Millions of British expats in Europe could be without healthcare in the event of a no deal Brexit, while EU nationals resident in the UK before 29 March will still be eligible for NHS treatment, the government has confirmed.

UK nationals have been warned they may face “limitations to their access to healthcare services” in Europe come 30 March in Department of Health and Social Care guidance.

It spells out for the first time the significant holes in preparations for assuring healthcare should Theresa May fail to win agreement over her Brexit deal with the EU.

While ministers say they still expect a deal, civil servants are now trying to negotiate reciprocal deals with individual EU states to guarantee the rights of citizens should the UK be relegated to “third country” status.

“In a ‘no deal’ scenario, UK nationals resident in the EU, EEA [European Economic Area] and Switzerland may experience limitations to their access to healthcare services,” according to the EU Exit Operational Readiness Guidance.

“The government is therefore seeking to protect current reciprocal healthcare rights through transitional bilateral agreements with other member states.”

An influx of British citizens in the EU, particularly those with long-term health conditions, could heap even more pressure on an NHS stretched to breaking point, but the guidance says it is “not possible to quantify” how many might return because of this issue.

Theresa May pledged in September that EU citizen’s rights would be protected in the event of a no-deal Brexit, but she has since suggested they could be watered down.

However, there is no EU-wide reciprocal arrangement in place, though ministers have struck a bilateral agreement with Norway, which not in the EU but is part of the EEA.

The report was sent out to hospitals and other NHS bodies late on Friday with Labour accusing ministers of “sneaking out deeply worrying news” to avoid scrutiny.

It puts hospitals on notice that new EU arrivals will not automatically qualify for free NHS hospital treatment and staff will have to check visa eligibility in the same way as other visitors.

NHS trusts and foundation trusts “should continue to maintain a strong focus on correctly charging those who should be charged directly for NHS care”, the guidance adds.

It also warns all NHS bodies to review staff holidays and on-call arrangements around the 29 March to ensure there is enough capacity, though it isn’t yet calling for action to cut activity or boost capacity.

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The guidance says hospitals and GP surgeries should “direct staff to promote messages of continuity and reassurance” to patients concerned about the health risks of a no deal.

In particular it says they should brief patients not stockpile medicines, after the government warned of six months of gridlock at Dover and major ports which account for 90 per cent of NHS drug imports.

Labour’s shadow health secretary Jonathan Ashworth said ministers should come clean to patients about how much is being spent on no-deal planning.

“This is money that is sorely needed on the NHS frontline this winter,” he said.

“While the NHS descends into winter crisis again, health ministers are demanding staff ‘promote messages of reassurance to patients’. If anyone should be promoting a message of reassurance it should be the secretary of state [Matt Hancock] and he could start by ruling out this irresponsible, chaotic no-deal Brexit.”

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More than a million people have backed The Independent’s Final Say campaign calling on Theresa May to guarantee the public a vote on whether to accept the terms of her deal or remain in the EU.

However the prime minister shelved a Parliamentary vote on her deal at the eleventh hour amidst fears that it would be sunk by her own party’s Brexiteer faction.

After surviving a vote of no confidence in her leadership she is currently trying to win further concessions, though the EU has said it will not negotiate further.

Niall Dickson, chair of the Brexit Health Alliance, which encompasses NHS organisations, patient charities and the pharmaceutical industry, welcomed the clarity but said it leaves “critical questions” unanswered.

“The decision to create a national Operational Response Centre shows that we are talking about a national emergency,” Mr Dickson said.