UNISON head of health Sara Gorton speaks in the debate, which was chaired by Channel 4's Victoria Macdonald
29 March 2019 "will be an inflection point, and probably quite seismic," said Saffron Cordery, deputy chief executive of NHS Providers. "Whatever we're planning, Brexit will soon be the backdrop: the sea in which we swim."
Cordery was speaking at MiP's Members' Summit late last year, during a panel debate on Brexit and NHS funding chaired by Channel 4 News health and care correspondent Victoria Macdonald; and her comments captured the huge challenge that Brexit presents to the management of health and care.
Funding is already inadequate, said Local Government Association deputy chief executive Sarah Pickup, pointing out that the additional £650m allocated to social care in October's Budget is "less than half of what we need in 2019-20 just to stabilise care." And a disruptive exit from the EU would put at risk the extra £20.5bn over four years promised in last summer's NHS funding settlement, she warned.
Recruitment and retention is another obvious threat: Pickup noted that 7% of care staff are from other EU nations, "so the settled status proposition is really important". Failing to quickly confirm people's residency rights, or the putting up of new barriers to skilled immigrants, would deepen existing staffing shortfalls, she warned. And that in turn would further overstretch budgets, noted Cordery: "One of the things that really knocks trusts off their efficiency targets is when they have to use agency staff."
Dr Layla McCay, director of international relations at the NHS Confederation, explained that the Brexit Health Alliance – bringing together NHS and public health bodies, researchers, patients and industry – has identified the key Brexit risks. These include threats to medicine and equipment imports; cooperation on research; the mutual recognition of qualifications and regulators; and reciprocal healthcare arrangements.
Working through these problems will not be a quick process, warned Cordery, particularly in the event of no deal. "The hump we need to overcome won't be a steep up and down," she said. "It'll go up then along for a long time, and come down eventually."
Public bodies are keen to prepare for Brexit, she added, "but the government has only just woken up to the fact that it needs to do things nationally as well as trusts and others doing things locally. That's been very difficult for organisations who wanted to get on with it and haven't been able to. It's a collective national issue that needs to be embraced, and that hasn't happened until very recently."
It's possible to find "cautious glimpses of optimism," commented UNISON head of health Sara Gorton: "We have a secretary of state who's staked his claim on listening and on workforce," while these days social care at least "has a profile".
"There seems to be a consensus around some of the things that will fit not just the short-term panic, but the longer-term problems we have with funding and workforce," Gorton added. And Cordery argued that many health bodies "are saying ‘this isn't working for us', and taking their destinies into their own hands". One trust, for example, has teamed up with the local university to provide free nurse training, she explained.
"If you push at the door, it may well be open," she concluded. "And it's incumbent on organisational leaders to support their managers to do what they can."