A bitter pill to swallow, a healthtech perspective on what needs to happen post-Brexit
This article was originally published in issue six of The New European.
One thing we are really, really good at on these islands is innovation. The Global Innovation Index, an INSEAD/Cornell funded barometer, names Britain the second most innovative economy in the world, ahead of the Scandinavians, Americans, Chinese and Japanese.
The other thing we are really good at is healthcare. Despite obvious pressures on the NHS, The Commonwealth Fund, a US think-tank, ranks the United Kingdom first overall. We’re equitable and efficient, capable of delivering high quality care outcomes for significantly less cash than other countries.
These sort of macroscopic rankings aren’t perfect, but as a healthcare professional who has been lucky enough to live, work and, er, get sick across the globe, I can confirm that the UK and the NHS truly are remarkable.
It follows that our economy is a petri-dish for HealthTech start-ups. Some emerge from our world class Universities, others via inspired nurses working on the frontline and several designed and developed by patients themselves.
There is just one small snag: what we do with Brexit. The total lack of an actual plan has left our industry in limbo. Yes, we remain stoic and determined, but we also need a strategy, stat.
The first challenge is staffing. I am the Irish co-founder of a start-up called Echo and we are trying to solve big, big NHS challenges. Our growing team consists of a Spaniard, a Latvian, two Poles, a Turk, a Frenchman, a South African, a Kiwi and four Brits. To complicate things further, our husbands, wives and partners cover another six nationalities.
Before dismissing our situation as an outlier chosen by The New European to make a point, consider this: we recently advertised for a software engineer to join the team in London. Of 28 applications received, only one came from a British national. Let’s also not forget that over 26% of NHS doctors come from abroad and 40% of doctoral researchers aren’t British. The NHS, HealthTech and life science industries are dependent on foreign talent and one fifth of start-up founders are immigrants to the UK.
Right now, the level of ambiguity surrounding our immigration status is a concern; meanwhile, the global competition for talent is only getting tougher. Our team have the pick of roles from Silicon Valley to Shenzhen — they’re here because they love the UK, believe in our mission and want to build a better NHS. But unless we address this ambiguity it will be harder to recruit top talent. And with regards to an ‘Australian-style points system’ — many of the very best software engineers in London are university drop-outs with no formal qualifications. What happens to them?
We need clear guarantees regarding to our right to remain in the UK. Can we start families, will we be entitled to national insurance and, frankly, are we still welcome? Its easy to dismiss these questions as post-Brexit histrionics, but with Berlin aggressively positioning itself as “the city [that] encourages people from all over the world to come here and live out their dream”, we need to act fast.
The second challenge is what is going to happen to funding for research. Despite being a privately-funded start-up, we have benefited enormously from research carried out by our colleagues in academia, whose work on medication adherence plays a big part in shaping our service. We haven’t left the EU yet but already there are reports of UK scientists being dropped from major projects. At least £1.2bn is at stake, much of it earmarked for HealthTech.
Sure, maybe it will all work itself out in the end, but right now a generation of researchers has been left in limbo, wondering when, or if, they will receive funding, effectively putting the brakes on innovation. We urgently need the UK government to guarantee funding for research, regardless of what deal we negotiate with the EU, in order to avoid academic stagnation and ensure the best minds stay in Britain.
The final challenge relates to what will happen to our access to the single market. Echo’s main competitors are based in the US, where they have access to a domestic market of 320m consumers. In order for us to compete with Silicon Valley (not to mention Beijing) we need unencumbered access to Europe’s 508m consumers.
Unfortunately, exporting HealthTech isn’t as simple as loading JCBs onto a freighter bound for Rotterdam. Healthcare is highly politicised and in reality, there never really was a single market for our industry. As the LSE’s Professor Tamara Hervey puts it “The logic and structures of European Union law are not the logic and structures of healthcare”.
For instance, part of Echo’s service involves the home delivery of medication, a common and well-regulated practice in the UK. However, in the Republic of Ireland internet pharmacy is strictly prohibited, a law that ironically leads to more counterfeit medication flooding the country.
To understand why something relatively mainstream here is illegal in our closest neighbour, you need to follow the money. Most Irish patients pay on average €50 per GP visit, none of which is reimbursed by the State. The cost of medication is also picked up by the patient, and one asthma inhaler can cost over €60. In total, Ireland spends 40% more on medication per capita than Britain and thus, innovation, competition and liberalisation are a threat to profitability.
The EU is acutely aware of this problem and has seriously stepped up its campaign to drive legislative reform; whether UK firms will now be able to benefit from these reforms is unclear.
We need to ensure that the UK remains part of the single market and has adequate representation at future negotiations concerning the liberalisation of EU healthcare — we are really, really good at this stuff and can help tackle some of Europe’s biggest problem.