5 Ways A Hard Brexit Will Sicken Britains Healthcare – Forbes

Having just reviewed the latest UK No-Deal readiness report, it reads like a manual of administrative committee sophism. It includes specific details on the marking requirements for Exporters of eating eggs, but then becomes imprecise for Suppliers of all medicines and medical products saying they: should ensure they are ready to comply with the new customs and border processes required to import and export goods between the UK and the EU. So, what will this mean to patients in need of drugs that have been tracked in short supply?

LONDON, ENGLAND - OCTOBER 07: A Lone Brexit supporter sits by a "Brexit Now" banner in the rain during the evening outside the Houses of Parliament in Westminster on October 07, 2019 in London, England. (Photo by John Keeble/Getty Images)

And what does this portend as October 31st approaches and voices advocating for a No-Deal Brexit suggest that a Hard Brexit is a workable option. You need only look at all of the UK travelers stranded by the Thomas Cooke travel agency bankruptcy and think will people seeking healthcare in the UK will be stranded in an eerily similar way, but with no Rescue flights to solve their problems.

More than three years ago I wrote Brexit Will Be Bad for Pharma (June 25, 2016) where I outlined some of the macro issues that the UK would face when and if it broke away from the EU.Now as talk of a No-Deal separation approaches, the challenge of providing continuing high-quality healthcare should be foremost and the ramifications will be more than just the worldwide pharmaceutical industry. Here are some detail views of what can happen with a Hard Brexit:

1.Drug Shortages

An evolving study by the British government named Operation Yellowhammer, concluded that there would be severe disruption to supplies of medicines for up to six months. In todays Just in Time environment, inventories for drugs, medical devices and the disposable medical supplies needed for modern medical care are maintained at a minimal level with continuous resupply being the norm.If a No-Deal Brexit is implemented, this kind of Just in Time supply management will be tested.

The UK has mandated a six-week supply of medicines and medical supplies by the current Brexit date of October 31.Even if that deadline is met, there are always some medicines where shelf life expiration(s) will make this more problematic in the long run.There have already been reports of shortages of some drugs.In a BBC News Report, 36 drugs were reported in short supply and the UK government has banned export of 19 Hormone Replacement Therapy (HRT) drugs and five other medicines, includingall adrenaline pens for severe allergies, hepatitis B vaccines and a number of contraceptives.A poll of more than 400 pharmacists reveals 84% are struggling to obtain any HRT stocks while others are running out of contraceptives, anti-depressants, blood pressure, diabetes and epilepsy medications.

To give some idea of the magnitude of the problem the UK faces, of the 12,300 medicines used in the U.K., 7,000 enter the country via short Channel crossings. Each weeks delivery of pharmaceuticals requires 2,326 heavy goods vehicles but the Department of Health and Social Care (DHSC) has made provisions to import only 25% of the medicines required by the U.K. and access to the entire freight capacity will not be attainable until November 30.

What isnt even considered is when people are taking precautionary steps on their own to assure a continued supply of the medicines they need; they often consider hoarding. According to an August 2019 piece in Supply Management Magazine, Britons are estimated to have spent 4bn so far on stockpiling efforts, the piece stated. The article also reported that Amid concerns over disruptions to supply that could arise in a no-deal scenario, 50% of people have stockpiled medicines, while 74% have built up supplies of food and 46% have stockpiled drinks.

Never before have we seen the possibility of medical hoarding to this degree in a modern, industrialized nation. If hoarding should happen it will surely cause uneven availability, with some hospitals or wholesalers having more of a drug than is needed while others dont have enough. Prices for commodity products like medical devices, medicines and supplies routinely fluctuate, but extensive hoarding will disrupt the medical supply chain, causing prices to fluctuate wildly. Sadly, hoarding will result in even higher prices for critical medicines in short supply. Stopping hoarding will become as big of a problem as managing it in a time of shortages.

2.Pharmaceutical R&D Will Struggle

The UK has always been a global anchor in healthcare and pharmaceutical research. It is of course, a major consumer of medical supplies with pharmaceuticals in the UK constituting a $26.416 billion industry in 2017. According to The Association of the British Pharmaceutical Industry (ABPI), medicines launched in the UK between 2012 and 2017 constituted 13.9% of the worlds total.By 2015 (the latest data available) there were 573 biopharma enterprises in the UK, employing 63,000 people. And this is where any disruption or volatility caused by Brexit can cause not just temporary issues, but also issues with projects that involve multi-year planning.

When disruption happens, we have to wonder what will occur with patient trials and research funding especially with small development-stage companies that rely on the capital markets to fund them (Will consolidation take place?). According to the Medical Research Council of the U.K., In 2017/18 the MRCs gross research expenditure, funded by The Department for Business, Energy and Industrial Strategy allocation and contributions from other bodies, was 814.1 million. Will this need to be increased to offset loss in private investment and by how much?

3.An Exodus of clinicians and medical professionals

Britain relies more heavily on foreign doctors than any other major EU nation. More than a third of NHS doctors (35%) were born abroad, according to a report by theOrganization for Economic Cooperation and Development (OECD). Round-the-clock nursing care also would be affected with 21.7% of nurses in British healthcare having been born abroad.

Foreign-born doctors and nurses are likely to leave the UK in search of greener pastures. Though foreign-born physicians might not be forced to leave Britain, it may not be as easy for their families to stay in Britain after Brexit. Will those from other EU countries no longer have automatic residency privileges in the UK?

Britain is a top exporter of medical professionals. 17,000 UK doctors work in other Organization for Economic Cooperation and Development (OECD) health systems, who number behind only India, China and Germany. More than 50,000 British nurses now work in health care systems in OECD nations behind only the Philippines and India. To put it plainly, with a potential loss of physicians in the UK medical community who will pay about 250,000 to train each replacement that will be needed?

4.The UK no longer hosts the European Medicines Authority (EMA)

As a reminder, in March 2019, the EMA permanently relocated to the Netherlands from the UK and this has already had an economic impact on the country. A simple fact is more than 1,000 people, with high-paying jobs having moved from Britain and the center of regulatory gravity for healthcare in Europe has shifted, which will affect other aspects of the UK pharmaceutical industry. The questions now are how much more will the focus of healthcare innovation shift, will this also affect future drug approvals and at what cost?

5.The last and biggest Unknown - The UKs medical issues wont be confined to the UK

Lets return to the world-wide pharmaceutical industry where I started my commentary three years ago. When there is a disruption in one facet of a large and geographically diversified industry like pharmaceuticals, the entire industry is disrupted. Britains problems could have a domino effect on worldwide pharma and that means loss of revenue, earnings and ultimately jobs around the world in the business of pharmaceuticals and biotechnology. The recovery from this disruption will be hard to restart and the pharmaceutical industry after the recovery may not be the same by todays capital market standards.

This has been well-documented - All of these Brexit issues have been written about in Healthcare journals.

In the British journal, The Lancet published in March, it found that Brexit would deplete theNational Health Service(NHS) workforce, create uncertainties regarding care for British nationals living in the EU, and put at risk access to vaccines, equipment and medicines. Among the challenges, supplies of life saving medications including cancer medication could be disrupted for up to six months under a no-deal Brexit. And today, it is generally agreed that the NHS is less prepared for a Hard Brexit than it was six weeks ago, because stocks of many drugs, especially those that were running short have not been replaced.

What a Hard Brexit could really do

A Hard Brexit could force the UK to initiate desperate steps to normalize medical care shortly after it starts.Many proposals are now being floated to address impending medical problems.One such proposal by MP Labour Leader, Jeremy Corbyn, is to create a state-owned pharmaceutical company. This like many other ideas can be filed in the category of good long-term initiative, but very poor potential as a short-term, emergency solution. To expect any de novo healthcare construct to be the answer to a crash artificial societal and economic upheaval will be simply courting more problems.

A No Deal Brexit, will have many ramifications, with a bureaucratic life-or-death healthcare crisis being the worst. The prevention or remediation of which should be considered very carefully and not for just the faint of heart, but by those with heart conditions as well

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5 Ways A Hard Brexit Will Sicken Britains Healthcare - Forbes