Welcome to the ‘About that bus…?’ weekly newsletter – giving you the inside track on how the fallout from Brexit is affecting the NHS at national and local level, edited by James Illman Contact me in confidence.

Some of the NHS’ most troubled health economies could face unprecedented port-related transport chaos under a no-deal Brexit. And it was revealed last week ministers may have downplayed the potential disruption expected beyond the south east coast. James Illman examines some of the potential problem areas.

What do the health economies of Kent, Lincolnshire, Liverpool, Southampton, and Suffolk all have in common? They all host one of the UK’s top 10 busiest freight ports, based on either number of cargo vessels or tonnage in 2018 (see list below).

The government’s Operation Yellowhammer report on the possible impact of a no-deal Brexit published earlier this month set out official concerns about the prospect of transport disruption in areas impacted by the Channel crossings.

A report last week has, however, revealed the controversial dossier may have downplayed the potential disruption expected at ports beyond those closest to France – an issue which could have dire consequences for some of the NHS’ already struggling health economies.

Department for Transport documents obtained by the Financial Times set out concerns additional customs checks would likely create significant extra queues around ports across the UK because significant numbers of trucks exporting goods to the EU could be prevented from crossing the border.

“Yellowhammer didn’t give us the full picture… one could say it was seriously misleading,” a source told the paper.

HSJ also revealed late last week that South East Ambulance Service Foundation Trust has warned it will need “mutual aid” from other NHS providers and move to the highest emergency response category, REAP level 4, if there is a no-deal Brexit on 31 October. 

The move is yet another indication of the high level of anxiety amongst senior local leaders, as ministers continue to peddle the increasingly unconvincing mantra that as long as everyone does what they’re supposed to do, the NHS will be alright.

The ambulance trust covers the already struggling Kent health economy, home to Dover, the UK’s busiest freight port in terms of how many “roll-on roll-off” ferries (where cargo is driven on and off in lorries rather than lifted by cranes) it receives.

The high volume of traffic from the so-called “ro-ro” ferries can unsurprisingly have a significant impact on local road networks. The county also has major ports at Folkestone and Ramsgate.

This has been a significant concern for national leaders focusing on ensuring the supply of medical goods through the ports does not grind to a halt. But there are also huge concerns about how ambulances, patients and staff will be able to get to hospitals and other NHS and social care destinations if the county’s poor road infrastructure becomes jammed up.

As HSJ exclusively revealed earlier this month local Kent leaders said they were “preparing for Armageddon”, block-booking hotel rooms for staff and planning with police to get workers and patients through “gridlocked roads”.

And NHS system leaders’ concerns about the impact of port-related traffic congestion on hospitals, health and care services go far beyond Kent, or even the south east.

Take for example, Lincolnshire, which according to official government data hosts the busiest UK port based on tonnage, and second busiest port behind Dover based on cargo vessels received – Grimsby and Immingham (See tables below).

The Lincolnshire road networks have long proved a challenge for ambulance crews, and its hospital trusts have been long-term concerns for quality and finance regulators.

Scunthorpe General Hospital, run by Northern Lincolnshire and Goole FT, is just half an hour inland down a busy A road, the A180, from the port. Major road disruption could put the already pressured district general in huge difficulties.

Down the east coast in Suffolk there are also concerns about the impact from ports. The county has one at Harwich and one at Felixstowe and there are concerns about the effect it will have on the main local arterial roads, the A14 and the A12.

The Orwell Bridge, which carries the A14 over the river Orwell on the edge of Ipswich, is already forced to close if there are high winds.

A senior local figure told HSJ that when this happens, around 30 per cent of Ipswich Hospital staff can’t get into work and over 40 per cent of patients can’t get to their appointments.

The hospital has plans and can manage when this lasts a couple of hours. But if as reports suggest, traffic under worst-case scenarios could be gridlocked for days on end, then the trust, East Suffolk and North Essex FT, will face fundamental difficulties getting staff and patients to hospital and also getting supplies in and out.

Like many trusts, HSJ understands it has considered banning leave in November, but this of course risks staff burn-out ahead of what will be a long and challenging winter with or without a no-deal Brexit.

HSJ understands NHS England Brexit chief Keith Willett and his team have been working with health economies with ports on their no-deal Brexit resilience plans.

But there’s very little anyone can do about the poor road networks, which unfortunately exist in many of the affected areas, so late in the day.

Areas such as Lincolnshire and Kent would have already expected to struggle this winter. And while Suffolk has notched up significant recent performance improvements, it also forecasts a long hard winter.

NHS organisations are of course experts in emergency and resilience planning and have gained a lot of valuable experience and practice over the last few winters, which have placed increasing demand pressure on the service each year.

But, if the worst-case scenarios play out in terms of port-related traffic congestion, the challenges will be taken to unprecedented levels in the affected areas.

The busiest UK freight ports

Top 10 UK major ports with most cargo vessel arrivals, 2018 (thousands)

PortRo-Ro vesselsTotal cargo vessels




Grimsby and Immingham















Tees and Hartlepool













Top 10 ports based on tonnage (millions)

PortTonnes (millions)

Grimsby and Immingham








Milford Haven


Tees and Hartlepool











Source: UK freight statistics 2018, Department of Transport