Speech delivered at the Council of the European Union of Medical Specialists, Brussels, 21 October 2017

Mr President, Secretary General, colleagues.

 

Since I last addressed you the Brexit negotiations have continued with the UK scheduled to leave the European Union, not Europe, in March 2019. This is a crucial difference – it is the European Union the UK is leaving, not the continent of Europe – we’ll still be within swimming distance of our neighbours in 2019.

 

You will all recognise that the UK’s vote to leave the EU was by the narrowest of margins – 51.9% versus 48.1%. That rejection was by a referendum of the people eligible to vote in the UK.

 

That rejection is hardly an emphatic rejection of over 40 years of shared peace and prosperity – the whole of my lifetime – and it is a rejection that was most definitely not supported by the British Medical Association.

 

Whatever the outcome of the negotiations, some form of regulatory cooperation between the UK and our European partners will continue. If France and Canada can work to coordinate accelerated recognition of professional qualifications across the Atlantic Ocean, then surely the UK and our European friends won’t let the 33km of the English Channel stand in our way.

 

It all will be easier if a withdrawal agreement can be secured and a smooth transition into a future regulatory relationship delivered.

 

Yet looking at achieving that outcome I cannot help but think that all parties must recognise that a solid base for a principled diplomatic solution – with foundations built of concrete and not quicksand – is never formed by one party’s desire to hurt the other.

 

The role of the European Union of Medical Specialists (UEMS), and our other European partners, in helping to deliver such a principled, diplomatic outcome should not be underestimated.

 

Since we last met, and following such joint lobbying, the European Parliament’s Brexit Steering Group chose to highlight the ongoing uncertainty over doctors’ professional qualifications in its critique of the UK government’s negotiating position.

 

If this smooth transition cannot be delivered and the UK leaves without an agreement, then, yes, there will be problems for us to deal with.

 

The banking industry, the insurance industries, and many other well-resourced lobbies, are also pushing for the prioritisation of their concerns and it remains vital that the interests of the medical profession – so that we can continue to deliver high quality care to our patients – are not forgotten.

 

Who will work to ensure that our national governments prioritise the development and management of the new systems required to ensure that the tens of thousands (specific examples here) of European doctors practising in the UK continue to enjoy the mutual recognition of their professional qualifications?

 

I’m talking specifically about the:

 

3196 Irish doctors

2553 Greek doctors

2415 Italian doctors

2193 German doctors

1987 Romanian doctors

1717 Polish doctors

1305 Spanish doctors

1112 Hungarian doctors

1053 Czech doctors

743 Bulgarian doctors

696 Dutch doctors

388 French doctors

380 Maltese doctors

346 Slovakian doctors

308 Lithuanian doctors

270 Portuguese doctors

251 Belgian doctors

219 Austrian doctors

200 Latvian doctors

189 Croatian doctors

128 Swedish doctors

108 Swiss doctors

103 Danish doctors

47 Estonian doctors

46 Finnish doctors

34 Slovenian doctors

28 Norwegian doctors

and the

24 Icelandic doctors

 

 

who are all registered and licensed to practise medicine in the UK. Over twenty-two thousand doctors in totality.

 

Who will work to ensure that that our regulators can continue to protect our patients through the ongoing sharing of information about doctors’ fitness to practice?

 

Who will work to ensure that those European medical students studying in the UK have certainty about where they’ll be able to practice?

 

You know the answer:

 

Us;

the UEMS; and

our national members, and the constituent parts of UEMS.

 

Whatever Brexit leads to, we can only secure our profession’s interests and those of the patients we serve by working together within UEMS.

 

Brexit is changing Europe and will impact upon our profession. UEMS may need to change too if we’re to mitigate this impact and over the time between now and the Spring Council meeting we need to start thinking about how the United Kingdom can continue to play a full role in the UEMS in the future, despite the Brexit vote by the general public.

 

We need to consider and agree how the UK can continue to support the continued and exciting developments within the UEMS, whose strength continues to grow.

 

Mr President, we, as doctors, are part of a scientific community; we are part of a complex European health and social care system; and, perhaps more importantly, we are all part of communities and the societies in which those communities exist.

 

We, as doctors, have a duty – for the benefit of humankind – to work collaboratively with our colleagues, and have a moral and ethical duty to do so, to do everything possible to act as advocates for our patients to ensure their health and wellbeing is promoted and protected.

 

The British Medical Association will continue to do everything reasonably possible that we can to work within the UEMS to ensure we have the highest possible standards of medical training across Europe. This is, of course, nothing short of what our patients across the continent of Europe deserve.

 

Mr President, Secretary General, Members of Council: thank you very much.

 

 

Professor Andrew Rowland

Head of the UK Delegation to the European Union of Medical Specialists

 

 

References

http://www.gmc-uk.org/static/documents/content/2017.02.21_GMC_data_on_EEA_doctors_in_the_UK.pdf

 

 

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World Medical Association statement on Child Abuse and Neglect

Statement revised by the 68th WMA General Assembly, Chicago, United States of America, October 2017

The welfare of children is of paramount importance. Health professionals should put the welfare of children at the centre of all decision-making related to individual children and young people and act in the best interests of children in all of their interactions with children, young people, families, policy-makers and other professionals.

Following my @WCMTUK Fellowship I had the opportunity to re-draft the World Medical Association’s statement on Child Abuse and Neglect.

After discussion within the British Medical Association a re-drafted statement was agreed and this was consulted on within the World Medical Association to seek the views of consistent Members. The feedback received was used to finalise the proposed revised statement which was put to the World Medical Association General Assembly in Chicago in October 2017.

The World Medical Association has 109 consistent National Members who together represent over 10 million doctors worldwide.

I’m delighted that the proposed revisions to the statement were accepted in full by the General Assembly and the newly revised statement is now publicly available.

The World Medical Association agrees that the health, safety and wellbeing of children is incredibly important in healthy and happy societies and that health professionals have a special and unique role in the welfare of the world’s children.

The British Medical Association has worked to improve child protection measures in the UK to combat abuse, including child sexual exploitation and female genital mutilation, taking steps such as calling for more effective training programmes for all professionals dealing with children and families, among other legislative measures.

It is positive to see other national medical associations around the world will dedicate themselves to supporting the health and wellbeing of children and young people by better identifying and preventing harm and ensuring young people’s rights to a healthy and safe childhood, around the globe, are respected.

Equal protection for children

In 2014 I was awarded a @WCMTUK Fellowship from the Winston Churchill Memorial Trust. During the travels that resulted from this Fellowship award, and a grant from the Association of Paediatric Emergency Medicine, I was fortunate enough to be able to travel to the USA, Singapore, Malaysia, Cambodia and Hong Kong.

I was able to look at strategies we could consider in the UK to better protect children and young people from harm.

One of the key recommendations I made in my report, Living on a Railway Line, was that legislation should be introduced in the UK to prohibit physical punishment of children. This recommendation was evidence-based looking at the scientific evidence that exists regarding the effects of physical punishment of children on their health and wellbeing.

This is a recommendation I have promoted widely since Living on a Railway Line was published in October 2014.

In a truly international collaboration, Felicity Gerry QC, Marcia Stanton MSW and I wrote an academic paper in the International Journal of Children’s Rights setting out the evidence behind why children and young people deserve and need the same protections that adults are entitled to and, hence, why there should be a change in the UK law to prohibit physical punishment of children.

The four Children’s Commissioners in the UK (Wales, Northern Ireland, Scotland and England) are on public record calling, on multiple occasions, for a change in laws to better protect children and young people.

Over recent months there has been consultation in Scotland surrounding the debate about future legislation to give equal protection to children.

The above developments are very welcome – and entirely consistent with both the findings from my Churchill Fellowship report and our academic research paper – and it looks as though Scotland may become the first country in the UK to give the equal protection that children and young people deserve.

I’ll be watching what happens in Scotland very closely and continuing to promote the scientific, academic arguments about why new legislation to protect children and young people from physical punishment is desperately needed.

Speech delivered in Madrid, 7 July 2017: Medical neutrality in times of conflict and protecting fundamental human rights | Brexit and the European Medical Profession.

<CHECK AGAINST DELIVERY>

 

Señor Presidente, señor Vice-Presidente, señor Coordinator de la Journada, distinguidos invitados.

 

Buenos dias, good morning, buongiorno, bonjour y bom dia.

 

Soy el profesor Andrew Rowland, de la Asociación Médica Británica.

 

Espero que me perdone por continuar el resto de mi discurso en inglés, pero creo que mi español no es muy bueno puede que no entienda si continúo en español.

 

I’m here to talk to you about the impact of Brexit upon the European medical profession.

 

Brexit means that the UK is leaving the European Union – the EU, a political entity. It clearly does not mean that the UK is leaving Europe.

 

We’re still European and still only 33km over the English Channel from you all.

 

Before I outline the challenges that Brexit poses to our profession and the patients we serve, I’d like to provide some context about the referendum result and the BMA.

 

The BMA is an apolitical organisation representing over 160,000 doctors and medical students from across the United Kingdom’s 4 nations – 2 of which, Northern Ireland and Scotland, voted to remain within the EU. The votes from Wales and England – with the bulk of the UK population residing there – were decisive and this resulted in the referendum result to leave the EU.

 

We did not advise our members how they should vote in the referendum as our political neutrality had to be maintained during the referendum campaign.

 

Instead, we provided our members with an objective analysis of the significant (and hugely positive in my personal view) impact that the EU has upon them and the health of the nation.

 

The enormous amount of feedback received from members since the referendum validated this analysis as we’ve heard countless examples of how Brexit will, and indeed already is, threatening our members’ ability to provide healthcare to patients.

 

For comparison, we have genuinely only heard of one potential benefit from Brexit: the UK will be able to implement “traffic light labelling” – on food and drinks in an effort to improve dietary choices.

 

I’ll leave it up to you to decide whether this warrants our departure… but the reality of the position we are in is that the UK public – by a very slim majority – have voted to leave the EU and it is those departure negotiations that have just begun.

 

So, how does Brexit threaten our profession and our patients?

 

Most obviously, it threatens the rights of the 300,000 plus UK citizens living in Spain and the 129,000 Spanish citizens in the UK to access healthcare and other social services.

 

The same concerns apply to the 200,000 plus Italians, 170,000 French and 132,000 Portuguese currently residing in the UK, as well as the 65,000 UK citizens in Italy, 185,000 UK citizens in France and 18,000 UK citizens in Portugal.

 

It also threatens in excess of 30,000 EEA qualified doctors registered in the UK who provide invaluable healthcare.

 

Simply put, our current National Health Service – the NHS – couldn’t function without the 2,400 Italian, 1300 Spanish or hundreds of French and Portuguese doctors currently working in the UK.

 

The issues at play are complex, whether they are residency rights; access to the labour market, pension or social security rights; or access to education.

 

We know that a significant number of European Economic Area doctors working in the NHS are considering leaving the UK in the light of the “Brexit” referendum, and if this occurs it would seriously impact patient care across the UK and only increase what are often already unacceptable delays for treatment.

 

Restrictions on their free movement and ability to practise, via the mutual recognition of professional qualifications, won’t just damage the UK but the whole of Europe.

 

This cross-fertilisation of ideas and skills and professional development opportunities provide related benefits to the European medical profession and, axiomatically, the patients it serves.

 

We know of, for example, a Spanish general practice trainee who works in the East of England who chose to do postgraduate training in the UK partly to learn from the British model of family medicine, which is very different from the system she had previously trained within in Spain.

 

In addition to broadening her experience of primary care ahead of a planned eventual return to Spain, her ability to speak with Spanish citizens in the UK in their native language is massively beneficial to all concerned.

 

This is, of course, just one example but it is useful reminder that the potential adverse effects of Brexit are bidirectional and not simply a matter for the UK or other individual European Countries.

 

“Brexit” may slow, but will not reverse, such pan-European professional migration.

 

Accordingly, it cannot be allowed to threaten the progress of patient safety measures like the European alert mechanism – an early warning system which advises all European regulators when a doctor is banned or their ability to practise is restricted – or ongoing efforts to ensure that minimum standards in medical education and training are met.

 

Comparable levels of pan-European professional migration also exist in the medical research and innovation sector with 15% of all academic staff at UK universities originating from other EU member states.

 

An end of free movement and related domiciliary rights will not only imperil high quality medical research in our own country but also in the EU as a whole.

 

Such pan-European collaboration has led to a quarter of the world’s top 100 prescription medicines being discovered and developed in the UK as well as the development of the largest pipeline of biotechnology products in Europe.

 

The importance of such pan-European collaboration to this sector, and to our respective economies, is all too clear.

 

You will be aware that the EU has played a key role in both the protection and improvement of population health through the development of cross-national strategies, collaborative working and the implementation of legislation.

 

You will also know that, as a member state, the UK has actively supported this as a priority policy area and played a key, cooperative role in the amelioration of Europe’s public health.

 

The UK’s departure from the EU cannot be allowed to threaten such existing pan-European cooperation as it becomes ever more vital in promoting the rights of vulnerable people in society, tackling health inequalities and chronic diseases, driving the development of progressive public health standards and in the protection against serious health threats.

 

Such challenges will be amplified in Northern Ireland, given its unique situation of sharing a land border – the EU’s future external frontier – with the Republic of Ireland.

 

We are particularly concerned with the challenges that colleagues will face with regards to cross border health services as many doctors, particularly those working in areas bordering the Republic of Ireland, deliver healthcare on an all island basis.

 

The most striking examples are perhaps the new Radiotherapy Unit in Altnagelvin Hospital in Derry, in Northern Ireland, which will provide access to radiotherapy services to over half a million people living in both Northern Ireland and the Republic of Ireland and the cross-border cardiology services operating in the same hospital which saved 27 lives in its first nine months of operation.

 

We’re doctors so we don’t just diagnose problems, we seek to manage symptoms, cure conditions and play an active partnership role, in resolution of problems that are identified.

 

However, resolving these challenges isn’t just about the Divorce settlement between the UK and the EU but about working to ensure that our future relationship, and the transitional period in between, protects the medical profession and, crucially, our patients.

 

In order to achieve this outcome, we need to ensure that all sides of the negotiating table – that is to say the European Parliament, Commission and EU 27 member state governments as well as the UK government – prioritise resolution of our common objectives.

 

The good news is that, with the invaluable support of our European colleagues – many of whom are today – we’ve been able to secure their prioritisation by the EU.

 

Indeed, the European Commission’s working paper “Essential Principles on Citizens’ Rights” states that “EU 27 citizens or UK nationals who resided legally respectively in the UK or EU27 at the date of entry into force of the Withdrawal Agreement should be considered legally resident even if they do not hold a residence document evidencing that right” and that it “should ensure, in the UK and in EU27, the protection…of recognised professional qualifications (diplomas, certificates and other evidence of formal qualification) obtained in any of the EU28 Member States before that date.”

 

The European Council’s recognition “of the unique circumstances on the island of Ireland” and “that flexible and imaginative solutions will be required” is also to be welcomed.

 

Most significantly though, and reflective of the unique nature of our profession, was Michel Barnier’s, the EU’s Chief Brexit negotiator, recognition of the European “nurses and doctors who contribute to the quality of healthcare in the United Kingdom” and the need for their status to be resolved as a priority.

 

The prioritisation of these mutual concerns would not have been possible without your support at both national and European level. For this assistance, you have our sincere thanks.

 

Whilst this is welcome, it is not the “beginning of the end” but very much the “end of the beginning” as negotiations will take years to complete and powerful, well-funded, sectors are also working to secure their interests.

 

The European medical profession must continue to work as one to ensure that its interests, and those of the patients it serves, remain at the top of the negotiators’ list of priorities and are dealt with as such during what will be a period of unprecedented peace-time political activity.

 

These are some of the most important features of that ‘cloud with a silver lining’ that señor Coordinator de la Journada talked about at the very start of today’s meeting. Señor Presidente, agradezco a mi estimado colega de Portugal por estimular el debate sobre las futras oportunidades que esperan la profesión médica europea.

 

Je souhaite echo à ce que mon estimé collègue Le Presidente d’order médecins français à dit… c’est les coeurs et les esprits. En ce moment c’est les coeurs et les esprits de la population en Europe qui pourrait être affectée par Brexit et donce les coeurs et les esprits des négociateurs.

 

Y me complace mucho el entusiasmo de señor Presidente consejo general de colegios oficiales de medicos de permanecer unido con la Asociación Médica Británica para afrontar los retos de Brexit.

 

Señor Presidente, recent discussions between the UK government and the EU have indicated that the “Brexit” negotiations may be carried out in a robust manner, albeit between longstanding allies.

 

Accordingly, we would ask for your ongoing support in ensuring that the principles of medical neutrality in times of conflict and of protecting fundamental human rights – guiding principles of our civilisation – continue to be applied during negotiations to ensure that “Brexit” does not result in any collateral damage to our patients’ health.

 

Señor Presidente obrigado, merci bien, muchos gracias, grazie y thank you very much.

 

Professor Andrew Rowland

Head of the UK Delegation to the European Union of Medical Specialists

Children, Young People, Young Adults & Families #Manchester I❤️MCR

My utmost respect goes to the members of the public and professionals who voluntarily joined us, who offered assistance to us whenever they could, and who worked tirelessly with us throughout the night in support of other human beings.
An atrocity targeting children, young people, young adults and their families.
A community that has selflessly pulled together with efficiency and genuine compassion for victims and families, in the light of last night’s events. Countless acts of kindness and altruism for the public benefit.
Some of you may know people who were there; some of you may know people who were affected; some of you may be affected.
Here is something that Children and Young People might find useful as they think about what happened last night:
Follow https://twitter.com/gmpolice for updates and information about what you can do to help.
My thoughts and condolences go to the victims, and their families and friends, involved in this terrible incident.
#Manchester I❤️MCR

Safeguarding the health of patients across Europe: Speech given at the Council of the European Union of Medical Specialists, Tel Aviv, April 2017

SPEECH

 <Check against delivery>

Mr President, colleagues, members of Council,

At the last Council meeting I had the opportunity to talk about the exit of the United Kingdom from the European Union – a decision taken by a majority of those people who voted in the referendum.

That speech I gave was one that I did not ever think I would have to give and we live now in difficult times; unprecedented times; extra-ordinary times with many traps, dangers and hurdles ahead.

No one at UEMS Council knows exactly what will happen over the course of the next two years of negotiations as the UK prepares to leave the European Union; no one at UEMS Council knows exactly what difficulties or indeed opportunities may lie ahead; and absolutely no one at UEMS Council knows exactly what the future will look like without the UK in the EU.

But what we cannot do at UEMS Council is to allow “Brexit” to damage the relationships between members of the UEMS family.

Whilst, of course, the “Brexit” negotiations will be carried out between our respective governments, not people in this room, and between long-standing allies, the same principle should be applied here to the medical profession in order to ensure that the UK’s withdrawal from the EU does not result in any collateral damage to our patients’ health.

Thanks to the support of UEMS and numerous other European Medical Organisations, the EU’s Chief Negotiator, Michel Barnier, has prioritised securing the rights of the European “nurses and doctors who contribute to the quality of healthcare in the United Kingdom” and British citizens resident in other EU member states and who benefit from healthcare under the same conditions as their hosts.

The EU also recognises that “flexible and imaginative solutions” are required to secure the existing provision of cross-border healthcare in Ireland. Whilst this is welcome, it is not the “beginning of the end” but very much the “end of the beginning” as powerful, well-funded, sectors are also working to secure their interests.

The European medical profession must continue to work as one to ensure that its interests, and those of the patients it serves, remain at the top of the negotiators’ list of priorities.

For example, whilst macro-level health issues are very much on Michel Barnier’s radar, ensuring that the specifics of UEMS’ concerns are equally well understood continues to require additional engagement.

Removing the uncertainty created by the UK’s decision to leave the European Union must receive the focus of the negotiators. For example, this uncertainty includes:

  • The Polish students who have access to British universities under the same conditions as British students;
  • The British pensioners who are resident in Spain and who benefit from healthcare under the same conditions as Spanish pensioners;
  • The doctors and nurses from, for example, Romania, Spain and The Netherlands who contribute to the quality of healthcare in the United Kingdom;
  • The doctors from multiple countries including, for example, Greece who come across to the United Kingdom to contribute to World-Class medical research and training;
  • Or the engineers from Italy, Germany or elsewhere who choose to work in the United Kingdom, just like the thousands of British people who have made the same choice to work or live in Berlin, Barcelona, Rome or Vienna.

Michel Barnier has said that guaranteeing European citizens rights will be an absolute priority.

The issues at play are complex, whether they are residency rights; access to the labour market, pension or social security rights; or access to education. We know that a significant number of European Economic Area doctors working in the NHS are considering leaving the UK in the light of the “Brexit” referendum, and if this occurs it would seriously impact patient care across the UK and only increase what are often already unacceptable delays for treatment.

Over 30000 registered doctors in the UK gained their primary medical qualification in another European Economic Area state and over 150000 EU citizens work in the UK’s health and social care sphere – with free movement playing a crucial role in both professional development and in meeting varying health and social care, including medical, workforce requirements across Europe.

Comparable levels of pan-European professional migration also exist in the medical research and innovation sector with 15% of all academic staff at UK universities originating from other European Union member States. With medical research becoming increasingly international in focus and integral to tackling the main current and future societal challenges, it is imperative that solutions are found to secure researcher mobility and the provision of clear long-term frameworks in a “post-Brexit” European Union.

Very recently within UK cross-party MPs have said that it is imperative that health and social care providers can continue to retain and recruit the brightest and best from all parts of the globe and that it is important to prioritise and resolve reciprocal health care agreements at the earliest opportunity to end the uncertainty for both EU citizens in the UK and UK citizens living in the EU.

Mr President; members of Council; by continuing to work together as a family of European Medical Organisations and within the UEMS family itself, then I am confident that both the UK’s exit deal as well as the arrangements concerning our future relationship with the European Union 27 will recognise, and reflect, the fact that the medical profession is unique and must be elevated above simple politics.

Colleagues, whatever happens politically; whatever happens in the media; and whatever happens to public opinions regarding “Brexit” I’m am pleased to reaffirm the UK delegation’s commitment to working with our European Partners to safeguard the future of the European Medical Profession and, crucially, the patients we serve.

 

Professor Andrew Rowland BMedSci(Hons)  BMBS(Hons)  MFMLM  MAcadMEd  FRCEM  FRCPCH  FRSA

Head of the UK Delegation to the European Union of Medical Specialists