Four years since the British public voted to leave the EU, “intensified” future relationship talks recommenced this week. Six months may seem ample time to reach an agreement but for the NHS, it comes during a period of unprecedented challenge and recovery from Covid-19, navigating a precarious tightrope of pressures on capacity, rehabilitation, workforce, funding, mental health and public expectations, to name a few.

The NHS could well do without the added and significant burden of standing up no-deal preparations, particularly as the threat of a second wave and localised outbreaks have not receded.

The further we advance through the next six months without clarity of an agreement, the greater the weight to be shouldered by the NHS and social care partners. Ambiguity has a cost – and it’s a significant one.

As the Brexit Health Alliance, a coalition of health sector organisations, argues in its Pandemic ready? paper, Covid-19 has provided sharp focus on the implications of the UK’s exit from the EU for protecting the British (and European) public from cross-border health threats such as infectious diseases.

Worldwide demand for supplies of medicines and personal protective equipment (PPE) has risen exponentially, as has the cost. The surge in demand has exposed both the importance and vulnerability of global supply chains.

Everyone is fishing in the same pond. Stocks prudently built up across the UK in readiness for Brexit are having to be replenished. What will happen if another pandemic strikes next year?

Without mutual recognition of regulatory standards, on 1 January 2021, medicines and medical equipment newly licensed for use in the UK will no longer be authorised for marketing in the EU and vice versa, leading to duplication and delays. The European Medicines Agency currently represents 25 per cent of the global pharmaceutical sales market compared to the UK’s 3 per cent share. Size matters. In Australia and Canada for example, new medicines come to market an average 6-12 months later than in the EU or USA. Similarly, failure to agree means the UK could also find itself excluded from taking part in EU-wide research and clinical trials of new vaccines and treatments.

The introduction of border controls next year will impede the free flow of goods in and out of the UK – currently, around three-quarters of the medicines and more than half the medical devices the NHS uses enter the UK via the EU.

The flow of people will also be affected: decisions on EU nurses’ social security benefits and healthcare similar to their current entitlements have been left dangling in the hands of the negotiators, breeding uncertainty and discouraging migration. The number of nurses annually joining the register from the EU has diminished from nearly 10,000 in 2015-16 to mere hundreds in 2018-19. The pandemic has frozen international recruitment from beyond Europe, as well as delaying “hands-on” training and clinical placements for homegrown recruits. There was an urgent need for workforce expansion before the pandemic hit and the new points-based immigration system looks set to be introduced with no obvious solution for social care. The timing could not be worse.

The “worst-case scenario” painted above isn’t inevitable, if UK and EU negotiators can knuckle down to craft an agreement that safeguards patients and prioritises health. So, what needs to be at the top of the negotiators’ in tray?

Any agreement would need to provide minimum customs and tariff barriers on importing and exporting medicines and medical equipment. There would also need to be mutual recognition of regulatory standards on items such as PPE and ventilators, and continued participation in key EU data-sharing platforms and alert systems to provide maximum preparedness for health threats. Ultimately, the best way to prevent and tackle health threats is to understand them. Continued participation in a Europe-wide medical research system that encourages cooperation and innovation is vital to all parties to retain Europe’s reputation as an attractive destination for cutting-edge research.

Coronavirus has shone an unwelcome spotlight on how health systems will be affected by exiting the EU but there is still time to aim for the sort of outcome from the negotiations that lightens our burdens.

That time is now. The clock, as always, is ticking.

Layla McCay is international director of the NHS Confederation, part of the Brexit Health Alliance