Whatever your views on Brexit, our key public services need to be fully prepared for 'no deal', should that occur on 31 October.
Top of mind should be the NHS hospital, ambulance, mental health and community service trusts that provide vital healthcare to a million patients every 36 hours. For some of those patients, getting the right treatment as soon as needed means the difference between life and death. So, with ten weeks potentially to go, how ready are those trusts to cope with a 'no deal' Brexit?
Whatever your views on Brexit, our key public services need to be fully prepared for 'no deal', should that occur on 31 October.Chief Executive
The good news is that the NHS has a long and proud tradition of performing well during a crisis – think Manchester Arena, London Bridge, Grenfell Tower and, further back, past flu pandemics. Trust leaders are used to planning meticulously for emergencies, working closely with other key public services, and then seamlessly moving into crisis management mode when required. As you would expect, there is a huge amount of Brexit planning and preparation being done at the moment. But there are two particular features of a 'no deal' Brexit that frontline leaders point to as key risks for the NHS, other public services and the government to collectively manage.
The first is timing, with a very awkward triple whammy potentially on the cards - a difficult winter, a flu outbreak and a 'no deal' Brexit. The NHS is at its busiest over the winter months. Current emergency care performance – the worst in over a decade – shows how much pressure the NHS is currently under, with real concern that we are heading for a very difficult winter. Levels of flu in Australia – often a good predictor for levels of UK winter flu – are the highest for some years though it's too early to be sure what this means for us. Combine that with the negative impact of a 'no deal' Brexit, should it occur, particularly if it lasts for some time, and you have a frontline NHS chief executive's worst nightmare.
The first is timing, with a very awkward triple whammy potentially on the cards - a difficult winter, a flu outbreak and a 'no deal' Brexit.Chief Executive
The second concern is how many of the risks that trusts would need to manage are beyond their immediate control and are dependent on close and effective working with other public services and the operational success of central government plans.
There's a long list of these issues with five examples towards the top of the list of concerns below.
The NHS uses 8,000 medicines which are dependent on European supply routes. There's a similar story on medical devices – radioactive isotopes for scanners, spare parts for dialysis machines and vital supplies like bandages and incontinence pads. Trusts will need to rely on government plans to ensure the continuity of this supply. That includes ensuring the public understand the plans and are confident they are robust and that the right medicines and medical devices will be available when needed.
Trusts will need to rely on government plans to ensure the continuity of this supply.Chief Executive
Trusts feed around 120,000 patients each day, with the right amount and quality of that food key to keeping patients alive and well. Trusts will need to rely on the security of our national food supply with appropriate prioritisation for the NHS if required.
Ambulances, patients and staff have to be able to get to the right place of treatment and work on time. Trusts in places like Kent, that are at potential risk of traffic logjam, will need to rely on a range of government departments and public services working together to ensure free flow of traffic.
The NHS needs certainty on what services EU citizens arriving after exit day are entitled to and how to recover costs for chargeable treatment. Under current government plans, these citizens will need to prove their right to free NHS healthcare and pay if they are ineligible. This is a big change of gear for a health system currently free at the point of use for all EU citizens, with NHS staff suddenly becoming responsible for eligibility checks they don't currently perform.
Uncertainty around Brexit since the referendum has already led to some European staff choosing to leave. But the NHS heavily depends on these staff.Chief Executive
The NHS is currently grappling with severe staff shortages. Uncertainty around Brexit since the referendum has already led to some European staff choosing to leave. But the NHS heavily depends on these staff. Trust leaders report considerable uncertainty amongst EU staff on what the latest messages on immigration mean in practice, with staff asking questions like “how easy will it be for me to get back into the country if I go home on holiday?” and “what paperwork do I need, when?” We need government to provide pin point certainty on these issues and do all it can to create an environment in which European staff working in the NHS and social care feel valued and appreciated.
These risks are all well known, though we can only know their true and real impact should a 'no deal' Brexit actually occur. Frontline NHS leaders are working hard to manage them, including working closely with central government and other public services. But we need to acknowledge that these risks exist and that they need effective management. We also need to recognise that is a complex and resource intensive task, alongside everything else an over stretched NHS is currently doing.
This article was also published in The Times.