Dark clouds on the horizon?

Mark Dayan and Matthew Elliott

As the COVID cloud begins to pass, the potential health and social care implications of a poor Brexit deal loom on the horizon

It is an irony that having consumed the majority of oxygen in Whitehall for the past four years, Brexit may find itself being overshadowed by an even greater challenge in the form of COVID-19.

For this week’s edition of the Health Insider we are delighted to showcase the insights of Mark Dayan from the Nuffield Trust, who has written extensively on the consequences of Brexit for the NHS, and Matthew Elliott, who is a veteran political campaigner, including acting as Chief Executive of the Vote Leave campaign.


Mark Dayan

Policy Analyst and Head of Public Affairs
Nuffield Trust

Deal or no-deal, the Brexit negotiations presents risks for the NHS

The possibility that the UK’s exit from the Single Market on December 31st may coincide with a lingering or resurgent coronavirus pandemic is a sobering one for the NHS. Each challenge would make dealing with the other harder. The intense global demand for certain supplies would make stockpiling for Brexit more difficult, and coronavirus would suck officials’ attention away from the kind of preparation done last time. The burden of extra paperwork on imports, and the problem of social care staff being cut off under the new migration measures, would make responding to COVID-19 even more difficult in 2021 than it was this year.

A lot of warnings about how leaving the single market may affect the response of businesses and society to COVID-19 have focused on a “no deal” scenario. But it is important to note that for health, a relatively unambitious deal would be hardly any better.

A customs border arrangement would risk delays to medicines given the paperwork involved in trade outside the EU – removing tariffs is of limited relevance since they are largely exempt anyway. The UK would still be subject to EU export bans and left out of EU buying processes. And the planned crackdown on the migration of care workers would still be initiated at a very difficult time for sectors such as care homes.

When it comes to regulation, analysis of negotiating positions shows the UK has asked for welcome and ambitious measures to smooth import and export. These include practical proposals such as the mutual recognition of the results of safety inspections of medicines factories, for example.

But the European Union shows no intention of accepting these, with some reports suggesting they are thinking along protectionist lines and hoping to ease competition for their pharmaceutical corporations. And while London has pushed fiercely on issues like fishing, apparently with some success, there is little sign so far that healthcare products have been afforded the same priority.

Negotiators have chosen not to trigger an extra transition period by the July deadline. This means the only sure way to delay the effects later in the year will be the potentially excruciating process of agreeing a special deal. But if we reach Autumn and the impacts of the two biggest challenges for British health care of the 21st century are set to collide, both the UK and the EU – who will also face many of these causes of disruptions to some degree – may nonetheless start wondering if it is the easiest way out.


Matthew Elliott

Former CEO of Vote Leave Campaign and MHP Adviser

A Brexit deal will go down to the wire

In the years following the EU referendum, I don’t think anybody envisaged another issue dominating political discourse in their lifetimes quite as much as Brexit. But then COVID-19 came along, and suddenly coverage about the Brexit transition disappeared and fighting the Corona-crisis took centre stage.

What is happening with the EU-UK negotiations? Where will things stand on the 1st January? And how can people involved in healthcare and life sciences best contribute to the process?

There are very few silver linings to the current situation with COVID-19, but one of them has been to highlight just how important the rest of the world is to our health and wellbeing in the UK. From the nurses, doctors and ancillary staff who have come to the UK work in our NHS, to the reliance on overseas suppliers for Personal Protective Equipment, to the manufacturing facilities outside of the UK required for a potential vaccine, to this week’s shift to using the Apple-Google model for our tracing app – all these examples show that Britain is not self-sufficient when it comes to healthcare.

As a result, when companies, organisations and individuals want to make submissions to Government ministers and officials about the final deal being negotiated with the EU, they have immediate case studies to demonstrate the supply chains, people and international relationships that are necessary for the UK to have a first class healthcare system.

Despite Covid – to coin a phrase – the Brexit negotiations have continued in the background. Like many others, I have participated in many Zoom webinars during the lockdown, and I’ve been particularly struck listening to regulators just how much work had been done quietly, away from the cameras, to ensure a deal can be done between the UK and the EU before the end of the year.

With all these processes, it takes the politicians themselves, representing the specific concerns and interests of their voters, to carry a deal over the line. And I suspect it will go down to the wire. But just as the possibility of a no-deal Brexit focussed the minds of politicians in the autumn of 2019, I suspect the prospect of no-trade deal end to the transition period will do so again in the Autumn of 2020.

One thing is for sure, COVID-19 has made it abundantly clear just how interconnected countries are globally, and has underlined the importance of international cooperation.