Intended for healthcare professionals

Feature Briefing

How will Brexit affect patient care and medical research?

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4380 (Published 16 November 2020) Cite this as: BMJ 2020;371:m4380

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  1. Layla McCay, director of international relations
  1. NHS Confederation
  1. layla.mccay{at}nhsconfed.org

As part of a series of briefings as we near the end of the Brexit transition period, Layla McCay looks at the potential impact of leaving the EU on patient care and medical research

What impact will the end of the transition period have on patients’ ability to access care in other countries?

Currently, by prior arrangement, UK patients can travel to an EU country, and vice versa, to receive specialist care or have regular sessions of treatment such as dialysis or chemotherapy while abroad. These arrangements will not apply after 31 December 2020, and it’s not yet clear whether a replacement scheme will be put in place and, if it is, to whom it will apply.

If a replacement is not agreed during the current negotiations, existing agreements between healthcare commissioners and providers are likely to continue, albeit on a different contractual basis. Unless mitigation is put in place domestically by the relevant governments, however, people with pre-existing conditions who want to travel on either side of the EU-UK border and to arrange specialist care while abroad could find themselves “uninsurable.”

UK citizens who are already legally resident in an EU country, or vice versa, before the end of 2020 are covered by the Brexit Withdrawal Agreement and can continue to get healthcare in their country of residence as they do now, for the rest of their lives. Arrangements for the provision of specific cross border healthcare services between Northern Ireland and the Republic of Ireland are not based on EU legislation and so shouldn’t be affected by Brexit.

What is happening with the European Health Insurance Card arrangements?

Both parties in the negotiations have said they want to continue something like the EHIC, as the scheme is mutually beneficial and works well. If, however, there is no deal then arrangements will depend on the UK having negotiated a bilateral reciprocal healthcare agreement with each country, and this is likely to be the case with some, but not necessarily all, EU countries. Where no such agreement exists, people travelling in either direction will need to take out comprehensive healthcare insurance, as they do now if travelling to a country outside the EU.

It’s worth emphasising that travellers have always been strongly advised to take out healthcare insurance and not to rely solely on their EHIC, as this only entitles them to medically necessary treatment on the same basis as local citizens and they may still face considerable bills. Also, UK citizens who are already legally resident in an EU country (or vice versa) before the end of this year have a pre-existing entitlement under the Brexit Withdrawal Agreement and can continue to use their EHIC when travelling.

How would a no deal Brexit affect UK medical research, and what might a good negotiated outcome look like?

Without an agreed future relationship agreement, it could become more difficult to conduct EU-UK clinical trials, to share data, and for researchers to travel. Despite both sides concurring on the benefits of collaboration and UK participation in EU framework programmes such as Horizon Europe, the detail and extent of participation are yet to be agreed.

Without association with Horizon Europe, joint research projects would become more difficult to progress as funding and long established collaborative networks that facilitate cooperation would be lost. The UK will also lose access to EU clinical trials infrastructure, which risks disrupting UK participation in cross border clinical research. EU-UK clinical trials benefit patients across Europe, particularly in rare disease areas where there are often few participants in any one country, making international collaboration vital.

To continue work in pan-EU clinical trials, the UK’s future regime should be as compatible as possible with EU regulation to avoid extra quality and safety checks that could delay trial drugs entering the EU from the UK. Further, although the UK doesn’t currently have any covid-19 focused research projects directly funded by the EU, the pandemic has highlighted the imperative for international collaboration and pooling of expertise to find a vaccine or treatments as early as possible.

What will the UK need to do to make up for any shortfall in research funding or projects?

If the UK’s association with future EU Framework Programmes is not possible, a funded alternative would be needed to minimise disruption. In a 2017 survey,1 84% of 135 UK research facilities reported receiving funding from EU sources, so many could be left short if the flow were to stop. While the UK could continue to participate in some parts of Horizon Europe, UK researchers would be locked out of some of the programme, including the European Research Council (ERC) and Marie Skłodowska-Curie Actions.

There is some commitment to make up shortfalls. For example, the UK government announced plans to launch discovery funding to replace prestigious EU science funding streams, like the ERC. The government’s research and development roadmap2 proposes increased investment to £22bn (€25bn; $29bn) per year by 2024-25 and full association with Horizon Europe.

Further, there are discussions on a new UK research agency modelled on the US’s Advanced Research Projects Agency to be established with an investment of around £800m, aiming to support the “high risk, high reward science” that might not be funded outside EU programmes. Additional funding streams have also been suggested, such as Cancer Research UK’s recently announced major global funding partnership,3 to leverage and award large grants to multinational teams.

How many researchers might leave the UK and what are the prospects of them being replaced?

A survey4 conducted last year found that two thirds of European engineers and scientists working in the UK have considered leaving because of Brexit. Worries about job security and losing EU funding were cited as the main reasons, as well as feeling less welcome in the UK.

More recently, a 2020 survey5 by the Association of Medical Research Charities (AMRC) found that concerns persist and that almost a fifth of researchers asked had considered an exit from research because of Brexit. The sector warns that this will only be exacerbated by the effects of the pandemic. Medical research charities fund the salaries of around 17 000 UK scientists, but the impact of the pandemic is already affecting these funding streams.

Funding uncertainty could particularly impact junior researchers’ likelihood of remaining in the UK. For instance, half of the respondents to the AMRC survey reported that their funding will dry up by the end of next year, while 82% said that they feel less secure in their career than they did last year.

In terms of “replacing” researchers who leave the UK, the new UK Global Talent visa presents an opportunity. It offers an accelerated path to permanent settlement, putting applications from EU citizens on the same footing as people in the rest of the world.

Footnotes

  • Commissioned, not peer reviewed.

References

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