What does leaving the EU mean for health?
This briefing is largely based on the briefing by the House of Commons Library ‘EU referendum: impact of an EU exit in key UK policy areas’. The opinions and judgements it contains are theirs. We expect to review and add to these articles periodically as events develop.
The EU’s public health strategy (dated 2009-2013, but still relevant), looks at the health of the EU’s aging population, pandemics and bioterrorism, and supporting new technologies for healthcare and disease prevention.
The early warning and response system for the prevention and control of communicable diseases provides a network for member countries to monitor, communicate and assist each other. The European Centre for Disease Prevention and Control is at the centre of this network, collecting information, providing expertise and co-ordinating related bodies
NHS Blood and Transplant implements EU rules on the procurement, storage, use and monitoring of all human tissue and blood in the UK. These rules ensure that this is done consistently across the EU as the use of human tissue for transplant and for research increases.
The EU has also played a leading role in other significant public health strategies, such as reducing alcohol misuse, promoting good nutrition and banning smoking in public places.
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EU Tobacco Products Directive
Tobacco control is an area where the EU has been very active. Most recently, the revised EU Tobacco Products Directive became UK law in May 2016.
It sets rules that 65% of the packet be covered in picture and text health warnings, that packets in future will contain a minimum of 20 cigarettes, and it bans flavourings of tobacco. The Directive also introduces a new rules on e-cigarettes.
Healthcare professionals and the recognition of qualifications
EU rules mean that health and social care professionals who qualified within the EU or the slightly wider European Economic Area will automatically be recognised in any other member country. For example, doctors who qualify from recognised medical schools within the EEA are able to register with the General Medical Council without additional checks, allowing them to practise in the UK. Healthcare workers from outside the EEA will generally have additional checks on their competence and communications skills.
Leaving the EU will allow UK regulatory bodies to introduce the same checks for EEA applicants as for non-EEA applicants. Restricting the free movement of healthcare workers could impact the number of non-UK citizens working for health service providers in the UK, as well as restricting UK healthcare professionals’ ability to work in Europe.
Junior doctors and the EU Working Time Directive
The European Working Time Directive limits the working week to 48 hours. This has applied to most health service staff since 1998. Initially this rule did not apply to junior doctors because there were concerns about the impact it would have on NHS services and training. But from 2004 to 2009 this was gradually introduced for junior doctors.
The previous government commissioned an independent review which found that high quality training can be delivered in 48-hour weeks, but the way training was carried out would need to change in order for this to happen. At the moment doctors and other NHS staff can work longer than 48 hours by signing an opt-out clause. Once the UK leaves the EU there could be more flexibility in the hours NHS staff can work.
Reciprocal access to healthcare
European Health Insurance Cards (EHIC) give EEA and Swiss citizens access to medically necessary, state-provided healthcare when they are staying temporarily in any of these countries.
The card allows EEA and Swiss visitors to the UK to get free NHS treatment, including treatment of pre-existing medical conditions, as long as they have not travelled to the UK just to get treatment. There is also a separate system under which these citizens can be referred to the UK for pre-planned treatment.
Any treatment costs under these schemes can be reclaimed from the visitor’s country of residence.
If the UK negotiates to stay in the EEA then it might be able to continue to participate in the EHIC scheme. Even if the government does not negotiate membership of the EEA, it might be able to have separate negotiations to allow the UK to take part in the EHIC scheme, as Switzerland has.
Pharmaceutical laws is consistent across all EU member countries. In 2004, the European Medicines Agency (EMA) was set up in London.
The EMA is responsible for scientifically checking human and veterinary medicines developed by pharmaceutical companies for use in the EU. It can also grant marketing authorisations for medicines which allow for their use across the European Economic Area.
This centralised procedure is compulsory for some groups of drugs. Companies can also apply to the authorities of individual EU countries, or use the mutual recognition procedure, which means that companies that have a marketing authorisation in one country can apply to have it recognised in other EU countries.
As Iceland, Liechtenstein and Norway are included in the centralised marketing authorisations, when the UK leaves the EU it might be able to continue this relationship with the EMA.
But if that doesn’t happen, pharmaceutical companies might need to apply for separate marketing authorisations from the Medicines and Healthcare products Regulatory Agency (MHRA) for every medicine they wished to supply in the UK as well as doing their EU application.