Experts are warning that a no-deal Brexit could ‘jeopardise people’s health’

The Lancet’s Health Policy Review warns of medicine and workforce shortages as well as funding pressures after evaluating four EU withdrawal scenarios

Brexit is threatening to cause significant harm to the NHS, according to health experts’ review of four possible EU withdrawal scenarios.

The Health Policy Review, published in The Lancet, found that a no-deal Brexit would be “by far” the worst option for the health service, impacting on workforce levels, causing medicine shortages, putting the squeeze on funding and halting medical research.

As well as no deal, the leading experts in public health and law analysed departures including a transitional agreement up until the end of 2020 as well as the Northern Ireland Backstop and the Political Declaration on the Future Relationship between the UK and EU.

And they came to the conclusion that each of the scenarios left the health service worse off than remaining in the EU – that scenario was not included in the study after the same experts assessed it in 2017.

Some people will dismiss our analysis as “Project Fear”. But with just over a month to go to Brexit, we need to move beyond slogans

The recruitment and retention of the health care workforce was one of the factors that came under the microscope. Theresa May’s Withdrawal Agreement may have been agreed with the EU but is yet to win over parliament – it covers reciprocal arrangements and mutual recognition of professional qualifications up to 2020.

But there is no provision for healthcare workers in the Backstop or Political Declaration while the £30,000 minimum salary threshold, under the proposed Immigration White Paper, could limit immigration of health workers to the UK.


Last year, 27,000 people worldwide earned an income selling street papers, making a total of £23.4 million.

With 63,000 NHS staff – or five per cent – in England from the EU, the NHS is facing a skills gap.

And the funding to fill it may also be hard to come by. Far from the “£350m-a-week” Brexit bus bonus promised by Boris Johnson, a lack of access to one of the largest areas of public expenditure, the European Investment Bank, could put pressure on funding in all scenarios.

That is especially true when coupled with the slowing economic growth that the economy has already experienced in the run up to Brexit.

Professor Martin McKee, co-author from the London School of Hygiene & Tropical Medicine, said: “Some people will dismiss our analysis as “Project Fear”. But with just over a month to go to Brexit, we need to move beyond slogans. We have set out the problems in detail, based on the best available evidence. If others disagree, then they owe it to the British people to say why. It just isn’t good enough to keep saying that “something will work out” without any details of exactly how.”

As for medicine supplies, the continuity of legal provisions will secure supply chains for medicines, vaccines, medical devices and equipment until 2020 in May’s Withdrawal agreement. But under a no-deal Brexit, the absence of a legal framework for imports and exports would have an immediate and drastic effect on supply chains with shortages likely as stockpiling can only cover a few weeks.

The UK will also no longer be a part of the European Medicines Agency, which could leave UK patients waiting up to two years to access new medicines.

And the experts also point to little evidence that the UK is prepared to overcome these issues with only two mentions of Brexit in the NHS’ 10-year plan.

Professor Tamara Hervey, co-author from the School of Law, University of Sheffield said: “It’s critical to be clear about the practical effects of disentangling over 40 years of legal integration. This is not something that can be done hastily without potentially jeopardising people’s health.”