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No-deal Brexit: doctor defends right to speak out

Birmingham consultant neurologist David Nicholl
NICHOLL: 'I am sure that patients will die if there’s a chaotic no-deal Brexit'

A consultant who advised the Government on no-deal Brexit planning – and yet was publicly accused of fearmongering by Jacob Rees-Mogg when he raised concerns – has said doctors should speak out on risks to patients’ health.

Birmingham consultant neurologist David Nicholl told the BMA that it was his responsibility to point out the risks of patient harm and increased mortality from a no-deal Brexit.

BMA council chair Chaand Nagpaul offered his strong support.

‘Individuals such as Dr Nicholl who, with vast experience and clinical judgement and after careful consideration, decide to speak out, should be supported and listened to, not dismissed and insulted by those in positions of responsibility and power,’ he said.


On call

On Monday, Dr Nicholl called Nick Ferrari’s live LBC radio show, in which Mr Rees-Mogg, the leader of the House of Commons and prominent Brexit supporter, was appearing.

Having raised the issue of drug shortages and asked Mr Rees-Mogg what excess mortality he would be willing to accept in the event of a no-deal Brexit, the cabinet member replied: ‘I’m surprised that a doctor in your position would be fear-mongering in this way on public radio.

‘I think it is deeply irresponsible, Dr Nicholl, of you to call in and try and spread fear across the country. I think it is typical of remainer campaigners, and you should be quite ashamed I’m afraid.’       

However, Dr Nagpaul (pictured below) said the opposite was true – that by speaking up on behalf of his patients, Dr Nicholl had acted profoundly responsibly. And far from ‘fearmongering’, he was raising concerns which were widely and justifiably held among doctors.

Chaand-Nagpaul-3 GPC chair 2015 16x9

He said: ‘The BMA is in no doubt that Brexit and specifically a no-deal exit from the EU, could have catastrophic consequences for patients and the NHS, with the potential for shortages in medicines being one of the key areas of risk identified in the association’s recent policy paper on no deal.’


Supply concerns

Dr Nicholl chose to go public with his concerns because he did not believe supplies of medicines were being adequately safeguarded in the event of a no-deal Brexit.

He said: ‘I’m glad I rattled him [Rees-Mogg] because I think this is a question that needs asking. Every organisation from the King’s Fund to the BMA and the [medical] royal colleges have been pointing out the risks of harm from Brexit, and particularly a no-deal Brexit. When we say harm, we mean actual patient harm.

‘No one can define how much harm that will be, in my own mind – I have to be blunt, I am sure that patients will die if there’s a chaotic no-deal Brexit, what no one knows is the scale of that. I think it’s quite wrong for someone to suggest that we can crash out with there not being any harm at all, that’s just untrue.’

Mr Rees-Mogg’s response to Dr Nicholl was a factor cited by the former minister and GP Phillip Lee in his decision to leave the Conservative Party for the Liberal Democrats. He said his former colleague had shown ‘distain and disregard’. The issue was also raised at prime minister’s questions, where the Government was accused by opposition leader Jeremy Corbyn of ‘hiding the facts’.

Mr Rees-Mogg, however, insulted Dr Nicholl again, saying he was as irresponsible as the disgraced researcher Andrew Wakefield.

The comments, described by the BMA as ‘utterly disgraceful’, could not be subject to a defamation action as they were made in Parliament.

This led to the chief medical officer for England Professor Dame Sally Davies publicly expressing her ‘sincere disappointment’ at the comments. Mr Rees-Mogg later apologised for the comparison with Dr Wakefield, an apology Dr Nicholl accepted.


Public interest

Dr Nicholl was one of a number of specialist doctors approached earlier this year to assist in the drafting of the Government’s contingency plans for a no-deal Brexit.

In April, the BBC’s Newsnight reported that the Government had been unable to stockpile certain drugs for six weeks, as health secretary Matt Hancock had said it would.

They included drugs for epilepsy and neuropathic pain. Dr Nicholl questioned at the time why the approach to doctors about the potential shortages was made in such a secretive fashion.

Dr Nicholl said the leaked publication of the Government’s Operation Yellowhammer report had vindicated the concerns about possible drug shortages which he had publicly expressed.

Watch the interview

‘When Yellowhammer came out, it basically backed up 100 per cent what I had been saying but obviously on a much bigger scale.’

He said he found recent press reports that the Government had not approached the medical royal colleges over making updates to the original Yellowhammer planning ‘jaw-dropping’.

‘I find that incredible given that we’re nearly six months ahead.’


Patient safety

Dr Nicholl emphasised that patients should not go to their GPs with concerns about medicine shortages, as there was nothing that individual doctors could do about the situation.

He said, however, that given the deadline for Brexit it was crucial that doctors spoke out on matters of concern around patients’ health.

He said: ‘This goes back to the GMC’s Good Medical Practice which is quite explicit in saying that if a doctor is concerned about patient safety or even patient discomfort, they should be speaking up.

‘It is very difficult to have faith in the Government when they persistently and repeatedly lie.

‘It is particularly troubling with the whole proroguing issue because that means there is no Parliamentary scrutiny and that means the Commons health select committee cannot drag ministers in to have these kind of discussions.’

BMA guidance on raising concerns

Information for doctors if there's a 'no deal' Brexit

BMA briefing: the dangers of a no-deal Brexit

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