'Alarming' Freight Service Plans for No-deal Brexit Medicine Supplies

Peter Russell

August 15, 2019

The Government announced a £25 million contract to set up an express freight service to deliver medicines and medical products into the UK to help ensure continuity of supply in the event of a 'no-deal' Brexit.

The Department of Health and Social Care (DHSC) said the service was intended to deliver small parcels of medicines or medical products on a 24-hour basis. However, it could also be used to move larger quantities on pallets if required within 2 to 4 days.

The British Medical Association (BMA) said the plans were further proof of the chaos that the NHS would experience if the UK left without a divorce deal.

Announcement of the contract came after Boris Johnson took over as Prime Minister following a campaign in which he repeatedly pledged that the UK would leave the EU on 31st October whether or not a deal was in place.

Terms of the contract said the service must be fully operational by 24th October to allow for advance testing.

The freight service would run for 12 months, with scope for an additional 12-month extension.

The taxpayer would only be liable for up to around £4 million of the total value of the contract, the DHSC said.

Chris Skidmore, the health minister, said: "I want to ensure that when we leave the EU at the end of October, all appropriate steps have been taken to ensure frontline services are fully prepared.

"That’s why we are stepping up preparations and strengthening our already extremely resilient contingency plans.

"This express freight service sends a clear message to the public that our plans should ensure supply of medical goods remains uninterrupted as we leave the EU."

The Government said the express freight service would provide an additional level of contingency as part of Brexit planning "to leave the EU on 31st October whatever the circumstances".

It said this was supported by an additional £2 billion from the Treasury across government that included £434 million to help ensure continuity of vital medicines and medical products through freight capacity, warehousing, and stockpiling.

Dr David Wrigley, BMA deputy chair, commented: "It is beyond alarming that the future delivery of medicine and medical supplies in the UK could be dependent on a freight service – for which the supplier hasn't yet even been appointed.

"This latest announcement from the Government is a further indication of the chaos that will lay in store for the NHS and patients in the event of a no-deal Brexit and highlights just how costly this will be.

"A no-deal Brexit could lead to untold disruption for health services and severely impact patients’ health if they either don't get the medicines they are totally dependent on or those medicines arrive damaged, unfit for purpose or just too late.

"The inability to supply critical medication will place patients' lives at risk."

Medicines Shortage Warning

The BMA warning came as health professionals said shortages of some medicines could worsen in Europe in the event of a no-deal Brexit.

A disorderly exit could mean that some drugs might not have the required regulatory approval by then to continue being exported from the UK to the EU, Reuters reported.

It quoted Andy Powrie-Smith, an official at the European Federation of Pharmaceutical Industries and Associations who said: "Despite intensive preparation by industry for every scenario, a no-deal Brexit risks disruption to the supply of medicines" throughout the EU.

However, according to the Reuters report, the European Medicines Agency said the bloc was well prepared for Brexit and had finalised authorisations for nearly all the 400 drugs under its watch that required further clearing because of the UK's impending departure.

No-deal Contingency Teams

NHS trusts were told they had until the end of August to ensure they had 'no-deal' preparation teams in place and that contingency plans could be tested in the event of a no-deal Brexit.

A letter from Prof Keith Willett, EU exit strategic commander at NHS England, sent on 22nd July, wrote: "It is reasonable for the NHS to continue to prepare for every EU Exit scenario, including no deal.

"As part of these preparations we expect all providers and commissioners to have full contingency plans in place to ensure safe services for patients can continue to be provided in the event that the UK leaves the EU without a deal."

The letter said each organisation should have a team in place to oversee EU exit preparations "to allow time for training, exercising and testing". An 'assurance exercise' would take place at the end of August to confirm teams were in post and ready, it said.

Prof Willett said further details of the operational response, and what was needed at a local level, would be given in September.

The letter came as Boris Johnson took over as Prime Minister following a campaign in which he repeatedly pledged that the UK would leave the EU on 31st October whether or not a deal was in place.

NHS trusts already created no-deal Brexit plans in preparation for the UK leaving the EU on the original departure date of 29th March, before successive extensions to the deadline were agreed.

Advice to Social Care Providers

The Government issued advice this week to local authorities and providers of adult social care to "manage any potential service disruption" in the event of a disorderly exit from the EU.

The advice from the DHSC included the supply of medicines, medical devices, and clinical consumables.

It said organisations that depended on products from the EU with short lead times of 24 to 48 hours should plan for longer lead times of up to 5 days following a no-deal Brexit.

It also urged bodies not to stockpile to prevent shortages and undue risks to service users.

Social care staff who were EU citizens should be told about the EU Settlement Scheme, the advice said.

Medical Radioisotopes

Organisations responsible for the procurement and use of medical radioisotopes urged the Prime Minister to give assurances about product supply and costs to the NHS, ahead of a potential no-deal Brexit.

In a letter to Boris Johnson, the Royal College of Radiologists, the British Nuclear Medicine Society, and the UK Radiopharmacy Group, questioned whether radioisotopes could reach hospitals in time if there were delays at the border.

Stressing the importance of medical radioisotopes, the authors explained: "Medical radioisotopes are crucial in the diagnosis and treatment of cancer and other conditions. However, as nuclear materials they are constantly decaying and their transport and use needs to be meticulously planned to ensure they reach patients in time."

Around one million NHS procedures a year use radioisotopes.

Some radioactive tracer products used in PET-CT scans can be created in particle accelerators in the UK. However, the majority are made in nuclear reactors abroad, with much of the UK's supply coming from reactors in the EU.

The authors write: "We appreciate the bulk of contingency planning rests with goods suppliers but, given the crucial nature of these materials, we believe the Government has a clear responsibility to update the health sector about outstanding concerns."

No-deal Food Supplies

The UK faces disruption and shortages to supplies of fruit, vegetables, and products with a short shelf-life in the event of a no-deal Brexit, but the Government is being secretive about the repercussions for fear of triggering panic buying, according to a leading academic.

Tim Lang, professor of food policy at City University of London, warned that low-income groups would be disproportionately affected by the impact on food prices and availability.

In a comment article in The Lancet , he said a late October departure would coincide with the end of the UK agricultural growing season, exacerbating a lack of fresh produce availability, and adding to planning and storage problems in the run-up to Christmas.

Prof Lang asserted that food prices were likely to rise by more than a previous estimate of 10% made in a leaked memorandum to cabinet ministers by Sir Mark Sedwill, the head of the civil service, and National Security Adviser.

Warning Over 'Profound Repercussions' for European Medicine

European medical bodies wrote to Ursula von der Leyen of the European Commission and David Sassoli of the European Parliament to urge European-wide safeguards to the ongoing provision of essential health services in the event that the UK leaves the EU without a deal.

The letter warned that the UK's impending departure was already having "profound repercussions for the European medical profession".

It said ongoing uncertainty for almost 22,000 European Economic Area (EEA) qualified doctors practising in the UK had led to over half considering moving abroad.

The letter, signed by bodies including the European Association of Senior Hospital Physicians and the European Junior Doctors Association, called for measures to "mitigate Brexit's impact on the European medical profession and the patients it serves across the continent".

Recovering Treatment Costs From EEA Visitors

The DHSC issued advice to NHS primary care staff for providing healthcare for overseas visitors from the EEA.

The document explained how the cost of providing healthcare for overseas visitors from the EEA could be reclaimed from the visitor's country of residence and what primary care staff could do to support hospitals in recovering costs from these visitors.

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