“Brexit is bad for health, and doctors should say so”. Neena Modi, president of the Royal College of Paediatrics and Child Health (RCPCH) in the UK, argued in a recent personal view in the British Medical Journal that leaving the EU will have wide ranging effects on the health of children in the UK and health care professionals. After last June’s elections – when no political party won a majority in the Parliament – it is unclear if the UK will choose a soft or hard Brexit. But either approach will affect health.
A recent poll has found that more than half of the UK’s National Health Service (NHS) trusts believe that Brexit poses a financial risk to their organisation. Staff recruitment and retention were identified as a key area of risk. This may be particularly detrimental to child health, as there already is a serious shortfall in the paediatric workforce in the UK. It has been estimated that at least 752 whole-time-equivalent extra consultants are required to meet standards for acute general paediatric services and paediatric specialist services. However, the number of applicants for paediatric training has fallen the past 2 years. Paediatric trainees report a fall in morale, which seems in part to be related to career disadvantage for those wishing to obtain experience in overseas medicine. In addition, one third of medical students are less likely to practice medicine in the UK following the Brexit vote, because of concerns surrounding working conditions, salary, future immigration laws and research opportunities. Non-UK qualified doctors currently make up two fifths of the career grade paediatric workforce. One in 10 doctors in the UK have European colleagues who have already left the UK because of Brexit and four in ten doctors are considering leaving the UK following the Brexit vote, aggravated by a reduction in non-UK applicants for consultant posts. Thus, Brexit is expected to worsen current paediatric workforce shortages. The RCPCH therefore calls the UK government to undertake urgent action. The UK government has announced a rise in the number of training places for doctors, but it takes at least 10 years to train a doctor. Better solutions need to be found.
Trainees from the UK belong to a younger generation that voted to remain in the European Union. They recognise that international collaboration is essential for the further advancement of medical science. UK surgical trainees voiced their concerns in a recent article in the Lancet that future UK access to EU initiatives and funding sources might be limited and that the vote for Brexit risks sending a negative message to their European collaborators. They therefore urged for ongoing incentives for international collaboration – such as research funding, training fellowships and reciprocal exchanges – between the UK and the European Union. Their perspective was supported by a reply in the Lancet from their Italian colleagues, who emphasized that European collaboration creates international connections and fosters local advancements.
The opportunity for researchers and clinicians to gain experience in different European countries, including the UK, helps to build successful careers and are crucial for developing young talent in paediatrics. Last month, the UK government pledged in their White Paper to maintain close links with European research institutions after Brexit and to discuss future arrangements to facilitate the mobility of researchers engaged in cross-border collaboration. Details are, however, lacking. Importantly, special attention should be paid to the (potential) effects on the development of medicines for children. No country is big enough to develop medicines for children in isolation. The UK currently provides valuable scientific coordination. Brexit should not result in reduced cross-border research collaboration, lesser access for British children to European clinical drug studies, or possible delays in accessing new treatments. Antimicrobial resistance and other treats to child health like pandemics and climate change can also only be tackled in a cross-border manner. In addition, the treatment of rare diseases and addressing the health needs of migrant children benefit from collaboration.
Brexit is expected to have far-reaching consequences for bystanders like refugees. The UK should continue to share responsibility for migrants and refugees, which includes healthcare for and integration of migrant and refugee children. The UK is a key player in European Reference Networks, which support European cooperation and knowledge sharing in the field of rare diseases. Children are disproportionally affected by rare diseases. In addition, UK-EU networks in areas with an effect on child health – like life sciences and environmental protection – are complementary and have developed in tandem over many years. Therefore, it has been argued that Brexit must preserve pan European advisory networks.
We strongly believe that child health in Europe and the UK can only advance further through true collaboration. True collaboration can only be achieved if paediatric trainees, clinicians and researchers are free to work, learn and teach across Europe. Therefore, the European Academy of Paediatrics supported the joint letter to the Chief EU Negotiator written by several European Medical Professional Societies earlier this year. All questions related to health care and medical research will be answered only after negotiations between the UK and the EU are completed. Whatever the outcome, Brexit will not let us stop from collaborating on projects and sharing ideas.
About the authors:
List of Authors
SIAN COPLEY is member of the Rcpch Trainees’ Committee and of young EAP. She is a 3rd year paediatric trainee at the Health Education North East in the UK.
LAILA VAN DER HEIJDEN is the chair of the Dutch Junior Paediatric Society and member of young EAP. She is a 2nd year paediatric trainee at the University Medical Center of Utrecht in the Netherlands.
LENNEKE SCHRIER is the european junior doctor representative to the European Academy of Paediatrics. She is a 4th year paediatric trainee at the Leiden University Medical Center in the Netherlands.
ROBERT ROSS RUSSELL is the chair of the Tertiary Care Council of the European Academy of Paediatrics. He is a consultant paediatrician at Cambridge University hospitals foundation trust in the UK.
New ways to test high-risk medical devices.
Manufacturers of medical devices need to test their products before being allowed to market them. Specifically, they require clinical data showing their medical device is safe and efficient. In this context, the EU-funded CORE-MD project will translate expert scientific and clinical evidence on study designs for evaluating high-risk medical devices into advice for EU regulators. The project will propose how new trial designs can contribute and suggest ways to aggregate real-world data from medical device registries.
It will also conduct multidisciplinary workshops to propose a hierarchy of levels of evidence from clinical investigations, as well as educational and training objectives for all stakeholders, to build expertise in regulatory science in Europe. CORE–MD will translate expert scientific and clinical evidence on study designs for evaluating high-risk medical devices into advice for EU regulators, to achieve an appropriate balance between innovation, safety, and effectiveness. A unique collaboration between medical associations, regulatory agencies, notified bodies, academic institutions, patients’ groups, and health technology assessment agencies, will systematically review methodologies for the clinical investigation of high-risk medical devices, recommend how new trial designs can contribute, and advise on methods for aggregating real-world data from medical device registries with experience from clinical practice The consortium is led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, and involves all 33 specialist medical associations that are members of the Biomedical Alliance in Europe.
