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When the UK left the EU and the Single Market, it abandoned the application of European law and institutions that had formerly underpinned many elements of health and social care in the UK. Regulations on medicines and devices, laws on the buying and selling of care, trade agreements, and rules on migration which had previously worked across most of the continent, were repatriated to the UK. 

More than three-and-a-half years on, these changes are still fuelling uncertainty in many aspects of our health and social care system.

Professionals have raised serious concerns about the impact of EU departure. Many believe that the failure to address these concerns would lead to serious consequences for the sector and the public. 

Our new report summarises much of the work carried out on the effects of Brexit on the NHS, health and social care since 2016. Our purpose in writing it is to raise awareness of the challenges and difficulties created and the impact they are having on the nation’s health and care, and to draw attention to the need for a more ambitious UK-EU agreement which would serve the needs of the sector and, as a result, the UK population. 

Concerns can be grouped around five main areas.

First, mobility. Across England, Scotland and Wales NHS workforce challenges are the most critical. Recruitment from countries outside the EU has increased, but the workforce gaps are still significant, and there is no credible plan to move to greater reliance on British staff. The situation in social care is the most urgent, where new immigration rules largely halt immigration from the EEA. 

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Second, the medicines, medical devices and life sciences industry in the UK faces great uncertainty. Border bureaucracy has increased dramatically. The current regime seems oblivious to the fact that product supply to the NHS relies on global trade. The NHS now regularly experiences delays in obtaining medical equipment and medicines from the EU, which puts patients at risk and limits treatment options. 

Alignment with the EU, as has been chosen for medical devices and equipment for Northern Ireland, allows for cheaper supplies. This model could be followed for Britain should the Government so choose. 

Third, trade negotiations have done nothing to help the NHS or social care. The Government once promised that the NHS and medicines prices would be kept "off the table" in trade negotiations, but this promise means little without specific commitments on key areas such as patent protections and investment rules. There does not appear to be a clear agenda to bring any benefits to health in the UK through trade agreements. 

Fourth, the lack of clarity over the Government’s plans for regulatory divergence from the EU is causing harm to the sector. Regulatory divergence from the EU could be used to meet policy goals (greater patient safety, incentivise industry investment or early product launch, for example), but risks increased costs associated with being a smaller market. 

There is a need for regulatory consistency and clarity. There is no ‘obvious right answer’, but the pros and cons of different positions should be acknowledged – as our report does – and debated.

Finally, the new settlement has harmed health and social care in the devolved nations. Governments in Scotland, Wales and Northern Ireland are concerned that they have lost some of their control over health protection, improvement of health outcomes and health-related funding. 

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The special situation of Northern Ireland is perhaps the most critical. Both product supply and workforce remain fragile aspects of the NHS in Northern Ireland. The gains to peace made through the health aspects of ‘Cooperation and Working Together’, following the 1998 Agreement, are too precious to be lost. 

What is needed now is a calm, evidence-led, realistic, and detailed discussion about where the UK (or rather, where Great Britain and Northern Ireland) wants to place itself in terms of our global relationships when it comes to health and the NHS. 

The relationship with the EU will continue to be the most important one for the UK, which shares its only land border with the EU, and where dense trade relations still apply. The relative size of the UK (or Great Britain) is an important contextual factor. 

There is no point in ideological statements about ‘Global Britain leading the world’: if we want to continue global health leadership we need to forge alliances through which to do this. Our most obvious partners remain our European neighbours. This isn’t ‘remain/rejoin ideology’ – it’s hard-headed and practical. 

What we need now is political leadership to step up. Without it, health and social care will continue to suffer – needlessly causing harm to those in need of care. 

Mike Buckley is the director of the Independent Commission on UK-EU Relations

Wera Hobhouse (picture: Bath Echo)

With the Labour Party leadership election continuing to drag on – longer than Götterdämmerung but likely to bring much the same outcome for that benighted party – little attention has been given to the other British political leadership that will take place later this year – that for the leadership of the Liberal Democrats.

It’s undeniable that the Liberal Democrats had a disappointing election. Buoyed by good European Election results and with Jo Swinson talking about how a Liberal Democrat win would be a mandate to stop Brexit, the outcome was brutal, especially in England; only 12 MPs and the apparent wholesale rejection of Liberal values in favour of an unashamed populist nationalism – English nationalism – of the right.

Assuming that Labour cannot reverse the Corbynist tide, that result provides possibly unique opportunities for the Liberal Democrats – if they can grasp them. Brexit was never simply about the question of whether the United Kingdom should leave the EU; it was one battle in a much larger culture war about the sort of society we want to be. Those battle-lines have become much clearer in the weeks since Johnson’s election win: a government that defines itself by its attacks on the institutions of liberal democracy – the judiciary, the Civil Service, even the BBC – while seeking a hard Brexit that will inflict untold economic and social damage in the name of satisfying nationalist cravings for what will clearly be an illusion of independence. Everything that has happened since the election – including the Labour Party election, characterised by its refusal to understand what really happened in December, and its participants’ apparent determination to anaesthetise its members with comforting, unthreatening narratives rather than dealing with root causes – points to the fact that the dividing line in British politics is no longer about left and right, or class, or identity, but between the politics of post-truth, populist nationalism on the one hand and of the core values of liberal democracy – of empirically-based, evidenced reform on the other.

Into that void comes the first avowed Liberal Democrat leadership candidate – Bath MP Wera Hobhouse. In both an article on the PoliticsHome website and on her own, new, campaigning website, Hobhouse sets out a vision for how the Liberal Democrats should move forward; she makes a persuasive pitch for the case for locating the party firmly on the centre-left.

There are two ideas that appear central to her case, and I think could offer the way forward for Liberal Democrats to seize the political agenda.

The first is essentially ground-clearing. It is essential that the Party acknowledges that coalition with David Cameron’s Conservatives was an appalling mistake – however well-intentioned – that seriously traduced the party’s values and damaged its credibility. In my view it is absolutely essential that we repudiate the coalition, publicly and unequivocally. It remains a huge political handicap that we have to deal with.

Second, Hobhouse argues that we should “keep the flame” of rejoining the EU burning. The language here is careful; I note that she does not say that we should campaign to rejoin, and I think she is absolutely right in that. In England in particular such a position would be politically disastrous; we have to accept that, whatever we think of the electoral system, Johnson has within the terms of British constitutional practice a mandate to take forward Brexit, most of all in England where Tories and Brexit Party combined took 49% of the vote. Technical arguments that the remain/people’s vote parties had a small majority of votes cast aren’t going to cut it in the current climate, and risk reinforcing the electoral coalition – many of whom are far from being natural Tory voters – that formed around Johnson’s message of getting Brexit done last December.

I think that the key message is slightly different. We Remainers constructed the largest popular movement seen in recent British politics; we twice got a million people on to the streets of London, got six million people to sign a petition calling for the revocation of Article 50, and how a network of active, grassroots campaign groups sprung up around the UK, often with little support or encouragement from a confused and conflicted anti-Brexit campaign in London. And those people where, whether they knew it explicitly or not, campaigning for liberal values. In many ways, that big Liberal Democrat vote in the European Elections in May 2019 looks like the triumph, not of the Liberal Democrats as such, but of the “for Europe” grassroots groups around the UK, who, while explicitly and rightly cross-party, created the climate in which that vote could happen; and they are the Liberal Democrats’ natural constituency. Their values are our values.

And likewise Liberal Democrats would do well to examine how the “for Europe” groups managed, with little in the way of structure or resources, to organise grassroots campaigns that made an impression and achieved a profile that many local Liberal Democrat groups could only dream of; and often did so with a minimal resources, but with passion and imagination; a lesson, perhaps, that there is a lot more to campaigning and engagement than sticking Focus through letter boxes. If Liberal Democrats want to engage with the grassroots politics that got a million people on to the streets of London – or indeed got a thousand people on to the streets of my own city of Cardiff – they should have the humility to learn lessons from that movement too.

The biggest strength that Liberal Democrats have now is the ability to rewrite the narrative in a time of crisis: to reach out and re-engage with the millions of people who yearn for Liberal values in populist times; the decent people who, outraged by the Liberal Democrats’ role in supporting Cameron’s austerity government, looked elsewhere – most of all to the movement against Brexit – to find expression for those values. And, as Wera Hobhouse writes, in order to do that her party needs to make common cause with the people who share those values and to make a clean break with the last ten years.

Lecture with Kalypso Nicolaidis (St Antony’s College). Respondent: Anand Menon (King’s College London) Convenors: Timothy Garton Ash and Kalypso Nicolaidis (St Antony’s College). The event was co-sponsored by The Oxford Research Centre in the Humanities (TORCH) and the Centre for International Studies at DPIR.

The IMF's austerity plan hasn't worked. Greece's possible recovery is down to a construction programme boosting the economy

It was nearly four years ago that the Greek government negotiated its agreement with the IMF for a harsh austerity programme that was ostensibly designed to resolve its budget problems. Many economists, when we saw the plan, knew immediately that Greece was beginning a long journey into darkness that would last for many years. This was not because the Greek government had lived beyond its means or lied about its fiscal deficit. These things could have been corrected without going through six or more years of recession. It was because of the "solution" itself.

Four years later, Greece is down by about a quarter of its pre-recession national income – one of the worst outcomes of a financial crisis in the past century, comparable to the worst downturn of the US's Great Depression. Unemployment has passed 27% and more than 58% for young people (under 25). There are fewer Greeks employed than there have been at any time in the past 33 years. And real public healthcare spending has been cut by more than 40%, at a time when people need the public health system more than ever.

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