The lack of preparedness for a No Deal Brexit must surely be a matter of concern to health professionals who will be on the front line if things go wrong

The world is looking with amazement at the United Kingdom. Once a beacon of democracy and the rule of law, its Prime Minister has been found to have acted illegally by proroguing Parliament. He has lost, at the time of writing, every one of the seven parliamentary votes held since becoming Prime Minister, as well as his majority in the House of Commons. He is in office but not in power. 

Despite these setbacks, he remains resolute. He will take the United Kingdom out of the EU on the 31 October, “do or die”. Quite how he will do this is unclear. It is apparent that he is not even trying to reach a deal, submitting a set of “non-papers” to the EU that contain nothing of substance, while betraying complete ignorance of how the EU works. The predictable response in Brussels is of despair. But should no deal be forthcoming, he has a problem. He is then required by law to seek an extension to EU membership that would go beyond the end of October. Constitutional experts have been dusting off ancient texts to search for evidence of a cunning plan to circumvent the law, but have dismissed all proposed so far. 

This is more than a political problem for the Prime Minister. A retired senior judge, considered one of the UK’s foremost experts on constitutional law, and who by coincidence is the uncle of Johnson’s adviser Dominic Cummings, widely seen as the architect of the current situation, has said that Johnson risks going to jail if he defies the law. This may seem far-fetched, but quite a few British politicians have spent time behind bars for offences committed when in office. 

The more immediate threat may be from the wrath of some of the largest backers of Brexit, and of Johnson’s campaign to become Conservative leader. Some well placed sources, including Philip Hammond, former Chancellor of the Exchequer, and Rachel Johnson, the Prime Minister’s sister, have suggested that some of these individuals stand to lose hundreds of millions of pounds on the currency markets should the UK not leave on the 31 October. Some of them are already reputed to have made enormous sums from Brexit related shifts in financial markets and Labour politicians have called for an inquiry. 

Given these considerations, the Prime Minister’s determination to leave is understandable and it is not at all clear how he can be stopped. But does this matter? Ministers tell us that they have done an enormous amount to prepare for a No Deal scenario and at most there will be a few “bumps in the road” to the “sunlit uplands” of a post-Brexit future. The only problem is that this is simply untrue.

How do we know? First, those who must make things work are, at last, speaking out, no longer restrained by non-disclosure agreements and threats to cut them out of discussions if they aired concerns publicly. When Michael Gove, the minister responsible for No Deal planning claimed that the car and retail industries had told him they were prepared, the Society of Motor Manufacturers and Traders and the British Retail Consortium flatly contradicted him, with the latter saying “We have been crystal clear that while retailers are doing everything they can to prepare for a no-deal Brexit on 31 October, there are limits to what can be done”. 

Second, we now have a National Audit Office (NAO) report on the preparations to supply the health and social care sectors. It makes grim reading. The Health Secretary has repeatedly declined to answer when asked whether he can guarantee that people will not die. This seems a prudent decision. 

The report begins by reminding readers that “There is no way of knowing exactly what may happen at the UK/EU border when the UK leaves the EU.” It does, however, recognise the enormous amount of work done by the Department of Health and Social Care (although it does not comment on the many problems in the NHS that could have been addressed had the £50 million spent so far and the staff involved not been tied up with Brexit). It then catalogues numerous problems that have still to be solved. The biggest problem is the short channel crossing, between Dover and Calais, where it is assumed that traffic will fall dramatically. As of 20 September only 25% of pharmaceutical product lines had alternative arrangements in place. There were plans to secure alternatives for another 20% but these had not been secured. There were no plans in place for another 33% and no information was available on the remainder. The government intends to charter additional freight capacity, but the report expressed considerable scepticism about how this could be put in place in time. Only 58% of suppliers of medical devices and clinical consumables had confirmed that they had stockpiled the six weeks of supplies the government recommends. However, some of the greatest problems could be in the social care sector, which requires supplies of products such as incontinence pads and rubber gloves. There was no detailed information on preparedness in this sector, which the report saw as a particular concern given the predominance of very small providers with little capacity to prepare. 

It is, however, important to recognise that the NAO report has a strictly limited remit and so only covers some of the problems. It deals only with transport and storage arrangements, only mentioning in passing the administrative challenges that are likely to arise when goods cross the border with the EU. This, it notes, is the responsibility of the government’s Border Delivery Group. Unfortunately, just after the NAO report was published, it was announced that the Group’s newest head was quitting, with one senior Whitehall figure quoted as saying that “for this to happen at such a moment is extraordinary”. His predecessor had left only four months earlier.

It is, however, the third piece of evidence that is most alarming. The UK government has published an exchange of letters between Brexit Secretary Steve Barclay and Michel Barnier. Barclay’s letter refers to areas where “we need to either improve our mutual readiness or put in place practical mitigations”. The areas he cites are far from trivial, including entry and access of people and goods and exchange of data. It is, in effect, a plea for help, asking Barnier to “signal to Member States” that he has no objection to the UK engaging in bilateral discussions with them. This recalls the comments of David Davis, the first Brexit Secretary, who thought that he could bypass the European Union and go straight to Berlin. He couldn’t. 

Barnier’s response was brief. The UK may be unprepared but the EU27 is not. Unlike the British government, which had to be forced to release a brief and incomplete summary of its preparations, the infamous Yellowhammer document, the EU has published six very detailed “preparedness communications” and 100 “Brexit preparedness notices”. Barnier points out that all these issues were addressed in the Withdrawal Agreement negotiated with Theresa May, which he sees as the only way that they can be resolved. Over a year ago he had made it very  clear that the EU would not agree the so-called “side deals” called for by British ministers to circumvent a withdrawal agreement, something he has now reiterated, saying that “we will not enter into any negotiations with the United Kingdom on these matters”. He did, however, conclude by saying that “we are open to consider all legally operative solutions that meet all the objectives of the backstop.” Few expect Johnson to propose such solutions. 

The Prime Minister is between a rock and a hard place. There is enormous pressure from his party members and those who are speculating on the currency markets to crash out of the EU with No Deal, yet he must surely know that the country is far from prepared, facing inevitable shortages of food and medicines. His strategy seems to be to pin the blame on the EU for what happens, even if this risks civil disorder. This must surely be a matter of concern to health professionals who will be on the front line if things go wrong. 

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