Brexit: three wildly different stances

The EU is the UK’s biggest trading partner for health technologies, with around £2bn worth of medtech goods exported into Europe each year and £3.3bn imported. As such, a strong relationship with Europe isn’t something the British industry can afford to lose, and it’s something many have felt justifiably concerned about since the 2016 referendum.

Should Prime Minister Boris Johnson lead the Conservatives to re-election, the party plans to push ahead with the current deal the government has stuck, which would see the UK leave the EU on 31 January 2020. The UK would leave the customs union and exit the single market, with a transition period to get the new system up and running lasting until December 2020. Instead, the UK and EU will work towards a Free Trade Agreement while the UK settles its financial obligations to the EU with a £33bn ‘divorce bill’.

Meanwhile, Labour and the Liberal Democrats maintain opposition to the proposed deal. If elected, Labour plans to strike a new deal with a permanent and comprehensive UK-wide customs union, close alignment with the single market and continued participation in EU agencies and funding programmes. The party then plans to run a second referendum on its deal, and will implement whatever the result is.

The Liberal Democrats take a more extreme stance, explicitly backing the Remain camp with a desire to revoke Article 50 entirely. The party is championing a people’s vote with the option to stay in the UK, in which it would fight to keep the UK in the EU.

NHS and investment: cash injections and deprivatisation

Every major party is promising to increase funding for the NHS, something which would have an immediate and direct impact on the medical device industry. A better-funded NHS would mean more opportunities for collaboration with private device developers, as well as chances for the development of new medical technologies from within the service itself, such as through the newly-launched NHS AI lab.

The Conservative government claims it will be giving the NHS its biggest-ever cash boost, the total sum of which is unspecified. It will use this to commission 20 hospital upgrades and 40 new hospitals, recruit 50,000 more nurses and 6,000 more doctors, all while freeing up capacity for an extra 50 million general practice appointments a year. It also claims to be investing in hospital upgrades and new screening machines in an attempt to boost early cancer diagnosis. The party is also looking to introduce an NHS Visa, which would allow clinicians from abroad with an NHS job offer to have their visa fast-tracked, along with reduced fees and dedicated support to come to the UK with their families. It has also promised a £25m cash injection for hospices, and to focus its efforts on medical research, robotics and AI to make the UK a leading global hub for life sciences.

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The Labour party, meanwhile, is looking to end NHS privatisationand the outsourcing of public services, as well as implement free prescriptions and free basic dental work. The party plans to expand health expenditure by an average of 4.3% a year, and also pledges to improve early cancer diagnosis by boosting screening rates. Labour also wants to repeal the Health and Social Care Act and reinstate the responsibilities of the Secretary of State to provide a comprehensive and universal healthcare system. It wants to end the requirement for health authorities to put services out for competitive tender, and advocates for a more joined-up NHS with better communication and collaboration between different NHS bodies.

Labour has also pledged to implement a £150bn Social Transformation Fund for public services, including hospitals and care homes, and an additional £2bn to modernise mental health hospital facilities. It says it will increase investment in AI, cyber tech and medical equipment to modernise outdated NHS services, and introduce medical innovation rewards and incentives for companies aiming to tackle the biggest health needs.

The Liberal Democrat party is likewise advocating a more joined-up service, alongside raising £7bn a year through an additional 1p on Income Tax which would be ring-fenced for the NHS and social care. It has pledged a similar £130bn for infrastructure including hospitals, and to use a £10 billion capital fund to make necessary investments in equipment, hospitals, community, ambulance and mental health services buildings. It also plans to reform the Health and Social Care Act to make the NHS more efficient and to end the automatic tendering of services.

The party also aims to increase innovation outside the ‘golden triangle’ of London, Oxford and Cambridge.

Cybersecurity, data, and technology

In the age of AI and digital health technology, cybersecurity and data regulation has never been more important to the medtech sector. With a lack of ethical guidelines around AI in place internationally and the fourth industrial revolution showing no signs of slowing up, the parties’ stances on the world of tech could be game changers for the medical device industry.

The Conservative party is planning to increase funding of cybersecurity, investing in computing and health data systems like the UK Biobank, Genomics England and the Accelerating the Detection of Disease project. It also plans to incentivise investments in cloud computing and data by increasing the tax credit rate to 13% and reviewing the definition of R&D. It would also look to introduce an annual health technology summit.

Labour has pledged to ensure data protection for patient information, ensuring it will not be exploited by international tech and pharma corporations. It also plans to create a Minister for Cybersecurity. The party pledges it will review the role of the National Cyber Security Centre to determine whether it should be given powers as an auditing body.

The Liberal Democrats has taken one of the strongest stances on cybersecurity, pledging to introduce a ‘Lovelace Code of Ethics’ to ensure the use of personal data and AI is unbiased, transparent and accurate, and respects privacy. It would give the Centre for Data Ethics and Innovation the power to ‘call in’ products which breach this Code and require all digital technology courses to include teachings on this Code. It would also see a kitemark awarded to companies which meet the highest ethical standards in their development of new technologies, and convene a citizens’ assembly to determine when it is appropriate for the government to use algorithms in decision-making. Companies would also be able to claim R&D tax credits against the cost of purchasing datasets and cloud computing, and a mechanism would be developed by which the public could share in the profits made by tech companies in the use of their data.

The industry responds

Global Medical Nomenclature Agency CEO Mark Wasmuth says: “The Conservative ‘Get Brexit Done & Unleash Britain’s Potential’ manifesto sounds positive, but medical was only mentioned in relation to doctors’ pensions! Support for the NHS is prominent, especially mobile screening, healthy living and more cycling.

“The Liberal Democrats certainly have a bright cover for their ‘Stop Brexit & Build a Brighter Future’ manifesto. A bit light on ‘medical devices’, medical was only mentioned in regulated access to cannabis & gender reassignment. Healthcare gets a big mention, but maybe the Liberal Democrats don’t know where innovation and change comes from?

“Labour’s ‘It’s time for Real Change’ manifesto looks like they have talked to someone in the industry and committed to ‘invest more in…state-of-the-art medical equipment’ and ‘will play an active role in the medical innovation model, ensuring rewards and incentives match the areas of greatest health need’. NHS and healthcare gets good coverage too.”

Wasmuth described the Conservative and Liberal Democrat manifestos as benefitting the medtech industry “two out of ten”, while he gave the Labour manifesto a more respectable score of six.

However, Labour is looking to significantly roll back NHS privatisation, which may be less well received by the medtech industry.

June Medical CEO Angela Spang says: “With many private players the prices could go up, so for medtech companies this could be a positive. The NHS as an organisation has huge buying power, so price transparency is lowering prices for medtech. For example, in the US the prices for medtech are much higher than in Europe. Usually we calculate around double.

“[Privatisation] may also be a good thing when it comes to improving efficiency in the NHS. I have seen the impact of the entry of private healthcare options on the Swedish public healthcare sector, and while it has made it challenging to train medical students as the private companies won’t do that ‘for free’, it has also had a positive impact on the quality of care in the public system.”

In terms of Brexit, Cambridge Medical Technologies CEO Jack Jachmann says: “The outcome of Brexit hinges on the trade deals that follow. We take pride in the power of UK medtech. That power should enable favourable trade terms since medicine is a global synthesis of science and technologies, and the UK has much value to contribute.

“We are the world’s second largest provider of medical technology to the EU, and there is probably untapped potential in the US – a single country market that is comparatively open and is 29% larger* than the entire EU. The major Far East country markets are large, concentrated, and hungry for medtech, so a well managed Brexit should be an opportunity for UK medtech.”