So it’s done. The UK is out of the EU. Now all that remains is for things to fall where they well, for good or ill – is what many would like to say. But not so fast! Just as Brexit itself dragged on for years, actually completing the process is still going to take more time and leave jagged edges on what used to be tied into the EU state of affairs.
There’s a lot of talk about how to ‘assume the new normal’ with regards to trade and economy, but perhaps what concerns most people is the state of healthcare going from here. Brexit’s irrevocable now. Pushing forward, are the most vulnerable people in the UK going to be left behind?
Disability Rights in the UK and the EU
People classed as disabled in some manner make up about 1 in 5 of the population, or about 13 million people. Of these, 3 million are in employment. Only 17% of people are born with disabilities, most acquire a disability later in their lives. The extent of disability increases with age, with only about 7% of children being disabled, rising to 18% for those in working age, and 44% of adults in their senior years.
Such a sizable demographic have natural concerns about what will happen to them after Brexit. Their most urgent concerns tend to be:
- The price of medicine and healthcare
- Accessibility and assistance
- Welfare benefits for foreign nationals and expats
- Employment rights
- Employment of Personal Assistants from the EU
- Human rights and access to justice & independent living
The Crisis State of the NHS
First we must address the reality of the overburdened state of the NHS. Across all the NHS trusts, there is a shortage of almost 100,000 key staff – including nurses, doctors, health professionals and care workers. Adult social care is specially hard hit, with around 122,000 vacancies. In preparation for Brexit there has been a large push towards recruitment, but in a limited pool of qualified manpower there can only be two outcomes:
- There will be shuffling of priorities as obviously qualified workers go to where they will be paid more or have easier access to their workplaces
- A lowering of standards to fill less demanding care work with inexperienced or questionable hires.
This is an inescapable fact: in the short term, before achieving the new normal, things will have to hurt. The NHS is already burdened as it is – administratively and fiscally, it cannot take a sudden upsurge in demand. It’s telling that the most the NHS can promise is that to have the same level of care that people were able to get before Brexit. No one has any illusions it could be done any better.
The costs of goods, the costs of employment, all of the are expected to rise. Preventing people from being left behind is a pressing concern, let us hope the NHS doesn’t go into a triage state.
The Price of Healthcare is Most Likely to Rise
Prior to Brexit, despite how it was argued that less convoluted regulations would make prescriptions easier to access, there existed avenues of competition for medicine. Why do people care about in the EU when all strive to the same healthcare standards? Because prices there are lower than here in Britain, hence why medical tourism to the EU was a popular thing before talks of Brexit. This is just how the free market works.
Brexit and the loss of the Common Travel Area . Without preferential trade practices with the EU, where else is the UK expected to find prescriptions at the most affordable price? The United States maybe? Who would ever believe that American pharmacies would allow the UK to pay less than what they do in their own market?
Former British ambassador to Washington, Sir Kim Darroch commented “I know what the US will be pitching for when they negotiate a free trade deal with us. They will pitch for massively greater access to agricultural products… They will also want us to pay the same for American pharmaceuticals as they pay in their own market.
“Do they want us to pay more for their pharmaceuticals? Do the pharmaceutical companies want to use this leverage? Of course they do.”
Conservatives state that “the price the NHS pays for drugs is not on the table”, but the US Pharmaceutical Lobby has boldly stated their objectives that “Narrow approaches to HTA, such as rigid cost-effectiveness methodologies, should not be the principle framework for assessing value.” It is going to be an uphill battle, but the UK lacks any leverage against those entrenched interests so happily entertained by the government in power.
Because the UK was so stringent about cutting loose from the EU for reputedly saving the NHS money going out, now there is no choice but to pay more developing pharmaceuticals in-house to keep prices down, or pay more whatever it takes to gain US or EU products otherwise unavailable at home and just rebate the difference to keep costs low for the end consumer.
In the former, it’s going to take a little bit more time and hope that a captive market has any ability to leverage prices and for the second there is only room for regret about what used to be easier to get. This is the new normal. The NHS possesses an almost monopoly in drug purchases which has helped keep prices down. But it is a box pulled at too many corners – anything to help resolve one issue means less resources to deal with another present need.
Accessibility and Aid for the Disabled after Brexit
When the UK was part of the EU, rights of the disabled rested upon the UN Convention on the Rights of Persons with Disabilities and the European Charter of Fundamental Rights. For the most part, rights will not be affected since most of these provisions are in the Equality Act 2010.
Implementation, now that is another matter entirely. One separated from the EU, the disabled no longer have access to any higher tribunal like the European Court of Justice to ensure that laws are not interpreted too narrowly. They would lose financial support from the EU trusts that foster development for disabled people.
“EU law would no longer prevent UK governments from rolling them back – nor from rolling back other disability rights measures currently set out in both UK and EU law,” said Anna Lawson, law professor and director for the Centre for Disability Studies.
Disabled persons in the UK would not benefit from any new developments in the EU regarding laws that better protect their rights.
The European Disability Strategy aimed to allow disabled people full rights to inclusive education, employment, health, and etc. Until recently, cross-border benefits meant that they, along with their carers, can afford to travel with peace of mind. Transport providers are obliged to make it convenient for the disabled to use their services. Complex needs and emergency medical treatments are assured under the European Health Insurance Card (EHIC), of which 27 million have been issued. There was no reason for a disabled person to feel any more trapped than anyone else.
That will soon enough cease to be valid. Reciprocal health insurance might not cover pre-existing conditions. Disabled persons will no longer have any confidence that disputes can be settled in their favor, that protections cannot be rolled back, and that infrastructure to support their needs to access public places and health care won’t be dragged on for lack of funding and priority.
Will the UK Inclusive Transport Strategy survive a budget crunch? Only time will tell.
Welfare Benefits from Out of the UK
But it’s more than just Britons who need to worry about the effects of Brexit. There are EU citizens within the UK who, for certain reasons may not be able to leave, and are cared for by their British relatives. They will be eligible to claim benefits until 31 December 2020, and then to continue receiving benefits they must apply for settled status.
Only those who have lived in the UK for 5 years in a row qualify for Settled Status. According to the UK-EU proposal:
In accordance with our obligations under the Withdrawal Agreement, EU citizens and their family members who can evidence to the UK authorities that they fall within the scope of the Withdrawal Agreement (i.e. are lawfully resident before the specified date) must be granted status by the UK authorities unless 1 of the grounds for refusal permitted by the Agreement is met. The UK authorities will have no discretion to refuse an application in other cases. We have already agreed with the EU that the conditions for EU citizens acquiring permanent residence/settled status under the Agreement will be as per the conditions set out in Article 16 of Directive 2004/38 (5 years of continuous and lawful residence as a worker, self-employed person, student, self-sufficient person, or family member thereof).
The issue is that many disabled EEA citizens find it hard to apply for a permanent residence card because they cannot prove to have worked for 2 years, due to their impairment. Some carers, EU nationals who care for family members, also have difficult asserting their right to reside because they are not considered working persons. They have until recently qualified to receive benefits from the NHS, and then suddenly their residence would retroactively be considered unlawful?
Disabled persons have families too, and splitting up families is not the reason for Brexit.
Employment and Discrimination for the Disabled
The Equality Act of 2010 sets provisions for the protection and allowance of the disabled in the job market. However, many still report feelings of discrimination in the workplace. Many who are otherwise willing to work find themselves closed off and must subsist on welfare, not just because of the reduced chances of being hired but because accessibility conditions in the workplace are not up to their needs.
About half of disabled people are in employment, compared to three-fourths of working age non-disabled people. A substantially higher proportion of those who live in families with disabled members live in poverty, with 21% of children in families with a disabled member compared to 16% of those children in families without a disabled member. The reasons should be fairly obvious; the increased time and expense needed for their care, and the increased hardship they must go through to access public areas, schooling, and work.
Brexit may be a two-edged sword. On one hand, everything will shortly become significantly more difficult for the disabled who participate in employment. Higher costs, less care availability, etc. On the other hand, employment shortages may lead to employers entertaining hiring more persons with a disability as long as they can do the job.
On the gripping hand, losing access to the EU Court of Justice puts a ceiling on how far the disabled may go to seek a remedy if they believe they are being treated unfairly. What’s even worse is that it’s not just the NHS that is facing a manpower deficit, the law and public aid services are even more under-funded and under-staffed. For disabled persons to get their voices heard, they must be prepared to go political.
Not So Fast, but Hardly Enough
The transition period for Brexit will only last until the end of 2020. Until then, the disabled citizens and EU residents within the UK can continue to receive benefits and protections as if they were still in the EU. After this, it’s mostly a matter of those who managed to thread the needles, got all their paperwork in order, and stockpiled the drugs they need to live.
If you’re a disabled person or caring for one, this probably is not the time for you to try and DIY your future. Consult with a solicitor about your options and how to move forward your concerns before it becomes critical.