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Brexit and health and social care—people & process Contents

Conclusions and recommendations

Issues arising from Brexit

1.Giving evidence on the impact of Brexit, Jeremy Hunt MP, the Secretary of State for Health, told us that the Government would not be publishing its own digest of the implications of Brexit because “the publication of what might be called the worst-case scenario could itself have an impact on negotiations.” We do, however, urge the Department of Health to produce a comprehensive list of those issues that will require contingency planning. (Paragraph 6)

Influence of health within the negotiations

2.We recommend that whenever health issues are being discussed, in particular the areas which we have identified, ministers or officials from the Department of Health should form part of the UK representation in negotiations with the EU. (Paragraph 10)

Departmental resources

3.We consider it essential that the negotiating team for the health related aspects of Brexit has the expertise, competence and appropriate support for this complex task. We recommend that the Department of Health identifies the dedicated senior officials handling negotiations for each of the areas we have highlighted, in addition to clarifying the expertise and make–up of the overall coordinating team for health. (Paragraph 16)

Contingency planning

4.We recognise that the Government does not wish to set out the terms of its negotiating stance. It would nevertheless be helpful if the Department of Health could provide a list of issues under consideration to enable stakeholders and civil society to provide relevant input for the negotiations and to identify any important gaps. (Paragraph 27)

Future rights & entitlements

5.R-EU nationals in the UK enjoy a full set of easily enforceable rights and entitlements that put them on a par with British citizens. This should be acknowledged by the Government when undertaking any assessment of the incentives required to attract workers into health, social care, and supporting roles, especially low-paid jobs such as in adult social care. We wish to make clear the value that we as a Committee place on the health and social care workforce from R-EU nations. (Paragraph 51)

Future staffing requirements

6.The Government’s plan for our post-Brexit future should both ensure that health and social care providers can retain and recruit the brightest and best from all parts of the globe and that the value of the contribution of lower paid health and social care workers is recognised. (Paragraph 67)

7.To inform this policy, we recommend that the Government undertake an audit to establish the extent of the NHS’s and adult social care’s dependence on both the EU and the wider international workforce in low paid non-clinical posts as well as in clinical roles. (Paragraph 68)

8.The Government must acknowledge the need for the system for recruiting staff to the NHS, social care and research post Brexit to be streamlined to reduce both delays and cost. We call on the Government to set out how this will be managed in future. (Paragraph 69)

Revisions to professional regulation

9.We support the principle that all clinicians working in the UK should be asked to demonstrate relevant language, skills and knowledge competence. Nevertheless, the UK has an opportunity to negotiate a more pragmatic approach to the mutual recognition of professional qualifications directive within the British regulatory model. (Paragraph 81)

10.Attention needs to be paid to the balance between patient safety as served by regulatory rules which may restrict access to the profession, and patient safety as served by having a workforce sufficient to meet the country’s needs. Regulation should not evolve into unnecessary bureaucratic barriers which inhibit the flow of skilled clinicians in to the NHS. Therefore, automatic recognition of some qualifications should not be excluded from possible future regulatory arrangements. (Paragraph 82)

11.Future regulatory arrangements should be established by a process which involves consultation with all stakeholders and full Parliamentary scrutiny. The Government is considering new primary legislation to reform the professional regulation of health and social care and this should be the vehicle to reform the implementation of the MRPQ directive in UK law. It should not be amended using delegated legislation under provisions granted by the ‘Great Repeal Bill’. (Paragraph 83)

12.The Government must take full account during the process of negotiations that it would not be in the interests of patients to lose access to the alert mechanisms which identify potentially dangerous practitioners and which exist as a central part of EU law on mutual recognition of qualifications. (Paragraph 84)

European working time directive

13.The medical profession should take the lead in examining the opportunities which would arise were the UK no longer bound by the requirements of the working time directive. The profession should advise how the junior doctors’ contract could be adapted to improve training, team working and flexibility. The Government should then work with the profession to achieve the legislative and contractual changes which Brexit might enable. (Paragraph 92)

Reciprocal healthcare

14.It is in the interest of many hundreds of thousands of British people living across the EU to maintain simple and comprehensive reciprocal healthcare arrangements. The Government’s negotiating objective should be preservation of the existing system of reciprocal healthcare so that EU nationals in the UK and people insured by the UK in other EU countries can maintain their access to healthcare. (Paragraph 126)

Next stages of our work

15.In the next stage of our inquiry we had planned to explore the choices that will have to be made to ensure safe access to drugs, products, devices and substances of human origin. We had also intended to investigate any opportunities that may arise to plug regulatory gaps and adapt regulation to new technologies and personalised medicine. Given the subject matter, this topic needs Parliamentary oversight and we hope that our successor committee will prioritise this work in the new Parliament. (Paragraph 133)

27 April 2017