The Brexit endgame — the question of deal or no deal

It’s now the Brexit endgame, where we find out how the UK will leave the EU at the end of the year — with or without a trade deal. In many respects, this will be the real moment of Brexit, given the UK left earlier this year, on 31 January, and has been in a period of transition since then whilst a deal is thrashed out. But with a looming deadline of 31 December 2020 to bring that transition to a halt, time is fast running out for the UK and EU to settle on a trade agreement. If such an agreement isn’t reached, the UK’s trade arrangements with the EU will move to World Trade Organisation rules.

Precisely how this will end remains to be seen — and the fluctuating state of whether the UK Government and EU have been negotiating or not has been confusing at times. There was anticipation that there would be clarity on a deal or no deal by 15 October (a deadline had been set by the Prime Minister) but alas, no answer was forthcoming. Instead, there were a bizarre few days of questioning the exact status of negotiations. At the time of writing, the latest noises are that post-Brexit talks will continue this week (w/c 26 October) — and 26 November is the latest date that the European Parliament can ratify a UK agreement.

Australia versus Canada?

Brexit has been rolling along for so long and one can sense fatigue. With the additional unprecedented pressures from COVID-19 this year in the mix, this is not surprising. Since the 2016 EU Referendum, the UK has essentially been on stand-by to prepare for what its eventual exit, and the nature of its trading relationships with the rest of the world, will look like. The sticking points of the UK’s negotiations are well reported: disagreement over how free the UK would be from common EU rules; EU access to fish in UK waters; and governance of any future agreement between the EU and UK (something that has been particularly contentious given EU leaders’ loss of faith with the ‘UK Internal Markets Bill’).

If there is a deal, the question at hand is how detailed it would be — previous EU agreements with other countries offer clues. On one end, there is the so-called ‘Australia-style’ arrangement, which is essentially a framework, statement of intent — a basic deal — as a precursor to something more detailed. However, the UK would largely be trading on World Trade Organisation rules in the meantime until that ‘something more detailed’ was agreed.

On the other hand, there is the ‘Canada-style’ arrangement, which could be more comprehensive but achieving mutually favourable terms between the UK and EU in such an agreement seems deeply problematic. Therefore, some sort of a basic solution may be the pragmatic way forward. But seeing this debate in such binary terms may perhaps be a little unhelpful, as should an agreement be made, it will be a unique product. Ultimately, we’ll know over the coming days whether a deal (in some form) or no deal is reached.

Health and social care

So what does this mean for health and social care? We can’t completely say for sure as there are still some areas needing answers. Despite the lack of clarity, the sector has been taking steps to prepare for some time. The King’s Fund neatly summarised that the anticipated key impacts of Brexit on health and social care would be on:

• staffing
• accessing treatment here and abroad
• regulation (e.g. medicines, supply of medicines and medical devices, competition law, and the working time directive)
• cross-border cooperation (e.g. public health, research, and clinical trials)
• funding and finance for the NHS and social care

With COVID-19, additional complications have been anticipated, particularly on supply of medicines and medical devices from or via the EU. The Nuffield Trust has recently considered how Brexit will affect the UK’s response to COVID-19 while trying to maintain normal services — it will be a juggling act but it would be helpful to have the context of agreement between the UK and EU to provide certainty.

Towards the end of last year, RCPCH published advice on what the impact of leaving the EU would have on child health. Our concerns still apply today. In preparing for exiting the EU, we urge the UK Government to ensure that the health and wellbeing of today’s children and young people are not harmed. We call for continuity of access to medicines, medical devices and care for children and young people, measures that do not destabilise the workforce, and protection of research.

Brexit has regularly been discussed at RCPCH Council and we’ve been working with our Medicines Committee given worries about medicines shortages and how they will be managed. Operationally, we’ve also been looking at data agreements to consider what impact this could have from an information governance perspective. On a number of these shared concerns, we’ve been liaising with other colleges through the Academy of Medical Royal Colleges.

Brexit Health Alliance

A focal point for joint-working has been the Brexit Health Alliance. Through the Academy via its membership of the Alliance, we’ve been pressing for action. This coalition brings together the NHS, medical research, industry, patients and public health organisations working together to prioritise health in the UK’s future relationship with the EU. As we approach the end of the Brexit transition period, the Alliance has issued advice on how the healthcare sector can prepare. Brexit will have a significant impact on the sector, including access to reciprocal healthcare arrangements, protecting public health and the supply of medicines and medical technologies. Data sharing between the UK and EU, particularly when it comes to public health threats needs to be addressed. Again, without the UK having some agreement in place with the EU on these areas, the concern is that the adjustment for the NHS and sector more widely will be significant and could affect the health and wellbeing of patients and citizens. Therefore, the Alliance is calling on the UK Government to:

• redouble efforts to reach a deal that protects patients, the continuity of supply of medicines and health tech and medical research, especially in the context of the pandemic
• urgently clarify arrangements to support patients, healthcare providers and researchers in the event of negotiations being unsuccessful and allow sufficient time for preparations across the sector

With the clock ticking, we have to wait and see where the situation lands between the UK and EU. If there is a trade deal in the next few days, there will be a race to get it ratified by European Parliament by 26 November and there’s the European Council Summit on 10 to 11 December before the 31 December deadline.

Whether there is a deal or not the College will update its leaving the EU resources for members as soon as we know more, so do check for updates. In the meantime, let’s keep watching the negotiations endgame.