How might the negotiations over the future UK-EU relationship affect healthcare access? Drawing on a new research briefing, Matt Wood provides a detailed assessment of the impact UK-EU and UK-US trade agreements may have on healthcare across Europe

Wood, Matt

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LSE Research Online

How	the	UK’s	trade	deals	will	impact	healthcareaccess	across	EuropeHow	might	the	negotiations	over	the	future	UK-EU	relationship	affect	healthcare	access?	Drawing	ona	new	research	briefing,	Matt	Wood	provides	a	detailed	assessment	of	the	impact	UK-EU	and	UK-UStrade	agreements	may	have	on	healthcare	across	Europe.Protecting	health	and	healthcare	was	one	of	the	key	issues	during	the	EU	referendum	in	2016,	andnow,	with	the	coronavirus	crisis	still	ongoing,	it	is	a	crucial	part	of	the	trade	negotiations.	Ournew	research	briefing	for	UK	in	a	Changing	Europe	suggests	the	need	for	greater	transparency	to	show	theimplications	of	the	current	UK-EU	and	UK-US	trade	negotiations	for	the	NHS,	and	for	health	more	generally.The	briefing	shows	equitable	healthcare	access	as	a	core	public	value	is	up	for	grabs,	with	differing	commitments	tohigh	regulatory	standards	and	private	sector	involvement	in	healthcare	evident	in	the	UK,	EU	and	US	negotiatingpositions.	Our	report	covers	a	range	of	areas	where	positions	between	the	negotiating	partners	diverge,	butparticularly	important	in	light	of	Covid-19	are	the	possible	impacts	on	the	immediate	lives	of	people	living	in	differentparts	of	the	UK	and	EU.Some	key	points	in	our	report	focus	on	how	UK	and	non-UK	citizens’	access	to	healthcare	may	be	impacted	indifferent	parts	of	Europe	by	Brexit.	With	further	lockdowns	and	growing	evidence	about	the	chronic	effects	of	Covid-19,	unequal	access	to	healthcare	in	the	medium	to	long	term	may	profoundly	worsen	already	existing	inequalities.Getting	the	trade	negotiations	right	will	be	vital	to	providing	a	safe	bridge	from	deep	uncertainty	in	this	period	ofnegotiation	and	crisis,	to	a	new	equitable	healthcare	settlement	in	post-Brexit	Europe.SpainEstimates	suggest	around	190,000	UK	pensioners	live	in	the	EU,	with	Spain	being	a	common	destination.	Thesepeople	rely	on	EU	rights	to	access	health	care.	Removing	those	entitlements,	and	not	replacing	them	withsomething	else,	would	mean	they	would	need	to	have	private	health	insurance.	This	would	impose	a	significant	costand	burden,	especially	for	those	with	chronic	or	multiple	conditions.Article	32	of	the	Withdrawal	Agreement	governs	access	to	medical	care	for	UK	nationals	living	in	EU	memberstates	after	31	December	2020.	UK	pensioners	who	have	retired	to	Spain	–	or	anywhere	else	in	the	EU27	–	beforethat	date	will	be	able	to	access	the	local	healthcare	system;	while	for	those	who	move	thereafter,	the	EU’snegotiating	documents	for	the	future	agreement	include	continued	access	to	healthcare	for	pensioners	(only,	not	forothers).	The	UK	negotiation	position	does	not	reciprocate:	EU	nationals	who	retire	to	the	UK	after	the	end	of	thetransition	will	not	have	access	to	the	NHS.MaltaSmall	EU	states	with	close	ties	to	the	UK	may	be	particularly	badly	affected	by	a	trade	deal	that	distances	the	UKfrom	EU	regulatory	institutions.	In	Malta,	for	example,	health	authorities	worked	with	the	UK’s	Medicines	andHealthcare	Products	Regulatory	Agency	(MHRA),	and	60-70%	of	medicines	used	in	Malta	are	supplied	by	UKbodies.Some	large	pharmaceutical	companies	may	be	reluctant	to	undertake	the	costs	of	securing	additional	regulatorycompliance	to	supply	the	Maltese	market,	if	ties	to	the	UK	market	dependent	upon	the	EU’s	regulatory	processesare	weakened.	This	could	have	a	significant	impact	on	the	cost	of	medicines	for	end	users	in	Malta.Central	and	eastern	EuropeA	number	of	central	and	eastern	EU	member	states	have	close	links	to	the	UK,	with	many	of	their	nationalscurrently	living	and	working	in	the	UK.	In	2017	the	Standing	Committee	of	European	Doctors	strongly	urged	theBarnier	negotiating	team	to	secure	future	mutual	recognition	of	UK	medical	qualifications	in	the	EU.LSE European Politics and Policy (EUROPP) Blog: How the UK’s trade deals will impact healthcare access across Europe Page 1 of 2		Date originally posted: 2020-08-04Permalink: https://blogs.lse.ac.uk/europpblog/2020/08/04/how-the-uks-trade-deals-will-impact-healthcare-access-across-europe/Blog homepage: https://blogs.lse.ac.uk/europpblog/This	has	been	achieved	in	part	in	the	Withdrawal	Agreement,	for	ongoing	recognition	of	qualifications	that	wererecognised	before	the	end	of	December	2020.	The	UK	and	EU	negotiation	texts	envisage	a	weaker	form	of	mutualrecognition	of	qualifications	going	forward.However,	in	practice,	unless	the	UK	departs	significantly	from	EU	standards,	there	may	be	relatively	few	changes.The	key	difference	will	be	that	individuals	will	no	longer	be	able	to	enforce	rights	to	have	their	qualificationsrecognised.	We	may	therefore	see	central	and	eastern	European	medical	professionals	choosing	other	EUcountries,	as	well	as	the	US	or	Australia,	as	alternative	destinations	with	better	systems	for	recognising	medicalqualifications	and	accommodating	migrant	health	professionals.IrelandThe	potential	impact	of	Brexit	on	Ireland,	and	particularly	the	Irish	border,	has	been	discussed	extensively	since	thereferendum	result.	In	health,	Brexit	may	have	substantive	impacts	given	the	island	of	Ireland	currently	has	a	highlyintegrated	cross-border	health	sector,	protected	by	the	Good	Friday/Belfast	Agreement	and	covering	access	tomedical	products,	provision	of	health	services	and	workforce	arrangements.This	means,	for	example,	that	Irish	citizens	can	receive	treatment	in	Northern	Ireland,	or	that	dentists	from	NorthernIreland	can	drive	across	the	border	and	work	in	Ireland.	The	Northern	Ireland	Protocol	in	effect	assumes	thatNorthern	Ireland	is	within	the	EU’s	customs	territory,	and	so	various	cross-border	health	arrangements,	for	examplecross-border	ambulance	travel,	are	protected.Nevertheless,	in	terms	of	patterns	of	trade	in	medicinal	products,	devices	and	medical	equipment,	issues	remainunresolved	in	the	UK-EU	trade	negotiations.	The	threat	remains	that	a	non-comprehensive	free	trade	agreementbetween	the	UK	and	EU	would	put	the	cross-border	health	sector	in	Ireland	at	significant	risk.Getting	a	trade	deal	right	for	healthThese	are	just	a	few	specific	instances	where	UK-EU	and	UK-US	trade	agreements	may	impact	healthcare	accessacross	Europe.	As	our	report	shows,	however,	if	the	trade	negotiations	are	not	conducted	rigorously	andtransparently	they	may	end	up	exacerbating	inequities	in	access	across	the	UK	and	EU.	This	is	just	when	equity	ofaccess	is	of	paramount	importance	in	the	fight	against	Covid-19.	This	crisis	has	created	anxiety	across	Europeabout	speeding	up	access	to	vaccines	and	treatments	as	a	priority.Yet,	there	is	a	danger	that	unless	both	UK	and	EU	negotiating	teams	take	time	on	getting	a	good,	comprehensiveand	fair	deal	for	health,	they	will	unwittingly	pull	the	rug	from	under	our	feet	in	the	fight	against	the	coronavirus.Please	read	our	comments	policy	before	commenting.Note:	This	article	first	appeared	at	UK	in	a	Changing	Europe.	It	gives	the	views	of	the	author,	not	the	position	ofEUROPP	–	European	Politics	and	Policy	or	the	London	School	of	Economics.	Featured	image	credit:	Jamie	(CCBY	2.0)_________________________________About	the	authorMatt	Wood	–	University	of	SheffieldMatt	Wood	is	a	Senior	Lecturer	in	the	University	of	Sheffield’s	Department	of	Politics	and	InternationalRelations.	He	is	currently	co-investigator	on	the	ESRC	project	Health	Governance	After	Brexit,	andwas	previously	an	ESRC	Future	Leaders	Fellow	from	2015-18.LSE European Politics and Policy (EUROPP) Blog: How the UK’s trade deals will impact healthcare access across Europe Page 2 of 2		Date originally posted: 2020-08-04Permalink: https://blogs.lse.ac.uk/europpblog/2020/08/04/how-the-uks-trade-deals-will-impact-healthcare-access-across-europe/Blog homepage: https://blogs.lse.ac.uk/europpblog/

How the UK’s trade deals will impact healthcare access across Europe

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How the UK’s trade deals will impact healthcare access across Europe

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