The impact of Brexit on the NHS has been a source of debate and controversy ever since the £350million figure appeared on the side of a bus during the EU referendum in 2016. As we we closer to 29 March 2019 – the official date the UK is about to leave the EU – what will the impact of Brexit really look like for the NHS, its staff and its patients?
There is a long list of concerns.
First, there is the future recruitment and retention of NHS professionals from EU Member States, and in particular nurses. Since the referendum, there has been a huge drop in the number of nurses from EU countries on the register of nursing professionals.
Just yesterday, the Royal College of Nursing warned that Brexit could particularly affect nurses based near the border with the Republic of Ireland, and that this poses a big threat to patient care. Ireland; cross-border collaboration and cooperation currently facilitates the delivery of care in a variety of areas.
For example, children’s heart surgery is no longer performed in Northern Ireland and children are instead transferred to a hospital in Dublin.
With this, as with many other issues, clarity over the position of the Irish border is vital.
If a withdrawal agreement with the EU is not finalized and the UK ends up in a no-deal situation, UK patients will no longer be able to rely on their European Health Insurance Cards (EHICs) which give currently access free or reduced fees for necessary care. medical care in EU Member States.
The Withdrawal Agreement offers current UK citizens abroad, such as pensioners in Spain, the right to access healthcare under existing EU reciprocal rights – without it they could be subject to considerable treatment costs should they fall ill.
Those traveling at this time would be well advised to ensure they have comprehensive travel insurance. Some patients with complex disorders, unable to obtain affordable travel insurance, may even decide they cannot take the risk of travelling.
Although there is a withdrawal agreement and a transition period until December 2020, there is no agreement yet on the continuation of EHIC insurance in the future.
But what about people in the UK? What impact will Brexit have on the supply and access to medicines, for example?
Concerns have been raised about possible further customs delays in a no-deal scenario.
The UK government has indicated that a six-week stockpile of drugs will take place. In the case of products with a limited shelf life, such as medical isotopes used by radiographers, specific arrangements will be made for these to be airlifted to the UK.
But such arrangements entail considerable additional costs for the NHS.
As it stands, without a specific deal with the EU on medicines, post-Brexit the UK will also no longer be part of the EU regulatory regime.
What does that mean?
Currently some, but not all, medicines marketed in the UK are subject to approval by an EU body, the European Medicines Agency (EMA), and some medicines such as pediatric medicines must go through this centralized process.
If approved by the EMA, the authorization is valid throughout the EU.
The government has said there will be consultations in the autumn on necessary changes to UK legislation in this area, including new regulations for medicines currently approved by the EMA.
Although this would regularize the situation in the UK, manufacturers would need to obtain additional approval if they intended to market the drugs elsewhere.
The government has also indicated that it wishes to continue to align itself with European legislation governing clinical trials on medicines; a new regulation is due to come into force in 2019, but after the March deadline.
Without a special agreement, the UK will then be excluded from other aspects of the approval process for these trials, such as a new centralized EU database.
Once no longer part of the EU pharmaceutical regulatory structure, the UK may no longer be considered by pharmaceutical companies as a priority launch market.
This would mean that new drugs could be launched later in the UK than in other EU countries, and patients could suffer.
Uncertainty remains over whether the Withdrawal Agreement and transition period will be concluded in the autumn and the vital Irish border issue remains to be resolved.
The prospect of a no-deal, cliffside Brexit for an already cash-strapped NHS desperate to maximize resources and staff is a very real concern – and time is running out.
Professor Jean McHale was co-author of the report, Cost of No Deal Revisited from the UK in a Changing Europe.