24 June 2016
The British public in the Referendum on the EU has voted for the UK to relinguish membership in the EU. This, in time, will be seen as a mistake for various reasons and of course it will take some time to come to pass.
While I have been from time to time critical of the EU, I think it has brought significant benefits to everyone in the healthcare arena, restrictions on competencies notwithstanding.
The Referendum choice is not without consequences for the UK. I for one do not expect the UK to be given an easy time by its former EU partners, but the risk is that in the end, a congenial arrangement will be needed, if nothing else, to offset the risk of isolationism in the UK, which would do no one any good. While it may be seen as an example of democracy at work, the Referendum ended up really being a political punching match amongst the political parties and not really about the EU membership itself. The Prime Minister Cameron failed to act in the country’s best interests by trying to ensure the focus was on membership issues and not political infighting but he had by mid-campaign lost any influence as jingoist sloganeering took over from reasoned discourse. It is not wonder that the public voted as they did, and made the referendum a vote of non-confidence in the government instead. As they say, now repent at leisure.
That said, there are a few areas to reflect on which a strict exit would involve and which we should really try to protect.
- The ability of UK citizens to have access to healthcare services when travelling in the EU, through the EHIC arrangement will at some point end. It may be protected should the UK decide to accept free movement of people. It is not a good situation for countries so close and where people move so easily across borders not to have a mutual arrangement for healthcare. This must be protected in some form, as there could be public health risks on the one hand, and avoidable suffering for people who become ill. Absent that, UK citizens will require some sort of medical travel insurance which is never a good deal at the best of times. I doubt anyone really thought of that.
- Reciprocal arrangements for providing access to a country’s social security/healthcare system (the S1/A1 forms) will also in time cease. This will impact people retiring, but also people working, even temporarily, in an EU state. I doubt anyone running a workshop in another state worries about whether they’re carrying the EHIC, S1/A1 or their social security cards, but for the British, where no cards are required, this will present a new requirement and added business costs if nothing else. As many European countries do offer considerable lifestyle benefits, Brits will still likely wish to retire in an EU state, whereever family or friends are or where their heart is. While it is sensible to have controls in place to ensure proper system funding, it should really be a matter of priority to ensure that retirees at least enjoy some measure of security. There are comparable arrangements worth looking where similar circumstances exist (e.g. Canadian “snowbirds” and Florida).
- UK research is, at least according to the domestic crowd, pretty good, and does stand up to international scrutiny with many UK universities in the top tier. But much of the research funding comes from EU sources and has supported academics, departments and much intra-EU research collaborations. Life sciences research in particular benefits and it is unlikely the UK government will in any form be able to replace the lost funding. The implications are on the order of fewer institutions actually do the high standard of work, simply because there is less money, some universities will for forced to scale down their research, becoming smaller and perhaps marginalised or just focus on teaching. But the UK university system is research driven and universities that do little research are low rated anyway. I do really worry that universities and research will suffer in the UK and hope that the UK continues to be an active participant, even if at arm’s length.
- We heard a lot about immigration during the Referendum, but more of the xenophobic sort without actually grappling with the value to the UK that immigrants bring. Past the rhetoric, the UK has been a good destination for people to build their careers. Many have come to work in the UK’s National Health Service (about 4% of the NHS workforce is from the wider EU). Will this stop or shrink? The UK does not have the educational production capacity to replace the loss of immigrants with skills for healthcare, such as doctors, or nurses. With the exit likely having a profound impact on public finances, it is unlikely either that the UK will be able to afford to build the necessary capacity to make up for the loss. This will further reduce the standards of care as staff shortages bite even harder. Of course this might change, but the NHS has had staffing shortages for decades, and manifestly under-produced graduates in healthcare professions, so it is not clear why they would suddenly find the money that wasn’t there before. The UK will likely either opt back into the single market / free movement of the Norway sort, or go its own way with some point-based system to control immigration. The latter will only lead to tit-for-tat retaliation by the EU, which is to no-one’s benefit.
- Without listing them all, the UK is part of so many networks in healthcare areas, from research communities, to health technology assessment, to rare diseases and public health surveillance and so on. One must assume that these will scale down unless efforts are made to ensure they are protected in some form. In the end, though, the UK will be the loser as will the EU. A brain-drain toward the EU is not unimaginable and indeed for many people likely. The US will clearly beckon and the EU member states should also consider the implications. The UK will not like this, but this may be a good example of the consequences of the referendum decision. A brain-drain, while asset-stripping the UK, will require I suspect some reform of domestic employment systems, but with high unemployment in some EU countries, why would they want to give jobs to “foreigners”. Of course, EU institutions might change their own employment policies to make it easier to employ folks from the UK and many would likely gladly move. I know I would.
That’s a short list of a few things, on this day of days I would have wished were otherwise.EuroSante