With Article 50 now triggered and Brexit negotiations to begin in fervour, the head of the NHS European Office considers what lies ahead for the NHS and social care over the next two years and beyond.
After nine months of gestation, the Article 50 Brexit notification has finally seen the light of the day. With today’s letter
informing the European Council of the UK’s intention to withdraw from the EU, Brexit business has become real and the leaving process has formally kicked off.
Today’s notification also marks the start of the two-year timeline for negotiation of an exit agreement, which will set the conditions for the UK’s withdrawal, including budgetary commitments and rights of UK citizens in the EU and EU citizens in the UK.
What is still unclear at the moment is whether during these two years the terms of the new relationship between the UK and the EU will also be negotiated, as requested by Theresa May, or if this will be left for discussions at a later stage once the divorce agreement has been settled.
It is important to make clear that during the next two years the UK will remain a full member of the EU and all the rights and obligations linked to our membership continue to apply. This does not mean, however, that nothing will change for the NHS for two years. On the contrary, some issues have already started to emerge from an NHS perspective.
The appetite to engage UK organisations in collaborative EU-funded health projects has already declined, with our EU counterparts preferring to build partnerships with colleagues in other EU countries for new EU projects, due to the uncertainty that emerged in the aftermath of the referendum.
Furthermore, currency fluctuations have resulted in price increases for NHS purchasers of drugs and other supplies from across the EU, at a time when the NHS is facing unprecedented budget pressure.
More important still, nurses and other health and social care workers across EU countries now see the UK as a less attractive country to migrate to. The weaker exchange rate and the UK government’s aim to reduce future net migration from the EU to the tens of thousands have discouraged some overseas health professionals from applying for jobs in the UK.
This trend is confirmed by recent data from the Nursing and Midwifery Council which show a decline in the number of new applications from EU nurses to join the register. In a similar vein, applications for EU students in UK universities have shown a slight decline.
Both the Prime Minister and the European Commission have indicated that the issue of citizens’ rights should be addressed at the beginning of the negotiations, so that both EU nationals living in the UK and Britons living in Europe can get clarity on whether their current rights will continue post-Brexit, as soon as possible.
We strongly welcome the commitment to address this important issue early in the Brexit process and hope that the resulting clarification will help reassure EU nationals who are considering moving to the UK to work for the NHS or in the social care sector.
Discussions on citizens’ rights will also clarify whether Britons travelling to or living in Europe (and vice versa EU nationals in the UK) will still be entitled to receive healthcare, or not, in the same way as the local population post-Brexit.
This is an important issue considering the number of UK pensioners currently living in southern Europe and the possible implications, in terms of increase in demand for NHS services, should the current cross-border healthcare arrangements not continue in future.
As negotiations progress and a new relationship with the EU is forged, other important issues for the NHS will materialise. This will include the relocation of the European Medicines Agency (EMA) from London and the UK leaving the EMA centralised system for the approval of new medicines. We will be vigilant as to the impact these changes will have on our ability to continue to participate in European clinical studies, and on NHS patients’ early access to innovative treatments.
In the longer term, the negotiation of new trade pacts with different economic regions outside the EU will also be significant from an NHS perspective, as the terms of these agreements could bring implications for public health.
The controversy generated by the EU-US free trade agreement negotiations (TTIP) some time ago is a powerful reminder of the complexity of international trade deals and of the importance of maintaining the highest public health standards.
With these important issues in mind, as the Brexit negotiations now begin in fervour, our office will follow the discussion from our privileged position in Brussels, with close proximity to the decision-makers involved. We’ll be providing helpful, factual analysis to support the NHS during this time of uncertainty and helping to prepare for the changes ahead.
Elisabetta Zanon is director of the NHS European Office, a part of the NHS Confederation.
Hear Elisabetta and Kate Ling, Senior European Policy Manager for the NHS European Office, speak at the NHS Employers and UCEA joint Brexit events.
Follow the organisation on Twitter @NHSConfed_EU
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