Does Brexit need a health check? Discussing the NHS post-Europe

Two years since the UK voted to leave the European Union and barely a day has gone by without a Brexit related news story. Hard, soft, squidgy - in the past few weeks we’ve seen politicians in Westminster making the case for every type of Brexit possible. Whilst we await the promised white paper setting out the Government's approach to the second phase of negotiations, it is perhaps a chance to reflect on the impact of Brexit for patients and the medical workforce. 

The RCP has been working to ensure that the interests of patients and doctors are central to the ongoing Brexit negotiations. The RCP’s Brexit priorities span workforce, medical research, collaboration, air quality and reciprocal healthcare.

Although progress across the past 2 years has been slow we are now beginning to get some insight into the Government's thinking. We will continue to ensure that the voices and concerns of our members and fellows are heard, as we did during a recent debate in Parliament which debated the implications of Brexit on the NHS. 

On workforce our first priority was to highlight the huge and essential contribution of EU doctors, 9.3% of the workforce, in the NHS, and seek guarantees for them post Brexit. We welcomed the first phase of negotiations which set out the protections for EU citizens agreed in principle between the UK and the EU. As we move closer to ‘Brexit day’, there are still significant issues to be resolved.

We don’t know what the future immigration landscape will look like and we don’t yet know the government's proposed approach to the mutual recognition of qualifications. Both of these are significant policy issues. The Government's recent relaxation of views on Tier 2 visas for doctors and nurses is helpful but we need to see how this will fit within the Brexit context.

On a positive note, the EU has announced the successor research funding programme to Horizon 2020, which will be called Horizon Europe and operate between 2021 and 2027. There have been various statements made by Government conveying a commitment to the UK continuing to participate in this collaboration, which has a budget of 100bn euros - however nothing is set in stone and terms will still need to form part of the negotiation process. The RCP has called for as close a collaboration on research as possible for the benefit of both patients and doctors - as with many things, the outcome remains to be seen.

Collaboration across Europe ensures that we are able to provide patients with the best possible care, and support doctors to share expertise, for example through European Reference Networks, which focus on support for rare diseases. We know that the European Medical Agency will be relocating to Amsterdam and that the UK's allocation of medicines has been reallocated. We welcomed the prime minister’s announcement in March that the UK will be seeking ‘associate’ membership of the EMA after the UK leaves the EU, but for now the uncertainty continues to cause concerns and we will raise this issue with ministers.

The RCP report Every breath we take highlighted that air pollution is contributing to around 40,000 early deaths a year in the UK and it is therefore vital that the government places protecting health at the forefront of Brexit policy making as it tackles the largest environmental risk to public health. Brexit presents opportunities to strengthen laws and regulations relating to air pollution, and we’ll be encouraging ministers to seize these opportunities.

We recently welcomed Michael Gove’s commitment to consult on a new, independent body to enforce environmental law and the government’s assurances that it will seek to retain EU air quality standards after Brexit. The EU has certainly played a significant role in implementing safeguards that control levels of harmful air pollutants. For example, when fully implemented; the new National Emissions Ceilings Directive is expected to reduce the negative health impacts of air pollution, such as respiratory diseases and premature death, by almost 50% by 2030. 

The future of Brexit remains uncertain but there have been several positive moves over the past couple of years in response to lobbying by ourselves and others. There is much still to be worked out and we will continue to be vocal and evidence based in our approach. Brexit is not something that we can just watch from the sidelines.

Dr Andrew Goddard is the registrar and president elect of the RCP. You can follow him on Twitter at @bodgoddard 

Further information about the RCP’s work on Brexit, and how it might affect you can be found our Brexit policy pages. If you want to get involved in supporting our work yourself, please contact publicaffairs@rcplondon.ac.uk