Intended for healthcare professionals

Rapid Response:

Austerity, Brexit with no deal, what next? “Will God save the Queen and the NHS”

I read the brilliant article by Van Schalkwyk et al (1) with great enthusiasm. I could not agree more than what was mentioned in the piece. They interrogated nicely the health consequences of the daunting impending “no-deal Brexit”. There is apparently no quick fix and no free lunch (referring to the divorce fee of £39 billion) on the Brexit horizon. As we are medical professionals and civilised individuals, first things first, we have to accept this unwanted reality but being optimistic, the situation does not look worse than a post war situation, but fairly critical, wouldn't you say?

A constructive criticism approach can be made without solely categorically blaming the politicians (having said that, I feel, there should be some sort of civilised sanction for politicians who are dishonest).

More importantly as a very basic democratic (parliamentary) culture, we have to accept the result of the referendum of 2016, and I feel, there is no valid point in blaming the public and repeating the referendum. In healthy democracies, repeating referendums would not be a popular option and be regarded as an absolute “No, No”.

I remember some people harshly criticizing the people who voted in favour of Brexit--even going so far as saying that uneducated or less educated people should not have the right to vote or at least should not be considered as equal compared with the well-educated individuals. Come on! If that’s the case, I am afraid we are talking about a regime like “pure aristocracy” or “oligarchy”, not a democracy.

Increasing homelessness, unemployment, low income jobs, increased taxation, discrimination, health care access difficulties and treatment ordeals would trigger public unrest as a consequence. According to a recent opinion article by Shahvisi, the NHS already has been named and shamed as a hostile Xenophobic environment towards migrants (2).

I agree “all forms of Brexit are bad for the health; the worst seems to be the no deal one (3).

I am not willing to see a similar calamity here in the UK, but, there could be similar riots, as have happened several times in France in the last few decades (4).

A hard border in Northern Ireland would be the worst hit in the island in terms of attracting all sorts of calamities like crime, mental and physical health problems, riots, terrorism, housing crisis, etc.

Scotland could likely join the EU in a few years’ time and would be a more prosperous country and perhaps would save its skin. Thus, we may face similar so called “back stop” issues / hard border even with Scotland in a decade or so. I do not wish to mention Wales right now, this also could happen immediately after a Scottish independence.

I feel Great Britain might see not only some regime changes like abolishing the monarchy, transforming the two house nature of parliament to the “House of Commons” only but also splitting up with the UK member states.

Are we going to see “yellow vest protests / riots” in our streets after 31st October this year? Who knows? I hope not: that would worsen the situation and we all have to act responsibly with common sense and concentrate on civilised, parliament-based solutions. PM Mr Boris Johnson’s recent closing of parliament initiative may lead to unrest amongst MPs and the wider public and might cost him his office of PM and even his seat as MP in the near future. As a result of hard Brexit, I am anticipating very much coalition governments in the near future. Buckingham Palace might increasingly become more a centre of interest in terms of expenses. I would not be surprised if the monarchy transforms to a pure parliamentary democracy.

Austerity, no deal Brexit, what next? Will God save the Queen and the clumsy NHS? Is there a life after Brexit?


1. Van Schalkwyk MCI, Barlow P, Stucler D, et al. Assessing the health effects of a “no deal” Brexit. BMJ 2019; 366: I5300.
2. Shahvisi A. Austerity or Xenophobia? The causes and costs of the “hostile environment “in the NHS. Healt Care Analysis 2019. Shahvisi, A. Health Care Anal (2019) 27: 202.
3. Dphil NF, Hervey T, Greer s. How will Brexit affect health services in the UK? An updated evaluation. Lancet 2019; 10174: 949-958.
4. Body-Gendrot S. Urban ‘Riots’ or urban violence in France? Policing: A Journal of Policy and Practice, Volume 1, issue 4, 2007; 416 – 427.

Competing interests: No competing interests

31 August 2019
Emre Pakdemirli
Consultant Radiologist
West Hertfordshire Hospitals NHS Trust
St Albans City Hospital, Waverley Rd. AL3 5PN, St. Albans, UK