Brexit, the NHS and the Irish Border

BREXIT AND THE BRITISH HEALTH SECTOR
 
After a storm of recent developments in the Brexit arena, a no-deal scenario continues to be a potential outcome of the Brexit debate. While Johnson and the EU have come to an agreement, there is still the possibility that British parliament will reject it, effectively dragging the UK back to square one. Nevertheless, treasury assessments show that a no-deal scenario would shrink our economy by £90bn, further reducing the money available for vital public services which are which are already stretched to dangerous levels by more than a decade of austerity measures. With many care providers already in difficulty, a hit to the public finances could have big knock-on consequences for the NHS.
 
The effect of a no-deal Brexit on the delivery of public health services has received particular media attention, with health think tanks, and several other organizations voicing their concern. In August, health union leaders, including the British Medical Association, joined forces to issue a strong warning that a no-deal Brexit could ‘devastate’ the NHS and lead to the “disintegration of the health service”. They said that leaving the EU without a deal could also intensify the staffing "crisis" in the NHS, adding that thousands of EU staff have already left since the 2016 referendum.
 
An open letter to MPs published by The King’s Fund – an independent charity aimed at improving health and care across England – voiced concerns about the potentially problematic implications of no-deal with regard to the NHS staffing crisis, shortages and price rises for vital supplies, funding shortfalls and providing care for returning emigrants. The Guild of Healthcare Pharmacists commented that the government was “not fully prepared” and risked increasing NHS costs without providing benefits to patients. 
 
Last month, Whitehall’s spending watchdog found that Ministers will not know whether there are enough medicines, medical supplies or freight capacity to support the NHS if the UK leaves the EU without a deal. Meg Hillier, the chair of the public accounts committee, said the report was deeply concerning and could result in the “gravest of consequences”. “The Department of Health and Social Care still doesn’t know whether all stockpiles are in place, it has no idea whether social care providers are ready and it is still not certain whether all the freight capacity government needs will be in place on time. If government gets this wrong, it could have the gravest of consequences,” the Labour MP said.
 
Meanwhile, England’s most senior medical adviser warned this week that people could die as a result of shortages of medical supplies in the event of a no-deal Brexit. Professor Dame Sally Davies, the outgoing chief medical officer, told BBC Radio 4’s Today programme: “Everyone has worked very hard to prepare but I will say what I said before. We cannot guarantee that there will not be shortages not only of medicines but technology and gadgets. There may be deaths, we can’t guarantee there won’t. [Patients’ lives] are at risk.”
 
Dame Sally's intervention comes a month after documents on the Government's own planning for a no-deal scenario revealed that food and medicines could be in shortage. According to files from Operation Yellowhammer, there could be "significant disruption lasting up to six months" of medicines coming into the UK.
 
"Whilst some products can be stockpiled, others cannot due to short shelf lives - it will also not be practical to stockpile products to cover expected delays of up to six months," the document said.
 
The original leak of the operation, which is being led by the Cabinet Office’s Civil Contingencies Secretariat (CCS), was followed by the MP-forced publication of the government’s ‘reasonable worst-case planning assumptions’ in September. According to The Observer, a senior Whitehall source said that the document is “not Project Fear, this is the most realistic assessment of what the public face with no deal. These are likely, basic, reasonable scenarios – not the worst case.”
 
As of September 2019, the government has committed £8.3 billion towards preparing for no deal, around £434 million of which is to be spent on stockpiling medicines and medical products as well as covering freight capacity and warehousing.  The National Audit Office praised the government for the "enormous amount of work" that had been done but said there were still "significant" gaps” and that it is still not known exactly what level of stockpiling is in place. The watch dog said that a no-deal Brexit presents risks to the NHS and care homes despite the extensive government planning. The NOA also said there was no clear evidence the care sector was ready, raising concerns that the sector has not received enough government support.
 
HOW WILL BREXIT AFFECT UK AND EU TRAVELLERS?
 
Unlike Britain’s health sector, there are clearer answers as to how travelling between the UK and EU will change in the event of a no-deal. As of the writing of this piece, the UK and the EU have agreed to a deal that both Boris Johnson and Michel Barnier are content with. However, for it to go through both the British parliament and the European parliament will need to approve it, and things aren’t looking promising for Johnson as the DUP has already stated that they won’t vote for it, and the majority of Labour MPs will likely reject it. As such, all eyes will be on the House of Commons’ Saturday sitting where MPs will discuss, dissect the deal and either pass it or reject it, and if MPs reject it the Benn Act would require Johnson to request an extension. Until we see what will happen in the coming days, we can only report on the information that has been available for the past few weeks.
 
 First off, according to the UK’s government website, if a UK citizen wishes to enter an EU country in the event of no-deal, then he or she will need to ensure that their passport is still valid for the next six months, and that it’s not older than ten years (even if it still has a 6-month validity). Much to the relief of holiday makers and business travellers, the European Commission confirmed that UK citizens will not need a visa to enter EU countries and they will not need one as long as they’re only staying for up to 90 days within a 180-day period. Flights between both entities will also not be effected in a no-deal scenario. However, the BBC reported those conditions won’t be in place forever because by 2021 British citizens (as well as citizens from other non-EU member states), will have to apply for a visa waiver for future trips to EU countries, the waiver will be known as the European Travel Information and Authorization System (ETIAS) and will need to be renewed every three years. If a deal is put in place, then both entities will have until the end of the transition period (slated for December 2020) to negotiate new travel arrangements. Until the end of the transition period, UK and EU citizens will be able travel freely with only a passport or an identity card, in other words things would stay the same until December 2020. 
 
As for EU citizens going into the UK, in the event that a deal is agreed then no changes to EU citizen’s travel and living arrangements in the UK will happen until 2021. The UK government website also states that if the UK leaves without a deal, then EU, EEA and Swiss citizens will be able to enter the UK without a visa even after October 31, moreover these citizens will be able to live and work in the UK until December 2021. However, the key date here is December 31, 2020 if EU citizens who arrived in the UK before it leaves the bloc wish to remain living there then they will need to apply to the EU Settlement Scheme. For future expats who wish to move to the UK after Brexit, they will need to apply for European temporary leave to remain. Moreover, EU citizens and citizens of Iceland, Liechtenstein, Norway or Switzerland will not need a visa to enter the UK, just their passports. As of writing of this piece, it seems that few changes will happen for UK/EU travellers and immigrants who wish to move freely within the bloc. This is especially true for British citizens and Irish citizens as no changes whatsoever will happen Irish citizens will be able to enter, work and study in the UK without a visa as they can now and vice-versa for British citizens wishing to settle in the Republic of Ireland, and both sides are determined to keep this arrangement with or without a deal. If Johnson’s deal goes through both parliaments, then the UK will abide by EU rules until the end of 2020 and the rights if EU citizens living in the UK and UK citizens living in EU countries will be guaranteed. As such, expats and travellers on both sides would have little to worry about. 
 
WHAT ABOUT THE IRISH BORDER?
 
The Irish border has been at the centre of the negotiations and Theresa May’s controversial backstop has been one of the major reasons why her deal has been rejected multiple times in parliament. Johnson’s deal has instead given Northern Ireland a special status in which it remains part of the EU single market and the UK’s customs territory. The deal specified that Northern Ireland, unlike the rest of the UK, will still be subject EU customs rules and there would be customs checks for goods moving between Northern Ireland and the rest of the UK. In other words, Northern Ireland would be de jure part of the UK customs territory, but de facto part of the EU customs union. The Northern Irish assembly will get to vote on the arrangements every four years, and changes would pass by a simple majority rather than a majority from both unionists and nationalists.