Between 1 April and 15 May 2016 the Royal College of Physicians (RCP) sought views from its fellows and members and health organisations closely connected to RCP on how the result might specifically affect healthcare and public health in the UK. The purpose was to help inform our fellows and members of the potential healthcare and public health implications of the referendum result
In total, we received 27 responses. The majority came from individual fellows and members but a number of submissions were from organisations and some had multiple authors. Where responses were substantive and focused on healthcare and public health in the UK the RCP approached the author/s for permission for their views to be published on its website. This resulted in the eight ‘submitted papers’ uploaded below. More succinct responses were also received along with some submissions that either did not comment on, or did not limit comment to, healthcare and public health issues. Those views have not been published on the website but where applicable have been considered within the overall summary below.
Strong views exist on both sides and individuals will come to their own decisions likely based on a range of issues. However, when considering the views submitted, they were in favour of remaining within the EU - the majority reflecting that the EU has many advantages in terms of health and healthcare.
Membership of the European Union has had a significant positive impact on public health and patient care in the UK through the setting of high standards in areas such as pharmaceuticals and medical devices, tobacco control, clean air and food safety. EU training and mobility rules mean that doctors and other health professionals who qualify in other member states play an essential and growing role in filling NHS workforce gaps. Significant European funding and scientific support is vital for UK medical research. These are some of the main conclusions of the views submitted:
For the UK to remain competitive in both the delivery of health care and the advancement of scientific practice and research requires it to be part of a community rather than standing alone
Professor Peter Kopelman FRCP
As a nation we are extremely successful in leveraging EU [scientific] grants and are second only to Germany in terms of the total share of available funding secured
British Society for Immunology
EU law affords European citizens, consumers and workers some of the best levels of protection in the world for our health
European Public Health Alliance
There is concern that a UK withdrawal from the EU would starve medical research of significant EU support, create uncertainty for vital EU trained health professionals in an already stretched NHS workforce and have a detrimental impact on public health:
The survival of the NHS and its capacity to improve hinge on three core needs: more money, more people and more research. Each of these will be negatively impacted should we leave the EU.
Professor Sir Simon Wessely FRCP
Separated from the EU, the UK on its own would lose the capacity to effectively control many of the most important determinants of our current and future health. These include pandemics, the environment, healthy sustainable food, and, perhaps most significantly, climate change.
Dr Christopher A Birt, FFPH, FRCPE
The 'Call for views' highlighted concerns about some specific EU policy areas – such as the potential negative impact of the EU-US trade treaty (TTIP) and the interplay between EU trade law and public health. However, a British withdrawal from the EU is not considered an appropriate response to these problems, given the loss of wider health benefits that the EU brings to the UK, as well as the likely post-Brexit influence of TTIP and EU trade law on the UK. Being outside the EU, the UK would no longer have any formal role in negotiations.
Progress can only be made in these outstanding areas of concern with the UK as a full member of the EU. To view departure from the EU as a solution to any of these specific concerns would be extremely short-sighted
Paul Belcher HonMFPH, Martin Mckee FRCP,
John Bowis HonFRCP, David Byrne HonFRCP
The RCP actively encouraged responses to the call for views from all sides – whether positive or negative – but received only two responses supporting withdrawal from the EU:
The EU referendum represents an opportunity to arrange an orderly exit from a failed political organisation and to restore constitutional democracy to the UK. The EU is so unstable that the alternative is a disorderly collapse, along the lines of 1848. That would not benefit public health anywhere in Europe.
Dr Ian Fellows FRCP
Commenting on the Call for Views, RCP president Jane Dacre said:
The RCP call for views has demonstrated support for the UK to remain in the European Union for health reasons. It has highlighted the considerable health benefits that EU membership brings to this country as well as the harm to patient care and public health that a withdrawal from the EU could entail. The EU is not without its faults, but there is a consensus that solutions are best found through continued EU membership, given that the health benefits of remaining in the EU outweigh the disadvantages of leaving.
To date (19 April), we have received few health-related comments in favour of leaving the EU but are very keen that both sides of the argument are available to members and fellows. We have not formed any position and actively welcome contributions from members and fellows from all sides of the debate.
What could it mean for healthcare and public health?
Many EU laws and programmes influence the delivery of healthcare and public health in the UK. For example, the free movement of doctors is regulated by the setting of minimum EU training standards as well as EU health and safety rules in areas such as working time. Patients have EU rights to healthcare in other member states when travelling, working or living in other European countries. EU research programmes provide funding for medical research and a variety of European public health programmes have been developed in areas such as drugs, tobacco, obesity and HIV/AIDS. The EU also regulates key areas, such as pharmaceutical licensing, clinical trials and data protection.
The RCP engages with EU institutions in a range of policy areas to input its expertise and influence discussions to promote its core mission of improving patient care and reducing illness.
Please submit your views to EUReferendum@rcplondon.ac.uk by 15 May. The RCP will then produce a response to help inform members of the potential healthcare and public health implications of the referendum result. A selection of relevant papers, focusing on the submissions of fellows and members, will be published below to inform debate.
Dr Andrew Goddard, RCP registrar
The House of Commons (HoC) Health Committee held an evidence session on the impact of membership of the EU on health policy in the UK on 26 April 2016.