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04 Dec 2018


Relationship with the EU

In the case of a no-deal scenario, it appears inevitable that there will be some impact on NHS delivery of services, recruitment of healthcare professionals and access to medicines. Very clear contingency planning may ameliorate some of the impact, reveals a new report by the academic group The UK in a Changing Europe, which includes researchers from the University of Birmingham.

The report, entitled ‘The NHS and Health Law Post Brexit: Views from Stakeholders and the Devolved Jurisdictions’, evidences major concerns expressed by interviewees as to the position of cross-border care in the border regions of Northern Ireland and the Republic of Ireland.

This provision is currently facilitated by a combination of EU law and bilateral agreements. Concerns were also raised that a no-deal scenario may lead to an exclusion from the EU Patients’ Rights Directive.

This could impact upon patient care in Northern Ireland where currently some patients have been referred to other EU member states for treatment. It is uncertain whether there will be attempts to continue such referrals post Brexit. While bilateral agreements with other EU member states may still be utilised as a means of addressing waiting lists, this may incur greater costs.

More broadly, the report considers the impact of Brexit on the NHS in the devolved jurisdictions from the perspectives of professionals and patients, pharmaceuticals and public health.

The report draws upon 22 semi-structured interviews with key stakeholders in the health sector in England, Northern Ireland, Scotland and Wales. The report shows experts on the ground are concerned about many aspects of health post-Brexit.

There are particular worries about a No-Deal Brexit, especially in Ireland; in terms of supply of basic consumables to hospitals and in how robust current practices for responding to shortages would be.

Professor Jean McHale, research leader for The UK in a Changing Europe and director of the Centre for Health Law, Science and Policy, University of Birmingham said: “Our research shows that there remains considerable concerns amongst stakeholders in relation to the impact of Brexit on the NHS.

There are particular worries regarding the impact of a no-deal Brexit on the island of Ireland, on staffing , the supply of consumables to hospitals, access to safety and vigilance networks and  on public health in the future.”

Other key findings of the report are:

  • Staffing remains a major issue to be resolved. Brexit is occurring in the context of a chronic shortage of healthcare professionals throughout the UK, but particularly severe in Northern Ireland.
  • The prospect of shortages in access to medicines but also to a range of other consumables is a matter of concern. Normally responses to shortages are centrally run and there is clearly an interface with the devolved jurisdictions. The key issue is the likelihood of multiple shortages taking place all at once, meaning that the normal responses are inadequate. The size of NHS England compared to devolved nations leads to worries about how professionals in Northern Ireland, Scotland and Wales will access consumables in order to treat patients, especially in the event of a no-deal Brexit.
  • Public health remains a concern amongst stakeholders across the devolved jurisdictions. There are perceived dangers that standards may be weakened due to the influence of commercial considerations, particularly in tobacco regulation.
  • Future regulation of e-cigarettes remains a matter of debate and indeed disagreement within devolved jurisdictions.
  • Concerns were raised as to the impact on the EU of the UK no longer being part of the EU public health networks. The relationship with ECDC should be pursued by the UK Government.
  • As a number of interviewees noted, the UK through its membership of the EU is involved in a range of vigilance systems that operate in relation to health professionals, pharmaceuticals, medical devices, blood and tissue which facilitate the protection of patient safety. Without a specific agreement, the UK will be excluded from these systems.
  • The social determinants of health and the potential adverse impact of Brexit on this through the loss of EU structural funding support and also potential adverse impact on industry from Brexit has been particularly highlighted in Wales and Northern Ireland. The practical potential adverse impacts of this on health need to be addressed by policy makers in the immediate, intermediate and long term period of Brexit.

You can download the report here.


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