Intended for healthcare professionals

Editor's Choice

Are we lioness enough to question the Brexit elephant?

BMJ 2022; 378 doi: (Published 04 August 2022) Cite this as: BMJ 2022;378:o1937
  1. Kamran Abbasi, editor in chief
  1. The BMJ
  1. kabbasi{at}
    Follow Kamran on Twitter @KamranAbbasi

What is the effect of Brexit? It’s a question few people in England seem willing to acknowledge and fewer still to answer. It’s a question that transcends party politics, and silence speaks to our inability to honestly appraise our decision making and learn from it. It’s a question that is easy to forget in the heady days of a historic victory on the footballing fields of England by a team now famous as “the lionesses.” If we had the courage of real lionesses, would we shy away from questioning Brexit?

To question any positive effect of Brexit or to moot the possibility that it is partly responsible for the UK’s ongoing woes is tantamount to treachery. Like unthinking loyalists, our only permitted mode is to speak of “getting it done” or “finishing the job,” even when some opinion polls suggest most British people now believe that leaving the European Union, a decision The BMJ opposed (doi:10.1136/bmj.i3302),1 was the wrong decision (

That negativity might change as the UK’s new prime minister grapples with the cost of living crisis. But the omens don’t seem good, as neither government nor opposition is paying attention to the Brexit shaped elephant in the room. How do you “get it done” or “finish the job” without a meaningful analysis of how it’s gone so far?

Health and social care are taboo subjects, even though week after week our columnists and writers detail the NHS and social care crises and their impact on patients, the workforce, and services (doi:10.1136/bmj.o1914, doi:10.1136/bmj.o1904, doi:10.1136/bmj.o1906),345 complicated by the additive burden of covid (doi:10.1136/bmj.o1909, doi:10.1136/bmj.o1887, doi:10.1136/bmj-2021-069868).678 In each round of Britain’s Got Prime Ministerial Talent, otherwise known as the Conservative Party leadership contest, responding to the NHS crisis isn’t an obvious showstopper (doi:10.1136/bmj.o1934, doi:10.1136/bmj.o1883),910 and there is little riffing on the welfare of health and social care staff (doi:10.1136/bmj.o1913, doi:10.1136/bmj.o1929).1112

Empirical studies and data would help, as they do in understanding the fast waning nature of immunity after covid vaccination (doi:10.1136/bmj-2022-071249),13 in concluding that the omicron variant is less potent than delta (doi:10.1136/bmj-2022-070695, doi:10.1136/bmj.o1806),1415 in the World Health Organization proposing that minimum alcohol unit pricing is effective against the harms of excessive drinking (doi:10.1136/bmj.o1810),16 and in advising that routine vitamin D testing is inadvisable (doi:10.1136/bmj-2022-070270).17 The dangers of rushing down a particular treatment pathway in the absence of sufficient data are evident in the fallout from Hilary Cass’s inquiry into gender identity services (doi:10.1136/bmj.o629, doi:10.1136/bmj.o1916).1819

In the absence of public debate and meaningful data six years after the UK’s Brexit referendum, we asked Richard Vize to examine the effects of Brexit on health and care (doi:10.1136/bmj.o1870).20 The news isn’t all bad, although there isn’t much good. Brexit hasn’t brought about a cut in NHS funding but did fail to deliver the £350m weekly windfall that Boris Johnson and others promised. The European Working Time Directive remains in place, and the predicted “stampede” of European doctors leaving the NHS hasn’t happened. But the impacts on social care and lower paid staff are harming delivery of care in an increasingly multidisciplinary service.

Health technology, life science industries, and research, where integration with Europe was greatest and benefits most obvious, are being damaged. Promises to cut red tape have created new complexities and been tarnished by suspect procurement practices at the height of the pandemic (doi:10.1136/bmj.o1893).21 Perhaps the most damning legacy of Brexit, however, is the state of unreadiness it created for a pandemic that required utmost readiness. Whether or not you agree Brexit was the right decision, you should at least agree that it is a decision worthy of question, analysis, and redoubled effort if the signs are good and possibly even reversal if the damage is too great.