This is the latest in a series of posts looking at the UK Government’s White Paper on the Future relationship between the UK and the EU (PDF, 748 KB). For a general overview of the proposals see our previous blog post.
This post looks specifically at elements of the White Paper that are most relevant to health.
The Welsh Government’s policy paper Brexit and fair movement of people states that the NHS in Wales is reliant on EU workers at every level. The Welsh NHS Confederation Policy Forum (PDF, 625.7KB) highlights that, as at April 2018, 1,462 individuals directly employed by the NHS in Wales identified themselves as EU nationals (1.6% of the total workforce).
This might not seem much but it includes a significant number of trained, qualified and dedicated staff who could not be replaced in the short term - for example, 6.2% of medical and dental professionals working in the Welsh NHS identify as EU nationals.
The social care workforce is a serious concern, highlighted by the Welsh Government and stakeholders in the health and care sectors. There is a lack of robust data on the make-up of this workforce, although it’s known that the number of EU nationals working in social care is much greater than those working in the NHS.
The Welsh NHS Confederation has said that the priority after Brexit should be to ensure that the UK can continue to recruit and retain much needed health and social care staff from the EU and beyond, while increasing the domestic supply, through robust workforce planning. Any future UK immigration rules must recognise health and social care as a priority sector for overseas recruitment.
What does the White Paper say?
As set out in the White Paper, free movement will end on 31 December 2020. A new framework for mobility will apply from 1 January 2021 and will set out how individuals from the EU and elsewhere can apply to come and work in the UK.
- The UK will seek reciprocal mobility arrangements with the EU, including facilitating mobility for students and young people, ‘enabling them to continue to benefit from world leading universities and the cultural experiences the UK and the EU have to offer’.
- It proposes a system for the mutual recognition of professional qualifications.
- Existing workers’ rights under EU law will continue to be available in UK law from the day of withdrawal.
The Brexit Health Alliance (which brings together the NHS, medical research, industry, patients and public health organisations) has called for straightforward and appropriate access to reciprocal healthcare for both UK and EU patients, preferably by preserving current arrangements.
Currently, residents of European Economic Area (EEA) countries and Switzerland can access medical treatment that becomes necessary during a temporary stay in another EEA country/Switzerland via the European Health Insurance Card (EHIC). There are also arrangements under which EEA residents can travel to another EEA country for planned healthcare (the EU Directive route and the S2 scheme), and for pensioners settling in another EEA country or Switzerland to access healthcare services in that country on the same terms as ordinary residents (the S1 scheme). Further information about the current arrangements can be found in our March 2017 blog post Cross-border healthcare – overseas patients.
What does the White Paper say?
The UK Government wants UK and EU nationals to continue to be able to use the European Health Insurance Card (EHIC) to access healthcare should this become necessary while visiting another EU country. As well as continued participation in the EHIC scheme, the White Paper also states that there should be reciprocal healthcare cover for state pensioners retiring to the EU or the UK, and cooperation on planned medical treatment. According to the White Paper, ‘this would be supported by any necessary administrative cooperation and data-sharing requirements’.
Health security/public health
The Assembly External Affairs and Additional Legislation Committee’s March 2018 report on Wales’ future relationship with Europe (PDF, 9MB) found that the UK’s continued membership of, and/or involvement in, agencies relating to the field of disease prevention and public health in Europe would be ‘unequivocally beneficial to all parties concerned’. The Welsh NHS Confederation Policy Forum has also emphasised that ‘strong coordination’ between the UK and EU will be key to protecting public health:
To ensure that public health for all EU and UK citizens is maintained post-Brexit, it is key that there is strong co-ordination between the EU and UK to deal with pandemics, communicable diseases, influenza outbreaks, infectious diseases and antimicrobial resistance. We must also seek the highest possible level of co-ordination on health promotion and disease prevention programmes.
What does the White Paper say?
The White Paper proposes continued, close collaboration with EU agencies to address public health threats, including cooperation with:
- the Health Security Committee and bodies such as the European Centre for Disease Prevention and Control (ECDC), including access to all associated alert systems, databases and networks, to allow the UK and the EU Member States to coordinate national responses;
- the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) to combat the harm caused by illicit drugs;
- the European laboratory surveillance networks to monitor the spread of diseases across Europe; and
- the EU and the devolved administrations in these areas, including direct sharing of information with ECDC and the ability for Microbiology Reference Laboratories in Glasgow, and Public Health Wales, to provide European Public Health Microbiology (EUPHEM) training.
The White Paper also includes proposals relating to:
- The UK’s participation in the European Medicines Agency (EMA). The EMA is responsible for the scientific evaluation, supervision and safety monitoring of medicines in the EU.
- Maintaining integrated supply chains, to avoid customs and regulatory delays at borders (this is relevant to the supply of medicines and other healthcare products).
- Continued participation in European Reference Networks (these support knowledge-sharing and cooperation on complex or rare diseases), and Horizon Europe (the EU's research funding programme post-2020).
Stakeholders are generally supportive of the White Paper’s proposals to protect health and health services. While welcoming the UK Government’s ambition, the Brexit Health Alliance cautions that:
We should be under no illusions of the consequences for patients if we fail to plan properly and do not reach a good agreement. That could result in a significant threat to the health of both UK and EU citizens.
Planning is underway at the centre of government, but it will be important for the sake of patients that NHS hospitals, clinics and community services are all prepared for every possible scenario.
Article by Philippa Watkins, National Assembly for Wales Research Service