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Brexit: the clock is ticking

BMJ 2018; 362 doi: (Published 27 September 2018) Cite this as: BMJ 2018;362:k4057

Brexit’s Long-term Impact on British Patients: A View from Brussels

The British media, economists, and medical community have focused largely on the implications for health British citizens will wake up to on Saturday morning, 30 March 2019, after shutting the door behind them on more than 45 years of membership in the largest and most successful economic and political union in modern history. What will be the impact of Brexit on the British citizen’s access to medicines and other medical interventions? What will be the impact on the availability of qualified medical personnel? What will be the impact on the National Health Service and on private healthcare? What will be the impact on health-related research? What will be the impact on the British citizen’s access to healthcare – in the United Kingdom and in the European Union?

Be it a ‘good deal’, be it a ‘bad deal’, be it a ‘no deal’, undoubtedly all the above aspects of public health will be impacted. And given the fact that Downing Street has yet to address these questions with concrete and public analyses alongside clear policy approaches, few would argue the impact on British patients will, regardless of which ‘deal’, be in anyway positive for the following 3 months, 3 years, 5 years. Trading access to good and reliable healthcare for Westminster’s autonomy may be a price some are willing to pay if the consequence of ‘being a few pills short’ is only for a relatively short period.

In Brussels, however, while we are concerned for British patients in the short term, believing any curtailing of access to the full range of health services is unacceptable, our larger worry is that British patients are so willingly foregoing their place at the European discussion table. When President Obama stood beside Prime Minister Cameron and threatened (unwisely) the British people with ‘the back of the line’ (one Obama policy President Trump appears in no hurry to rescind), President Obama missed what was most important to British patients: having their voice heard in all matters concerning their complaints and having the necessary and sufficient resources (medical, scientific, economic) employed to expediently address their ailments.

The exodus of the UK from the EU will likely not entirely stymie the voice of British patients on the continent, but it will surely result in a weakened voice outside vital decision-making – and this not only in the short term. The British patients' access to medicines, access to science and innovation, and even access to hospital care will suffer even more in the long term than in the short term.

Why would British patients trade their place at the European table for decisions made solely in London rather than jointly with their European partners: those suffering the same complaints, the same diseases? We in Brussels are looking also to the long term for British patients, and we are at a loss to understand their coming absence from our discussion table following all we achieved together. For us this is a hard pill to swallow (if swallow we must).

Competing interests: Francis P. Crawley has worked for more than 25 years at the intersection of patients, science, and ethics with patient organisations and researchers on both sides of the Channel, including several European-funded projects to build patient consortia and ensure their voice at the European discussion table. He is an active member of the Faculty of Pharmaceutical Medicine, Royal Colleges of Physicians, London.

29 September 2018
Francis P. Crawley
Executive Director
Good Clinical Practice Alliance - Europe (GCPA) & Strategic Initiative for Developing Capacity in Ethical Review (SIDCER)
Brussels & Leuven, Belgium