AFTER yet another defeat in Parliament, and with just 40 days to go until “Brexit Day”, the Prime Minister and her Government are fast running out of road – and the threat of no deal is hanging over all of us like a sword of Damocles!

The Government spin machine is already trying to put the blame on Ireland and the EU, but the real reason for the impasse is the division over Europe in both main parties, the contradictions of the Prime Minister’s red lines and the outrageous promises made by Brexiteers during the referendum campaign.

While the Prime Minister talks about passing her “deal” and “putting Brexit behind us”, what she has negotiated is only the withdrawal agreement, while the political declaration – the outline of the future relationship – contains little but vague, aspirational phrases. Brexit negotiations will dominate everything for years to come. This is, therefore, a “Blind Brexit”, with no more talk of frictionless trade or “having our cake and eating it”. It means we would jump off a cliff on March 29, with no idea where we are headed, and just hope someone knits a parachute on the way down.

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Brexit will have a significant impact on our health and wellbeing in many ways, from increased financial hardship to the loss of the reciprocal health care agreements which allow us to access medical treatment while travelling, working or retiring in another EU country.

Leaving the European Research Network will remove funding from Scottish and UK universities, weaken research collaboration and see our academics left out of major projects and medical trials. It has already led to the European Medicines Agency HQ moving to Amsterdam, taking more than 900 high-quality jobs with it.

Brexit also threatens a lowering of food safety and environmental standards as the UK Government seeks a trade deal with the US. However, two aspects of Brexit seem to already be affecting our health care: workforce and the likelihood of medication shortages.

I haven’t written much about the threat from a no-deal Brexit as, until recently, I thought no serious government could allow such a thing to happen. While I still hope we can avoid it, the Prime Minister refuses to rule it out and many Conservative members see it as the only “real” Brexit. As the UK Government’s desperation grows, they are pushing hundreds of pieces of legislation through Parliament before Brexit day on March 29, which means they don’t go through the normal legislative debates but merely a single committee meeting. While much of this consists of fairly dry changes, such as removing references to European institutions, each piece of legislation must be scrutinised in advance to ensure nothing else is being slipped under the wire.

Some legislation is also being snuck through without even this minimum level of scrutiny, using a procedure whereby a copy of what’s called a Statutory Instrument (SI) is simply put in the House of Commons library, and if no one complains about it within 40 days, it passes!

Last week I discovered that one of these SIs gives powers to the UK Health Secretary to place a drug on to the Serious Shortage Protocol if there are supply problems. This gives the pharmacist the legal power to change the strength, quantity or make of any drug in short supply or to dispense a totally different drug which they think is a reasonable replacement.

Controversially, however, all of this is without the requirement to discuss the options with the patient’s GP or prescriber. This is concerning, as the pharmacist cannot see the patient’s records to select a good alternative and avoid something that has caused significant side effects in the past. This undermines the doctor’s legal responsibility and I find it incredible that something so significant should be pushed through with no scrutiny or debate, especially when it turns out the General Medical Council weren’t even being consulted on the matter.

Removing the requirement to consult the prescribing doctor before changing a drug suggests the UK Government are expecting so many drug shortages that it would be impractical for the pharmacist to phone the GP each time. While Matt Hancock boasts about being the largest purchaser of new fridges – to store insulin and vaccines – diabetics are concerned about secure supplies of insulin, which is not made in the UK.

The Royal College of Radiologists has highlighted the risk to the steady supply of medical radioisotopes, for diagnostic scans and cancer treatments and, as these isotopes lose half their activity every 66 hours, they cannot be stockpiled in the case of a no-deal Brexit. I am getting letters from constituents even now highlighting some drug shortages and have to wonder how the stockpiles are being gathered. The Health Secretary can’t demand that non-UK companies produce extra quantities of drugs, so one has to wonder if the stockpiles are being taken from the normal supply; thereby reducing availability now, before we even leave the EU.

Leaving the EU will have a significant impact on the health and social care workforce, particularly with the loss of some of the 150,000 EU staff who diagnose, treat and care for us as nurses, doctors and social care workers across the UK. Workforce is one of the biggest challenges faced by all four UK health services, with Scotland having a 4.8% nursing vacancy rate, while in NHS England it is more than 11.5%.

Surveys by the British Medical Association and General Medical Council in 2017 suggested up to half of all EU doctors were considering leaving the UK, while there has been a three-fold increase in EU nurses leaving and a 90% drop in EU nurses registering to work in the UK since the referendum.

This affects the quality of care and the patient’s experience, while a shortage of GPs and hospital doctors leads to difficulties getting an appointment and increased waiting times.

After two years worrying about their future status in the UK, EU citizens do not feel secure here, particularly after the Windrush scandal. Many EU medics are concerned about their families’ rights as, while they have been accepted for permanent residency or citizenship, their partner or children may have been turned down.

It is clear that the Brexit vote itself, media coverage and speeches such as the Prime Minister’s recent “queue jumpers” accusation have made the UK seem a very unwelcoming place for EU nationals. This will have a huge effect in Scotland as, particularly in the Highlands and Islands, a significant proportion of doctors are from the EU, as are up to 30% of care workers.

The draft immigration Bill looks to replace freedom of movement with a strict system requiring EU citizens to obtain a Tier 2 Visa and defining skilled workers as those who earn more than £30,000. Using such a crude measure would rule out young graduates in many professions, and it is estimated that 75% of the EU nationals currently living in Scotland would not have been eligible under such rules. In particular, social care staff are unlikely to achieve such income levels to be granted a permanent visa in the future and would only be allowed to come for a year. Scotland’s NHS and care sectors are therefore under threat due to the Tory obsession with immigration.

All three Unionist parties want to deny Scottish voters a choice but, as we approach this major crossroads, it is crucial we get to choose our future – as a backwater of Brexit Britain, or as a modern European country, taking its place in the wider world.

Dr Philippa Whitford MP is the SNP’s spokesperson at Westminster for health and social care. She studied medicine at Glasgow University, and is a breast cancer surgeon who has helped design accreditation standards in Scotland.