Problems loom large for British health and social care. Like many other European countries, a number of these problems are domestic: the UK has an ageing population with the demands on the NHS and social care growing at a near-exponential rate, and raising questions as to how public services can be funded in future. But Brexit has also raised questions about how it will be resourced.
Regulation – a brief introduction
On the face of it, leaving the EU shouldn’t mean a great deal for health and social care. It is, after all, a closely guarded national competency by every member state. And, as part of the Leave campaign in the UK, suggestions abounded (albeit hotly contested ones) that Brexit could result in more funding for the NHS.
But it’s a mistake to think the EU has no role to play. Indeed, its influence is extensive. European regulations affect the pharmaceuticals and medical technology markets, procurement and working time regulations – i.e. how much time a doctor can work per week. The EU has also introduced the European Health Insurance Card, which enables citizens falling ill in another member state to receive free at point of delivery healthcare.
The European Medicines Agency (EMA) is also based in London, with responsibility for:
- Scientific evaluation of human and veterinary medicines for use in the EU
- Marketing authorisations for medicines, allowing their use across the EU, Iceland, Liechtenstein and Norway
The application procedure to host the EMA closed in August 2017, with nineteen countries making a bid. While a decision will be made by European Institutions in November, the UK could be expected to pay as much as £520m in relocation bills In November, it was announced that the EMA would move to Amterdam, beating Milan after a tie meant that names had to be drawn from a bowl.
The UK is a member of the European Centre for Disease Control and Prevention to help respond to the threat of communicable diseases. And there’s the EU Tobacco Products Directive, which is an example of the EU’s work in public health.
Finally, but very importantly, is a European Directive that allows health and social care professionals to have their qualifications recognised by the relevant regulator in any EEA country. The result? Nearly 5% of all NHS staff – and 10% of all doctors – are from other EU countries. Nearly 20% of social care workers were also born outside the UK.
A new NHS Europe Transition team has been established to work in the UK Cabinet Office and Department of Health. Why? To ensure patient interests are heard, with concerns increasing over the possible consequences for health and social care
- Some restriction on freedom of movement will be a major topic of Brexit negotiations. The restriction of movement could exacerbate an existing staffing and recruitment crisis in the NHS – but also pose challenges for MedTech and pharma companies looking for skilled staff, depending on the final shape of any new rules
- Pharmaceuticals could face disruption or duplication of processes required to get new medicines authorised
- Divergence between UK and EU regulation for pharmaceuticals and medical technology if the UK leaves the single market would not necessarily be helpful
- The UK will be exempt from the EU’s Working Time Directive – which could influence the working patterns of health and social care professionals
- There could be reductions in funding for science and medical research in the UK with the loss of EU funding and grants
- The departure from the EU could result in additional funding for the health service
- There is some speculation that limiting EU immigration could open up more non-EU immigration – but this remains to be seen
- Government is unlikely to enact wholesale changes to NHS procurement models – this will allow suppliers a measure of certainty
A new Brexit Health Alliance has been launched to speak for the NHS, medical research, industry, patients and public health organisations, to ensure that there is a focus on issues such as healthcare research and access to medicines and technologies during the Brexit negotiations.
It’s negotiation priorities include:
- Maximum levels of research and innovation collaboration
- Regulatory alignment for the benefit of patients and population health
- Preservation of reciprocal healthcare arrangements
- Robust coordination mechanisms on public health and wellbeing
- A strong funding commitment to the health and public health sectors