is possible. We can all play our part in urging the best possible outcome for health by asking these five questions and insisting on better answers.