Offline: UK citizens are losing the right to health—who cares?

Abstract

If and when Brexit takes place, 66 million people living in the UK will lose their legally enshrined right to health care. The loss of this fundamental right has been almost totally missed in the debate about the UK's departure from the European Union (EU). Yet the forfeiture of this legal right to health care is the most important setback ever seen in the country's quest to protect and advance the health of its people. How has this calamity come about? The European Convention on Human Rights came into force in 1953. Although Article 2 of the Convention states that “Everyone's right to life shall be protected by law”, there is no statement about the right to health care. The UK entered the European Economic Community (as it was then called) in 1973. Over the next two decades, political momentum to extend the rights offered to European citizens grew. Written in 2000, the Charter of Fundamental Rights of the European Union codified the right to health care for the first time. Under Chapter 4 (entitled “Solidarity”), Article 35 states that: “Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices.” The Charter became European law in the Lisbon Treaty of 2009. The UK sought an opt-out from the Charter and believed it had negotiated an exemption. But subsequent experience has shown that the British opt-out has no legal force. The rights established under the Convention are protected through the European Court of Justice. It is these rights, including the right to health care, that UK citizens will lose if and when Brexit becomes a reality. Why? Because the UK Government has made it clear that the Charter will not be retained in UK law after Brexit. The progressive realisation of the right to health in the UK will not only stop. It will regress. The loss of the right to health care for UK citizens will place great responsibility on two institutions to ensure that this right remains foundational to any notion of modern British society. First, Parliament. However, as we have seen from the political chaos since the referendum of June 23, 2016, UK citizens cannot rely on Members of Parliament (MPs) to guarantee the right to health care. MPs have been utterly unable to define a progressive future manifesto for a post-Brexit world. Second, the health professions. In 2005, Baroness Julia Cumberlege chaired a Working Party for the Royal College of Physicians entitled Doctors in Society (disclosure: I was a member of her Working Party and drafted its final report). We redefined the concept of medical professionalism and wrote that the values of medicine “form the basis for a moral contract between the medical profession and society. Each party has a duty to work to strengthen the system of healthcare on which our collective human dignity depends”. We explained: “It seemed to us that the idea of a moral dimension to medicine was important. It indicated something right and good in relation to the behaviours and actions of a doctor. The ultimate expression of those behaviours and actions is perhaps best summed up in the idea of a contract between the public and the profession—a moral contract.” Last week, Dinesh Bhugra, President of the British Medical Association Council, convened a roundtable discussion to review medicine's contract with society. The conclusions of this meeting were that the idea of a social contract between medicine and society remains relevant in today's National Health Service, but that this contract is under threat from corrosive government policies, rising public expectations, and increasing demand for health care. The loss of the right to health care after Brexit was not discussed. But without that right, it seems clear that the social or moral contract between health professionals and society becomes the chief instrument for defending the right to health care. Never has more political responsibility for health been in the hands of health professionals. Whatever one's views about the merits or otherwise of the EU, Brexit will eliminate the right to health care enjoyed by the British people since the Lisbon Treaty. It is now an urgent imperative for doctors, together with fellow health professionals, to work together to demand a UK Constitution that reasserts the soon to be lost right to health care.