Grave concerns prompted by leaked analysis of no deal Brexit preparations cannot be dispelled or tackled by hollow assurances, says Martin McKee

The leak of a secret document on the effect of a “no deal” Brexit sent the UK government’s news management operation into overdrive. Ministers and their spokespersons were given two “lines to take.” One was to portray the analysis as hopelessly out of date. The second was that it had been leaked by a disgruntled former minister, seeking to undermine Boris Johnson’s new approach to the EU, which is to abandon any attempt at negotiation and instead threaten the EU27 by showing that the UK is deadly serious about leaving without a deal, hoping they will somehow back down on what was previously agreed. 

Neither argument is credible. Firstly, as the BBC Economics Correspondent Faisal Islam has shown by some forensic analysis, the document must be very recent. This is because the estimates for the reduction in freight flows, due to delays imposed by the French authorities, have been changing. At first it was thought that every truck would be inspected physically, but the French have been investing heavily in technology which will reduce this. The figure quoted is the revision that Faisal was told had been adopted in July this year. For this reason, he concludes that it cannot be more than a few weeks old, with other evidence suggesting it dates from late July or early August. Incredibly, ministers expect us to believe that quite remarkable progress has been made in that time, without any explanation of how this miracle was achieved. 

Secondly, if it was prepared so recently, and the Sunday Times reports that it was “compiled this month”, presumably because this is stated somewhere on the original document, then this would be after those former ministers had left government. But, more importantly, the leaked documents contained little that was not already known to those involved in Brexit preparations in the UK, even if they are prevented from saying this by the many non-disclosure agreements imposed by the government. It is inconceivable that those working on Brexit in the rest of Europe will be unaware of the true situation. 

The document is reported to predict significant disruption of medicines lasting up to six months, with HGVs facing a delay of up to 1.5 to 2.5 days at the border. This seems entirely plausible. Switzerland is closely integrated with the EU yet, as a BBC report revealed by following a single van across the Swiss-German border, the process is extremely complex. With no deal it would be vastly worse. Yet this is only the beginning. Shortages of permits that will be needed by hauliers to operate in the EU27, work permits for drivers, uncertainty about legal liability and insurance if things go wrong, and the cost of vehicles and drivers being tied up in queues, all raise questions about how many transport firms will think that trade with the UK is worth it. 

These problems will impact on many sectors, especially food, which will also be threatened by loss of seasonal agricultural workers. This is an inevitable concern given the very many people in the UK dependent on foodbanks. However, for health professionals, the greatest concern is medicines. 

Medicines have several characteristics that make them especially vulnerable to supply chain threats. These can be fatal, something that is observed every day in many low income countries where procurement, transport, and supply problems allow sub-standard medicines to reach the market, for example because of breaks in cold chains. They also encourage the activities of organised crime syndicates, diverting genuine medicines to the black market or introducing counterfeits. The UK’s departure from systems for sharing intelligence will make this more difficult to detect. Specifically, the Association of the British Pharmaceutical Industry has voiced serious concerns about the UK’s exclusion from the European Union’s Falsified Medicines Directive, to which the UK contributed substantially. 

As the leaked document conceded, the requirement to apply Good Distribution Practices makes it impossible to stockpile many medicines. This calls into question the frequent reassurances by ministers that this is happening. 

The fundamental problem with medicines is that, in an increasing number of cases, one cannot be substituted for another. The pharmacogenomics revolution has seen a transformation of cancer care. The first drugs, some derived from chemical weapons, were based on a scorched earth approach. Now they are targeted to individual molecules that can vary widely within what appears to be the same type of cancer meaning the wrong drug is useless. In some cases, even a small change in formulation can have serious effects, as with epilepsy. David Nicholl, a neurologist who was shown Brexit planning documents, was so alarmed that he felt obliged to speak out. His concerns have not been assuaged. This is very different from the situation with food. While some children express a dislike for broccoli, at least they will not die if cauliflowers are provided instead (although as a reminder of our vulnerability, even the latter are now in short supply because of extreme weather conditions).

Added to this is the fact that supply chains for many medicines are fragile at the best of times. With thousands of different products, ensuring that supplies are adequate and get to the right place at the right time is immensely complex. Even now, there are shortages of hormone replacement therapy, a very commonly used treatment.  

Quite why the Yellowhammer documents were leaked, and by whom, may never be known. The government seems to have done little to identify the source of another recent leak, which led to the removal of the UK’s ambassador to Washington, again connected to Brexit. In normal times one might ask cui bono, or who benefits, but these are not normal times. 

It is simply not good enough for ministers to say that these documents are wrong. They must provide ones that are right. It is still unclear whether the Health Secretary Matt Hancock actually did say that people will die in the event of a no deal Brexit, but we must hope that, somewhere in his Department, someone has undertaken an assessment of whether this is true, as seems extremely likely. If so, it should be published forthwith, especially as Theresa May’s government, under pressure from the Faculty of Public Health, agreed that the Brexit process would “do no harm”. Without an impact assessment, how can it know? And it is not just for reasons of transparency. He has also said, frequently, that all will be well if everyone does what they need to do. Maybe he could explain how on earth they will do that if the government’s assessments are secret?

Martin McKee is professor of European public health at the London School of Hygiene and Tropical Medicine.

Competing interests: Martin McKee is an unpaid member of the advisory board of Scientists for EU.