Assessing the potential impact on health of the UK's future relationship agreement with the EU: analysis of the negotiating positions

Abstract

While policy attention is understandably diverted to COVID-19, the end of the UK's post-Brexit ‘transition period’ remains 31 December 2020. All forms of future EU−UK relationship are worse for health than EU membership, but analysis of the negotiating texts shows some forms are better than others. The likely outcomes involve major negative effects for NHS staffing, funding for health and social care, and capital financing for the NHS; and for UK global leadership and influence. We expect minor negative effects for cross border healthcare (except in Northern Ireland); research collaboration; and data sharing, such as the Early Warning and Response System for health threats. Despite political narratives, the legal texts show that the UK seeks de facto continuity in selected key areas for pharmaceuticals, medical devices, and equipment [including personal protective equipment (PPE)], especially clinical trials, pharmacovigilance, and batch-testing. The UK will be excluded from economies of scale of EU membership, e.g. joint procurement programmes as used recently for PPE. Above all, there is a major risk of reaching an agreement with significant adverse effects for health, without meaningful oversight by or input from the UK Parliament, or other health policy stakeholders.

How will Brexit affect the healthcare workforce?

“…Increased vigilance over fitness to practise will therefore be critical to maintaining standards of patient care. 13 The outcome of the negotiations will have implications for working conditions. The EU wants to secure a non-regression clause in labour standards, whereas the UK wants the ability to develop standards independently.…”

“…However, exchange of information about fitness to practise cannot occur, as the UK will lose access to the EU’s Internal Market Information system because it insists on leaving the internal market. Increased vigilance over fitness to practise will therefore be critical to maintaining standards of patient care 13…”

“…If there is no agreement, erosion of employment conditions may compound the impact of immigration changes on staffing levels. However, domestic law and policy could embed working conditions in practice: the terms of junior doctors’ contracts in England include existing working time rules based on EU law, although these protections have long been a target of Brexit supporters 1314…”

The changing health needs of the UK population

“…121 However, the UK has failed to engage effectively with the process of negotiating a future trade deal with the EU. 122 As of November 2020, the prospect of anything more than a minimal agreement in place in early 2020 seems remote. This makes it very difficult to have any clear understanding of what the future situation might be.…”

Impact on the NHS and health of the UK's trade and cooperation relationship with the EU, and beyond

“…In addition, the 'Common Travel Area' (CTA), a set of arrangements that has evolved over time allowing largely free movement between the UK, Ireland and the Isle of Man and Channel Islands, profoundly affects the UK's relationship with the Republic of Ireland. These agreements governing the UK's relations with the EU have avoided some of the worst consequences for health and the National Health Service (NHS) (Fahy et al, 2017(Fahy et al, , 2019(Fahy et al, , 2020. Although all forms of Brexit are bad for health, some (especially 'No Deal Brexit') would have been worse than others.…”