The fallout from last Thursday’s momentous result is ongoing. The predictions of a decision to leave the EU stretch from a return to recession, to a global crisis akin to a nuclear Armageddon. The rhetoric will surely moderate, but resolution could be some time away, as both principle English parties look to new leadership and realignment.
What isn’t in doubt is that as the UK negotiates its exit from the EU, there will be consequences for the whole NHS, but particularly for England which finds itself in an already precarious situation.
The story in England is one of increasing crisis in the acute sector in particular, but increasingly in areas such as Primary Care and Community services, from failing access targets and to deteriorating finances.
The move by the centre to stabilise this through the 44 Sustainability and Transformation Plans (STPs) will struggle to keep pace with the efficiency agenda set out in the Five Year Forward View and Lord Carter’s report. Last Thursday’s decision has ratcheted up the risk considerably.
A photo on Twitter over the weekend showed doctors manning the ‘front line’ in one Trust. They come from The Republic of Ireland, Germany, Spain, Greece and Pakistan. Sudden changes in our immigration rules place new pressures on a workforce already under considerable stress. While precipitous change in the rules of entry are unlikely, the perception may be different.
Many of those who have relocated from Europe and are currently providing nursing, medical and other clinical services to the NHS, may make plans to go elsewhere where they feel they would be more welcome. We are not the only national health service with staff shortages. In the long run if we don’t produce enough essential staff we must continue to recruit from abroad but the short term risk is real.
The consequences for some of our most challenged local health economies may cause system failure. NHS England will have contingency plans for such threats to service delivery, as will each CCG, but will this be enough if even a small percentage of essential staff leave now or are not recruited soon?
So as we start to negotiate our exit, what will be put at risk?
There is a risk of disinvestment from the EU even before Article 50 is triggered, resulting in reduced research and development monies being made available to our academic and research institutions. Another ‘brain drain’ to the US, emerging markets and Australasia may become inevitable.
While the European Medicines Authority currently resides in London, its move to mainland Europe is inevitable. This will signal to global pharma and MedTech that the UK now plays a significantly diminished role in the market entry and evaluation of new products, and they may choose to disinvest.
While we commission most of our own services we depend on collaboration for many of the treatments for rare and very rare diseases; this cooperation would be at risk. The wider public might be more concerned with the disappearance of reciprocal agreements for ‘emergency treatments’ across the EU, which could go fairly rapidly with a consequential increase in travel insurance.
But the most significant risk is an economic one.
The UK spends significantly less on healthcare than most of its western competitors. It has some of the worst health outcomes for cancer and cardiovascular disease.
We have started to see the beginnings of a turnaround, as monies are being directed into more effective care. Austerity however has had a significant impact on performance within the service, and the risk even of a short-term downturn in economic performance will trigger further decline.
A healthy economy improves health outcomes; a healthy population improves economic performance. Let’s hope the transition to a new relationship with the EU can mitigate some of the risks highlighted above, but prepare for the worst. The NHS must keep to its tasks of improving local health systems through the STPs but there is an urgent need to reinforce this message and to reassure staff who find themselves in an already fragile workplace.
Measurement and evaluation