NHS European Office

With the Brexit white paper now unveiled, what next for the NHS? | Elisabetta Zanon

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The head of the NHS European Office takes a look at how exiting the EU will impact the health sector.

The publication of the government white paper today setting out its plans for Brexit, together with Theresa May’s speech on 17 January and Jeremy Hunt’s appearance before the Health Select Committee on 24 January have allowed us to shed some more light on how exiting the EU will impact the health sector.  

What has become clear is that the UK will leave the EU single market and that it will seek to sign a comprehensive free trade agreement with the EU which will allow us to trade goods and services with the EU with as few barriers as possible in the future. This is a very significant clarification because, as I stated in some of my previous blogs, one of the main elements for assessing the potential impact of Brexit on the NHS is whether or not we will remain in the EU single market post-Brexit. 

The Prime Minister has confirmed that controlling immigration is our top Brexit priority and indicated that it is her intention to bring annual net migration to the UK down to the tens of thousands. This means that one of the pillars of the EU single market – the free movement of workers – will cease to apply once we leave the EU and that a different migration system will be applied to EU and EEA nationals. A system which could, for example, be based on work permits or visas and which potentially could make it more difficult or time consuming for the NHS and the social care sector to recruit from across the EU.

Jeremy Hunt provided reassurance to the Health Select Committee of the government’s intention to increase the number of domestically trained health professionals. He also indicated that he will make sure that we have an immigration policy that, first, meets the needs of the health and social care system, and, secondly, meets them efficiently without long or complex processes. 

With newly emerging evidence that the number of EU qualified nurses on the Nursing and Midwifery Council register has decreased recently and that applications via UCAS to nursing and midwifery courses at English universities have dropped by more than 20 per cent after the abolition of bursaries, from an NHS perspective it will be crucial that this promise is maintained when decisions on the new immigration system are taken.  

Both Theresa May and David Davis, including in his statement to the House of Commons today, emphasised that any future migration system will continue to allow us to recruit highly qualified professionals, but a question mark still remains over the position of less qualified workers whose contribution is vital to maintain our health and social care services. Through our membership of the Cavendish Coalition our office is ensuring that this important group will not be overlooked.

Another important consequence of leaving the EU single market will be that, as the Secretary of State made clear, the UK will no longer be part of the European Medicines Agency (EMA) system. For two decades, the EMA has overseen medicines regulation across the EU and has granted pharmaceutical companies a single marketing authorisation that provides access across the whole of the EU market. Mr Hunt indicated that while leaving the centralised licensing system for medicines, we will seek strong partnership with the EMA, ideally through a form of regulatory equivalence, such as mutual recognition of licences. He was however very clear that this will depend on the outcome of the UK-EU negotiations. 

The experience of Switzerland – a non EU country with a strong pharma sector – shows us that the majority of new medicines are approved in that country with a delay of almost 6 months. This is because pharmaceutical companies think carefully about their launch sequences for new products and usually file an application to the EMA and FDA (the regulator in the USA) first, and only after that consider whether to fill an application in other smaller markets. 

The EMA serves a market of over 500 million people across the EU, accounting for 25 per cent of all global pharmaceutical sales. On its own, the UK accounts for around 3 per cent and therefore particular attention should be paid to ensuring that leaving the EMA system will not result in delays for NHS patients in accessing innovative therapies.

Ending our membership of the EU single market also raises issues about whether the European Health Insurance Card and other EU arrangements which allow citizens to receive healthcare in another EU country on the same conditions as their nationals will continue to apply, or not, after our withdrawal from the EU. When giving evidence Jeremy Hunt stated that it is possible to agree the continuation of reciprocal healthcare rights as they currently exist.  However, as these rules and mechanisms are intrinsically part of the functioning of the EU single market, this will clearly be a matter for the UK-EU negotiations. 

The Secretary of State also made it clear that leaving the EU single market and European Court of Justice Jurisdiction could also offer opportunities to adapt elements of EU law in a positive way. He cited in particular EU rules on the recognition of qualifications, saying that there could be the possibility to review elements of the legislation in a positive way and in particular to introduce new clinical competence testing for EU’s doctors to bring it in line with the testing for non-EU migrant clinicians. 

All these are important changes from an NHS perspective and full consideration should be given to their possible impact in terms of patient care and the operation of NHS frontline services as the UK Government shapes its negotiating position.  The NHS Confederation, through our European Office, will follow the progress of discussions, both in Brussels and in the UK, very closely. Our aim, as ever, will be to do our utmost to ensure the needs of the NHS and our patients are right at the top of the political decision-makers’ agenda.

Elisabetta Zanon is director of the NHS European Office, part of the NHS Confederation. Follow the organisation on Twitter @NHSConfed_EU

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