How could Brexit affect paediatric care in the UK?

London, United Kingdom – The British parliament is currently in turmoil as politicians argue about the terms on which the United Kingdom should leave the European Union and whether there should be a second referendum on the matter. 

One of the key messages of the “Vote Leave” campaign was a £350m ($458m) figure – the sum the campaign stated the National Health Service (NHS) would receive each week after leaving the EU. 

This slogan, notoriously plastered on the sides of buses during the lead-up to the referendum, was later revealed to be a lie. 

The potential impact on the country’s health service has been well documented by doctors and scientists since the referendum in June 2016. A poll by the British Medical Association in 2017 showed that one in five EU doctors working for the NHS had made plans to leave as a result of the Brexit vote.

One of the concerns as the deadline approaches is a potential shortage of medicines and a spike in prices of available ones. 

Last November, Matthew Shaw, then-medical director and now chief executive of Great Ormond Street Hospital (GOSH), the UK’s biggest paediatric research hospital, told a medical conference how Brexit will impact paediatric care in the UK.

“The European scheme for research Horizon 2020 has 40 child health projects and the UK is involved in 32 of these. We punch far above our weight. The funding for these projects is 200 million euros ($229m). All of these programmes are at risk. Even before transition, world-leading clinicians at GOSH are being excluded from European research programmes after years of being at the forefront of them,” he said. 

Shaw also voiced his worries about the availability of radioisotopes, which cannot be stockpiled, after Brexit. Radioisotopes are essential for the diagnosis and treatment of various cancers in both children and adults. In the UK, it is estimated that around 700,000 nuclear medicine procedures using radioisotopes are carried out each year. 

The UK does not produce any of the longer-lived radioisotopes used to treat a range of cancers. They are currently imported via road or air with a majority arriving through Coventry Airport. 

In the event of a no-deal Brexit, it is uncertain how delays at borders could affect the transport of these isotopes, some of which have a half-life of just six hours.

Andrew Kuc, a doctor and medico-legal writer told Al Jazeera that a number of components with regards to radioisotopes remain unclear. 

“The European Commission have proposed basic measures on aviation in the event of no-deal. This is reassuring given the UK’s contingency plan to airlift medical radioisotopes. But will the UK have the specialist capacity to receive these supplies by air? Will delivery supply chains be as seamless as now? We know that supply disruption can quickly lead to procedures being cancelled or re-scheduled. This can be distressing for patients and families, especially when children are being treated. And, of course, this is suboptimal in terms of care.

“And what will be the cost for the NHS? I don’t think it’s unreasonable to question where the NHS would get the additional money. Either new funds are found or diverted, or ultimately less people get treated.”

I have no trust in the future economy and I think the quality of life will deteriorate.

by Sara, Dutch paediatrician

 “We too are worried about the availability of key diagnostic tools using isotopes – without regulations allowing their transport to the UK, tests can’t be conducted and this could affect treatment outcomes,” Russell Viner, the president of the Royal College of Paediatrics told Al Jazeera. “Medicines for children are very different from those for adults.

“The EU allows a much broader array of drugs, which is particularly important for patients with rare diseases – it also allows access in a frictionless way. The European market is substantially larger than ours, and manufacturers are more likely to seek approval on the continent prior to the UK.

“Legislation isn’t in place in the UK to be able to approve drugs in the way that we need to do in the future and this concerns us. In addition, differences in the way the UK regulates paediatric medicines will mean added licensing costs to manufacturers and possible delays.”

Sara, a Dutch paediatrician working in London who wishes to remain anonymous because of the work she carries out with children, told Al Jazeera she would have returned to the Netherlands already if she didn’t have a family here. 

“I’m married to an Englishman and I’ve got a daughter who goes to school here,” she said. “If that wasn’t the case, I certainly would have gone back, the reason being I have no trust in the future economy and I think the quality of life will deteriorate.

“The hospital doesn’t have a pathway or a plan for no-deal Brexit, at least not that has been communicated with the staff, apart from helping and paying for staff to apply for the permanent right to stay in the UK.

“I have absolutely no idea what is going to happen in terms of import of medication. I know that the government is saying they are stocking up for six weeks, which is a relatively short amount of time.”

Sara is also concerned about the impact of not being able to apply for EU funding for research and not being involved in EU research programmes. 

“Pharmaceutical companies may not choose the UK for clinical trials if it has separate legislation to Europe.”

Any Brexit deal will be worse than remaining in the EU.

by Martin McKee, professor

Late last year, Lord Shaughnessy, who had previously been the parliamentary under-secretary for health, resigned. 

Some medical professionals who had been working with him, particularly on the supply of radioisotopes, have privately told Al Jazeera of their disappointment at this resignation, which they believe puts them back to square one on this issue. 

“The biggest problem is uncertainty,” says Martin McKee, professor of European Public Health at the London School of Hygiene and Tropical Medicine and a vocal campaigner about the problems Brexit will create for the NHS. “Any Brexit deal will be worse than remaining in the EU.”