Good morning and thank you, convener. I am pleased to have the opportunity to give evidence on the implications of Brexit for health and social care in Scotland.
We are now almost exactly a year away from the day on which the United Kingdom will withdraw from the European Union. People in Scotland voted decisively to remain in the EU and I continue to believe that that is the best option. Short of EU membership, the Scottish Government believes that we should stay inside the single market and the customs union. Given the announcement yesterday, it now looks certain that progress will be made at the European Council later this week on the form and duration of a transition period, then talks should start in earnest on the future relationship between the EU and the UK. The outcome of those talks will have a major impact on economic and job prospects for current and future generations. The stakes could hardly be higher.
As I said in my letter to the committee of 24 January, the EU does not have huge competence over health and social care. Nevertheless, the implications of withdrawal are manifold. I outlined five key areas of concern, which have all been drawn to your attention in written evidence and your oral evidence sessions, which I have been following closely.
The first thing that I want to make clear is that EU citizens currently make a vital contribution across the public sector in Scotland, including in our health service, where they often fill skilled vacancies in hard-to-recruit specialisms in geographical regions, and in our social care sector, where they fill many vital roles. The Scottish Government has been clear that our fellow EU citizens who have chosen to live and work here are welcome, that this is their home and that we want them to stay. If free movement of EU nationals in the UK is curtailed as a result of the Brexit negotiations, it could have serious consequences for recruitment and retention of health and social care workers in Scotland. It could also negatively impact the free movement of medical researchers between Scotland and other EU countries and affect the ability of our academic institutions to attract medical students to come here to study and train, which would impact on the provision of healthcare.
This Government does not want any of that to happen, and we have made that clear with concrete policies such as guaranteeing that undergraduate tuition for non-UK EU students will be free for the duration of studies, even after Brexit, for those beginning their studies in the period from now until the academic year 2019-20. We have also committed to looking to pay the fees of EU citizens working in the Scottish devolved public services who wish to apply for settled status.
What we need to do now is ensure that, whatever may come from the Brexit negotiations, Scotland is able to continue to benefit from free movement from Europe and is able to manage international migration in a way that addresses our specific needs. That policy has been set out in detail in the recent Scottish Government paper “Scotland’s Population Needs and Migration Policy”.
A second area of concern relates to medicines and medical devices. As the committee heard last week, with 82 million batches of medicines crossing the UK-EU border per month, any decision that results in the UK leaving the EU as the regulatory regime for medicines and medical devices could have a detrimental impact across our health service. The risk is that patients might suffer as a result of slower or reduced access to new medicines and equipment. There could also be an economic impact on the pharmaceutical and medical devices industries here in Scotland. The ability to continue to operate or participate within the range of relevant EU frameworks and legislation would be in the best interests of Scotland. In our view, the best way to meet the UK Government’s stated commitment to continued close working and collaboration with the EU is for the UK to remain within the European Medicines Agency and to continue to secure access to the EU clinical trials portal.
Withdrawing from the EMA is highly likely to be detrimental to patients. The risk is that pharmaceutical companies could be less attracted to the UK market than they would be to the larger combined states of the EU and the US, potentially resulting in delays to patients getting access to the medicines they need. We are also concerned that medicine manufacturers could be negatively impacted by additional costs as a result of having to work separately with the UK. That may mean that some manufacturers choose not to do so at all.
In July last year, I wrote to the Secretary of State for Health and Social Care, Jeremy Hunt, urging him to secure the UK’s continued place within the EMA. Lord O’Shaughnessy’s response to my letter in August, setting out the UK Government’s intention to continue co-operation with the EMA, was less than reassuring, given that there is no example of a non-European Economic Area country having associate membership of the EMA. Against that difficult background, I can confirm that my officials are in close and regular contact with both the Department of Health and Social Care and the Medicines and Healthcare products Regulatory Agency to ensure that we are as ready as possible for any of the possible scenarios that may arise in this area as a result of Brexit.
Our third concern relates to those areas where we may need UK-wide common administrative frameworks if EU law is no longer applicable. There is a clear issue of principle at stake here in what might seem like rather an esoteric argument. We have always been clear that, on leaving the EU, common UK frameworks may be desirable or necessary in some areas and that we would agree to them where it is in Scotland’s interests, but we absolutely cannot accept the imposition by the Westminster Government of common UK frameworks, whether legislative or non-legislative, nor will we trade consent for consultation. If there are to be such UK frameworks, Scotland must agree to them.
In the health and social care portfolio there are a number of interests covered in the list of policy areas subject to discussions on UK common frameworks, which was published by the UK Government on 9 March. I will mention just two of them now, with the caveat that discussions on all areas are still on-going and that no final decisions have been taken.
The first is that changes to the current UK-wide system for mutual recognition of qualifications for a wide range of healthcare professionals could have profound effects on recruitment and retention on top of those that I have already mentioned. My view is that cross-border recognition of professional qualifications, education and training has to continue in order to support that workforce supply pipeline. If it does not, we will have an immediate and serious problem post-Brexit.
The second is reciprocal healthcare. We recognise that the rights of Scottish citizens to access state-provided healthcare across the EU, and vice versa for EU citizens in Scotland, should be guaranteed after Brexit. Some progress has been made on this area in negotiations with the EU, but uncertainty remains. My officials have been working closely with the Department of Health and Social Care and with other Government departments in these areas, in the context of the negotiations with the EU and the UK Government, on the possible need for common frameworks to ensure that Scotland’s interests are fully protected.
My fourth concern is that the Brexit negotiations have created uncertainty in relation to research, particularly with regard to access to future EU funding and collaborative EU partnerships in areas of interest for Scotland such as dementia and alcohol. The Scottish Government is keen to see on-going access for Scottish organisations to EU-funded research programmes, which will be important to ensure that Scotland can continue to be at the forefront of on-going international research collaboration. Loss of access to EU funding such as horizon 2020 will significantly impact on research in Scotland, unless mitigated. It is likely that international companies will be more likely to invest in facilities and manufacturing in the EU, which is a significantly bigger market than the UK, rather than risk tariffs and other barriers to trade. Withdrawal from the EU brings a real possibility of creating a research funding gap. Only 7 per cent of research money allocated by the EU and the European Research Council in the past decade has gone to non-member states. It is not only the scale of funding that is significant, but the locomotive effect that resources have to drive collaboration and forge partnerships that allow our researchers to achieve more than they would achieve on their own. There is also a concern that UK partners will be given less opportunity by other collaborators due to a perception of not being fully engaged.
My fifth area of concern relates to the potential consequences of future trading arrangements entered into by the UK. The process by which any such agreements are arrived at must be fully transparent. No constraints should be placed on the devolved powers of this Parliament. I have two main portfolio concerns here. First, we share the concerns that have been expressed by many that any post-Brexit trade deals that the UK enters into must not open up our NHS to privatisation. On 7 February, the Prime Minister, at Prime Minister’s question time, specifically failed to rule out opening up the NHS to competition. That cannot be allowed to happen. Secondly, we do not want to see post-Brexit trade deals being allowed to compromise the many public health benefits that we have realised in Scotland, such has in relation to alcohol and tobacco.
In conclusion, I can confirm that our assessments and preparations for Brexit are well advanced, but they are necessarily constrained by the lack of clarity about what EU exit will finally look like. The challenge is complicated by multiple scenarios and uncertainty about the UK Government’s objectives. In addition, many critical issues are reserved and the responsibility of the UK Government. We are seeking to mitigate some of the risks that we are facing by maintaining and strengthening our relationships with EU nations, through both the consular network here in Scotland and our office in Brussels. We are also upping our engagement with UK institutions that operate across Europe, ensuring that, come what may, Scotland will remain a progressive, outward-looking nation.
What I have presented to you this morning is by no means a comprehensive list of either my concerns or the actions that we are taking to mitigate some of the risks that we are facing, but I hope that it gives you a clear sense that we are alive to all the implications and challenges of Brexit and that we are doing what we can to mitigate risks that we did not seek and cannot avoid. I would be happy to take questions on all of those and any other related issues.