HCL Issue 10 - Page 3

EDITORIAL 3 ‘ The only thing we have to fear is fear itself Brexit’ S o, about Brexit. I know we’ve all heard more about it over the past three years than our sanity can really take. So much said, yet so little clarity offered. In fact, the only thing that seems clear about Brexit is that nothing is clear. But however tempting it is to turn the Brexit button off, the potential effects of it do, of course, make it impossible to ignore. At the time of writing, the UK was due to leave the EU in weeks, with no decision reached on a deal. By the time you read this everything could have changed, or nothing at all. What is evident is that experts are fearful of the impact of Brexit on the NHS and social care. And no, we haven’t all ‘had enough of experts’. There are a number of Brexit scenarios and they all seem to fall into one of three categories when it comes to their predicted impact on healthcare: bad, disastrous and Armageddon- level catastrophic. Unsurprisingly, no deal is considered the most detrimental. At the end of last month, the BMA wrote an open letter to the Prime Minister in which it stated ‘there is no clearer immediate threat to the nation’s health than the impact of Brexit’. The doctors’ union was particularly vocal on the dangers of no deal, saying ‘we have repeatedly warned that a no-deal Brexit will have catastrophic consequences for patients, the health workforce, health services and the nation’s health’. And earlier last month, a study published in The Lancet warned that while all versions of Brexit are likely to be bad news for healthcare, a no-deal exit would be ‘by far the worst scenario’. There are many reasons to be concerned about what Brexit could mean for the health service, including medicines supplies. As Healthcare Leader reported last month, the Department of Health and Social Care (DHSC) expects to spend £11m on warehouse contracts to secure the space to stockpile medicines – The only thing that seems clear about Brexit is that nothing is clear although, unsurprisingly, ‘stockpiling’ is not the term the DHSC used – in the event of no deal. And then, of course, there is the knock-on effect on the workforce. With the NHS already struggling to stay sufficiently staffed, and with 63,000 (5.6%) NHS staff being EU nationals – 6.8% for nurses and health visitors, and 9.7% for hospital doctors – concerns about Brexit exacerbating the workforce crisis are rife. In November last year, a Cavendish Coalition report warned there could be a 5,000-10,000 drop in nursing numbers following Brexit – on top of the more than 40,000 nurses the NHS is already short. Data from the Nursing & Midwifery Council showed a 29% increase in nurses and midwives from the EU leaving the register between April 2017 and March 2018 compared with the year before, and an 87% drop in those joining. Interestingly, as our King’s Fund columnist Anna Charles (page 38) highlights, the long-term plan only mentions Brexit twice. However while Brexit may not feature heavily in the long-term plan, the plan does feature prominently in this issue. We address it in our interview with The King’s Fund chief executive Richard Murray (page 8), our look at cancer diagnosis targets (page 20), and our long-term plan data breakdown (page 22). Nora Elias is editor of Healthcare Leader Healthcare Leader 2019 Issue 10