![\"mcKee_martin\"](\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2012\/12\/mcKee_martin.jpg\")
<\/a>There can be no doubt that the prime minister\u2019s January 2018 cabinet reshuffle did not turn out as planned. However, the subsequent discussion about who was in or out, and why, overshadowed one widely trailed prediction that did not come to pass. This was the idea, which had earlier featured prominently in several <\/span>British newspapers<\/span><\/a> that Theresa May would appoint a minister with responsibility for a \u201cno deal\u201d Brexit. The story was only officially denied when the reshuffle was finally over, reportedly leaving Brexit supporting Conservative MPs who had been anticipating this announcement <\/span>\u201cdumbfounded\u201d<\/span><\/a>. \u00a0<\/span><\/p>\nAn obvious question is whether, when the prime minister states that <\/span>\u201cno deal is better than a bad deal\u201d<\/span><\/a>, she really means it, or is it simply a negotiating ploy? Like so much about the British government\u2019s position on Brexit, it is impossible to know. Even now, it is unclear whether the Brexit impact assessments, which David Davis described as setting out the issues in <\/span>\u201cexcruciating detail\u201d<\/span><\/a>, actually exist. What is apparent is that the documents that were released contained nothing of any relevance, leaving conspiracy theorists to speculate that no government could be so poorly prepared, so proper assessments must exist somewhere, perhaps buried deep inside the Treasury, but are just so awful that they cannot be seen in public. <\/span><\/p>\n On \u201cno deal\u201d, the signals are distinctly mixed. On the one hand, the <\/span>\u00a33 billion<\/span><\/a> set aside in the recent budget to pay for a \u201cno deal\u201d scenario suggests she is serious. On the other hand, realisation that others were taking it seriously seems to have caused shock in Whitehall, when a <\/span>leaked letter<\/span><\/a> from Davis to May complained that the European Commission was planning for such a possibility. The Commission had published a series of documents describing what would happen in different sectors without some sort of agreement covering the period immediately after the UK leaves the EU. Davis considered this to be most unfair, prompting a European Commission spokesman to say that he was <\/span>\u201csurprised that the UK is surprised that we are preparing for a scenario announced by the UK government itself\u201d<\/span><\/a>. The letter revealed that Davis had considered taking legal action against the Commission, but sensibly noted that he had received advice that there was little chance of success.<\/span><\/p>\n Each of the EU\u2019s reports begins by pointing out the obvious, that when the UK does leave, it will be what is termed a third country. Unless it can find some way to replicate the existing arrangements, for example by remaining in the single market or customs union, options that it has repeatedly rejected, and without some sort of trade deal, such as that between the European Union and Canada, an <\/span>agreement<\/span><\/a> that took seven years to conclude, it must revert to trading under World Trade Organisation (WTO) rules. Crucially, this would affect not only the United Kingdom\u2019s relationship with the rest of the EU, but also with much of the rest of the world, as it would no longer be party to the estimated 759 <\/span>existing trade and related agreements<\/span><\/a> that are participates in as a EU member state. This stimulated one diligent researcher to seek examples of countries that do trade <\/span>only on WTO rules<\/span><\/a>. Initially, he seemed to have found only Mauritania, a country in West Africa with only one major export, iron ore, and where a sizeable proportion of the population is effectively enslaved. However, it was subsequently discovered that even it participates in an agreement with the EU on fisheries.<\/span><\/p>\n The EU\u2019s documents go on to present the implications of \u201cno deal\u201d. The warnings are stark. For example, its <\/span>\u201cnotice to operators\u201d<\/span><\/a> in the aviation industry points out that not only will British airlines no longer be able to fly between the United Kingdom and the EU, but also to any of the many countries and the rest of the world covered by EU agreements. A similar <\/span>document<\/span><\/a>, directed at the road haulage industry, points out that British driving licences will no longer be recognised in the EU. <\/span><\/p>\n It is, however, to a detailed <\/span>report<\/span><\/a> by a House of Lords committee that we must look for a comprehensive overview of the issues that might arise. This assessment can be summarised in a single sentence from its summary: “it is difficult to envisage a worse outcome for the United Kingdom than \u2018no deal\u2019\u201d. Only one witness, the co-chair of the \u201cLeave means Leave\u201d campaign, argued that such a outcome had any benefits. The Lords were clearly unconvinced.<\/span><\/p>\n The report looked in detail at a number of sectors of the economy. Two were particularly relevant to health, although consequences such as the damage to the financial sector would have an inevitable large-scale indirect effect, with falling tax revenues reducing the funds available for health and social care. <\/span><\/p>\n The first is the agri-food sector, which would be especially hard hit, with shortages of key food products and higher prices, in part due to the imposition of tariffs, in some cases of up to 40%, but also because of the additional cost of customs and veterinary checks at borders. Although, in theory, it might be possible to increase domestic production, \u201cno deal\u201d would threaten the viability of some elements of British agriculture that are dependent on exports, such as sheep production. Clearly, in a country that has seen a rapid rise in the use of <\/span>food banks<\/span><\/a>, a policy that threatens food security is far from desirable.<\/span><\/p>\n The second is medical research. The consequences go far beyond the immediate loss of EU funding, which the British government has undertaken to replace at least until the end of the current funding cycle. More important is the ability to attract high-calibre international staff and students and to participate in international collaborations. These depend crucially on common standards, for example on data protection, allowing the transmission of information between Member States. Without a clear legal framework, this would be impossible. <\/span><\/p>\n Although the report only looked in depth at some sectors, there can be little doubt that the consequences would be profound for the NHS. There would be no basis for recognition of medical qualifications obtained in the EU. Pharmaceutical companies would have to seek separate authorisation to market their products in the United Kingdom and EU. Continuity of supplies of <\/span>medical isotopes<\/span><\/a> would be threatened. Those who support a \u201cno deal\u201d argue that a solution would be found, on the basis that <\/span>\u201cthey need us more than we need them\u201d<\/span><\/a>. Yet, time and again, this argument has been exposed as nonsense. The EU can only act in accordance with its Treaties, and it is simply not feasible for the UK to expect the remaining 27 Member States to change the Treaties just to suit it.<\/span><\/p>\n Those who have argued for a \u201cno deal\u201d scenario have misunderstood the issue fundamentally. In most negotiations, a failure to reach agreement means that the status quo is retained. The Brexit negotiations are quite different. Without an agreement, everything will change. Anyone reading the House of Lords report can be in no doubt that the results would be catastrophic. <\/span><\/p>\n President Trump\u2019s tweet proclaiming that he was really a \u201c<\/span>very stable genius<\/span><\/a>\u201d was an invitation to the world to question his judgement. Any politician suggesting that they really do see a \u201cno deal\u201d Brexit scenario as viable achieves exactly the same result. Yet, just as President Trump continues to convince a <\/span>substantial share<\/span><\/a> of the American population that is really fit for office, despite the evidence to the contrary, there are also those who believe that leaving the European Union without a deal is a <\/span>viable proposition<\/span><\/a>, despite clear evidence that this is dangerous nonsense. <\/span><\/p>\n Martin McKee<\/strong> is professor of European public health at the London School of Hygiene and Tropical Medicine.<\/em><\/p>\n Competing interests<\/strong>: None declared.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" It is difficult to envisage a worse outcome for the United Kingdom than “no deal” Brexit\u2014it would have serious implications for health […]<\/p>\n