“No man is an island entire of itself; any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.”
—John Donne (1624)
This statement is almost certainly true—and sadly in a negative way not just for the UK but for all of Europe. On March 29, 2017, the UK Government officially started the process of leaving the European Union (EU)—so-called BREXIT. This step commits the European community to a minimum of 2 years of uncertainty—and in reality probably considerably longer.
The UK’s departure from the EU and the ensuing uncertainty will almost certainly have a negative impact on health care in the UK and possibly throughout Europe. One wonders whether those who voted for this extraordinary decision really understood that at all. Much is unknown, but there are some harsh realities that will certainly impact health care in the UK and may be highly visible in cancer care and research.
‘Victims of Our Own Success’
The UK’s National Health Service is regarded by many as an interesting and aspirational model for health care, but the 21st century reality is that provision of the best modern health care, free to patients at the moment of need, is unsustainable. The reasons are multifactorial, but nothing exemplifies the problem better than the provision of cancer care. Put bluntly, we are victims of our own success.
The UK’s departure from the EU and the ensuing uncertainty will almost certainly have a negative impact on health care in the UK and possibly throughout Europe.— John F. Smyth, MD
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In recent years, every aspect of cancer care has developed at an enormous pace—screening, diagnosis, surgery, radiation therapy, chemotherapy, and now immunotherapy. Survival rates improve, patients live longer and therefore have other age-related medical needs. The costs of providing comprehensive cancer care have escalated beyond anyone’s imagination when the UK’s National Health Service was conceived. Irrespective of which particular politicians are in power, the reality is that the UK’s National Health Service is already grossly underfunded. This affects resources in general, costs of medicine in particular, and especially recruitment and retention of staff—doctors, nurses, and other health-care professionals. Leaving the EU is predicted to result in a serious recession in the UK, along with reduced gross domestic product growth across several European countries.
Impact on Medical Research
The financial impact will not only cause further problems for routine care, but is bound to influence medical research, well exemplified by the development of new medicines. Having served for many years on the United Kingdom’s regulatory body, the Medicines and Healthcare Products Regulatory Agency, and the European Medicines Agency’s Scientific Advisory Group for Oncology, I have first-hand experience of the contribution the UK makes to regulatory affairs, which currently affect all member states of the EU. When Britain leaves, everyone involved in the drug-approval process will feel the consequences—not least the European Medicines Agency, the governing body for drug regulation in Europe. The European Commission is almost certainly going to move the European Medicines Agency from its current location in London to another member state—possibly Germany, Italy, Sweden, or Denmark. The European Medicines Agency speaks of a “power vacuum” without the UK’s respected input, and the uncertainty surrounding this is already leading to staff migration.
I am greatly saddened by what is happening in Europe at present, especially when science is offering us so many realistic new ways to manage cancer.— John F. Smyth, MD
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The UK is also at risk of losing aspects of health-care innovation after leaving the EU—for example, in the conduct of clinical trials for new drugs. At the moment, pharmaceutical companies can apply for a single registration across all member states. They can therefore run EU-wide, multicountry studies registered on a single EU -clinical trial database; after leaving the EU, companies in the UK wanting to be part of these studies will have to apply individually to each country, resulting in a huge administrative and cost burden. Consequently, the UK and the EU would need to maintain separate databases in pharmaceutical products, both in their development and in the marketplace. There would therefore be increased costs for the UK, contributing to the National Health Service’s existing budgetary difficulties. Apart from this new expenditure, the UK would also lose its current disproportionate credit from current funding streams for medical research across the EU.
Recently, President Trump had to withdraw his proposal to repeal the Affordable Care Act, and in an interesting article in the Financial Times,1 Evelyn de Rothschild suggests that the major problem was the President “insisted on steaming ahead as if speed were the principal criteria in such an important reform; the consequence was an unholy mess.”1 She then states: “Health care has long presented the U.S. with a philosophical dilemma. More than Europeans, Americans are suspicious of state intervention and fear that a huge health bureaucracy would introduce socialism through the backdoor.” Ms. de Rothschild then details the measured way in which the National Health Service was introduced and developed in the UK and goes on to recommend creating a Commission to study systems that work well in countries such as Canada, Australia, and the UK. Their findings, she recommends, should then be adapted to the specific U.S. context.
Globalization Preferable to Isolation
I am greatly saddened by what is happening in Europe at present, especially when science is offering us so many realistic new ways to manage cancer. But having worked in the UKs National Health Service for almost 50 years, I can testify to the many strengths as well as financial difficulties (impossibilities) of funding this through government-raised taxes. To me, globalization is so much more preferable to isolation. Our departure from the EU will negatively impact the UK’s National Health Service, but I believe in any case, the time is fast approaching for a radical reform in the UK’s way of delivering health care. Maybe we should ask to join the proposed U.S. Commission and attempt to use intelligence (in the fullest meaning of the word) to influence and override the all-too-hasty politicians on both sides of the Atlantic! ■
DISCLOSURE: Prof. Smyth reported no conflicts of interest.
Prof. Smyth is Professor Emeritus of Medical Oncology, University of Edinburgh.
1. de Rothschild E: Speedy healthcare reform with bring an unholy mess. Financial Times Weekend, March 25, 2017. Available at https://www.ft.com/search?q=Evelyn+de+Rothschild+. Accessed May 24, 2017.