A no-deal Brexit will leave vulnerable patients in danger

As the ninth and final round of future relationship negotiations draws to a close this week, we are now in the final three months of the Brexit transition period and less than 100 days before health services and industry, educators, researchers, public health and patients will be entering a new relationship with the EU or none at all.

Irrespective of narratives from London and Brussels, this really needs to be a “smell the coffee” moment, as there is a very real danger that our most vulnerable patients (who rely on unhindered access to medicines and medical supplies) could be left in a Brexit transition to nowhere. Yes, Brexit fatigue is understandable, particularly when working flat out to meet the demands of Covid-19, but that fatigue is shared by the very people who will be charged with dealing with the implications of no deal come 1 January 2021.

The health and care workforce has risen to immense challenges over the last six months and is set to face a capacity-inhibiting cocktail of winter pressures, infection-control measures and a backlog of treatment due to Covid-19. And that’s before factoring in the challenges of Covid-19 outbreaks and surges. Adding Brexit uncertainty, or worse, no deal, to that mix is the tonic no one asked for.

The pharmaceutical industry has been tasked in recent months with developing treatments and vaccines at extraordinary rates in circumstances where supply chains are already stretched to capacity due to Covid-19. In addition, the industry will also have to resolve the hangover of reconfiguring a medicines supply chain. A supply chain that sees 45 million packs of medicines moved from the UK to the EU and 37 million the other way, as jointly highlighted by the Association of the British Pharmaceutical Industry and European Federation of Pharmaceutical Industries and Associations this week. Last but not least, patient groups have had to negotiate a conveyor-belt maze of communications through the coronavirus crisis. These groups will need go into overdrive during the peak of a second wave to ensure patients know where they stand.

Protecting patients cannot be an addendum reached in early 2021, it’s a day-one issue for the more than 500 million citizens across the UK and EU. As the latest briefing from the Brexit Health Alliance sets out, the days remaining for the EU and UK to take action to protect patients are numbered.

We acknowledge that the scale of change is ambitious and represents an unprecedented challenge across the whole country and economy. The Brexit Health Alliance, which represents organisations right across the health sector including public health, industry, universities, research organisations, royal colleges and patient groups, has never taken a stance on the merits of Brexit or otherwise. However, the latest briefing from the alliance is a final plea that patients and our health service are protected, regardless of the political developments.

With numerous rounds of no-deal preparations it may feel like we have been here before and we know how the story ends – but we don’t. The UK and EU should not underestimate the foreseen and unforeseen challenges that will arise in less than 100 days for patients should a free trade deal not be reached. Covid-19 has already put the health and care workforce, the pharmaceutical industry and patient groups under immense strain, the exacerbating effect of failing to agree a free trade agreement could see it snap. The impact becomes all too real when you delve beneath the millions set to be affected by the failure to reach a free trade deal to the individuals who rely on medicines in their daily lives.

Kidney Care UK, a charity that works closely with some of the UK’s most vulnerable patients, report that those who live with the rigours of kidney disease every day say they feel forgotten about and want some clarity about what happens next. Fiona Loud, the director of policy, said: “The impact of not being able to get away on a holiday on your mental wellbeing is huge, we’ve seen how millions of people in the UK have had to handle not being able to get break in 2020 due to Covid-19. For around 30,000 people who are on dialysis in the UK this could become a permanent reality unless reciprocal healthcare arrangements are made after 1 January 2021. Without a replacement to EHIC in our trade deal with the EU, travel in Europe will be out of reach for thousands of patients; they will be left trapped at home as there is simply no health insurance that covers dialysis.” Reaching a free trade deal is not just the right answer for kidney patients, it’s the right answer for all patients in the UK and the EU.

The NHS has made remarkable progress in meeting the extraordinary demands of Covid-19 but we are not out of the woods yet, which are set to thicken as we seek a path through the months ahead. What the NHS, indeed the pharmaceutical industry and patient groups need now is to be able to plan with as much certainty as possible to be able to look after patients this winter. This means avoiding frantic last-minute no-deal preparations, with unanswered questions on issues such as the status of Northern Ireland and the future of regulation in the UK. It may feel like there is more road to run. There is not.

Failure to agree a free trade agreement will result in industry, the NHS, research organisations, public health and regulators having to make a significant adjustment to prepare for the end of the year at a time where we are all working incredibly hard and adjusting to the new normal that Covid-19 has created.

The government needs to urgently clarify arrangements to support patients, healthcare providers and researchers in the event of a non-negotiated outcome to the talks to allow sufficient time for preparations. Our latest briefing clearly lays out what that should look like. Frontline services, through this adversity, are working flat out to deliver critical services and it is the Brexit Health Alliance’s raison d’etre and final plea to highlight the implications of failing to support them – patients will be in danger of a transition to nowhere.

Layla McCay is international director of the NHS Confederation, part of the Brexit Health Alliance