Preparing for the unpredictable

The Brexit negotiations are high political drama with the direction of the UK’s history at stake. The ending of the story is completely unknown. Government ministers still talk of a range of diverging futures that run from leaving without a deal to trade with the EU on World Trade Organization terms, to the close and complicated deal implied by Theresa May’s recent Florence speech.

With no majority, we cannot even be sure the current Government will remain in control throughout the negotiations, and Labour has a different set of priorities and possibilities. The EU has its own principles and red lines, and is holding back from discussing any future relationship at all until it gets enough assurance on its highest priority issues: money and citizens’ rights.

Destination unknown

My briefing today looks at what these diverging futures would mean for the NHS. The short answer is, a lot.

Health and social care services in the UK will bear the consequences if an exit deal does not enable vital care to continue across the Irish border, and give staff from the EU the security to keep working in hospitals and social care.

A trade deal will determine how much we can keep the benefits of drawing medicines and devices from across the EU – or whether we strike out on our own, with a very different set of costs and possible benefits.

The agreements we reach on customs, and whether we have time to prepare, will determine whether delays and disruption hit hospital finances and vital supplies.

And if the UK will have to leave European scientific and medical bodies, can we find new models for co-operation to benefit both sides?

Supplies for the road ahead

Beyond this, the sector must make the case for decisions within the UK’s control to give it the best possible chance. Migration of nurses will have to be allowed to continue if staff shortages are not to worsen. The NHS will need additional resources to deal with any British pensioners returning from the EU needing treatment here.

Social care funding, already in a critical state with companies struggling to carry on, may need to be even more radically rethought if there was also a need to raise wages to attract more British workers.

Out of our hands

There is an important role for the NHS – the institution the British public look up to most – to try to influence the debate in the interests of services and patients.

But we also need to be realistic. So many of the factors that will determine whether we leave with a workable settlement or not are out of the hands of even the British Government and European Commission. These negotiations are unprecedented, unpredictable and uncontrollable. They will rest on swings in public opinion we cannot anticipate, on manoeuvres in Parliament behind closed doors, and on politics at every level across 27 very different foreign countries.

Be prepared

So the next step in our work will be to explore what health and social care can do to prepare for the unpredictable future.

For staffing, Brexit throws up still more difficulties for a health and social care system already deep in a workforce crisis. Can we replace some of the future inflow of EU staff that we may lose by training more domestic workers, or by making services places where current workers want to stay on? Will this be the shock the health service needs to improve workforce planning so that a situation like this does not arise in the future?

Across science, procurement and working practices, Brexit casts uncertainty across a range of regulations that shape health and science in the UK. This comes just as major new EU laws, on issues such as data protection and clinical trials, are due to come into effect. What steps can we take to be ready if we cannot keep working as smoothly across Europe? Do we want to use the flexibilities Brexit may create to work differently?

Then there is the place of the pharmaceutical and medical device companies that work with the NHS. How can they deal with new obstacles to trade and to bringing in European staff on whom they too have come to rely?

The Nuffield Trust does not have the answers, but we know that the organisations who face these questions directly are working hard on them. In the coming weeks, we will be inviting a selection of people from law, industry and bodies representing health and social care employers to share what they believe we can do to prepare for Brexit – whether it turns out good, bad or ugly.