Cooperation over health and medical provision in the EU has never hit the headlines – but it has undoubtedly saved many lives. The detachment of the UK from this system now threatens lives. Yet the government appears oblivious to this.
For example, we have a jointly agreed system in Europe for sending medicines across borders without hold-up or delay. Every month, some 45 million packs of medicine move from the UK to EU27/EEA countries, with 37 million moving from the EU27/EEA to the UK.
This works because we have agreed common regulations, safeguards, methods of supervision and legal redress. Keeping (some of) the EU regulations, as the government is now proposing, is not enough: it’s the ecosystem of cooperation and collaboration on practical details, of joint supervision, and of legal safeguards (backed up, in the event of disputes, by the ability to go to the European Court of Justice), that matters.
Without this, and even more so if trade between the UK and EU be subject to border inspections, import/export declarations and goods-testing (or even customs duties and import VAT), there will be significant disruption to the supply chain for medicines.
Another vital part of the EU ecosystem is the European Medicines Agency (EMA). This acts as the hub of a network for regulating, testing and approving medicines across the EU and EEA. The UK’s national regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) has acted as an important member of this network. The MHRA was responsible for arranging and supervising the tests for about one in five of the EU procedures for licensing medicines now prescribed across Europe, including in the UK. The UK agency also carried out over 30% of manufacturing inspections coordinated ultimately by the EMA.
Over 2,600 medicines are made (or have part of their manufacturing process) in the UK. Some 1,000 medicine licences are held by UK-based legal entities and would need to be transferred to an EU-based legal entity if there is no agreement on retaining ongoing cooperation with the EU on the regulation of medicines.
Also overlooked is the fact that research into rare diseases is far more effective across the 500 million population of the EU than in any given country, where there are too few cases for meaningful research. This is currently organised around 24 specialist centres on a pan-EU basis and the UK currently leads research in a quarter of these. Leaving the EU would mean leaving this network with a double whammy of implications: highly specialised research jobs and funding moving out of the UK, and access to medical trials for rare conditions no longer being available to patients in the UK.
There are other numerous others examples of cooperation across Europe for the benefit of public health. The European Centre for Disease Control provides a common database for EU countries with the latest information on communicable diseases outbreaks and public health risks. The EudraVigilance system, operated and monitored by the European Medicines Agency, focuses on medicine safety. In addition, the UK is now starting to implement the EU’s Falsified Medicines Directive; its rules mean that most medicines prescribed all over Europe will in future be verified for authenticity when dispensed.
Unless we manage to negotiate otherwise, Brexit also means going over a cliff edge regarding the rules that support Europe-wide patient safety. No patient wants to hear the words “Sorry, we don’t have that medicine any more” or “we can’t use this device as it’s no longer authorised”. Yet that might be the consequence of leaving Europe’s system of common standards and mutual recognition of medicines and medical devices.
Put simply, the entire integrated and coherent pan-European system for medicines and patient safety, which has taken years to build, looks like fracturing with Brexit.
And at home, our health and care sectors cannot function without EU staff. Some 165,000 European nationals, including 90,000 in adult social care and around 60,000 in the NHS itself are employed in the UK. Nearly one in ten NHS doctors are EU citizens, many specialising in areas of treatment that are already facing severe workforce shortages. We have 21,000 nurses and over 13,000 clinical support staff who are from the EU If they left, the workforce crisis our NHS currently faces would become a catastrophe. And they are starting to leave, or not coming to the UK in the first place. NHS figures released in September 2017 showed 10,000 EU employees had already quit. NHS recruitment from the EU has fallen, with the number of nurses and midwives coming to work in Britain from Europe falling by 89% in the year after the referendum and the number of doctors falling 9% in 2017 to an eight-year low, according to the General Medical Council.
Then there is the more mundane matter – but still vital in certain circumstances – of what happens to the European Health Insurance Card (EHIC), which we all rely on when travelling in the EU to guarantee emergency health care at no extra cost. “Brexit means Brexit” says Theresa May. So is it goodbye to that too? Will we all have to take out special private insurance whenever we travel?
No wonder more and more people are asking “Brexit – is it worth it?”