Assessing the potential impact on health of the UK's future relationship agreement with the EU: analysis of the negotiating positions.

Nick Fahy,Mark Dayan,Mark Flear,Holly Jarman,Tamara Hervey,Mike Galsworthy,Martin Mckee,Scott Greer

doi:10.1017/s1744133120000171

Abstract

While policy attention is understandably diverted to COVID-19, the end of the UK's post-Brexit 'transition period' remains 31 December 2020. All forms of future EU-UK relationship are worse for health than EU membership, but analysis of the negotiating texts shows some forms are better than others. The likely outcomes involve major negative effects for NHS staffing, funding for health and social care, and capital financing for the NHS; and for UK global leadership and influence. We expect minor negative effects for cross border healthcare (except in Northern Ireland); research collaboration; and data sharing, such as the Early Warning and Response System for health threats. Despite political narratives, the legal texts show that the UK seeks de facto continuity in selected key areas for pharmaceuticals, medical devices, and equipment [including personal protective equipment (PPE)], especially clinical trials, pharmacovigilance, and batch-testing. The UK will be excluded from economies of scale of EU membership, e.g. joint procurement programmes as used recently for PPE. Above all, there is a major risk of reaching an agreement with significant adverse effects for health, without meaningful oversight by or input from the UK Parliament, or other health policy stakeholders.

Highlights

COVID-19 is likely to dominate the health policy agenda for most of 2020 and some time beyond
Data from the Nursing and Midwifery Council show that an inflow of nurses and midwives from the EU into the UK until 2016 has become a net outflow ever since (Nursing and Midwifery Council, 2019)
In November 2019, there were over 100,000 vacancies across NHS England (The Health Foundation, The King’s Fund, and Nuffield Trust, 2018), of which almost 44,000 were in nursing, representing 12% of the nursing workforce, according to the Health Foundation (Buchan et al, 2019)

Summary

Introduction

COVID-19 is likely to dominate the health policy agenda for most of 2020 and some time beyond. The UK government faces the twin challenges of designing and implementing a response to one of the most severe COVID-19 situations in Europe while negotiating its future relationship(s) with the EU How can it secure the ‘least worst’ outcomes for health and the NHS? The worst outcomes for health have been avoided so far, by the entry into force of the Withdrawal Agreement on 1 February 2020, a formal international treaty that establishes a transition period during which the UK is no longer an EU Member State but both parties agree to apply most EU law and policy as if it were This period is scheduled to end on 31 December 2020, by which time the EU and UK should have concluded negotiations on their future relationship and agreed one or more legal texts.

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