Sector engages with the Department of Health over Brexit negotiations, priorities and implications.

On 28 September 2017, NICVA facilitated a discussion session with the Department of Health and sector representatives to begin to pin down areas of concern with regards to Brexit. The immediate fallout in the sector, the potential long-term repercussions and recommendations from the sector with regards to Brexit were among topics under consideration.

A brief reflection of the Department of Health’s approach to Brexit:

• The DoH assured sector representatives that discussions at official level are open and ongoing.
• A cross-departmental  ‘EU Future Relations Project’ has been established by government to co-ordinate work on highlighting and addressing the implications of Brexit. The core panel overseeing this includes representatives from four key departments considered to have particular Brexit impacts to address, namely the Departments of Justice, Economy, Finance, and Agriculture, Environment and Rural Affairs. It has so far been limited to these four, but also deals with many cross-cutting issues affecting other departments.
• Assurances were given that the DoH is and will continue to feed into discussions at an inter-departmental level on a regular basis.
• The DoH acknowledged the atmosphere of uncertainty surrounding Brexit in the sector. ‘The European Union (withdrawal) Bill’ otherwise known as ‘The Repeal Bill’, which will translate current European legislation into domestic legislation, as well as the possibility of a period of transition, were highlighted in the hope of moderating such fears. Emphasis was placed on an  approach to Brexit that favours ‘business as usual’, and the DoH was keen to stress addressing Brexit concerns is not a bureaucratic exercise.
• A formal process of information gathering is underway, the urgent demand for data from the sector has been acknowledged.
• Due to our current political context, the letter issued to the Prime Minister in August 2016, drafted by both the First Minister and Deputy First Minister outlining five key Brexit objectives, continues to inform the Northern Irish agenda. The objectives outlined are as follows -​​​​

1. That the border does not impede the movement of people, goods and services
2. That businesses must remain competitive retaining access to labour and not incurring additional costs
3. The need to avoid undermining the all-island energy market
4. Clarity on EU funding
5. Vulnerability of agr-food and fisheries sector

• With regards to the field of Health, the DoH identified four major areas as priorities in relation to Brexit, namely –

1. Health and Social Care Workforce
2. Cross Border Healthcare and access to Healthcare in other EU states
3. Funding issues
4. Financial risks re Non- Pay Expenditure

Leading sector concerns:

• The absence of data from which to glean an oversight of the issues and subsequently make informed decisions.
• Workforce concerns surfaced as a common theme, the sector fears Brexit will act as a catalyst for even more acute pressure on an already stretched workforce. Question marks arose over;

1. The employment and rights of resident EU citizens –  Notably, representatives from the British Heart Foundation highlighted 1/5 of their research staff as being European.
2. The need to maintain mutual recognition of professional qualifications
3. The importance of continuing to attract talent in the field of health
4. The protection of pensions

• Lack of engagement with the sector to date over the health implications of Brexit; particularly in comparison to the activities of our Southern counterparts.
• The potential to miss capitalising on or creating possible opportunities for the sector due to the time sensitivities which accompany Brexit.
• Funding anxieties. Promises of ‘match funding’ have been paid lip service, but formal guarantees remain absent.
• Moreover, questions of financial security and project longevity arise. Will the UK continue to generate a similar scale of funding schemes in a post-Brexit scenario? How will the state of the UK economy and fluctuations in currency play in this equation?
• The potential for isolation. Beyond immediate funding concerns comes the threat to intellectual exchange and access to regulatory networks such as those for food, disease prevention, new technology and drugs licensing.  
• The barrier of a border. Will cross border relationships be maintained? Will there be capacity for new initiatives to develop? Will Brexit have a disproportionate effect in NI; financially, judicially and operationally?
• The impact on rights and equality measures in relation to access to healthcare. In both a cross border and broader EU context.
• Lack of political representation and concern over the timeline for resolution raised its head as being of vital importance. What does the current political stagnation mean for how Northern Ireland’s voice is heard at the negotiating table?
• Lack of clarity and transparency as new cleavages unfold in Brexit debates.  Amongst concerns were; is post-Brexit scenario planning happening in a Northern Irish context? Who is the relevant point of contact? What would a potential transitional period look like for the sector?

Subsequent recommendations from the sector:

Improving engagement and communication:

• The DoH was urged to increase its engagement with the sector, and its input into government strategy.
• The desire for the Department of Health to be co-opted onto the ‘EU Future Relations Project’ was strongly projected. Given the specific sector concerns, as highlighted by this piece, it is a logical and necessary step.
• Representatives stressed the need for the widespread circulation and continual update of relevant points of contact for the sector, particularly as structures engaging in Brexit evolve.
• With regards to data gathering underway it was suggested a session through which the sector could be updated on progress and feed into the programme for work could be arranged.
• Establish a working group for external stakeholders, perhaps monthly consultation process.
• Engagement should be routine and substantive, not a tick box exercise.

Clarity on NI Policy Direction:​​

• Calls were placed for direction from the British government in the absence of a functioning Executive.
• The limitations of the Civil Service were acknowledged, the sector are calling on Westminster to provide political cover and fill the current policy vacuum in Northern Ireland.
• The sector hopes for more transparency and guidance in the future to manage this time period of political, social and economic uncertainty.

Financial Planning

• A thorough assessment of the monetary impact of Brexit on the sector must be a priority.
• Due consideration should must be given to the loss of EU funding for the field of medical research in the UK. Sufficient funds must be found in order to guarantee projects underway and in the pipeline. 
• A call for a commitment to investment in the workforce. Suggestions for further investment in tertiary education was recommended in order to future proof medical services.
• The impact of Brexit on pension schemes needs to be examined and solutions to circulating fears must be either put in place or further articulated.

Retaining access and partnerships

• There was a focus of discussion around the need to engage in damage control surrounding the impacts of Brexit on current cross border and broader EU partnerships which run deeper than funding.
• Areas of concern include exclusion from EU drugs licensing, threats to cross border emergency healthcare or Extra Contractual Referral Arrangements with regards to social care.