• Leading think-tank says deal “not as positive for the NHS” as the last deal
  • Senior NHS figures raise concerns around medical supplies and economic prospects
  • NHS Confed says service must stay focused on no-deal Brexit preparations 

The NHS will be exposed to more risk by the government’s latest Brexit deal than by Theresa May’s original agreement, health service experts and lobby groups have told HSJ.

MPs are set to vote on Boris Johnson’s withdrawal agreement bill today. The government is bidding to ratify the bill this week, an incredibly tight timeframe leaving little time for scrutiny from MPs, so it can meet the 31 October Brexit deadline.

But experts have raised a series of concerns around the impact on the continuity of medical supplies which could result from potential trade friction, and the impact on the NHS of the UK’s growth prospects being downgraded by experts under the new deal.

One senior NHS figure also said the shorter transition period attached to the latest deal means the UK has less time to broker a new trade deal with Europe before it could face another potential fresh “no-deal” cliff edge in December 2020.

Nuffield Trust Brexit expert Mark Dayan told HSJ “The deal is, overall, not as positive for the NHS than the May deal in the longer term.

“This is because the new ‘front-stop’ arrangement [the border across the Irish Sea - see explainer box below] seems to set a course for more trade friction than the old backstop, and because of the fiscal implications of that. Under the new ‘frontstop’ arrangement, there is no all-UK customs union with the EU.

He said: “The backstop set the minimum relationship under most circumstances. Because it was a customs union with the rest of UK that guaranteed reduced paperwork and no tariffs.

“There are no tariffs on medicines or pharmaceutical products, but studies indicate [the backstop] would have reduced extra [trade] costs as well as the impact on the pound.”

Mr Dayan added that a study by The UK In A Changing Europe, one of the only organisations to have tried to assess the economic consequences, calculated the impact on gross domestic product would be between 0.5 and 1.5 percentage points worse than under the May deal.

“That’s a hit to public finances between £16bn and £50bn, which is pretty substantial. This would mean there would be much less fiscal headroom for things like the substantial reform needed for social care, for example,” he said.

The NHS Confederation also said there new arrangements could cause friction at the border which could impact the NHS.

Its director of international relations Layla McCay told HSJ: “The new customs proposals do mean extra checks and controls will likely need to take place, mainly on goods entering Northern Ireland from the mainland UK - which could mean delays thanks to extra paperwork - not to mention potential additional costs, even if some will be rebated.”

Another expert closely involved in the NHS’s Brexit response and preparations told HSJ the UK government also had “considerably less” breathing space than with the May deal.

The source said: “The transition period is still set to end in December 2020, so there’s nearly a year lost in terms of time to negotiate the future relationship with the EU. The transition period is extendable by two years, but trade deals usually take far longer to agree.

“If the government fails to agree a deal then we effectively face another no deal cliff edge in December 2020.

“NHS organisations must continue to be prepared for ongoing uncertainty over an extended period even if a deal is passed, because of how much there is to agree in the next phase.”

The source added: “We also need to remember the potential knock-on effects of any economic impact – a range of public services act as key health determinants, in particular social care, education, housing and the welfare system. If investment in these areas is lost, then we will see the results in further rising demand for the NHS.”

NHS Confederation said local health service leaders should remain focused on preparing for a no-deal Brexit with so much uncertainty surrounding the process.

The group has published a survey which identifies the seven key areas of concern for local leaders around a no-deal Brexit.

Top of the list for many local leaders was the supply and availability of medicines and other goods, and how local areas will cope with the impact of a no-deal Brexit on top of day-to-day operational pressures.

In an exclusive comment for HSJ Dr McCay said: “Six other concerns were raised by health leaders in our Brexit Temperature Check: long-term disruption, transport disruption, the timing of Brexit coming as the NHS enters the winter period, reciprocal arrangements, workforce and funding.”

Explained: The “front-stop” replacing the Irish backstop

The so-called “front-stop” has been developed as the latest attempt to tackle the complex conundrum posed by the need to ensure EU-UK customs checks can be completed but without bringing back a hard border on the island of Ireland.

Former prime minister Theresa May stated that a Brexit deal would need to ensure that the UK left both the single market and the customs union.

The hope was the two sides could agree a comprehensive trade deal by the time the UK left the EU which would ensure the Irish border remained open as it is now.

But the deal included the so-called Irish “backstop” arrangement.

The arrangement was an insurance policy to ensure frictionless trade could continue across the border even if the new detailed customs arrangements – which have proved fiendishly complex to agree – could not be hammered out by the time the UK left the union.

Boris Johnson and other Brexiteers vehemently oppose the backstop because it would tie the UK into the EU customs union and takes away the UK’s chance of striking new trade deals.

The prime minister’s deal means the UK would leave the EU customs union on day one after Brexit. This means Northern Ireland and the Republic of Ireland would be in different customs territories.

Lorries entering the Republic of Ireland from Northern Ireland would therefore need to complete customs declarations to ensure the correct taxes on imports were paid when UK goods enter the EU customs union.

But instead of a physical north-south border, the government is instead bidding to create an east-west border down the Irish Sea – which has been rejected by Democratic Unionist Party.

The government says this would keep the north-south border frictionless.

It said most checks would be done “electronically”, while a “very small proportion of movements”, and this is contested by critics, would be carried out at warehouses or “designated locations, which could be located anywhere in Ireland or Northern Ireland”.

There is little detail over where these “designated locations” would be and significant scepticism around the technology the deal would be reliant on.

The Department of Health and Social Care and the Association of the British Pharmaceutical Industry were approached for comment. Neither had responded at the time of publication.