In which I think about the effects on health of a No Deal Brexit
“I cannot guarantee people won’t die as a result of a no-deal Brexit.”
Matt Hancock, Health Secretary speaking to Cabinet
Pretty stark to see this in black and white. I have seen the videos in which Matt Hancock doesn’t actually say this, but refuses to rule it out, and some people have questioned whether he actually said these words. Yes, he did. Not in a public interview, but whilst speaking to Cabinet. It is a matter of record.
Do we really believe that our Government would be so reckless as to allow people to die for their ideals?
When the Prime Minister Prorogued Parliament for 23 days, he pretty much signed the death warrant for a number of people.
Now, many will accuse me of ‘Project Fear’. Being a remain supporter I am trying to frighten people in to my way of thinking. But I was not the one who predicted a shortage of medicine in the event of a no deal Brexit. That was the government themselves. I may bang on a bit about Project Yellowhammer, the leaked document that was prepared to help the cabinet to focus on the real dangers of a No Deal Brexit.
When the document was leaked Michael Gove tried to fob us off by saying that it was “absolute worst case scenario”, which doesn’t really make you feel full of confidence.
Several Cabinet members said that it was an old document, and not something that was current. In fact it is true that the document’s existence was first brought to light on the 6th September 2018. Old news then!
Erm, no. In mid-August 2019 an official cabinet Yellowhammer documentfrom earlier that month was leaked. It is a live document that is still being revised. Do you know what it said? Would you like to see? Well, I’m going to show you anyway as this is my blog:
“The Border Delivery Group/Department for Transport planning assumption on reduced flow rates describes a pre-mitigation reasonable worst-case flow rate that could be as low as 40% on Day 1 of No Deal via the short straits [main Channel crossings], with significant disruption lasting up to six months. Unmitigated, this will have an impact on the supply of medicines and medical supplies.”
“Supply chains for medicines and medical products rely heavily on the short straits, which makes them particularly vulnerable to severe delays: three-quarters of medicines come via the short straits. Supply chains are also highly regulated and require transportation that meets strict Good Distribution Practices. This can include limits on transit times and temperature-controlled conditions. While some products can be stockpiled, others cannot because of short shelf lives. It will not be practical to stockpile six months’ supplies. The Department for Health and Social Care is developing a multi-layered approach to mitigate these risks.”
I present this ‘as is’ so that you can see that Government are genuinely thinking about how they can mitigate this, but they don’t offer any solutions.
So, getting drugs in to the country may become a challenge. About time it was, you might say. No, not that kind of drug – we mean pharmaceuticals.
It gets worse.
“France will impose EU mandatory controls on UK goods on Day 1 of No Deal and has built infrastructure and IT systems to manage and process customs declarations and to support a risk-based control regime. On Day 1 of No Deal, 50%-85% of HGVs travelling via the short straits may not be ready for French customs. The lack of trader readiness combined with limited space in French ports to hold “unready” HGVs could reduce the flow rate to 40%-60% of current levels within one day.”
“The worst disruption to the short Channel crossings might last 3 months before flow rates rise to about 50%-70% (as more traders get prepared), although disruption could continue much longer. In the event of serious disruption, the French might act to ensure some flow through the short Channel crossings.”
Disruption lasting 3 months! I have read other articles on the logistics problems of No Deal that have suggested 6 months or even 9 months. The Government thinks 3 months, but says disruption to drug supplies will last 6 months.
Looking back at the information on drug imports, you will see that the statement is made that “three-quarters of medicines come via the main Channel crossings”.
That is a lot of medication that is not arriving in the UK come 1st November.
How do we cope? The answer that the government has given us is ‘by stockpiling’.
For 18 months the government has been asking pharmaceutical companies to stockpile 6 weeks of medication on a rolling basis before we reach the leave date. Give them their due, most companies have been getting on with this and are reporting that they ‘expect’ to be ready. None of them seem to be saying they ‘will’ be ready. Several are saying they will not be able to do this.
Stockpiling is a poor solution.
Most medications are made using Just In Time production principles where the constituent parts of a product are ordered often 6-12 months in advance, prepared, packaged and sent to our pharmaceutical wholesalers, arriving just in time to send them out to those who need them.
To stockpile drugs you need to order more constituent chemicals, but orders are normally put in a long time in advance (it helps to get a better price, you know). There is a limit to how much extra you can get, as most of it needs to be manufactured before being sent to be made up in to the familiar drugs we know and love.
So to stockpile we need to increase the initial production level of the medication components, get the pharmaceutical companies to increase production of the medicine (with no extra equipment I might add), and then get it packed – with even more need to advance order packaging – and shipped to the UK, to be put in a warehouse.
This is not practical. So how else can we stockpile?
There is a supply coming in already. If we throttle the supply to the NHS and other big buyers we can put some medication aside for a rainy day. What that means in practice is ‘borrowing from Peter to pay Paul’ as I used to be told. Taking medication from one pile to go in to another. The result – medication becomes in short supply before we even start to leave the EU with No Deal.
But of course this is Project Fear. It is not like there is a shortage yet is there.
Unless you have been ignoring the news, yes, we are already seeing medication in short supply.
https://www.theguardian.com/politics/2019/apr/09/brexit-medicine-shortages-pharmacies-england
https://www.bbc.co.uk/news/health-46843631
https://www.bmj.com/content/366/bmj.l5226
I like the last link, it is from the BMJ (British Medical Journal). Let’s face it, if anyone would spot shortages, they would.
In most reports we are told that the Department of Health are on the case, but there is no solution being put forward.
Can we cope in another way
Amazingly someone has already thought of asking this question.
Laws have been put in place allowing your local pharmacist to offer you alternative medication if the one your doctor prescribed is not available. Think online shopping. You order carrots, they send you condoms. Mainly, pharmacists have been asked to distribute generic rather than branded medicines as an alternative, to see if there is a similar medicine in a different form (pill, liquid, suppository – I may have added that last one myself, but you get the idea) or to offer a reduced dose or an alternative medicine that does a similar thing. And all this without the need to talk to a doctor! Wow!
The Good Law Project has argued that Pharmacists are not qualified. The Pharmaceutical Journal says of the submitted skeleton argument:
It said that the legislation, which came into force on 9 February 2019, “allows an existing clinical judgment made by qualified persons (doctors and other properly qualified professional persons) to be substituted or interfered with by an unqualified person (a pharmacist)”
Now let me say that I have the greatest of respect for our pharmacists. They are highly trained, capable individuals who really know their stuff when it comes to the drugs they dispense. I would not insult them by suggesting they are not qualified to follow these laws. I would, however, like to draw your attention to the fact that they are NOT doctors, don’t have full access to your medical record, and when the first person dies because of this I will not be surprised. I also won’t blame the pharmacist.
Fly them in, can’t be that hard
Yes, they have thought about this too. The Government have put in place a contingency to fly in short shelf life medicines to get around this.
Please note – Short Shelf Life medicines only. But we are already seeing shortages of non-short shelf life products, so this is not really helpful. The total budget for preparations for Brexit for healthcare is £434 million. If that is the money that they have to spend on healthcare, they will need to ship the drugs by Ryanair! Actually with the luggage surcharges this might not work out.
But Matt Hancock has chartered a plane!
“Mummy, when can I have my Insulin.”
“Hush child and look to the skies. Here comes Matt Hancock with his plane full of drugs!”
Fade out to The Dambusters March!
Actually, there is no agreement in place for air travel. Come the first day of a no deal Brexit planes will no longer be able to fly in or out of UK airspace. We’ll have to find space at overseas airfields. ‘Package for Heathrow? We’ll drop that off in Miami for you.’ Who thinks this is workable solution? Yodel? (Sorry guys, I know you do a great job delivering packages coming to me to other addresses in the local area, but not mine – I jest…)
But people won’t actually die, will they?
Well, they already have been, so I guess they will.
OK. Grab on to your seat. Here is the mathematics of reality…
In our area (Morecambe and Heysham) there is ONE doctors practice. Why they still need to practice I don’t know. Haven’t they trained for long enough? Sorry, off topic. We are all registered with one practice. In Lancaster it is the same.
The rules are simple. If you need any repeat medications you can order them 7 days before they are due to run out. (Not 7 working days. This is important to remember). But the prescribing team only work Monday to Friday, so if the first day I can order is a Saturday my order will be processed on Monday. I now have 5 days of medication left.
The way the new system works is amazing. The pharmacy team processes your request and sends it electronically to the pharmacist, to be with them by 4.00 pm, two days later. In theory that means that if I order on Saturday, I can pick my prescription up at 4.00 pm on Wednesday. I now have 2 days of medication left.
The pharmacy will wait for me to be able to get in to sign the prescriptions before they will start making the order up. On that Wednesday they are therefore able to fulfil my order, providing I am there, between 4.00 pm and 6.00 pm. Heaven help me if I need to be at work or attending a medical appointment, or get stuck sitting on the M6 car park for several hours, or any of numerous other things I need to be doing because then I won’t be able to get in until Thursday.
Let’s be serious here. It is going to be Thursday before I can get there. So I arrive and I sign the reams of paper needed to let the NHS know that my condition means I do not need to pay for my prescriptions, and I then sit down with the 20 or 30 other people doing the same thing.
About 45 minutes later, if I am lucky, the pharmacist will call my name.
“Can you tell me your address?” He will ask me, despite having had the same pharmacist for three years and often being greeted by name when I arrive. So I tell him and hold out my hands expecting a large carrier bag to be dropped in it. All fine with a day to go.
“We’ve run out of Medication A, I’m afraid. Hopefully we will be able to get it in some time tomorrow.”
But tomorrow is it! My last day of meds! If I get stuck in traffic and can’t get to the pharmacy, or have an appointment or anything else I won’t be able to pick up my life saving medication until….MONDAY! I will not have any medication for Saturday or Sunday. I’d better make sure I am there. Perhaps sit at home all day like a recluse, ringing them every half hour for an update. And what will they do if the medication does not arrive tomorrow, what if the wholesaler has run out?
This is the reality of the current system for millions of people who rely on life saving medications every day in the UK. If there is a bank holiday you can run out of medication far too easily as it can remove a day from your 7 days (2 at Christmas and Easter).
At Easter this year I made sure that my daughter’s medication was ordered so that we could pick it up on Thursday. I let the pharmacist know that we would not have enough for the four day weekend, so they needed to be ready for the prescription to come through.
On Thursday I arrived to pick the prescription up, to be told that one of the essential medications that keep my daughter alive had run out at the wholesaler. It was a particularly difficult drug to get hold of as it was expensive, and pharmacy’s didn’t like to keep it in stock. They could have it in by next Tuesday, but we needed it before then! With I smile he handed me the prescription for that particular drug and wished me luck finding it somewhere else.
I drove from Pharmacy to Pharmacy, no-one could help. Eventually ASDA Pharmacy said ‘we haven’t got it, but we can have it here on Saturday if that helps’. It did. We were saved.
Now imagine a delay of 3 days at the ports for the pharmaceuticals to come through. We are almost always at the very last day before we manage to secure all the medication that my daughter needs now, using the current system. Add in a three day delay and my daughter is without this lifesaving medication for several days every month. It does not bear thinking about.
Since I posted about this on Facebook earlier this week I have been contacted by many people who are in the same position and are desperate. We can’t afford a No Deal. When we march and protest we are quite literally doing it as if our lives depended on it, because they do!
I have been moved to post, and even to speak out on the streets, that I don’t understand how our government could be so foolish as to put the lives of their citizens at risk, just because they want to leave the EU. I have asked ‘how many people need to die for us to get a successful Brexit’.
Too many people say that Britain survived two world wars, so we can survive Brexit. I am sorry to tell you this, and it may come as a bit of a surprise to you, but people died so that we could survive the world wars. And this time we are not at war, so there is no need for people to die.
I will say it loud ‘Boris, I don’t want to die for your Brexit dream’.
Nuff Said.