Intended for healthcare professionals

Rapid response to:

Editor's Choice

Seeking informed consent on Brexit

BMJ 2018; 363 doi: (Published 15 November 2018) Cite this as: BMJ 2018;363:k4816

Rapid Response:

Re: Seeking informed consent on Brexit

Dr Morris is, unfortunately, misinformed on a several counts.

First, his belief that there is a “general fading of the importance of nation states” suggests that he is unaware of the arrangements by which the European Union is governed, with major decisions taken by the European Council, comprising the governments of the member states. These governments have agreed to pool their sovereignty but this enables them all to have a stronger voice on the global stage. Indeed, it is widely accepted that, if it leaves, the voice of the UK will be diminished and, in reality, it is the UK whose power will begin to fade.

Second, he seems to believe that the National Health System, funded from taxation, is somehow unique in Europe. It is not. Very similar systems operate in the Nordic countries and several in Southern Europe, such as Spain, Portugal, and Italy. Indeed the current health systems in Spain and Portugal drew heavily on the NHS when those countries transitioned to democracy in the 1970s, in part because many of those involved had trained in the UK.

Third, the European Treaties have always been absolutely clear that the organisation of health care is a national competence. The European Union has a very limited role, largely in facilitating co-operation among member states -- for example, to ensure that British migrants, and especially pensioners moving to countries such as Spain, can take advantage of freedom of movement knowing they will have access to health care, or to enable those caring for children with rare diseases to access the best advice available within Europe through the European Reference Networks. The German sickness funds would be just as upset as Dr Morris is about the NHS if the European Commission started to tell them how to run their health systems.

In another response, Mr Newman makes several claims that are demonstrably false. We may wish to read the proposed Withdrawal Agreement to discover what the £39 billion payment will give us. Quite simply, the UK wants to continue to benefit from many EU programs and this costs money. Similarly, he may wish to read the proceedings of the Commons Health and Social Care Select Committee if he really believes that leaving with no deal will be on no long term detriment.

We should be grateful to Dr Morris and Mr Newman for reminding us that there is an enormous lack of understanding about how the European Union actually works and why it is so important for health. This is perhaps unsurprising given the continuing false statements by pro-Brexit politicians and the seeming inability of many British journalists to challenge them. It is not, however, excusable.

Competing interests: MM receives research funding from the European Commission

05 December 2018
Martin McKee
Professor of European Public Health
London School of Hygiene and Tropical Medicine
15-17 Tavistock Place, London WC1H 9SH