Southampton University Hospital is a leading teaching hospital within the NHS. Its ultra-modern cancer centre will open soon following a major fundraising effort. The hospital is at the forefront of clinical trials and new treatments for a range of conditions. Much of that work is funded with assistance from the Europeans Union. All of this is threatened by Brexit.
I visited the Hospital on 1 February and met with Professor John Harrison (pictured below) who heads up the research faculty. He explained a series of factors that together mean that outside the EU and in particular outside the Single Market the UK’s medical science efforts and with them the NHS will be hard hit. These are the factors that will hurt the NHS:
Recruiting leading researchers
Since the referendum it has proved very difficult to tempt leading medical researchers to Southampton. It’s the same story elsewhere. It would be wrong to say there is a single reason, but a string of family, personal and practical reasons, uncertainty over the rights of EU citizens and pension insecurities have led to sought after applicants turning down offers in the UK for offers in Europe and the USA or simply declining to apply.
Keeping EU citizens
There is not a flood of high profile medical staff queuing at the check in with one way tickets to Berlin and Paris, however, there are enough to worry research leaders.
The success of UK Universities
Ironically, these problem are made worse by the success of the UK Universities and research institutions. UK academic qualifications are up with the best and a passport to interesting work all over the world. So talented scientists from the UK will always want to travel and work overseas just because they can. If the salaries are good - and they often are - even more so.
Some will say that people will always leave whether the UK is part of the EU or not - which is true, and it isn’t a problem so long as you can replace those you lose with new recruits. If you can’t it becomes a vicious and decreasing cycle that cannot be easily addressed.
Follow the Money
Researchers follow research money. First of all because it might pay their salaries or provide their job security and secondly because it means they can do their work with a better chance of success. Many of the UK’s programmes are carried out through the European Union’s Horizon 2020 Programme. This funding stream, otherwise known as ‘Framework 8’ ends in December 2020 - the point where the UK intends to end its much touted but yet to be agreed ‘transition phase’. Unless the Brexit extremists like John Redwood get their way the current programmes should continue to their conclusion.
What happens after 2020?
All we can say for sure is that in 2021 there will be a new 7 year EU Budget which will include funding for Framework 9. The UK’s involvement in Framework 9 (which doesn’t yet have a snappy title) won’t be agreed until the negotiations over the UK’s future relationship with the EU and the corresponding price tag is agreed. The Conservative UK Government has, so far, indicated that it wants to be involved BUT, and it’s a big BUT, it is highly probable that while UK institutions may be partners in EU projects they are unlikely to be able to lead them - as many currently do. It is worth saying here that the leading player in a typical project will receive more funding that a partner institution. It is hard to imagine the likes of Oxford, Cambridge, UCL and Imperial - among the top 10 universities worldwide - are likely to be happy to play second fiddle but they may not have much choice. If the Brexit extremists get their way they won’t be able to play at all.
Why doesn’t the UK just do its own research?
Because research, particularly, medical research, doesn’t work like that. To trial treatments and drugs and therapies most effectively big populations with different samples in different places reflecting different social conditions and circumstances are needed - I’m not an expert on this but, unfashionably, I choose to believe those who are.
Approved by who, for who?
This is the really sticky bit. Like them or hate them, the pharmaceutical companies invest a great deal in new drugs. Naturally enough they want to see their products approved for use across the biggest market possible. So if there are two different regulatory regimes do you choose to seek approval in that which makes the product available first to around 500 million people or do you seek to make it available to 60 million? The EU Medicines Agency has been based in London for good reason. The UK has led in this field, has great expertise and so it was a logical place to put it. Now the Agency will move if the UK leaves. The scientists tell me that clinical trials will, logically, be based in the area of jurisdiction even if it is not strictly required. If that is outside the EU, and at least the single market, then the future for clinical trials and therefore the early availability of drugs and treatments is clearly affected. In practice this is likely to mean a two year delay. The UK, of course, COULD decide that drugs approved for use in the EU are ‘deemed’ approved for use in the UK but if we were to take such a course what of all that stuff about sovereignty and taking back control?
A spiral of decline
So a decline of leading staff, less funding for projects, fewer engaged institutions, few if any institutions leading research projects, leading edge clinical trials done elsewhere, later approval of drugs and treatments. The result, new treatments available to patients later than would otherwise have been the case and, bluntly, lives lost that may otherwise have been prolonged.
Of course there may be strategies institutions can employ to protect their funding, to maintain their involvement in projects and to assert their leading roles through excellence alone but in the landscape outlined to me at Southampton there is little prospect that this could be successful across the sector. The world leaders may do OK, even well, but the middle tier of Universities and the generality of the NHS will suffer and that is a great worry. What we need, if the UK is indeed to leave, is a framework of free movement for academic, science and research staff, full involvement in Framework 9 programmes and being part of a single regulatory framework - something like the single market? Don’t be surprised, however, if the EU27 were to say, 'well, that’s called the EU'.
It is easy to dismiss all this as the concerns of an engaged elite who have done well from the UK’s EU membership. That’s true, but it’s also true that ordinary patients have done well too. Try telling the cancer patient who can’t get access to a new drug or take part in a clinical trial that two year’s extension of their life is a price worth paying for an abstract concept of sovereignty.
