Dutch say hundreds of companies plotting Brexit switch

The Netherlands says it has attracted 1,923 jobs and €291 million in investment, and plans a lot more.

The Dutch government said it helped 42 companies move to the country in 2018 because of Brexit and is in talks with more than 250 others about a switch, according to a report out today.

The companies — including Japanese investment bank Norinchukin and media company TVT — translated into 1,923 jobs and €291 million in investment, the government report said.

The figures also includes the transfer of the EU’s European Medicines Agency from London and the opening of new office space by financial service providers such as MarketAxess and Azimo, in addition to shipping insurer UK P&I Club.

“These [newcomers] are predominantly British companies, but also American and Asian organizations that are reconsidering their current European structure due to uncertainties caused by Brexit,” the Dutch ministry said.

In 2017, only 18 companies transferred operations. The report said both Bloomberg and Discovery were also planning extra investment, according to figures collated by the Netherlands Foreign Investment Agency, which works under the Dutch Ministry of Economic Affairs and Climate Policy.

In the race to attract jobs and investment from the U.K., the Dutch did concede they face competition from Germany, France and Ireland in picking over the Brexit spoils.

“Due to the growing international uncertainty surrounding Brexit and changing global trade policies, the importance of a good Dutch business climate for all of us is continually increasing,” said Eric Wiebes, minister of economic affairs and climate policy.

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EU powers set up firm to thwart Trump’s Iran sanctions

Company is meant to allow Europeans to keep doing business with Tehran.

The EU’s effort to thwart U.S. President Donald Trump’s Iran sanctions is open for business.

France, Germany and the U.K. — the European guarantors of the Iran nuclear accord — announced Thursday that they had officially established a corporate “special purpose vehicle,” registered in Paris, to help European companies that want to continue doing business with Iran despite Trump’s renewed sanctions.

The corporate vehicle will facilitate business deals with Iran without using the dollar or the U.S. financial system and will essentially structure sales as indirect transactions — steps that the Europeans believe will technically avoid violations of the U.S. sanctions.

The special purpose vehicle is called INSTEX, for Instrument in Support of Trade Exchanges. It had been in development for months, since shortly after Trump last May declared the unilateral U.S. withdrawal from the nuclear accord, called the Joint Comprehensive Plan of Action (JCPOA).

The official announcement was made by French Foreign Minister Jean-Yves Le Drian, German Foreign Minister Heiko Maas and British Foreign Secretary Jeremy Hunt in Bucharest, Romania where they were attending a meeting of EU foreign and defense ministers.

Russia and China have also stuck with the accord despite Trump’s withdrawal.

The establishment of the special purpose vehicle is the most visible and substantive rebuke of Trump’s foreign policy by European allies that have disagreed with many of the American president’s decisions, including his withdrawal from the Paris climate accords and his relocation of the U.S. embassy in Israel to Jerusalem from Tel Aviv.

Washington said it was still examining the new entity but issued a stern warning against violating U.S. sanctions.

“Entities that continue to engage in sanctionable activity involving Iran risk severe consequences that could include losing access to the U.S. financial system and the ability to do business with the United States or U.S. companies,” the State Department said in a statement.

INSTEX was registered in Paris using the address of the French Ministry of Economy and Finance. France, Germany and the U.K. are joint shareholders and the entity’s president is Per Fischer, a veteran German banker who spent many years as a senior executive of Commerzbank.

French Foreign Minister Jean-Yves Drian, U.K. Foreign Secretary Jeremy Hunt and German Foreign Minister Heiko Maas, in Bucharest | Daniel Mihailescu/AFP via Getty Images

It is not clear how many businesses will make use of INSTEX and tempt the wrath of the Trump administration. Many are loath to risk losing access to the far larger and more lucrative U.S. market in order to maintain far less profitable dealings with Iran.

But even if it gets limited use, the creation of INSTEX is an important symbolic step, providing concrete evidence to Iran of Europe’s continued commitment to the JCPOA. Russia and China have also stuck with the accord despite Trump’s withdrawal.

Many experts believe that the key to preserving the JCPOA is maintaining Tehran’s commitment and the creation of INSTEX potentially helps answer Iranian critics who have been urging the government to withdraw in response to Trump. In Europe, the hope is that Tehran will hold on long enough for Trump potentially to be voted out of office.

The EU and the European powers insist that Tehran has been living up to its commitments under the agreement, citing 13 reports by the International Atomic Energy Agency.

Separately, the EU has taken steps to punish Tehran over allegations of military meddling throughout the Middle East and at least two assassination attempts on European soil. But the EU has insisted that those issues should not be conflated with the JCPOA, which they say has successfully halted Iran’s nuclear weapons program.

“The lifting of sanctions is an essential dimension of the JCPOA,” the EU’s high representative for foreign affairs, Federica Mogherini, said in a statement praising the creation of INSTEX. “The instrument launched today will provide economic operators with the necessary framework to pursue legitimate trade with Iran.”

“The European Union continues to be committed to the full and effective implementation of the JCPOA in all its aspects as long as Iran continues to implement in full all its nuclear commitments, as set out by the agreement,” Mogherini said, adding: “This is a matter of respecting international agreements and of advancing our shared regional and international security.”

“Today we have taken a significant step forward in delivering our commitment under the Iran nuclear deal to preserve sanctions relief for the people of Iran,” Hunt, the British foreign secretary, said in Bucharest. “This is a clear, practical demonstration that we remain firmly committed to the historic 2015 nuclear deal struck with Iran.”

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Equal rights in Northern Ireland threatened by Brexit

Legal equality between Irish and British residents in the region has largely relied on EU membership.

The U.K.’s membership in the EU was the glue that helped hold together the Good Friday peace agreement — Brexit threatens to unstick it.

With just weeks until Brexit day, a significant portion of Northern Ireland’s 1.9 million residents could find themselves losing rights that their neighbors continue to enjoy — for example to education, medical care and some types of housing.

The potential consequences of a no-deal departure, which have been largely overlooked thus far, are set to impact hundreds of thousands Irish citizens who are native to the region. In a series of House of Commons votes Tuesday night, MPs indicated they want to avoid no deal. But an attempt to prevent it happening on March 29 failed to win support, meaning the cliff edge is still very much in sight.

It is particularly alarming in Northern Ireland’s febrile and polarized political atmosphere, where all citizens, whether they identify as British or Irish, were promised that they would continue to be treated equally after Brexit.

The region has had no government for two years and a potential hard border with the Republic of Ireland threatens to provoke a return to violence between the region’s mostly Protestant unionists and largely Catholic nationalists. A car bomb earlier this month in Northern Ireland’s second city Derry (also known as Londonderry) highlighted that the potential for violence is not far from the surface.

Sinn Féin MEP Martina Anderson called the situation for rights in Northern Ireland “dire” | Ahmad Gharabli/AFP via Getty Images

“We have a situation that Irish citizens [would] have no legal connection to the jurisdiction or country in which we are born,” said Martina Anderson, a Sinn Féin MEP. “The last thing we need in Northern Ireland is a differentiation of rights.

“The situation is dire,” Anderson said, adding that her constituents regularly contact her worried about the situation post Brexit and that neither British nor Irish governments have done enough to reassure them.

Equal rights

Under the terms of the 1998 Good Friday Agreement, which largely put an end to decades of conflict over Northern Ireland’s constitutional status, people born in the region are entitled either to British or Irish passports (or both) and are guaranteed equal rights regardless of their nationality. About 20 percent of Northern Ireland’s population holds only an Irish passport, according to 2011 census data.

The U.K.’s membership in the EU had papered over many of the tricky details of the arrangement, but with Brexit due to happen on March 29 with or without a deal, those legal ambiguities are due to be exposed.

“We’re actually in quite a difficult situation,” said Daniel Holder, the deputy director of the Committee on the Administration of Justice, an independent human rights group. “No one’s really working on it.”

Researchers found that few of the provisions of the Common Travel Area are included in domestic law.

The list of issues to sort out is long: from immigration rules, to rights related to residency, access to education, social security and health care. To take one example, under Northern Irish health care legislation, only British citizens or European Economic Area citizens are currently entitled to certain types of home help or community care. But EEA citizens, including Northern Ireland-born Irish citizens, stand to lose this benefit after Brexit if there is no deal and hence no transition period.

Similar concerns exist over education, where it remains unclear whether Irish citizens will be able to pay the (less expensive) home rate for Northern Irish universities. Although few expect a sudden post-Brexit hike in fees, it would be legally difficult for universities to discriminate in favor of Irish citizens over, for example, Spanish or French students, according to Holder.

A research paper commissioned by the Joint Committee of the Irish Human Rights and Equality Commission and the Northern Ireland Human Rights Commission came to similar conclusions about the need to clarify post-Brexit rights.

Politicians commonly invoke the earlier Common Travel Area between the U.K. and Ireland as guaranteeing a fallback for ensuring a range of rights for citizens of both jurisdictions. However, the human rights researchers found that few of the provisions of the CTA are included in domestic law.

“The CTA is written in sand, and its terms are much more limited than is often believed to be the case,” the report says.

“There is a need to identify clearly rights and entitlements that stem from EU law” — Les Allamby, Chief Commissioner of Northern Ireland’s Human Rights Commission

Other rights, currently enjoyed by all residents of the island, are set to be disrupted. Take health care access along the 500-kilometer border. Due to overlapping EU rules in a number of areas, all-island health care currently exists for situations such as emergency health care provisions and access to highly specialized treatments such as radiotherapy. Cancer patients in the northern county of Donegal, in the Republic of Ireland, are entitled to receive radiotherapy in neighboring Derry’s Altnagelvin Hospital, just over the border.

Fill the gaps

Holder said the British government has only very lately been thinking of all the implications of leaving the EU for Irish citizens in Northern Ireland, if at all, and that there is an urgent need to introduce legislation to fill the gaps.

Chief Commissioner of Northern Ireland’s Human Rights Commission Les Allamby largely agreed. “There is a need to identify clearly rights and entitlements that stem from EU law,” he told POLITICO.

“To provide legal certainty and clarity, we need a formal Common Travel Area treaty to cover immigration rules, travel rights, residency, and related rights to education, social security, work, health, security and justice,” he added.

There are indications that both the British and Irish governments are aware of the need to move quickly. Ireland’s Deputy Prime Minister Simon Coveney said earlier this month that a new bilateral agreement between Dublin and London is “ready to go.” No similar announcement followed from the British government, however.

Ireland’s Deputy PM Simon Coveney | John Thys/AFP via Getty Images

A spokesperson for the U.K.’s Department for Exiting the EU said the government is “working to ensure that the necessary steps are taken to protect all these rights.

“The people of Northern Ireland who are Irish — and thus EU citizens — will continue to have access to rights, opportunities and benefits that come with EU citizenship,” she added.

Pain’s East-West divide

Cancer patients in Eastern Europe are less likely to have access to palliative care and morphine than in the West.

This article is part of the Global Policy Lab: Decoding Cancer

The late stages of many types of cancer can be excruciatingly painful without the right kind of pain relief and care. Whether you get that depends to a large extent on where you live.

In the European Union, residents of Western Europe are far more likely to receive what’s known as palliative care than those living in the East. Indeed, the line separating countries that routinely offer pain relief and emotional support to cancer patients from those that expect them to tough it out cleaves the Continent in two.

Take morphine. The availability of the pain-killing opioid is, generally speaking, a good marker for the availability of palliative care. A 2010 study conducted by the European Society for Medical Oncology (ESMO) and the European Association for Palliative Care (EAPC) found “profound differences” between East and West. The top nine countries for morphine usage were all in Western Europe, the lowest nine were all in Eastern Europe.

Before the palliative care movement got going in the 1960s, there was not much difference in morphine consumption. But by 2006, average morphine consumption per person in Western Europe was about 12 times what it was in Eastern Europe. In a “Quality of Death” analysis of 80 countries by the Economist and the Lien Foundation published in 2015, the United Kingdom ranked No. 1, with a score of 93.9/100. Five of the top 10 countries were in Western Europe. The highest-ranking Eastern European country was Poland, which was 26th with a score of 58.7/100.

Data collected by the Pain & Policy Studies Group at the University of Wisconsin in the United States shows there have been some improvements since 2010. But overall, the divide between East and West is still stark.

“There are still very restricted regulations in many Eastern European countries,” said Lukas Radbruch, one of the authors of the 2010 study and president of the German Association of Palliative Medicine.

But regulation isn’t the only reason it’s harder to gain access to palliative care in Eastern Europe.

“A lot of those countries are quite new and just developing,” said Julie Ling, the head of EAPC. Many are still working on setting and achieving health care goals.

Radbruch suspects that one reason many Eastern European countries are still lagging behind may be the result of the Soviet Union’s former rule over the region, and now the influence of Russia — specifically “the Russian culture that you bear pain, and you don’t need analgesics.”

The belief that palliative care is only for those on death’s door also scares away some potential patients and physicians.

“People don’t want to die,” said Stein Kaasa, a palliative care expert at Oslo University Hospital. “If you understand palliative care as identical to end-of-life care, you might not want it.”

Yes, palliative care experts typically step in to help patients with life-threatening diagnoses better tolerate pain and discomfort caused by difficult therapies. But their work is not limited to the last weeks and months of a patient’s life.

“Even in Germany I still meet GPs who say opioids are only for the dying, and this patient isn’t imminently dying,” said Radbruch.

Perhaps one of the most important factors holding back palliative care is the bad reputation of opioids.

“In many European countries, opioids have been very restricted because of fears of addiction,” said Kaasa.

The World Health Organization has included opioids on its list of essential medicines, but because of the fear of abuse, many Eastern European countries — and some in the West — make them difficult to prescribe.

Authorities limit the number of days available in a prescription, or the dosage, or the type. Some European countries also require several doctors to sign off, or make doctors pay for prescription forms. In many countries, doctors aren’t taught about palliative care or pain management at all.

Opioid use in cancer patients does not in fact lead to addiction the way it has in chronic pain patients in the U.S., cancer experts say. “We do not see a problem,” said Radbruch.

Proponents of palliative care for cancer patients also argue it will ultimately save money. Several studies comparing the cost of treatment for cancer patients who choose palliative care as compared to those who refuse it show lower medical bills for those who opt in.

Thus, the lower per capita incomes of Eastern Europe shouldn’t be a reason to limit palliative care, experts argue.

Conditions for cancer patients have improved somewhat since the damning 2010 study. A European Union-funded project in 12 countries, Access to Opioid Medication in Europe, has made some headway in loosening up prescribing limits, for example.

“Things are starting to change and already have changed in some countries,” said Radbruch. In Estonia, for example, opioid prescriptions for 30 days are now allowed, instead of just 14 days.

Various medical groups and NGOs, including ESMO, EAPC and Hungarian-American financier George Soros’ Open Society Foundations, have been working to educate doctors across Europe and to make legitimate opioid prescribing easier.

But progress is still too slow, advocates of palliative care say, and there are clouds on the horizon. The escalation of the epidemic of opioid addiction in the U.S. could scare governments in Eastern Europe from granting better access to morphine, and Brexit could stand in the way of advances in the field, which kicked off in the U.K. in the 1960s.

U.K. pain experts have been a vital part of the palliative care movement and “Brexit could hurt collaborative research,” said Kaasa. “We won’t be able to work as closely.”

Meaningful policy changes and improved services just aren’t happening fast enough, especially in countries with the most severe limitations in services, said Julie Torode, head of special projects at the Union for International Cancer Control.

“We can still say in 2019 that the under-treatment of pain and the suffering that ensues is a public health catastrophe,” said Torode.

Even in Western Europe, where access to palliative care is higher, there is work to be done.

“If you look at the countries that are ranked highly for palliative care provision, there are still complaints about people not doing well,” said EAPC’s Ling. “We haven’t got it all covered in any country.”

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Dutch hospitals warn on medical supplies if there’s a no-deal Brexit

EU certification granted in the U.K. to medical supplies made in other countries could become invalid in the event of a no-deal Brexit, Dutch hospitals group warns.

A no-deal Brexit carries “great risks” to medical supplies in the Netherlands and across the EU, the Dutch Federation of Academic Hospitals (NFU) warned Wednesday.

An “emergency law” has been requested to license the use of U.K.-certified medical supplies until the end of 2019, Reuters reports, amid growing concern that hospitals across the EU could be left without sufficient medical supplies if Britain crashes out of the bloc on March 29 with no deal.

Medicines and medical goods account for one tenth of Britain’s exports to the Netherlands.

A large number of medical supplies, from bandages to pacemakers, made in other countries receive an EU certification in Britain, and that certification would become invalid if the U.K. exits the bloc with no trade deal on goods and services.

“This varies from medicines, tissues and medical supplies becoming unavailable, to problems with data storage and the registration of doctors. The safety of patients is at risk,” the NFU said.

Dutch Health Minister Bruno Bruins said he had “taken up the issue” with EU colleagues, but is yet to give a progress update.

Despite attempts by U.K. opposition MPs to block the possibility of a no-deal Brexit, the European Union has warned that no-deal is still the “default” result in the absence of any agreed alternatives.

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The great British Brexit stockpile

From airplane food to car parts, companies are hoarding goods to prepare for a no-deal Brexit.

With the prospect of crashing out of the EU looming, the U.K. is battening down the hatches.

Companies are stockpiling food, medicine and car parts — but they’re running out of space to store it all.

Tesco, Britain’s largest supermarket, has rented an emergency supply of refrigerated units to mitigate any chaos in the event of a disorderly Brexit. Marks & Spencer has begun stockpiling non-perishable goods. Pharmaceutical giants, meanwhile, have secured additional U.K. warehouse space for medicines and vaccines that require cold storage. And automakers like BMW are frantically looking to store components.

In all, warehouse space is already 75 percent full, according to data from the UK Warehousing Association, whose members have roughly 9.3 million square meters of space nationwide.

“We are facing a ‘perfect storm’ in the warehousing and logistics industry, with little speculative build in the pipeline [and] urban development land earmarked for residential but not for the warehousing required to fulfill rising consumer demand,” UKWA said in a statement. In the last quarter of 2018, 85 percent of UKWA’s members received Brexit-related inquiries.

“There is a little bit of a worry that if you talk about it too much, you might create the problem you are trying to avoid” — Retail industry official

Whether it’s supermarkets, drugmakers or car manufacturers, it’s hard to find a segment of British industry that is not undergoing a costly process of contingency planning, especially now that U.K. lawmakers have rejected Prime Minister Theresa May’s Brexit deal.

“Retailers are planning ahead to meet consumer demand in all eventualities. Where it is feasible, given the nature of the product and available storage space, they are doing the prudent thing and increasing some stock,” said Andrew Opie, director of food and sustainability at the British Retail Consortium, whose members include the Sainsbury’s, Asda and Tesco supermarket chains.

Although the stockpiling of dry goods such as tinned tuna, baked beans and pasta is possible, Opie said perishable produce such as fruit, vegetables, fresh fish and meat “cannot be stored for any prolonged length of time.”

Marks & Spencer declined to specify its stockpiling plans, and Asda did not reply to questions. Tesco declined to comment but pointed to comments made by its chief executive, Dave Lewis, on January 10, when he told reporters Tesco had “sat down with each individual supplier partner and decided what, if any, is the need for stock and where that is best to most appropriately [be] kept and maintained.”

Shoppers walk past a Marks & Spencer shop on Oxford Street in central London | Tolga Akmen/AFP via Getty Images

As the March 29 deadline approaches and May looks to Brussels to make changes to the so-called Irish backstop — which is designed as a fail-safe mechanism to avoid the need for a hard border on the island in all circumstances — companies like Gate Gourmet, which supplies 20 airlines at 10 airports in the U.K., have begun stockpiling frozen entrées, pizzas, dried snacks and sandwiches at warehouses in Peterborough and London to ensure passengers will stay fed, a company spokesperson said.

Gate Gourmet produces most of its meals in Germany and Spain and fears any holdup at the British border could disrupt its business model.

Panic fears

Two industry officials in the retail sector, who spoke on the condition of anonymity, said supermarkets are extremely reluctant to talk about finer details or the scale of their contingency planning for fear of sparking a bout of panic buying. Worries among the public about possible shortages have prompted the creation of Brexit “prepper” Facebook groups, while manufacturer Emergency Food Storage is selling so-called Brexit Boxes for £295, containing freeze-dried meals, a water filter and a fire starter.

“There is a little bit of a worry that if you talk about it too much, you might create the problem you are trying to avoid,” one of the industry officials said, adding that some supermarkets have studied which products would be hit hardest by tariffs in the event of a disorderly Brexit and have begun prioritizing those items.

Many retailers are also frustrated about having to invest more in storage facilities when a Brexit deal could still be negotiated before March 29, the two officials said, noting that the cost of warehouse space has risen markedly of late as fears of a no-deal rise.

Very little can be done to stockpile fresh produce though. Strawberries, for example, can be irradiated — a technique already deployed in Belgium — and apples can be stored in a dark, cool room with high levels of carbon dioxide as a way of keeping the fruit fresh for months on end. But the vast majority of fresh items like cheese and meat will simply perish if held up at the border due to customs controls.

“We are looking for additional [warehouse] space but in the end, it’s not possible” — Stephan Freismuth, BMW customs manager

“The whole point in ‘just in time delivery’ is that you don’t have to put aside cash to store goods,” said Neil McMillan, director of political affairs and trade at EuroCommerce, a lobby organization for the retail sector. “The scale of movement across the Channel is just immense. If fresh veg is stuck for even a couple of days, it’s off by the time it comes across.”

There are similar limitations for automakers.

BMW Customs Manager Stephan Freismuth said that stockpiling could be achieved for a matter of days. Anything longer would require building “the highest building in the world.”

“We are looking for additional [warehouse] space but in the end, it’s not possible. We are producing ‘just in time,’ and just in sequence,” Freismuth said, noting that BMW in the U.K. imports about €2 billion worth of car parts from the EU every year, or double the amount it sources from inside the country.

Carmakers such as Nissan, Toyota and Honda face similar problems as hundreds of trucks carry components into the U.K. on a daily basis to snap into just-in-time supply chains at plants across the country.

In the pharmaceutical sector, U.K. Health Secretary Matt Hancock is working to ensure Britain is prepared for a no-deal Brexit. According to the Association of the British Pharmaceutical Industry, AstraZeneca has increased the number of finished medicines available to pharmacies and hospitals in both the U.K. and EU by 20 percent as a response to the risks of no deal.

British Health Secretary Matt Hancock | Dan Kitwood/Getty Images

It has also spent £40 million preparing for a no-deal Brexit, including building labs in Sweden to duplicate product testing.

The French pharmaceutical giant Sanofi has secured additional U.K. warehouse space for medicines and vaccines that require cold storage and is also moving some manufacturing operations from the U.K. to elsewhere on the Continent.

Don’t speak out

Aside from being worried about the possibility of a panic if they disclose too much about their plans, companies are also limited in what they can say publicly. The British government has used non-disclosure agreements to prevent organizations and businesses from revealing information about Brexit-related stockpiling.

Over the last few weeks, Labour MP Rushanara Ali has questioned the government over its use of non-disclosure agreements, which prevent organizations and businesses from revealing any information related to contingency plans drawn up by government departments in no-deal Brexit preparations.

Following her inquiries, the government admitted the Department of Health and Social Care has used 26 non-disclosure agreements to restrict what businesses and organizations could say publicly.

Nissan’s production plant in Sunderland, England | Christopher Furlong/Getty Images

“It is unacceptable that the government continues to pursue a policy of silencing businesses and industry from speaking out about the disastrous implications of a no-deal Brexit,” she told POLITICO.

“By effectively ‘gagging’ these organizations, these secretive agreements are preventing essential information from being shared, are undermining transparency, and are hampering businesses’ ability to speak out.”

When asked by POLITICO, a U.K. health department spokesperson said that signing non-disclosure agreements allows the department to “talk to the industry in confidence prior to making public statements and issuing advice. This means that when we go out to the whole industry we can be confident that any requests of them are clear, appropriate and deliverable.

“As part of any standard contract, in government or the private sector, we use these clauses to protect the commercial interests of government and its suppliers in a reasonable way.”

Helen Collis contributed reporting.

UK MPs to vote on Brexit deal on January 15

Theresa May had delayed the vote on the deal agreed with the EU before Christmas.

LONDON — The House of Commons will vote on the Brexit withdrawal deal next Tuesday, January 15, Prime Minister Theresa May told her Cabinet today.

The debate will be opened again Wednesday by Brexit Secretary Stephen Barclay and will be closed by May next Tuesday, her spokesman told journalists at a briefing today.

May had delayed the vote on the deal agreed with the EU27 leaders before Christmas to seek further assurances over the Northern Irish backstop, amid opposition from her own MPs.

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5 ways the UK’s health plan falls flat

Theresa May promised a £20.5 billion spending boost but there’s concern it won’t go far enough.

There’s life beyond Brexit, according to the U.K. government. Nobody else seems convinced.

Prime Minister Theresa May visited a hospital in Liverpool on Monday to lead a carefully choreographed announcement of the new 10-year plan for the National Health Service. Designed to show the government is capable of doing more than just leaving the EU, the plan aims to “save almost half a million more lives” in the next ten years by focusing on prevention and making better use of digital health services.

With most domestic policy initiatives on hold because of Brexit, the government has promised a £20.5 billion spending boost by 2023-24 to back up its health plans — money May said will come in part from the windfall to be enjoyed when the U.K. stops sending money to Brussels.

But the reactions from health care providers focused largely on the uncertainties facing the NHS ahead of Brexit, both in terms of finance and the departure of EU27 nationals that will worsen staffing issues. (Few believe a Brexit windfall is likely despite the Vote Leave’s red bus.) Lengthening wait times for services was another politically sensitive issue set aside in the government’s announcement.

“This is not about miracles — money will be tight and staffing will remain a headache for years to come,” Niall Dickson, chief executive of the NHS Confederation, which represents health service providers, said in reaction to the plan. Warning of the risks of “over-promising,” Dickson said: “Our plea is that politicians be honest about the trade-offs that will be required and that we are realistic about what can be achieved given the ever-increasing demands of an ageing population.”

Health groups say the £20.5 billion budget increase by 2023-24 unveiled in June is not enough to get the NHS back on track following years of austerity

The announcement also suffered from the government’s strategy of pre-announcements: major policy initiatives from new cancer screening to mental health service improvements had been widely previewed, leaving praise confined to celebrating the “vision” of tying those initiatives together.

Here’s five reasons why the plan failed to match expectations.

1. Not enough money

Health groups say the £20.5 billion budget increase by 2023-24 unveiled in June is not enough to get the NHS back on track following years of austerity. The figure amounts to a 3.4 percent increase in funding, but think tanks such as the Nuffield Trust say a 4 percent boost is needed at least to “put the NHS on a sustainable footing.”

“Ultimately, there is a need for honesty about how far the £20.5 billion over five years will stretch,” British Medical Association (BMA) council chair Chaand Nagpaul said Monday. “World class care requires world class funding and the investment in the long-term plan will still leave the U.K. falling behind comparative nations like France and Germany.”

Britain’s Health Secretary Matt Hancock | Ben Stansall/AFP via Getty Images

Plus there’s concern a no-deal Brexit would deplete the promised funding — “the extra costs and tasks required would eat up the first instalments, stopping progress dead in its tracks,” Nigel Edwards, chief executive of the Nuffield Trust, said in a statement.

Health Secretary Matt Hancock has promised the extra funds will be available “irrespective” of the outcome of Brexit talks with the EU, which doesn’t quite fit with May’s suggestion it will come in part from money London will no longer be sending to Brussels.

2. Ignoring staffing woes

Staffing shortages are top of the list for nearly 60 percent of U.K. voters when asked where the extra NHS cash should be spent, according to a poll by The Times, but the government’s plan kicks that can down the road.

The plan promises “NHS staff will get the backing they need” by balancing “supply and demand across all staff groups.” The funding for hiring, training and professional development of NHS staff “has yet to be set by government” and won’t be published until “later in 2019,” it said.

Staff “are routinely struggling to cope with rising demand and, as a result, are subject to low morale, stress and burnout” — Chaand Nagpaul, BMA council chair 

The BMA, which represents doctors, and NHS Providers, which represents various NHS staff, cautioned the NHS will be hard-pressed to make good on the plan’s promises if it doesn’t improve the staffing situation. One in 11 posts are estimated to be vacant and the situation is predicted to worsen after Brexit, with the King’s Fund, Health Foundation and Nuffield Trust predicting a shortfall of around 250,000 NHS staff by 2030.

Nagpaul of the BMA said doctors and staff “are routinely struggling to cope with rising demand and, as a result, are subject to low morale, stress and burnout.”

3. Hedging on waiting times

The government’s plan commits to reducing waiting times for mental health services across the board, ranging from children to adults and community-based care to crisis situations.

But as the NHS continues to come up short on waiting times for emergency care and routine surgery, the new plan offers no clear path forward other than to say “sufficient funds” will be allocated to local NHS services to cut long waits.

NHS chief Simon Stevens | Tolga Akmen/AFP via Getty Images

“We also need immediate, practical solutions and the necessary investment for hospitals to deliver both in the long and short-term,” said Nagpaul of the BMA.

NHS chief Simon Stevens said there should be “tougher, faster” standards when it comes to emergency room waiting times in an interview with BBC Radio 4 on Monday, and suggested the existing four-hour guideline by which NHS progress is judged needed to be updated. “The problem with that is it doesn’t distinguish between turning up at A&E with a sprained finger and turning up with a heart attack,” he said. He declined to commit to specific targets.

4. Mixed messages on prevention

One of the main pillars of the government’s plan is prevention — stopping health problems before they start by trying to reduce smoking and drinking or increase exercise, for instance.

While many groups supported this move, they couldn’t help but note the hypocrisy of the fact that government funding for local public health services has been cut in recent years. The latest projections are a cut of £85 million for 2019-20, to £3.1 billion.

“The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again” — Nigel Edwards, chief executive of the Nuffield Trust

Nagpaul of the BMA urged the government to take bolder stances on issues such as a minimum unit price for alcohol and restricting sugar in food.

“The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again,” said the Nuffield Trust’s Edwards.

5. Raised expectations

U.K. Chancellor Philip Hammond hit the nail on the head when he wrote in the Daily Mail on Monday: “The leaders of the NHS must now ensure they get the basics right. Alongside greater quality of care and ending waste, the public will demand that progress is made on the back of their investment.”

The widely-touted funding rise will leave people expecting a better and more efficient NHS, which requires delivery on the basics such as wait times that the plan doesn’t address.

The government’s major targets are focused around specific diseases: the plan aims to prevent 150,000 heart attacks, strokes and dementia cases, and 55,000 cancer-related deaths, and help 380,000 more people get treatment for anxiety and depression. As Conservative Party MP and health select committee chair Sarah Wollaston noted, some of the priorities mirror those set out in the previous five-year plan, “many of which remain unfinished business.”

“The last plan was undermined by the cuts to social care, public health, capital and training budgets and it is important not to see this repeated,” Wollaston wrote in a blog post.

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Irish government prepares for no-deal Brexit with ‘sobering’ contingency plan

Dublin’s Plan B makes for ‘stark reading,’ Ireland’s Minister for Foreign Affairs and Trade Simon Coveney warns.

Ireland will need to pass 45 emergency laws ahead of Brexit Day if U.K. MPs fail to back Theresa May’s Withdrawal Agreement next month, according to the government’s contingency plans.

In its 131-page “Getting Ireland Brexit Ready” report published late Wednesday, the Irish government says the country’s domestic legislative program will require significant legal changes before March 29, 2019 in areas such as agriculture, the single electricity market, housing, health care and cross-border trade, among others.

Speaking to media in Dublin Wednesday night, Ireland’s Minister for Foreign Affairs and Trade Simon Coveney said the report was worrying for the trading relationship between Northern Ireland and the Republic.

Dublin’s “contingency plans for a no-deal Brexit make for sobering and stark reading,” Coveney said. “The report would require an immediate focus on crisis management and possible temporary solutions.”

The contingency plan notes that as England is the land bridge between Ireland and the European Continent, severe traffic delays in the aftermath of a no-deal Brexit are likely on the Dover-Calais shipping route, and adds that Ireland’s transport department is working with companies to identify alternatives.

The paper says the government’s main focus is to prevent the emergence of a hard border between Northern Ireland and the Republic.

Extra land will be needed at Dublin and Rosslare ports and at airports to deal with the “significant increase” in checks that will be needed if the U.K. crashes out of the EU, according to the report.

The additional facilities required at Dublin port will include 33 inspection bays for trucks coming off ships, 270 parking spaces to prevent logjams of trucks awaiting inspection, a dedicated border control post for the movement of live animals and new office space. Similar facilities will be required at Rosslare port in the southeast of the country, which is a major passenger and freight route to northern France.

Extra inspection rooms and a border control post for animals will also have to be constructed at Dublin airport.

Legislation is currently being prepared to address the issue of medicine supply and cross-border medical services, according to the report.

Vehicles cross the border between Ireland and Northern Ireland | Paul Faith/AFP via Getty Images

The paper says the government’s main focus is to prevent the emergence of a hard border between Northern Ireland and the Republic, though it doesn’t specify how that will be prevented if Westminster rejects the U.K.-EU Withdrawal Agreement.

The Republic of Ireland has an open land border with Northern Ireland, which is in the U.K. If the U.K. leaves the EU without a Brexit deal, the dividing line separating the two jurisdictions will become the frontier between the two.

Coveney said the plan is an “evolving document” and will be subject to change as talks continue between London, Brussels and Dublin.

The Irish Cabinet will meet on January 3 to discuss further contingency planning.

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UK publishes post-Brexit immigration plan

EU citizens’ automatic right to settle and work in the UK will end.

LONDON — British businesses will be given “time to adjust” to the end of free movement from the EU, U.K. Home Secretary Sajid Javid said while announcing plans for a “new route” for workers of any skill level to come to the U.K. for a year at a time after Brexit.

The policy, contained in the U.K. government’s long-awaited white paper on immigration, will remain under review but could stay in place until 2025.

It would apply to nationals of unspecified “low risk” countries but is aimed at ensuring sectors that depend on EU labor continue to have access to it after Brexit, the white paper states. EU citizens’ automatic right to settle and work in the U.K. will end.

The white paper states that the U.K.’s new immigration policy should “control the numbers and type of people” coming to the U.K. and should “reduce annual net migration to sustainable levels as set out in the Conservative Party manifesto.

However, speaking to BBC Radio 4’s Today program on Wednesday, Javid refused to repeat the Tory 2017 manifesto’s commitment to bring annual net migration to the U.K. — currently estimated at around 273,000 — down to the “tens of thousands.”

But when asked during her final Prime Minister’s Questions session of 2018, Theresa May said – categorically — that reducing numbers to the tens of thousands was still the government’s intention.

As recommended by the independent Migration Advisory Committee earlier this year, there will be no cap on high-skilled workers coming to the U.K. from either EU or non-EU countries. The MAC suggested that, alongside recognized qualifications, workers coming to the U.K. would require a minimum salary of £30,000.

The government is not yet committing to this figure, and will now undergo a a 12-month period of consultation with businesses before finalizing immigration rules.

However, a new Immigration Bill, enshrining in law the end of free movement, will begin its passage through parliament on Thursday and will need to be completed by the U.K.’s exit day if the country leaves the EU without a deal.

If the U.K. leaves with a deal, EU migrants will continue to enjoy their existing free movement rights during the 21-month transition period. When the transition ends in December 2020, the U.K.’s new immigration rules will come into force.

The U.K.’s final immigration rules could also be subject to trade negotiations with the EU and with other countries, which are likely to seek favorable access for their citizens as a quid pro quo for improved trading terms.

In his foreword to the white paper, Javid acknowledged that the “future system will be flexible as we go on to strike future trade deals with the EU and other countries.”

Under the new temporary “route,” workers would be able to secure a visa to come to the U.K. for a year, with or without a job offer. After 12 months they would be subject to a 12-month “cooling off period,” meaning they could not renew their temporary immigration status for a year. They would also be unable to access public funds or bring dependants to live with them.

The white paper states: “We acknowledge that there are particular difficulties in recruiting staff in certain parts of the UK, particularly more rural and remote areas and regions. We also recognise that some sectors have built up a reliance on lower skilled workers from the EU, often for relatively short periods, such as those which require additional workers in the run-up to Christmas.

“We recognise that employers in these areas require a period of time to change their ways of working once they have certainty about the shape of our future immigration system.”

Javid described the measures in his white paper foreword as “a transitional measure, a temporary short-term workers route to ensure businesses have the staff they need and to help employers move smoothly to the new immigration system.”

He added: “We understand this is the most significant change to the immigration system in more than 40 years, and so employers will need time to adjust.”