How will a ‘no deal’ Brexit affect the NHS?

At a recent meeting of UK urologists I asked for a show of hands of those who had voted to remain in the European Union – around 90% of the sizeable audience indicated that they had. They, like me, seemed appalled that David Cameron had gambled the future of the country on a simple referendum – 51% and you’re out – whereas other countries faced with far less momentous issues opt for two stage votes or a super-majority. He took this gamble merely to appease the Eurosceptic wing of his party and to staunch the haemorrhage of votes to the UK Independence part, and in doing so fired the starting gun on the political mayhem that we have all had to live with for the past two and a half years.

Uncertainty over the UK’s future relations with the European Union is now leading to acute problems with contingency planning by NHS trusts and boards across the UK. Trusts have been unable to accurately forecast how the supply of medicines and workforce availability are most likely to be badly affected by Brexit.

Freedom of Information requests were recently sent by the BMJ to all 231 NHS trusts in England, and 26 health boards across Scotland, Wales, and Northern Ireland. Responses were received from 71% of recipients. The investigation found that so far only 9% of trusts in England have established any sort of committee or body to oversee preparations for the country potentially crashing out of the EU on March 29th 2019.

A Scottish Government spokesperson said: ‘We’re working with Scottish health boards to mitigate as much as is possible against the risks that come from any form of Brexit. The reality is that no matter the preparation that is put in place we will not be able to mitigate against all the real problems that Brexit are likely to bring. We have made repeated representations to the UK government on these matters, not least on seeking clarity from them of the potential impact on the supply of medicines.’

A spokesperson for the Department of Health and Social Care said: ‘The Department has already set in motion contingency plans to minimise any disruption to the health and social care system as we exit the EU. We are working closely with NHS Trusts, relevant companies and their supply chains so patients can continue to access healthcare services and medical supplies in the same way they do now.’

What is your own experience? Is ‘no deal’ Brexit planning any further advanced in your own Trust or practice? Is chaos in the NHS the most likely scenario after the 29th of March?

Comments (12) Add yours ↓
  1. Matthew Perry Consultant Urological Surgeon

    Brexit is turning European staff away from the NHS just at a time when we need them. To turn off the supply of good quality staff when staff retention and recruitment is so low is an incredible dereliction of duty. The lack of any planning before considering the result of a referendum was the worst form of leadership.

    January 2, 2019 Reply
  2. Michael Kirby Professor

    We are already seeing issues with supplies of drugs through pharmacies, probably due to stock piling & European research grants look to be more complex in the future.
    What a mess it is!!!!!

    January 3, 2019 Reply
  3. Christopher Smallwood Former chairman, St George's University Hospitals NHS Foundation Trust

    Why should anyone expect chaos after March 29? No one is going to stop us importing drugs – that’s down to us. If stock piling is taking place as well, this underlines the fact that the chances of drug shortages are extremely small. Equally, no one wants to restrict the supply of labour for the health service. Any successor immigration policy will be based on an assessment of need and health staff will be top of the list.
    I doubt whether the NHS will notice we’ve left – unless hysteria generates irrational behaviour.

    Happy New Year to everyone!

    January 3, 2019 Reply
  4. Roger Kirby Professor of Urology

    In a new briefing paper published today, the BMA outlines what is at stake for health services if the UK and the EU fail to reach a deal on the Withdrawal Agreement by March 2019. The paper warns that, in a worst-case scenario, a no deal scenario could:

    Cause real disruption for almost a million patients receiving treatment for rare diseases as the UK would be excluded from the European Rare Disease Network;
    Cause delays in diagnosis and treatment for cancer patients because the UK would have to source important radioisotopes from outside of EURATOM;
    End reciprocal healthcare agreements which could disrupt patient care and increase insurance costs. If 190,000 UK state pensioners currently signed up to the S1 scheme and living within the EU return to the UK it could cost the health services between £500 million and £1 billion per year;
    Weaken the UK’s response to pandemics and increase the chances of diseases spreading as we lose partnerships with key EU bodies, such as the European Centre for Disease Prevention and Control;
    Risk the return of a hard border between Northern Ireland and the Republic of Ireland which could see doctors leaving the profession and patients having to travel miles to receive care;
    See fewer doctors and other medical staff, at a time when there are already huge shortages of these roles, due to uncertainty over future immigration status and confusion around the mutual recognition of medical qualifications across the EU.

    January 4, 2019 Reply
  5. Richard Morey Anaesthetist

    Agree decision for referendum was a misjudged political one hence Cameron’s resignation. The people have spoken however informed, uninformed or misinformed they were and we have to respect the result.
    The major problem revolves around the failure of proper preparedness for a no deal Brexit. Ironic as that’s what is supposed to be ingrained in the NHS.
    29th March will be challenging as no doubt the DoH will not have practiced what they preached and taken appropriate preparedness actions in a timely manner.
    The long term future should however be rosy if new markets are engaged. The world is smaller than in 1973 and transport considerably swifter.
    There’s too much Project Fear around. The British Safety Standard was more rigorous than the CE mark so perhaps we could use the opportunity to raise our standards again!

    January 4, 2019 Reply
  6. Ben Challacombe Urologist

    i so agree with all the above. Not usual for me to have any strong political views but
    I cant see ANY good side to Brexit. NO one knew what we were voting for and really still dont but it doesnt look good. Most of Europe doesn’t abide by the policies we are seeking to avoid anyway. I have signed 2 colleague’s forms for Irish passports last week.
    Awful for research and collaboration, and the impact of staffing is potentially appalling. I haven’t met many doctors who are pro BREXIT- maybe 5% max? and bizarrely many originally not from a UK background which i dont understand.
    Hopefully the vote wont be passed

    January 6, 2019 Reply
  7. Richard Morey Anaesthetist

    Hi Roger
    As medical professionals we are rightly risk averse and should be circumspect about the way we view things. Unsurprisingly this includes the doubts and fears that the Brexit uncertainty produces.
    However, the mess that has been produced is due to our political leaders following their own agendas and not what 52% of the public voted for. If “no deal” had been assumed from the start we’d have prepared properly for 29th March. This would have included proper planning for the NHS which should have involved staff, medicines equipment etc. Ironic really as the NHS expects us all to prepare assiduosly for major clinical emergencies.
    The world is considerably smaller than it was in the 70s and 80s meaning distant markets and economies are far more readily accessible now than they were. Those of us who remember the Kite Mark will remember how sought after it’s award was and its replacement by the lower standard CE as sacrilege.
    It’s time we stopped being retrospective and grasped the opportunities the future outside the EU offers.

    January 6, 2019 Reply
  8. Piyush Sarmah ST3 Urology

    Both Nitin Shrotri and I wrote an article for Urology News back in September last year (link below) when there was increased talk of No Deal, and how it might impact existing urological practice in the UK. One of our conclusions was that there was still so much that we don’t know, and given the political actions we still haven’t a clue what will happen. I personally have heard absolutely nothing from my own Trust about preparations for No Deal, and everyone is continuing as normal as if nothing’s going to change. We can again only wait and see what happens with the eventual outcome after this week and the next.

    January 7, 2019 Reply
  9. Roger Kirby Professor of Urology

    NHS figures show 111,000 full-time vacancies in the NHS in England, 41,000 of them nurses, and on weekend TV health and social care secretary Matt Hancock was unable to explain how these would be filled. Brexit has added to this crisis. Over the summer the prime minister belatedly committed to allowing EU citizens resident before 29 March to stay, and NHS staff were given a two-week window to apply for settled status in December, before general applications opened.

    The announcement came after two years of botched negotiations, which have resulted in 3,000 fewer nurses from the EEA working in the NHS in 2018, and a collapse of new applicants.

    While doctors and nurses are exempted from visa caps, there is still no clarity over how the proposed “low skilled” visa threshold on those earning less than £30,000 will affect EU applicants after 29 March.

    The new 10 year NHS plan says part-time degrees and a shift to train more generalists and GPs will help the NHS attract more staff equipped to manage rising numbers of elderly patients with more than one condition. This is in addition to changes to make a 25 per cent expansion in the numbers of nursing and medical training places that the government has already announced. It will be essential to ensure that the quality of medical and nursing professionals is maintained. Currently the uncertainty surrounding Brexit is undoubtedly making recruiting staff from abroad considerably more difficult.

    January 8, 2019 Reply
  10. Peter Rimington Consultant Urologist

    The worrying thing is that the exact outcome of our relationships with important European collaboratives is not clear to us even if we accept Theresa May’s unsatisfactory “deal”.
    But I have a sneaking suspicion that British research facilities are excellent and have an outstanding reputation for good reason and our equally confused European colleagues will continue to want this expertise, that the NHS will struggle through and continue to be (at least in comparison to European standards) a generous and egalitarian employer, we will be free to employ the hordes of graduates from countries outside the EU who are currently typing our letters in centres around the world, and we may see a return of registrars from foreign climes who realise that they can be taught a great deal in the UK. and I think the same goes for businesses.
    However, I am an Aquarian and we are accused of being dreamers!
    There is something akin to the Millenium Bug scare going on at present and only the very worst outcomes are being aired. Take heart people. There are some possible advantages!

    January 8, 2019 Reply
  11. David Redman Cons Anaesthetist

    Wiĺl the sun ever shine again? Is this the end of the world? No deal is better than Mrs May ‘s awful deal Take the brief hit and enjoy euro debacles from the outside. Why buy a trade deficit?
    Not everyone is a privileged Londoner, life will still be possible.

    January 10, 2019 Reply
  12. Roger Kirby Professor of Urology

    NHS staff could be asked to sleep at work if traffic is gridlocked in the event of a no-deal Brexit, according to contingency plans being drawn up by one Kent trust.

    Details of no-deal preparations at Kent Community Health NHS Foundation Trust show it is looking at “staff accommodation at bases”, mapping out where staff live and work, and how alternative methods of travel or remote working could be used.

    Kent Community is one of those most vulnerable to disruption. It operates home visiting and nursing services along the M20 where ministers are preparing to turn parts of the carriageway into an overflow lorry park in the event of disruption at channel ports on 29 March.

    The planning, revealed in board minutes approved earlier this week, notes gridlock at Dover, Ramsgate and the Eurotunnel terminal as potential risks to services, according to the Health Service Journal.

    February 3, 2019 Reply

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