Martin McKee: Brexit—the confusion continues

mcKee_martinIt is now over two months since the British electorate voted narrowly to leave the European Union. The UK has a new prime minister and cabinet, including two new government departments created to implement this decision. So what have we learnt about our future relations with the EU? And what does this mean for health and research? Not much, it would seem.

It is clearly impossible to know what Brexit will mean for health and research until we know what form Brexit will actually take. Shortly after becoming prime minister, Theresa May helpfully clarified that “Brexit means Brexit”, a statement that will provide long hours for students of logic as they search for any meaning in it. Consequently, observers of the political scene waited with anticipation for the statement to the House of Commons by David Davis, the new Secretary of State for Exiting the EU, on the 5 September 2016. Sadly, they were to be disappointed. In fairness, he did go slightly further by defining Brexit as “exiting the European Union.” This was received with obvious incredulity by MPs from all parties, including Conservatives. Several MPs asked “is that it?” while the former Labour minister Yvette Cooper summarised the mood of the House by describing it as an “astonishingly empty statement” with “no plan, no sense of grip, no detail.” At times it recalled the scene in The Hitchhiker’s Guide to the Galaxy when the supercomputer Deep Thought reported, after calculations lasting 7.5 million years, that the answer to “life, the universe and everything” was 42.

Yet perhaps this is a little unfair, given what happened next. David Davis had said that it was “improbable” that the UK would remain a member of the Single Market. Soon afterwards, a government spokesperson clarified that, in fact, this was not government policy and he had only been expressing his “opinion.” Now, one of the advantages of the UK’s absence of a written constitution, almost unique among nations, means that rules can be adapted when needed, or as Lewis Carroll famously said in Alice in Wonderland, “a word means just what I choose it to mean.” But, nonetheless, it was a revelation to many that a Secretary of State giving a formal statement, on his brief, at the despatch box, could simply be his personal opinion rather than government policy. What it also revealed was that there clearly was no agreed government policy, something suspected by many observers but now confirmed.

The lack of clarity in the UK contrasted markedly with that in Tokyo, where the Japanese government issued a 15 page document setting out its concerns about Brexit. This demonstrated a clear grasp of the issues that has been absent from the UK government discourse, most of which has involved pointing out that the promises of the Leave campaign, such as a points based immigration system, are off the table. The Japanese paid particular attention to the serious consequences for the UK pharmaceutical industry of the inevitable post-Brexit move of the European Medicines Agency from London.

Meanwhile, at the G20 meeting in China, things were not going well for Theresa May. Barack Obama reiterated that the UK would be at the back of the queue for any trade deal. Korea echoed Japan’s concerns about the damaging consequences of Brexit for the world economy. The one glimmer of hope was a commitment by the Australian Prime Minister to push for a rapid trade deal, although even this was tempered in an interview with the Australian trade minister a few days later who re-emphasised that negotiations could not begin until after the UK actually leaves the EU.

This, inevitably, raises the question of when that will be. Here again, there is no clarity, except that Article 50 will not be triggered in 2016, almost certainly a good idea given the obvious confusion within government. However, there is another problem. The current EU budget runs until 2020. The UK has three options. It can either opt to remain in the EU until the budget period ends, although this will extend beyond the next EU general election, which could easily become, in effect, a second referendum, as could the European Parliament elections in 2019. It could opt to leave before 2020, although this would require it to continue payments to the EU post-Brexit, which is unlikely to be well received by its supporters. Or it can seek to renegotiate its contribution, a process that is likely to take several years, well beyond the current budget cycle.

So what can we say about health and research post-Brexit? We already know, from the excellent work undertaken by Scientists for EU that anxiety about the future is already leading researchers to consider emigration or those recruited from abroad to decline job offers, concerns echoed by the UK’s leading universities. The government’s commitment to underwrite funding from EU research grants goes no further than restate existing legal obligations. It offers no long term certainty at all. Concerns, but no solutions, have been raised about how the NHS will cope if the 10% of the medical workforce who are EU citizens decide to leave or what will happen if large numbers of elderly British pensioners, denied their rights as EU citizens, return from Spain. Other issues have received almost no attention at all. These include the now complex and very effective arrangements for patient and professional mobility, including important safeguards such as the Alert system to exchange information on health professionals about whom there are concerns, provisions on data protection, clinical trials, and much else.

The picture that is emerging is one of considerable confusion and contradiction, as the sheer complexity of the UK’s embeddedness within the EU becomes apparent. There is, however, one small glimmer of hope. At least the Japanese government understands the issues. Perhaps the Prime Minister should have spent her holidays on the slopes of Mount Fuji rather than in the Swiss Alps.

Martin McKee is professor of European Public Health at the London School of Hygiene and Tropical Medicine.