This week Brexit negotiations resumed between the UK and the EU. Taking place over video link, this particular round of talks are the last before the EU leaders’ summit on 18 June. The negotiations have so far have made little ground, with both the EU and UK negotiators; Michel Barnier and Sir David Frost, taking contrasting stances on most issues. This is despite the Government’s approach stating a deal would be preferable to reduce barriers to trade and streamline processes. However, the looming end to the agreed transition period at the end of December brings an increased risk of a no-deal outcome. Such a situation would bring a host of implications for health and care providers, the staff that work for them and, by extension, the patients, and residents they serve.
Partnerships at risk
The global coronavirus pandemic has reminded governments across the world of the importance of international collaboration. A global effort to develop a vaccine is only part of international cooperation needed to combat this virus. International emergency PPE supply chains have been established, data and strategy has been shared, crucial clinical equipment has been traded and healthcare professionals have crossed borders.
During the transition period, the regulation of medicines and medical technologies in the UK continues to be managed by EU systems. This facilitates access to medicines and secures standards of patient safety. According to the NHS Confederation, 45 million patient packs go to the EU from the UK each month. The supply chains used to develop these products often involve operations across nations.
With the UK leaving the European Medicines Agency (EMA), the UK will, at the very least, be less attractive to the pharmaceutical and life sciences industry as a place to invest and develop new medicines. However, the impacts could stretch well beyond this. Being outside of the EMA’s rapid authorisation mechanism for pandemic vaccines and medicines means the UK will have to “join the queue” with others outside the bloc to get access to treatments. In addition, and perhaps most importantly, the UK will lose access to the benefits of the “accelerated assessment” of products developed during the pandemic.
In the longer-term, the UK could create a rapid market authorisation mechanism of its own, say Martin McKee, Anniek de Ruijter and Mark Flear, writing in the Guardian, but significant challenges in attracting staff and ensuring consistent standards with the EU would need to be overcome. For companies looking to sell into the EU, it would make perfect sense to base clinical trials at an EU-compliant location.
The UK has already resigned its access to the emergency bulk-buying mechanism for vaccines and medicines and will not benefit from large joint orders with other member states. The Brexit Health Alliance has called for negotiators to provide patients and industry with as much clarity as possible. The group has urged the UK Government to agree the ‘maximum possible’ regulatory and customs cooperation for medicines and close alignment on patient safety and public health conditions with the EU.
Dr Anthony Cox, Senior Lecturer in Clinical Pharmacy and Drug Safety at the University of Birmingham believes a no deal outcome will “complicate” existing drug shortages with “potential border delays.” I am inclined to agree that in the short-term at least with the added pressures of Covid-19, this could be disastrous. These delays will impact everything from medicines to personal protective equipment (PPE).
The UK Government has already introduced a Serious Shortage Protocol for drugs with known supply problems enabling pharmacists to prescribe alternative forms and strengths of medicines without contacting the prescriber. Furthermore, in anticipation of delays at ports, drug wholesalers have been requested to keep six-week stockpiles and an express freight service has been developed.
Of course, whilst medicine supply chain disruption is expected to damage the UK, any disturbance will also impact EU member states connected to the UK, such as Ireland.
As part of the ‘no-deal’ planning last year, industry had heeded the calls of the UK Government to stockpile medicines in preparation for a ‘no-deal’ outcome. Given these stockpiles, the UK was well prepared when the Covid-19 pandemic struck. During the pandemic, the UK has been globally recognised as a world leader in its response from a clinical research perspective. Given the predicted long-term implications, it is important for the UK to recognise the contribution of the life sciences and research sectors, given the likely need to mitigate the negative impact of a ‘no deal’ scenario.
A shortage of NHS and care worker heroes
Perhaps even more concerning than a medicines delay is the impact of a no deal Brexit on the heroes of the NHS and social care sector, the workforce.
Years of free movement have helped build a health and social care system highly reliant upon its foreign workforce. Recent analysis from the Nuffield Trust found that 50 per cent of the total increase in health and care staffing over the past decade has been from workers born abroad, with one in four current hospital staff being born outside of the UK.
EU workers account for some 65,000 (5.5 per cent) of all NHS staff and an estimated 115,000 (nine per cent) of all adult social workers in England. In fact, with exceptions for Norway and an Ireland, the UK has a greater proportion of doctors who have trained overseas than any other European nation.
Brexit has already had a damaging effect on the UK’s ability to recruit specialists from overseas. Data from the General Medical Council (GMC) in 2019 shows the number of doctors joining the UK medical register to be down 40 per cent from 2014. There are contributory factors to this. For instance, the drop in the value of the Pound makes the UK a less appealing option for foreign workers who may now earn less here than in their home countries.
That the Government has sought to provide security to the 165,000 European Economic Area (EEA) staff currently in the UK is reassuring, but the EU settlement scheme must give EU nationals the means and incentive to continue and make the critical contributions they already make. This is most important when agreeing the future of the UK’s immigration policy.
The Government’s proposed system would treat EEA migrants in the same manner as non-EEA migrants, removing limits on the numbers of skilled workers able to come to the UK but simultaneously creating an earning s threshold of £30,000. Clearly, this threshold will have massive implications for the UK’s ability to recruit overseas staff. In no sector will this be more acutely felt than in social care.
Even before the coronavirus pandemic, care providers were reporting climbing vacancy rates across the country, with recent totals in the region of 120,000 (accounting for 9 per cent of all care worker positions). Given the fact that the average wage of a newly qualified social care worker is around £22,000, the new threshold of £30,000 makes recruiting newly trained overseas care workers well-nigh impossible.
If Brexit causes further disruption to overseas recruitment, it is hard to see a way for the sector to meet the growth in demand that will happen as a result of our ageing population and their complex health needs.
With few developments expected this week and a looming end to the current transition period at the end of the year, the likelihood of a ‘no-deal’ exit gets higher and, unless an extension can be agreed, further problems in the healthcare sector will creep over the horizon.
Ben Howlett was formerly Conservative M.P. for Bath and Chair of the Parliamentary Group for Stroke and Rare, Genetic and Undiagnosed Conditions. After leaving Parliament in 2017, he joined global policy institute, Public Policy Projects and advises governments, businesses and organisations around the world on the effective delivery of healthcare. He has authored several evidence-based white papers on the impact of Brexit on the UK healthcare system