Political uncertainty became endemic during 2019, despite a lot of government planning

Pharma companies in the UK have become used to political uncertainty over the past three years, but 2019 tested their patience as never before. The year saw not one, but two, Brexit deadlines come and go without the UK making its promised departure from the EU. In both cases, until just a few days beforehand, it looked like the deadline really would be kept. Indeed, Boris Johnson, who became prime minister in July, vowed he would rather be “dead in a ditch” than delay October 31’s deadline. Yet delay it he did, forcing pharma companies to put their no-deal Brexit plans on ice once again.

With a general election now due on December 12, those plans may be needed again next year. Based on opinion polls, The Economist Intelligence Unit’s core forecast is that the Conservatives will win a larger majority, which will give them the leeway to push through Johnson’s renegotiated transition deal with the EU. However, a hung parliament would leave the UK once again heading for a no- deal Brexit at the end of January 2020. A Labour victory (with or without a coalition) is unlikely, but if it happened it would probably herald another EU referendum – with a Scottish independence referendum thrown in.

The persistent delays to Brexit did at least allow the government and companies to hone their no-deal contingency plans during 2019. It has been an expensive and time-consuming process. To avoid trade disruptions, the government has given four ferry companies contracts to get urgent medicines into the country, and listed 32 medicines that cannot be shipped out of the country. It also set up a Medicines Shortage Response Group to manage flows, if necessary via Serious Shortage Protocols, while the NHS has built up a stockpile of medicines in case the worst happens.

These moves, however, were just for the short-term disruption. Long-term shifts also started happening in 2019. In January the European Medicines Agency shifted to Amsterdam, along with most of its workforce, but failed to end its £500m lease on its London office. Left to its own devices, the MHRA issued a whole set of guidance documents on how pharma regulation will change when the UK leaves the EU. The government’s guidance for healthcare companies, meanwhile, amounted to 80 documents. One notable inclusion: guidance on how to charge overseas visitors for NHS care, under a no-deal Brexit.

Not just Brexit

Although Brexit left the government scant room to focus on other policies, there have also been some longer-term plans put in place this year. In January, the NHS finally unveiled its ten-year long- term plan, which sets out priority spending areas. In line with this, in September the government unveiled additional spending of £1.5 billion in 2020/21 for social care services, although that is very little compared with the cuts of the past decade.

Workforce planning for the NHS was also centre stage during 2019, with an eye to how Brexit will affect overseas recruitment. According to a government report in July, 5.5% of NHS England staff are nationals of other EU countries, and 7.6% come from non-EU countries. In March the government nearly abandoned the four- hour waiting target for A&E, only to backtrack. By November, breaches had reached record levels.

Not surprisingly, all these issues came to a head during the election campaign, when NHS spending promises abounded. The Conservatives pledged 6,000 more GPs and other health workers, providing 50 million more appointments by 2024-25. Overall they promised £20 billion more in spending over their term if they won the election. Labour countered with a pledge of £26 billion, and a four-day working week for NHS staff. As voters headed for the polls, it was clear that Brexit and the NHS are the only two issues that count, but the future still looks uncertain for both.

Ana Nicholls is director, Industry Operations, at the Economist Intelligence Unit.