Aftershocks: Brexit, partnership and health

Usman Khan, Interim Director, European Health Management Association

As a Director working in Europe but no longer living in it, my first experience of post-Brexit life was to meet a few shell shocked colleagues on the 6.50am train out of St Pancras and to be greeted with condolences at my first meetings in Brussels.

As the days have become weeks, parallel worlds are rapidly developing where ‘business as usual’ sees the organisation I lead discussing Horizon 2020 projects with UK partners, whilst at the same time I see evidence of a culture of retrenchment manifesting itself in exchanges such as that from a prominent UK health policy NGO informing me that in future they would be more ‘domestically focussed’.

The European Health Management Association is one of a network of pan-European organisations that act as a bridgehead between European health policy making and the national, regional and local health infrastructure. EHMA is distinct in that it brings together service providers with policy makers, but what makes it unique is its deep connection to the academic community. So the impact of Brexit for EHMA is likely to manifest itself to different degrees and in different ways across our developing, facilitating, regulating and researching activities.

In terms of the European health policy EHMA has not seen the UK as having the same level of influence within the Brussels Bubble as that felt in policy areas such as trade. As such, the impact of the UK withdrawing from the European health policy sphere may not be highly significant. Whilst policy debates on issues such as critical care, or the management of long term conditions will undoubtedly be weakened by the absence of a UK presence, as with public health the impact of Brexit can be mitigated through continued engagement with bodies such as the WHO and the OECD. The same can be said for activities focussed on facilitating the delivery of effective health care, although with important caveats. Through initiatives such as the Joint Actions on Health Workforce where the UK Department of Health played a key role, Brexit may be felt more keenly in the future if the UK finds itself excluded from important discussions regarding data sharing and the development of common platforms, with a concomitant impact on the functioning and comprehensiveness of systems designed to facilitate the efficient and equitable resourcing of European health services. Where things are also likely to unravel is in relation to the regulation of health, most notably within the arena of pharmaceuticals. The almost certain withdrawal of the European Medicines Agency from its current home in London’s Docklands is only likely to be the most immediate signal of the end of Britain’s involvement in regulatory practice, with a wider impact on cross-border healthcare that could continue to unravel over decades. 

However, from the perspective of an organisation such as EHMA the single largest risk for Brexit is on research and academic partnership.  The EU is the world’s most concentrated centre for research with UK led consortia preeminent within the EUs 80€bn Horizon 2020 programme. The leading role that the UK has played in bringing the very best European research thinking together, is based upon a process that has been four decades or more in the making and which has seen the development of an unparalleled and intricate network of partnership working. If poorly handled Brexit could paralyze this network and if it does then the consequences will be felt globally as much as it will be domestically, undermining cutting edge biomedical and health services research and through this on the health and well being of our population.

Consequently, as an organisation whose very mission is to foster European academic partnership working in health, EHMA has seen that within our network good will still exists for continued British involvement, although it is not inconceivable that this could soon begin to weaken. Whether this happens will in part depend on UK partners making a conscious effort to reassure, reengage and go that extra mile perhaps to offset the sense of negativity that Brexit has triggered.

Brexit has been perceived by many stakeholders as a rejection not simply of the European Union as a supra national government or the political and economic project which it has promulgated, but it has also been seen as a rejection of the notion of partnership and the value of cooperation. Those Brexiteers driven by a more positive mind set would undoubtedly deny this, but their sincerity will be judged by actions more than by words. Yet, the early portents do not appear promising. Firstly, there is the challenge of being heard and from early responses it does not appear that health is likely to figure very highly in the priorities of politicians charged with unravelling 40 years of pan European law making, whist simultaneously seeking to establish a credible platform for international trade outside of full membership of the Single Market. More troubling still is that those early words that have come out of the Government do not appear promising, with the UK government recently refusing to commit to covering in full any reductions in research funding that might result from Brexit.

Britain prior to Brexit could be said to have resembled someone doing the backstroke as they headed towards a waterfall. Pan European NGOs such as EHMA will redouble efforts to mitigate the impact of the resulting fall, but the challenges to European partnership working appear significant and the risk remains that the fall will be long and the outcome for European healthcare fundamentally negative.