“A vote to leave the EU would be the start, not the end, of a process. It would begin a period of uncertainty, of unknown length, and an unpredictable outcome.”
– an official government paper, via The Independent
The Great British public has a lot to consider with the impending June 23 European Union referendum vote: its implications will inevitably be impactful whether the UK votes “yes” or “no” on leaving the EU.
The NHS, immigration and financial security are among the issues being discussed, and finding hard facts regarding these subjects is challenging, especially given the mechanical efficiency in which both Remain and Leave camps have shot down the other’s “evidence” that their view is the correct one.
But what would leaving the EU mean for people with diabetes? Understandably, this isn’t being discussed on the national agenda – there are other issues at hand – but Brexit could yet have stark implications for the diabetes community.
One of the big talking points regarding a potential Brexit extends to people with diabetes: the economic ambiguity of the UK leaving the EU means that it is hard to predict what will happen to interest rates, inflation and national debt – factors which will affect the government’s financial planning in the short- and long-term.
It is unknown is how the government would be able to invest in the NHS, and this could affect diabetes care and treatment.
How would Brexit affect diabetes care in the UK?
The NHS is a primary subject of Brexit. Leading Brexit campaigners argue that leaving the EU could free up £100m per week for the government to be spent on the NHS by 2020, but this claim has been refuted by the Institute for Fiscal Studies (IFS).
Conflicting reports such as these are common when it comes to Brexit, particularly in regard to the financial state of the NHS. Of course, remaining in the EU may also lead to changes in NHS financing.
One thing is certai, though: the NHS is a unique institute within the EU. Healthcare is entirely free and funded by taxpayer’s money, and it provides a wholly remarkable service for people with diabetes.
Diabetes patients receive free insulin and metformin on the NHS, while all type 1s and some type 2s get free blood glucose testing equipment. Additionally, access to structured diabetes education courses such as DAFNE is provided without charge.
You’re quite likely to find conflicting reports such as these regarding what the financial implications would be for the NHS following Brexit. Of course, remaining in the EU may also lead to changes in NHS financing.
Currently, the NHS costs around £100b a year to ru, and diabetes takes up 10 per cent of this budget.
Earlier this year, Diabetes UK warned that NHS staffing levels in hospitals are “not keeping pace” with the increased demand for beds occupied by diabetes patients, and concerns have been raised that Brexit could affect NHS staffing.
Justice Secretary Michael Gove argues that immigration could make the NHS unsustainable by 2030.
Speaking in Westminster, Gove said: “If we vote to remai, I fear the NHS will only face additional pressures. Even without the accession of any new countries, we can expect a continuing net flow of 172,000 new individuals from the EU to the UK every year.”
But Labour MP for Leicester East Keith Vaz, argues this point. Vaz has type 2 diabetes and is part of the All-Party Parliamentary Group for Diabetes (AAPG). He is also in favour of remaining in the EU.
Vaz told Diabetes.co.uk: “NHS services and staff are already stretched to breaking point to cope with current demands. Whilst arguments have been made that unlimited EU migration adds to this, people also forget that many NHS employees are EU migrants themselves. At present, 11 per cent of the NHS’s staff was born outside of the UK.
“I fear that leaving the EU will deprive the NHS of this vital workforce and those services, particularly for long-term chronic conditions such as diabetes, will suffer.”
How would Brexit affect diabetes research in the UK?
The ambiguity of Brexit’s impact on the NHS and the economy also extends to diabetes research in the UK.
UK scientists are currently making some big strides in several aspects of diabetes. Earlier this year Newcastle University reported that a very low-calorie diet can reverse type 2 diabetes for up to six months – a study funded by Newcastle Biomedical Research Centre and a Novo Nordisk UK Research Foundation Research Fellowship.
But UK scientists are also involved in high-profile collaborations with European scientists. The ongoing REDDSTAR project, for example, involves scientists from the UK, Portugal, Germany, USA, Denmark and Netherlands, and the EU’s funding contribution is over 70 per cent.
It is this funding which is an issue of potential significance for diabetes research. Because it is unknown what effect Brexit would have on the economy, it is also unclear how funding could be shaken up.
“The European research landscape is complex,” says CaSE (Campaign for Science and Engineering). “Both the European Union (EU) and individual European countries fund research. Researchers collaborate with each other within Europe and internationally.”
Research funding is a key topic on the BBC’s “UK and the EU: Better off out or in?” online feature, broken down into the main views of both Leave and Remain camps.
A key Leave consideration is that “the UK will be able to increase funding to science out of savings from not paying for EU membership”. In 2015, the UK paid £12.9m for full membership to the EU.
On the other hand, Remain supporters claim that UK universities receive millions in research funding from the EU, and many of the UK’s top scientists come from elsewhere in Europe with the help of EU grants.
“Overall, the UK is a net contributor to the EU, but it is a net receiver of EU funding for research; receiving €8.8bn between 2007 and 2013,” added CaSE. “Moreover, the importance of EU funding to research is growing, with half of the increase in UK university research budgets over this period coming from EU government sources.”
Labour MP for Copeland Jamie Reed is particularly concerned as to the effect Brexit would have on diabetes research. Reed, who has type 1 diabetes and also belongs to the AAPG, told Diabetes.co.uk:
“I think it’s a matter of real concern to people who care about the state of diabetes research in Britain and the EU that if we were to leave – which could take anywhere between a two and 12-year period to complete the divorce process – that the links between our universities and our industries in the EU would be disturbed.”
There is a mutual interest for the UK and the EU regarding scientific research, and considering there is a diabetes epidemic in Europe, European collaboration could be pivotal in tackling rising diabetes rates.
How would Brexit affect diabetes care for Britons in Europe?
Most people with diabetes will be familiar with the European Health Insurance Card (EHIC), a must-have item when travelling to Europe, which entitles state healthcare either at a reduced cost or sometimes for free.
The EHIC covers the cost medical treatment until one’s return to the UK, but the future of this agreement would be shrouded in doubt if the UK was to leave the EU.
“The effect on the EHIC scheme of the UK leaving the European Union would be dependent on the UK’s circumstances after it pulled out,” according to a EHIC blog. “As such, there are a number of possibilities that we have to consider.”
A significant factor in the EHIC remaining available to British citizens would be whether the UK severed ties with the EEA (European Economic Area), as the card is not a European Union initiative.
The UK may choose to negotiate an arrangement in which British citizens can still use the EHIC when travelling through Europe. But if EHIC became unavailable to British citizens, insurers could be left to pay for all medical treatment because the EHIC system would no longer fund a proportion of the bill.
“There are countries, such as Norway and Iceland who are EEA members but not EU members, and all accept the EHIC, so the UK could feasibly adopt this model,” writes James Connington in The Telegraph.
Switzerland is another exception that is not a member of the EU or the EEA, but accepts the EHIC as part of the single market.
Ambiguity is a vulgar component of this issue too: the UK may choose to negotiate an arrangement in which British citizens can still use the EHIC when travelling through Europe, but if EHIC became unavailable to British citizens, insurers could be left to pay for all medical treatment because the EHIC system would no longer fund a proportion of the bill.
“At the moment, British citizens holidaying in other European countries are entitled to urgent medical treatment, being granted the same rights as citizens of that country,” said Mr Vaz. “This is vital for diabetics, as managing and monitoring your blood can be more difficult whilst abroad.
“Easy access to health care is essential, particularly for those prone to hypos. When I travel to Europe, I travel with the peace of mind that should I fall ill, I will be able to walk into a hospital and get the same treatment that I would here in the UK, without having to foot a hefty bill. If we vote to leave the European Union on 23 June, I fear that we will no longer be afforded this luxury.”
How would Brexit affect diabetes medicine in the UK?
Then there is the European Medicines Agency (EMA).
The London-based firm is responsible for approving medicines for all EU countries, but Brexit could “potentially disrupt healthcare regulation in the world’s biggest trading bloc,” according to Reuters’ Ben Hirschler.
Hirschler said: “In the event of a Brexit, which could also cast uncertainty over the future of the bank authority, Europe’s equivalent of the U.S. Food and Drug Administration may have to find a new home, in a jolt to the current drug approval system. This could slow the approvals of medicines across Europe during this transition process, including in Britain if it has to re-engineer its system.”
The EMA approves all diabetes medication in the UK and Brexit could lead to a messy transition in which British expertise might not contribute to the agency any longer.
If the UK leaves the EU, British officials would have to decide if remaining part of the EMA was a benefit and include this caveat in the exit negotiations.
If this didn’t happe, the responsibility of approving new products would most likely fall to the Medicines and Healthcare Products Regulatory Agency (MHRA), the UK medicines regulator.
Sir Mike Rawlins, head of MHRA said he was “hoping and praying” this doesn’t happe, and that Britain would remain in the EU.
He believes Brexit could lead to the watchdog struggling with the burden of work if it couldn’t share its workload with other EU countries. Furthermore, Britain would be unable to access rapid warnings of dangers found in drugs, including diabetes drugs, according to Sir Mike.
Unfortunately, this issue is just as unclear as the others, which provides a fitting yet ultimately unsatisfying conclusion to our title question.
The ambiguity of all these issues means that standing by a viewpoint is challenging. We simply don’t have enough insightful information as to how remaining or leaving the EU will affect people with diabetes.
We will know the outcome of the EU referendum on June 24, that is for certai, but we won’t know how the diabetes community will either benefit or endure for months or even years to come.