{"id":45913,"date":"2019-10-22T13:38:26","date_gmt":"2019-10-22T12:38:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=45913"},"modified":"2019-11-27T18:29:31","modified_gmt":"2019-11-27T17:29:31","slug":"the-withdrawal-agreement-bill-and-do-no-harm-to-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/22\/the-withdrawal-agreement-bill-and-do-no-harm-to-health\/","title":{"rendered":"The Withdrawal Agreement Bill and “Do No Harm” to health"},"content":{"rendered":"

Brexit, in any form, poses a <\/span>threat to health<\/span><\/a> in the United Kingdom. A series of peer reviewed studies evaluate a range of post-Brexit scenarios, from minimal divergence from the single market and customs union through to leaving <\/span>without a deal<\/span><\/a>, either now or at the end of 2020. Put simply, these studies show that the further that the United Kingdom moves away from the European Union, the greater the threats to health.\u00a0<\/span><\/p>\n

The change of language of the Johnson government, compared to that of the May government, has been interpreted as signifying a wish to diverge markedly from the EU27 in terms of the regulatory environment. This involves commensurately greater risks to health.\u00a0<\/span><\/p>\n

These threats to health fall into at least four broad categories. The first is damage to the economy. Sajid Javid, the chancellor of the exchequer has refused to conduct an assessment of the economic impact of the Johnson October 2019 Withdrawal Agreement, stating that it is <\/span>\u201cself-evidently\u201d<\/span><\/a> in the interests of the British economy. This view is not supported by any of the serious economic assessments that have been conducted, including by the government. The most recent, by <\/span>The UK in a Changing Europe<\/span><\/a> research group, estimates that the public finances will be worse off by between \u00a319 and \u00a349 billion per year. The corresponding figures for May\u2019s November 2018 Withdrawal Agreement are \u00a313 and \u00a339 billion. For comparison, spending on the NHS in 2020\/21 is estimated at <\/span>\u00a3128 billion<\/span><\/a>.\u00a0\u00a0<\/span><\/p>\n

The second threat is to the workforce. Priti Patel, the home secretary, has made it clear that freedom of movement will stop when the UK leaves the EU. This will mean that the restrictions that currently apply to health professionals from the rest of the world will apply to those from the EU 27. However, a steady stream of stories of health professionals who have fallen foul of the hostile environment created by the government, for example by making a <\/span>minor mistake<\/span><\/a> on an application form or allowing their bank account to <\/span>fall fleetingly below a certain threshold<\/span><\/a>, has exposed an immigration system that is not fit for purpose. In these circumstances, the government\u2019s claims to be welcoming skilled health professionals and scientists ring hollow.\u00a0<\/span><\/p>\n

The shortage of workers has other implications for public health. The cost of food is one. British farmers have become dependent on seasonal agricultural labour, much of it from the new member states. The National Farmers Union reports that <\/span>at least 16 million apples<\/span><\/a> have been left to rot this year alone as a result of labour shortages. Meat production is also likely to be affected. British abattoirs are highly dependent on vets from other parts of the EU. Their workload will increase dramatically because of the additional paperwork involved in movements between Great Britain and both the EU 27 and Northern Ireland.<\/span><\/p>\n

A third threat arises from shortages to essential goods, in particular food and medicines. Public statements by ministers that the supply of medicines and medical isotopes has been <\/span>secured<\/span><\/a> are contradicted by the government\u2019s own <\/span>assessments<\/span><\/a>.<\/span><\/p>\n

A fourth threat relates to the loss of the many safeguards to public health that derive from EU law. At present, a new Act of the UK Parliament cannot unilaterally remove this binding law. Post-Brexit, safeguards, including food safety, air and water quality, and medicines, devices, vaccines and blood safety, could be removed, especially under No Deal, or if the future EU-UK trade relationship does not secure regulatory alignment.<\/span><\/p>\n

The existence of these threats led to the Faculty of Public Health and other health organisations to call upon the government to commit to introduce safeguards as it negotiated the UK\u2019s new relationship with the EU. Based on the existing EU obligation to ensure a high level of health in all policies, it sought a commitment to “<\/span>Do No Harm<\/a>.”<\/span>\u00a0In response, ministers stated, in Parliament, that:<\/span><\/p>\n

“there is now genuine recognition on all sides of the Brexit argument that public health must be at the epicentre of our engagement.”<\/span><\/p>\n

The government also gave a <\/span>series of other commitments<\/span><\/a>:<\/span><\/p>\n