Has the NHS been sidelined in Brexit negotiations?

Last week, the draft treaties the UK presented to the EU confirmed once again that we are on course for a hard Brexit.

Leaving the single market and customs union was always going to pose problems for access to the very large proportion of NHS medicines and medical devices that come from the EU. Both government and independent analyses have tended to suggest likely price rises of 5-10%. In a health service with an array of price controls, increases in cost tend to mean shortages. The added burdens would also be a disincentive to introduce or manufacture new medicines in the UK.

That is to say nothing of the wider disruption of a general hard border. Ahead of no deal last year this was predicted to cause prolonged shortages, and most of the extra paperwork and requirements responsible would still be there in leaving the customs union and single market with a deal in place. We would need to monitor very carefully officials’ estimates of the potential disruption to supplies important for facing the coronavirus. 

But there are also ways to soften the blow through negotiation and agreement. The EU has previously negotiated deals with countries like the USA and Australia. These eliminate some of the doubling up in regulation that bogs down trade outside the single market, and also improve safety.

One important area is mutual recognition of good practice, eliminating the need for manufacturing of medicines to be inspected and approved twice by different authorities. Another is “conformity assessment”, where another country can sign off products like medical devices as meeting EU standards, and vice versa.

Protectionist positioning

Yet these provisions are notable for their complete absence from the EU draft treaty published in March.

One expert, quoted by the Telegraph in a rare article highlighting these issues, suggests that the European Commission hopes to gain a “commercial advantage” by adding costs to UK exports so that EU customers have to turn to domestic suppliers. That would suggest a regrettable set of priorities. Any commercial advantage for European pharmaceutical corporations would come at the direct expense of European doctors, hospitals and patients forced to pay more or get less.

But another expert quoted suggests this may simply be a negotiating strategy: something to force the UK to make some concessions. So what is the UK’s position?

Fish first

The UK’s draft treaty, by contrast, does contain most of these measures – or at least the annex to it does.

The question is how hard the UK is pushing to achieve these aims. The concern is that they seem very far from the limelight. The overarching UK policy document that accompanies the treaty, ministerial speeches and briefing of the press have all focused heavily on pushing back against the so-called “level playing field” – a set of provisions where the EU wants the UK to keep applying minimum standards on issues like state subsidies. The second most regularly highlighted issue is fisheries.

Even the relatively arcane question of whether the agreement with the EU is one overarching one or several separate ones has been picked out for firm rhetoric. 

Issues around the trade in medicines or devices have been given very little visibility or impetus at this political level. In fact, other key health issues like science funding, public health alerts or the sharing of intelligence on safety have barely seen the light of day either.

Of course we do not see what goes on in the negotiating room, but the emphasis still seems far away from the services and products that we are relying on to handle Covid-19.

Health or life sciences have never been featured as their own theme in the agendas of rounds of negotiation. British lead negotiator David Frost’s rather pugnacious letter accompanying the draft treaties does mention conformity assessment in passing, but the “level playing field” is again the overwhelming focus. No other aspect of health merits a mention.

The case for seriously considering extending the transition until the coronavirus has been entirely controlled will only grow stronger if we are not on course for a deal that does all it can to ease imports and exports for health care.

This is not a good time for patients and health care systems to be failed by a negotiation where at times it can appear as though things they rely on are little more than a bargaining chip – and not an especially highly valued one.