Four years on, Brexit negotiations still risk damaging the UK’s NHS
Image: @groovelanddesigns
Nick Fahy, Mark Flear, Mike Galsworthy, Scott L. Greer, Tamara Hervey, Holly Jarman and Martin McKee
In the middle of the COVID-19 pandemic, people all across the UK stood on their doorsteps to give a round of applause in support of essential health workers. This coordinated ‘clap for carers’, along with individual fundraising efforts and the proliferation of homemade signs in UK neighborhoods proclaiming love for the NHS, all speak to the importance that people in the UK place on their healthcare system and their fears that it is failing and could be further undermined.
In June 2016, the UK public voted to leave the European Union. The referendum campaign, which divided the country, was centered on the future of the NHS. Campaigners in support of Brexit claimed, falsely, that leaving the EU would save large sums of money that could be reinvested in the NHS, a claim that found traction with many voters.
After the vote, it became clear that no-one in power had a clear idea of the UK’s path to Brexit, a problem so extreme that Prime Minister Theresa May gave a speech centered around the slogan ‘Brexit means Brexit’. Given that extreme uncertainty, what would be the actual impact of Brexit on the NHS? How could this impact be minimized?
We have spent much of the past four years trying to answer those questions. Our assessments have evolved as the options for Brexit have become clearer, first comparing the consequences of a ‘soft brexit’, ‘hard brexit’ and a failed brexit in 2017, then comparing the potential effects of a No-Deal Brexit, a Withdrawal Agreement, the Northern Ireland Protocol’s Backstop coming into effect and the Political Declaration on the Future Relationship between the UK and EU in 2019.
In each of these assessments, we found that there were very few benefits and substantial harms to the NHS under any Brexit scenario. Above all, a ‘No Deal’ Brexit would produce the worst outcomes for the NHS.
In 2019, our analysis showed the substantial risks to the NHS from a No Deal scenario.
Four years later, Brexit is still being negotiated. The UK/Britain has formally left the EU and is in a transition period which will end on December 31st, 2020. The UK government has rejected the idea that it should call for an extension. If an agreement between the parties is not in place by the end of 2020, their relationship will continue on a ‘No Deal’ basis.
While important details of the path to the UK’s exit remain unclear, more information on the potential shape of the post-Brexit relationship is publicly available in the form of the parties’ negotiating positions. Our analysis of these positions shows that while all forms of future EU-UK relationship are worse for health than continued EU membership, some forms of future relationship are worse than others.
Current negotiating positions show significant risks from Brexit to NHS staffing, funding and capital financing (click for full table)
Our analysis finds that there are some important points of agreement between the parties. The two sides’ negotiating positions on the recruitment and retention of EU nationals, mutual recognition of qualifications, continued reciprocal healthcare arrangements, capital financing, public spending, use of medical isotopes, exchange of comparable data, data protection, cross-border care, public health and research are relatively compatible.
But compatibility of negotiating positions does not negate the risks to health in the UK that stem from Brexit. The biggest risks to the stability and integrity of the NHS going forward relate to recruiting and retaining NHS staff, generating public funding for health and social care, and securing adequate capital financing. Smaller negative impacts on health are likely to result from changes in cross-border healthcare, research collaboration and data sharing.
Other important likely effects on health stem from the UK’s loss of power and influence, both globally and among its European neighbors. Going forward, the UK will no longer be able to take part in setting the rules for one of the world’s biggest markets, and will carry less weight when negotiating with its other trading partners and entities like Big Pharma, for instance when agreeing prices for COVID-19 vaccines or treatments.
Finally, a further set of challenges arises from the flaws in the negotiating process itself, given the UK’s constitutional arrangements. Brexit is a symptom of deep problems within the UK’s governance structures, including political devolution without legal constitutional support, executive dominance and a lack of transparency in political decisionmaking. In the context of the ongoing Brexit negotiations, the UK’s ‘political constitution’ translates into a lack of adequate oversight for the process on behalf of the UK Parliament, legislatures in Northern Ireland, Scotland and Wales, and inadequate broader scrutiny via public debate. These governance problems are likely to persist throughout the transition period and beyond.
