UK-EU negotiations threaten healthcare access

How might the negotiations over the future UK-EU and UK-US relationship affect healthcare access? Ian Youngman suggests the UK’s current trade plans will not protect healthcare access for either UK or EU patients.

A new research briefing by Dr Matt Wood from the University of Sheffield, co-investigator on the Economic and Social Research Council (ESRC) project, Health Governance After Brexit, provides a detailed assessment of the impact UK-EU and UK-US trade agreements may have on healthcare across Europe.

The briefing, for the independent research group UK in a Changing Europe, suggests the need for greater transparency to show the implications of the current UK-EU and UK-US trade negotiations for the NHS, and for health more generally.

Equitable healthcare is up for grabs

Protecting health and healthcare was one of the key issues during the EU referendum in 2016, and is a crucial part of the trade negotiations. The briefing report shows equitable healthcare access as a core public value is up for discussion, with differing commitments to high regulatory standards and private sector involvement in healthcare evident in the UK, EU and US negotiating positions.

The report covers a range of areas where positions between the negotiating partners diverge, but particularly important in the light of Covid-19 are the possible impacts on the immediate lives of people living in different parts of the UK and EU.

Some key points focus on how UK and non-UK citizens’ access to healthcare may be impacted in different parts of Europe by the UK leaving the EU. 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 of negotiation and crisis, to a new equitable healthcare settlement in post-Brexit Europe.

Changes for UK patients living abroad

Estimates suggest 190,000 UK pensioners live in the EU, with Spain being a popular country of residence. These people rely on EU rights to access health care. Removing those entitlements, and not replacing them with something else, would mean that they would need to have private health insurance. This would impose a significant cost 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 member states after 31 December 2020. UK pensioners who have retired to Spain – or anywhere else in the EU27 – before that date will be able to access the local healthcare system. For those who move thereafter, the EU’s negotiating documents for the future agreement include continued access to healthcare, but only for pensioners not for others.

The UK negotiation position does not reciprocate: EU nationals who retire to the UK after the end of the transition will not have access to the NHS.

Examples of risks: Malta and Ireland healthcare

Small EU states with close ties to the UK may be particularly badly affected by a trade deal that distances the UK from EU regulatory institutions.

In Malta, health authorities work with the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA), and 60-70% of medicines used in Malta are supplied by UK bodies. Some large pharmaceutical companies may be reluctant to undertake the costs of securing additional regulatory compliance to supply the Maltese market, if ties to the UK market dependent upon the EU’s regulatory processes are weakened. This could have a significant impact on the cost of medicines for end users in Malta.

The potential impact on Ireland of the UK exiting the EU, and particularly the Irish border, has been discussed extensively. In health, the UK exit may have substantive impacts given the island of Ireland currently has a highly integrated cross-border health sector, protected by the Good Friday/Belfast Agreement and covering access to medical products, provision of health services and workforce arrangements.

Irish citizens can receive treatment in Northern Ireland. The Northern Ireland Protocol assumes that Northern Ireland is within the EU’s customs territory, and so various cross-border health arrangements such as cross-border ambulance travel, are protected.

But in terms of patterns of trade in medicinal products, devices and medical equipment, issues remain unresolved in the UK-EU trade negotiations. The threat remains that a non-comprehensive free trade agreement between the UK and EU would put the cross-border health sector in Ireland at significant risk.

These are just two specific instances where UK-EU and UK-US trade agreements may impact healthcare access across Europe.

If the trade negotiations are not conducted rigorously and transparently, they may end up exacerbating inequities in access across the UK and EU. This is at a time when equity and speed of access to treatments and vaccines is of vital importance in the fight against Covid-19.