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What now? Reality Brexit, and palliative and end of life care. A personal view.

After one referendum, two general elections and with the issuing of a commemorative coin Brexit is entering the next phase. During the last four years Brexit has been different things to different people - “hard”, “soft”, “EFTA”, “red/white/blue”, “in name only”, “no-deal”, “blue passport”, “clean-break”, “Norway”, “bonkers” and ”WTO”. And who could ever forget “Malthouse Compromise”? In the next year or so Brexit will start to become something different - “reality Brexit” or perhaps “harsh reality Brexit”.

Whilst there remained a possibility that Brexit might not happen SPPC articulated its considered view that “in all likelihood Brexit will significantly damage the care which people receive towards the end of life”. SPPC highlighted key concerns about how Brexit would likely negatively impact workforce, scientific research, medicines supply and funding. These concerns remain.

What may feel like the exhausted end game of Brexit is really the beginning of the most important stuff. Evidence suggests that all Brexits are likely to be harmful to palliative and end of life care, but some Brexits will be much worse than others. The Big Ben Bong phase of Brexit will be completed in a couple of days with both genuine joy and genuine sadness/anger expressed copiously. Thereafter Getting Brexit Done will be a matter of choosing where the UK will sit on a continuum of harm which runs from bad to really very bad. The UK Government will then attempt to negotiate the dull and massively complex multitudinous details necessary, within the ludicrously short timescale that it has chosen to inflict on itself.

There is an opportunity for the palliative care sector to influence the shape of this post-Brexit world. Over the past fortnight the Westminster Government has sent conflicting signals on the extent of regulatory alignment they are seeking between the UK and the EU. They have rowed back a bit on previously envisaged salary thresholds for immigration. The Prime Minister continues to wish away ( others might say “lie about” ) the customs and regulatory checks in the Irish sea which are a legal consequence of his own Withdrawal Agreement, which is now law. It is probably a mistake to attach too much significance to specific individual pronouncements. However, this is a government now trying to manage a situation where four years of essentially sentimental rhetoric about “sunlit uplands” and “Buccaneering Britain” is in slow motion collision with reality. They clearly haven’t got it sorted, stuff is in flux and the tough choices and trade-offs inherent in the Brexit project can’t be ducked for much longer.

Many organisations and individuals chose for good reasons to keep out of a Brexit debate which was divisive, polarizing and sometimes outright toxic. Those articulating concerns about negative impacts of Brexit were often accused, often fairly, of trying to stop Brexit. Now however Brexit is happening. The debate need no longer be framed as “Brexit yea or nay”. We need a trade policy, we need an immigration policy and we need a policy on scientific collaboration. The shape of each of these policies will have profound impacts on palliative and end of life care. The responsibility to inform and attempt to influence – that’s on all of us, whether we supported Brexit or not. The responsibility to decide and to account for the outcomes – that’s on the Westminster Government.

By Mark Hazelwood, Chief Executive of the Scottish Partnership for Palliative Care.

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