Brexit: The negotiations begin

The Brexit negotiations started on 19 June 2017, but are they going anywhere, asks Martin McKee. Regardless of what happens, there are now three fundamental threats to the NHS and health policy in the UK, he says.

Read more about the implications of Brexit on the NHS and healthcare with our Brexit opinion pieces.

One in 10 doctors have European colleagues who have left the UK because of Brexit, says BMA

Brexit poses financial risk to NHS finances, trust leaders warn

The results are in

On 23 June 2016 the UK government held a referendum on EU membership. Vote Leave won with 52% of the votes.

In the immediate aftermath of the vote, we set up a live blog to track reactions from health experts and scientists, and in the week that followed asked a range of people for their thoughts

Blame austerity not immigration for the inequality underlying the referendum decision, says Danny Dorling. "Almost all other European countries tax more effectively, spend more on health, and do not tolerate our degree of economic inequality. To distract us from these national failings, we have been encouraged to blame immigration and the EU," he says. 

Journalist Anne Gulland followed this with a deeper assessment of the outlook for UK science and health outside the EU, considering how Brexit will affect NHS finances, the pharmaceutical sector, key public health legislation, and other sectors. 

In related news stories BMJ journalists Tom Moberly and Gareth Iacobucci report, respectively, on how Brexit threatens the stability of the medical science workforce and NHS staffing.

Martin McKee has written three blogs: one looking at the impact that this vote might have on health, a second blog discussing the growing confusion as Britain has been thrown into political turmoil, and finally a third blog lamenting the fact that we live in a post factual society. This has important implications for communicating science and health messages, he says. US doctor Bill Cayley says this sends out a warning signal to the US for their forthcoming presidential elections. Margaret McCartney discusses our messy divorce from the EU. John King, a retired doctor, offers his thoughts saying "Terrible crimes are committed in the mistaken belief that “there is no going back.” David McCoy offers some chance of hope in among the despondency by telling doctors what they can do so that "the voice of the progressive health community is heard loudly and clearly."

A month after the vote and we are still not any clearer about how Brexit will play out. However, some experts have warned that it will hamper the introduction of seven day services in hospitals, and the government has had to look into claims of discrimination against UK scientists.

On a more positive note, Clare Marx, President of the Royal College of Surgeons of England blogs about how to make the best of Brexit.

European Working Time Directive

What is the future of European legislation enacted in the UK? Abi Rimmer considers what might happen to working time rules if the UK left the EU. In a related editorial, Andrew Goddard wonders whether the decision to leave the EU will mean the end of the EWTD, although he says that this will not happen yet and not without an act of parliament.

The Brexit debate

The articles listed below are a collection of free articles and other resources published in the run up to the referendum from The BMJ about the pros and cons of "Brexit" in relation to medicine, pharma, research, the law, the NHS, and global trade agreements.

The BMJ's editors believe the UK should stay in Europe. Their article arguing for Remain was published on 14 June. A second article was published at the same time by Conservative MP and former GP Sarah Wollaston. Wollaston, chair of the UK Parliament's health select committee, explained why she had switched from supporting Brexit to supporting the Remain campaign.

The journal's regular columnist Margaret McCartney also joins the debate, concluding: "I wouldn’t wish to leave a union where the NHS and research community benefit from close ties with colleagues across the EU. We should not want to be Little Britain."

What Brexit could mean for . . . The NHS?

David Owen

The launch of the Vote Leave group’s Save Our NHS campaign in April 2016 warned of the growing control and influence the European Union would have over the NHS if the country voted to remain in the EU. Pro-EU campaigners accused the group of “scaremongering” and said that the NHS would be protected from trade deals. 

In a letter to The Times newspaper published on 14 June, 60 former presidents and chairs of medical royal colleges and the BMA set out why the UK should remain in the EU.

This article examines what the leave campaign said about the NHS, and how the experts answered. Stephen Dorrell, a former Conservative health secretary, and now chair of the NHS Confederation, told the Confederation's annual conference on 15 June: “We need a strong economy to guarantee the growth in funding that the health and care service requires and evidence suggests leaving the EU would undermine this.” 

Not all prominent doctors share their views. David Owen, the former Labour foreign secretary who was health minister at the time of the last European referendum in 1975, said: “We in the cross-party Vote Leave campaign, however, share a common democratic commitment. We will restore legal powers and democratic control of the NHS to voters in the UK. If we vote to leave, we will be able to protect our NHS from EU interference."

But would a post-Brexit NHS look any different? Anne Gulland investigates

Public health

EU legislation covers everything from food labelling to disease control, so how might a Brexit affect policies and activities that promote the UK's health? Anne Gulland assesses the effects of leaving in key public health battlegrounds, including marketing and pricing of alcohol and tobacco, food standards and legislation, and environmental health. Retired civil servant Bernard Merkel offers a personal perspective, based on his experience of working with the European Commission on its public health programmes.

Pharma

Big UK based drug companies have said they want the country to remain in the EU. Would a Brexit affect access to medicines? Anne Gulland investigates.

Finance

John Appleby

Economist John Appleby's analysis concludes that after 43 years of membership of the EU, unwinding agreements, obligations, and laws, and then renegotiating trade, security, legal, and other relationships with the EU is unlikely to be a snappy or straightforward process.

He adds: "The problem for referendum voters keen on evidence is that there is no comprehensive and reliable cost-benefit analysis that weighs up the facts, the positives and negatives, over the short, medium, and long term and across different groups in society of exiting or remaining in the EU."

Trade

Martin McKee

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, asks if the survival of the NHS is threatened by continued British membership of the European Union, with a particular focus on the Transatlantic Trade and Investment Partnership (TTIP), which if agreed would ease trade between the EU and the United States.

Employment law

Chris Cox

What would a Brexit mean for employment law in the UK? Christopher Cox, director of membership relations at the UK Royal College of Nursing, says the EU has been the source of many employment rights, including working time, work-life balance, key areas of equality including equal pay for work of equal value, and the treatment of part time, fixed-term contract, and temporary agency workers.

"If there was a vote in favour of leaving, many complex issues would have to be resolved. It would take at least two years, if not longer, to serve notice of withdrawal and agree terms with the remaining Member States," he concludes.

Looking specifically at doctors, Anne Gulland assesses how leaving the EU would affect working conditions, and in a separate article, asks if Brexit would stop the flow of doctors and patients between EU countries.

Science and research

Paul Nurse

In April 2016 a report by the House of Lords Science and Technology Committee warned that leaving the European Union would cost UK scientists money and influence. Research funding is one of the few areas where the United Kingdom gains more money than it spends, said Nigel Hawkes in his news article, adding: "Of the country’s gross contribution to the EU, £5.4bn (€6.84bn; $7.77bn) can be attributed to the community’s research, development, and innovation activities. But the UK gets back £8.8bn in research grants, so exiting the EU would in theory leave a gap of £3.4bn to be filled."

Paul Nurse, director of the Francis Crick Institute and former president of the Royal Society, had earlier said that anyone in the UK science and research disciplines who supported the so called “Brexit” was displaying “naivety” and “intellectual laziness.” A letter published in The Sunday Times, signed by more than 100 university leaders, claimed an exit would harm UK research and damage universities’ education alliances.

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