Dr Dominic Pimenta MD Profile picture
Jul 27, 2018 15 tweets 5 min read Twitter logo Read on Twitter
Dear @MattHancock.

I’ve been trying to understand the WTO/No Deal scenario. For the NHS, there is no contingency plan for “No Deal” that won’t stop people dying.

Firstly, here is my attempt to understand WTO rules and what happens to us if we leave on no deal:

I’ll wait.
2/ The NHS, long before Brexit, from your govt & your mate Jeremy, is in poor shape.
- We don’t have enough staff (100,000 short total, 40,000 nurses, 10,000 doctors)
- we don’t have enough funding (~£26b)
- Demand continues to rise by 4% every year

All the NHS alarms are blinking red:
- Worst A&E waiting times on record
- Longest ever operation wait on record
- Worst ever cancer referral wait on record
- GP numbers falling
- Nursing numbers falling
- Deficit at est £6b (£500m surplus 2010)
4/ This isn’t just inconvenient, the stakes are human lives.
- Nursing numbers/patient are vital to surviving illness
- 120,000 deaths in U.K. since 2015 due to NHS cuts
It feels insane to have to say this as “background” but in healthcare money really MATTERS.
Like “Gran won’t be with us for Christmas” matters.
To No Deal. Firstly May’s proposed NHS funding boost was linked to a “Brexit dividend”. There is no “dividend”.
Your govt themselves est No Deal will cost 8% GDP over 15 years- that’s £159b. Thats the entire NHS AND schools budget combined.
So money will be tighter. So will staffing levels.
Post Brexit EU nursing applications fell by 96%. Currently there are 55,000 EU NHS.

No Deal will mean these citizens have no legal basis to work or live or receive pensions here.

We cannot afford to lose any more staff
8/ Other parts of our NHS are tied up in the EU:
- The European Medicines Agency approves drugs. With no deal we will have to approve our own, a long & costly process.
- Drug companies will de-prioritise the U.K. for new medicines, like new cancer drugs.

We also import a lot of medicines. Leaving the EMA and customs union without a licensing agreement will stall future medicine imports for months if not years.
EURATOM monitors, stores & transports nuclear material.
We use these for diagnostics including cancer, heart disease & treatments for thyroid & bone diseases.
With No Deal we don’t have a solution to do this ourselves: scans and even cancer treatments will stall until we do.
Horizon 2020 is a £500m European research initiative, funding cutting edge research in the U.K. Since Brexit these projects are no liable for funding beyond 2020. With No Deal they cease entirely before then. gaeu.com/item/brexit-im…
12/ Lastly health isn’t just determined by the resources available to treat disease, preventing is just as if not more important.
- Further social care cuts precipitate worsening mental and physical health
- Economic hardship worsens mental and physical health
13/ A No Deal Brexit will have a massive knock on effect on the nation’s health and it’s healthcare.

People will die as a direct consequence of this decision.

And that is on your government @MattHancock , contingency or otherwise. /end
Addendum. Case Study 1.

This is what a #NoDeal #Brexit may look like to an individual.

This is what terrifies me.

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More from @DrDomPimenta

Sep 13, 2018
I am a doctor in the #NHS.
Every scrap of evidence I’ve seen points to total disaster if #NoDealBrexit comes to pass. We must #StopBrexit - here is why. /thread
Thus far I’ve tried to focus solely on the facts, and the facts alone. Informed consent is the bedrock of medicine- I don’t believe anyone knew the consequences of leaving EURATOM or the EMA for example when they voted. Feel free to prove otherwise. /1
It’s not my job to tell people what to do. And I am not. If you still think Leaving with No Deal will be good for the NHS after absorbing all of the above, then that is your decision. You are wrong, but it’s your right to be wrong. /2
Read 18 tweets
Sep 6, 2018
Another tragic and unnecessary death. I think every junior doctor in today’s NHS can empathise. We’ve all been there, to some degree. Myself included. This is what it’s like. /thread

I’m a “junior” doctor. I’ve been a doctor for six years, in training for twelve years. There are four levels, from newest to most senior: F1 (first year). Senior House officer (1-3 years), Registrar (1-5 years). I am a Registrar. /1
The hardest parts of our jobs are not usually the textbook bits: it’s all of the other bits that keep me up at night. /2
Read 28 tweets
Aug 27, 2018
#Jacksonville happens and it’s time to re-hash the same gun facts to counter the same arguments and expect the same absence of action. Here they are anyway. /thread
“Criminals don’t pay attention to gun laws”. Except where do they get guns from in the first place? >300,000 guns are stolen every year. Reducing the availability of guns, especially assault rifles, protects everyone. /2
“We need guns for self-protection”.
You are far more likely as a gun owner to be killed by your own gun than to kill an attacker in self-defence.
Every year >1000 children are injured accidentally by guns, many fatally. /3
Read 10 tweets
Aug 18, 2018
Nigel Farage is “back” with this piece in the Telegraph. He’s taken the time to really hone his art of total twaddle to a whole new level. /1
“The political class in Westminster.” ...is literally you - you’ve been in frontline politics for 25 years and an MEP for 19 yrs, with one of the worst voting records in the European Parliament.
“Their media allies”- this is you. You do more media than politics, even though you’re supposed to be an MEP. you have your own @LBC radio show, Fox News, Question Time (!). Not to mention Bannon, Breitbart, Fox News. You’re writing IN the Telegraph. google.com/amp/s/uk.news.…
Read 12 tweets
Aug 17, 2018
Now we are down to name-calling, and still no safe or sensible plan. Is it a #disgrace NHS doctors like me are terrified of the impact of a No Deal #Brexit on our patients? 🤔 /thread
Is it a disgrace a No Deal Brexit means we will, even temporarily, be unable to import vital medicine? Like insulin? google.com/amp/s/amp.theg…
Perhaps it’s a disgrace that we only make enough insulin in the U.K. for 1-2000 patients, when 400,000 patients need it every year. Is it a disgrace we are having to stockpile medicine like this? channel4.com/news/factcheck…
Read 16 tweets
Aug 15, 2018
This is hard watching, but this honestly could’ve been any of us. #IAmHadiza

Watching this I remember a nearly identical case I was peripherally involved in. A young boy, misdiagnosis, Group A streptococcus sepsis, which lead to his death.
The hospital was overrun, in special measures, with multiple failures in communication. Just like Leicester.
Read 10 tweets

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