Following last week’s virtual general assembly of the CPME (Standing Committee of European Doctors) – which represents 28 national medical associations from across Europe – I decided to write this blog. It’s a blog in praise of our European medical colleagues, of our continuing membership of European medical organisations, of the mutual benefits for doctors and the patients we serve that these links create and maintain – and it’s a plea to our government to obtain sufficient negotiating time for optimal maintenance of these benefits after we finally depart from the European Union.
My presidency of the BMA is a short-term affair but I’ve been a BMA representative on the CPME since 2007, and this long association has reinforced my recognition that the values of medicine transcend politics and borders, that medical solidarity based on those values can sway governments, national and international, to protect both doctors and the health of the patients and populations we serve; and that maintaining that medical solidarity is particularly important to minimise the massive additional mortality and morbidity that COVID-19 is inflicting, and is likely to continue to inflict for several years to come.
It was of course COVID-19 that occupied a substantial part of the CPME’s virtual general assembly, replacing the necessarily cancelled meeting in Zagreb.
While far from ideal – modern technology can’t (yet?) replicate the benefits of full-blown social interaction – nonetheless a full day of discussions also covered, though in necessarily abbreviated form, many of the issues affecting Europe’s doctors and patients. These included the CPME’s current work on e-health, telemedicine and AI; public health and healthy living; pharmaceuticals, medical products and our profession’s ambivalent relationship with Pharma; professional practice, patients’ rights and a particularly important session on the health of refugees.
The day started with reports from across Europe generally emphasising the same lack of PPE, testing and ICU capacities that challenge our own frontline members. There were some exceptions, however, with the CPME president, and immediate past president of the German Medical Association, Professor Frank Ulrich Montgomery, explaining how prompt planning and a health system that deliberately provided a cushion against emergencies enabled Germany to increase its testing capacity from 100,000 to 500,000 a week.
Sadly, we also heard about the all too real risks that doctors are facing on the front line across the continent. While the Italian medical associations (FNOMCeO and Anaao Assomed) aren’t members of CPME, all of us shared the views expressed in a letter from the BMA’s chair of council, Chaand Nagpaul, to their presidents:
"It is with deep sadness and horror that we learn that the lives of more than 50 doctors have now been lost in Italy to COVID-19, and I would like to extend my sincerest condolences, on behalf of the British medical profession. Our thoughts are with the loved ones of these doctors and we send a message of solidarity to those brave and committed colleagues who continue to battle the pandemic that is gripping your country and continues to spread across the continent and the world."
None of this was surprising for our excellent European office, which has coordinated and provided us at the BMA with updates from our European partners since the pandemic began. Paul Laffin and Ellie Walden are our year-round ambassadors in Brussels and do a superb job as they cooperate with the European medical organisations and the medically orientated members of the Commission and Parliament, promoting BMA policies and interests.
Recently, for example, the CPME and other health stakeholders – including our partners in the UEMS (European Union of Medical Specialists) and the EJD (European Junior Doctors’ Association) – co-signed a public statement useful in our own battles with Government, calling on the European Commission and governments to ‘support and protect healthcare professionals fighting COVID-19’.
Summarising the situation facing doctors across Europe, the statement continued:
"Staff must be provided with Personal Protective Equipment (PPE) and must be regularly tested, regardless of reported symptoms or exposure.
"As Europe has become the global centre of the COVID-19 pandemic, healthcare professionals are working hard to contain the spread of the virus, putting themselves at risk to protect the communities. Despite the unprecedented efforts to stop the pandemic, healthcare professionals are at the front line without adequate PPE. The number of infections and deaths of healthcare staff is increasing every day.
"Even in times of crisis, adequate working conditions must be ensured. Staff must have breaks and time off between shifts, to be able to carry on in what could be a long-term global crisis. The Working Time Directive should apply. Working in such conditions takes its toll on the psychological health of staff, so appropriate support services must also be put in place."
Reacting to such calls, the EU has created rescEU – a strategic stockpile of medical equipment – and launched successful joint procurement initiatives for PPE and for respiratory ventilators.
Incredibly, and despite the UK being eligible to participate in such initiatives until the end of the transition period (December 2020), our government initially claimed that it wouldn’t be taking part because ‘we are no longer members of the EU’. This explanation was swiftly replaced by a ‘missing emails from the European Commission’ explanation.
Could it be possible that the Government was deliberately prioritising ‘Brexit over breathing’? Or was it simply another case of ‘Hanlon’s razor’? As our council chair wrote when urging NHS England’s director for acute care to take advantage of the rescEU scheme, ‘geography, not politics, dictates that we must work with our European partners to win this fight’.
The same pragmatism and pan-European solidarity were also on display during last Friday’s CPME general assembly, where delegates approved a statement calling for EU member states to take in refugees from refugee camps in light of the COVID-19 emergency.
Likewise, the president reiterated the CPME’s ongoing support for our efforts to ensure that the European medical profession can continue treating its patients to the highest possible level beyond the end of the Brexit transition period.
At present, and despite the COVID-19 postponement of the last round of negotiations, the UK Government is insistent that it will stick to the existing timetable: ‘The transition period ends on 31 December 2020. This is enshrined in UK law.’ As with the rescEU shambles, I hear that nobody on the other side of the Channel, or across the Irish Sea, believes the UK Government about this. Political heavyweights from within both the European Parliament and the Irish political establishment are openly questioning this approach and calling for the UK to request an extension of one or two years to the transition period – a request that would almost certainly be granted.
Christophe Hansen MEP, negotiator of the post-Brexit agreement in the European Parliament’s Committee on International Trade, put it like this:
"Under these extraordinary circumstances, I cannot see how the UK Government would choose to expose itself to the double whammy of the coronavirus and the exit from the EU single market, which will inevitably add to the disruption, deal or no deal. I can only hope that common sense and substance will prevail over ideology. An extension of the transition period is the only responsible thing to do."
The potentially disastrous health implications for us – and internationally – of an abrupt departure without a deal or with a rushed and grossly suboptimal deal at the end of this year must surely lead us all, Brexiteers and Remainers alike, to wonder if a one- or two-year extension is needed in order to negotiate our healthiest possible future relationship with the EU.