As UK politicians prepare to vote on Prime Minister Theresa May’s Brexit deal tonight, the possible impact of leaving the European Union without a deal on the country’s healthcare is only just becoming clear. At worst, pharmacies could run out of certain drugs, and hospitals may have to delay operations, scans and other procedures.
A no-deal exit from the EU on 29 March would pose immediate problems for the supply of important drugs. About two-thirds of medicines used in the UK are imported from the EU. At the moment, 90 per cent of these come through the French port of Calais. “You have got all your eggs in one basket,” says Mike Thompson at the Association of the British Pharmaceutical Industry.
The fear is that, if new customs checks are introduced after March, even small delays at the border could lead to long queues of lorries building up at ports, delaying delivery of medical products to pharmacies and hospitals. The UK government has said it will not impose extra checks on the UK side, but the European Commission has said if there is a no-deal Brexit, it will impose extra customs controls.
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“It’s fine for luxury cars to be sitting at a border for two to three days, but it’s not acceptable for drugs,” says Niall Dickson of the , an umbrella group of health bodies. “People need these medicines. We can’t play games with this stuff.”
To reduce the health risks of a no-deal Brexit, the UK government is putting in place a range of emergency measures to protect medical supplies. These include ordering firms to stockpile drugs, and opening new ferry and air trade routes. The government also plans to provide pharmacists with emergency powers to give patients different medicines from the ones they were prescribed, if stocks run low.
Essential medicines
But medics warn that these steps may be insufficient to avoid shortages of essential drugs. “Anything that a patient is taking for a long-term condition, they worry about,” says Ash Soni, president of the Royal Pharmaceutical Society.
All medicines that are used in the UK have a manufacturer that holds stock in UK warehouses. Manufacturers tend to hold between one and six months’ worth of medicines in these warehouses. In August 2018, the government told firms to . It is also setting up refrigerated warehouse space for medicines that need to be kept cold, such as insulin and vaccines. “What we don’t know is, is six weeks sufficient?” says Soni.
It is impossible to say for certain which medicines are most vulnerable to supply disruptions, but interruption of many long-term medications could be life threatening. If someone ran out of a treatment to lower blood pressure, for instance, they could have a stroke. Being unable to get hold of medicine after an organ transplant could lead to rejection by the immune system.
Insulin is a particular concern. People with type 1 diabetes may need to inject it several times a day, and can die without it. And unlike with some medicines, if pharmacists have to switch people onto a different form of insulin because their usual brand has run out, there could be side effects such as blood sugar swings, says Pav Kalsi of patient group Diabetes UK. “It’s a very anxious time for patients who are uncertain about their access to insulin, which keeps them alive.”
Cancer treatments
An inquiry by the Parliamentary Health and Social Care Committee has identified , which are used in scans to diagnose cancer and heart disease, and also to treat cancer.
These compounds cannot be stockpiled as their radioactivity quickly decays after manufacture. The most commonly used one, called technetium-99m, is made from a compound that is a by-product of some European nuclear reactors and has a half-life of about three days. The government has asked suppliers to have plans to air freight their products if necessary.
In December 2018, hospitals, pharmacies and patients were told not to stockpile any medicines themselves, as this could create shortages. Health secretary Matt Hancock wrote to family doctors saying there was no need to prescribe longer courses of medication than normal.
Hancock has also warned pharmacies that their medicine-ordering patterns would be monitored and any , although it is unclear how this would be done or what sanctions might be taken. “There’s no precedent,” says Soni.
A Department of Health and Social Care press officer told żěè¶ĚĘÓƵ: “If we see evidence of over-ordering it would depend on the case and the scenario. We would need to look into it.”
Stockpile warning
Soni says that while people shouldn’t try to build up extra supplies of their medicines, they should order repeat prescriptions before they run too low on supplies. “Continue to do what you do normally, but don’t leave it until you’re about to run out,” he says.
It would be understandable if some people do start trying to stockpile, says Martin Sawer of the Healthcare Distribution Association, which represents pharmaceutical wholesalers. “I could understand people wanting to do that if they have a life-threatening condition.”
As well as problems for the UK, border restrictions could also affect the supply of medicines made in the UK that are exported to Europe. While from the EU each month, the UK sends 45 million packs the other way.
Of particular concern is a treatment for breast and prostate cancer that is only made in the UK. This drug has a highly complex manufacturing process, and it would take more than three years to build a factory capable of making it elsewhere.
A no-deal Brexit could also make it harder for people from the UK to access healthcare when they are in EU countries and vice versa, says Dickson.
Article amended on 17 January 2019
We corrected the spelling of Niall Dickson’s name
