2. Materials and Methods
2.1. Screening and Scoping
2.5. Monitoring and Evaluation including Review and Reflection
3.1. Findings of the HIA
3.2. Reporting, Review and Reflection (Including Monitoring and Evaluation)
Challenges/Limitations of the Work
Conflicts of Interest
|Priority Determinants of Health||Potential Impact on Health||Potential Impact of Brexit||Comments/Rationale|
|Health and Social Care|
|Medicines and medical devices—regulation and licensing||Yes||Negative||Medicines and Healthcare Regulatory Agency (MHRA) currently works with the European Medicines Agency (which is moving to Amsterdam)—post-Brexit position still unclear.|
|Medical and professional qualifications||Yes||Negative||United Kingdom Government (UKG) proposing to continue with existing arrangements but subject to agreement by European Union (EU).|
|Staffing and recruitment||Yes||Negative||British Medical Association (BMA) survey has shown that 45% of EU doctors considering leaving UK. Royal College of Nursing (RCN) and others have expressed concern about recruitment of nurses.|
|Research and development||Yes||Negative||UKG plans to discuss temporary mobility of scientists and researchers subject to agreement by EU. Access to EU networks may be reduced.|
|Working hours and conditions||Yes||Negative||UKG assurances on long-term continuation of existing workers’ rights under EU law questioned by RCN and others.|
|Reciprocal healthcare||Yes||Negative||UKG proposals for continuation of reciprocal healthcare for United Kingdom pensioners, the European Health Insurance Card (EHIC) scheme and cooperation on planned medical treatment subject to agreement by EU. Position on other types of reciprocal healthcare unclear.|
|Fitness to practise||Yes||Negative||UKG position on continuation of participation in EU Internal Market Information (IMI) alert system that records cases of professionals unfit to practise unclear.|
|Health protection and security||Yes||Negative||UKG proposals for ongoing work with key EU agencies on health security to enable information sharing and access to key datasets subject to agreement with EU.|
|Rare diseases||Yes||Negative||As above.|
|Patient care and services||Yes||Negative||Subject to staffing and recruitment and other issues.|
|Pandemics and infectious diseases||Yes||Negative||See Health protection and security.|
|Clinical trials||Yes||Negative||UKG proposals for continued participation in EU wide clinical trials subject to agreement with EU.|
|Life sciences||Yes||Negative||UKG proposals for continuation of existing or similar arrangements subject to agreement with EU.|
|Medical students||Yes||Negative and Positive||Potential vacancies created by fall in EU students may lead to increased opportunities for UK students.|
|Health promotion||Yes||Negative||UKG position unclear but Welsh National Health Service (NHS) Confederation calling for highest possible level of coordination on health promotion.|
|Behaviours affecting health|
|Food and diet||Yes||Negative||UKG proposing common framework with EU but subject to agreement with EU. Implications of Trade Agreements, i.e., regulations and labelling.|
|Alcohol, cigarettes, nonprescribed drugs||Yes||Negative||Continuation of EU cross-border approach to antismoking measures through the Tobacco Products Directive (TPD) unclear. Implications of Trade Agreements, i.e., regulations and labelling.|
|Mental well-being including:sense of control, resilience and participation||Yes||Negative and Positive||Likely to dependent on population profile and attitudes/belief.Indirect impact of potential economic downturns post exit.|
|Social and community influences|
|Family organisations and roles||Yes||Negative and Positive||Likely to depend on population profile and attitudes/belief. Impact of changes to immigration rules—impact on non-UK EU nationals who live and work in Wales.|
|Citizen power and influence/social isolation/community networks/racism/hate crime||Yes||Negative and Positive||Likely to depend on population profile and attitudes/belief.|
|Living and Environmental factors|
|Built environment||Yes||Negative||A significant portion (>90%) of environmental legislation currently derives from EU law, giving rise to uncertainty in the short term.|
|Housing||Yes||Negative and Positive||Stock may increase if EU and other non-UK nationals leave but house prices may fall subject to market conditions.|
|Noise/air quality/waste/community safety||Yes||Negative and Positive||A significant portion of environmental legislation currently derives from EU law, giving rise to uncertainty in the short term, although the majority of environmental legislation is devolved.|
|Workplace and working conditions||Yes||Negative||The majority of health and safety legislation derives from EU law, giving rise to uncertainty.|
|Economic inactivity/income/employment||Yes||Uncertain||Dependent on market conditions/future trade agreements.|
|Skills||Yes||Negative and Positive||Expected short-term shortages may lead to increased opportunities for UK nationals to gain skills in longer term.|
|EU Funding||Yes||Negative||UKG has guaranteed funding for EU projects agreed before Brexit, but it is likely the majority of EU funding will disappear.|
|Access and quality of services|
|Careers advice||Yes||Unclear||Will likely depend on economic conditions.|
|Other caring services||Yes||Negative and Positive||Short-term shortages may mean increased opportunities for employment for UK nationals in the longer term.|
|Shops and commercial services||Yes||Negative and Positive||Potential price rises and reduction in choice may led to closures, but opportunities may arise to create new businesses.|
|Public amenities/services||Yes||Negative||Will likely depend on economic conditions.|
|Education and training||Yes||Negative and Positive||Reduction in EU students may lead to increased opportunities for UK students.|
|Information Technology||Yes||Negative||UK proposals on a data protection agreement subject to agreement by the EU.|
|Macro-economic, sustainability and governmental factors|
|Gross Domestic Product||Yes||Uncertain||May increase or decrease, depending on market conditions.|
|Government policies||Yes||Negative and Positive||Following transition from EU to UK law, policy impacts may be mixed.|
|Economic Development||Yes||Uncertain||May increase or decrease, depending on market conditions.|
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|• Positive—impacts that improve or maintain health status|
|• Negative—impacts that diminish health status|
|• Confirmed—actual direct evidence in existence|
|• Probable—more likely to happen than not, direct evidence but from limited sources|
|• Possible—may or may not happen|
|• Major—sufficiently great or important to be worthy of attention, noteworthy|
|• Moderate—average in intensity quality or degree|
|• Minimal—of a minimum amount, quantity or degree, negligible|
|• S = Short term—less than 1 year|
|• SM = Short to medium term—1–3 years|
|• ML = Medium to long term—3–5 or 10 years|
|• L = 10+ years|
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