John Lister comments –

The last-minute ‘night before Christmas’ trade deal with the EU signed by Boris Johnson and endorsed by Conservatives and most Labour MPs in a Commons vote on December 30 avoids some of the very worst feared outcomes of a no-deal exit, but will have an impact on the NHS and social care.

Early in December a leaked government document had spelled out a “reasonable worst case scenario” if no deal were signed, which included warnings of public disorder, shortages of fuel, rising food prices, and initial reductions of up to 40% in supplies of medicines and medical products for the first three months.

The deal that has been signed avoids these problems, although delays are still likely and the NHS is certain to be landed with some of the extra £7.5 billion in administrative costs that the HMRC has predicted would be incurred as a result of Britain leaving the Customs Union, triggering a near-fivefold increase in numbers of customs declarations.

The other problem that has been flagged up since Priti Patel first published her reactionary “points based” system to restrict immigration is that while most health care staff should meet the entry criteria,  staff who look after older people in care homes won’t, and can no longer be recruited from overseas to work in the UK, as they earn below a £25,600 threshold for skilled workers.

The axing of freedom of movement will therefore have its most brutal impact on the care for frail elderly residents in increasingly under-staffed care homes, especially in parts of south east England where up to 30% of care staff have been recruited from EU countries. Patel’s hard line legislation also blocks recruits from non-EU countries, worsening a chronic shortage.

The Nuffield Trust’s programme lead Mark Dayan, has warned that the new rules, which Patel had already announced for 1 January, would hit social care especially hard, noting that the problem is of the British government’s own making: “Ultimately the migration system is now a free choice for Britain: if we want the functioning, protective, social care system the Prime Minister has promised, we may need to choose differently.”

An additional longer term problem highlighted by the NHS Confederation is that the Brexit deal ends mutual recognition of professional qualifications. While the UK (in need of professional staff) has unilaterally decided to continue to recognise EEA qualifications for up to two years, the EU has made no equivalent concession. This will limit British-trained professionals from developing their skills and research by taking up posts in EU countries.

Health staff who are EU nationals now face more bureaucracy if they want to work in the NHS. The government summary of the deal makes clear that new recruits from the EU will need visas to work here and have to pay the immigration health surcharge on top of regular taxes.

Barts Health, one of the biggest NHS trusts, has more than 1,700 staff from the remaining countries of the European Economic Area.  Barts issued a statement on December 31, warning that the end of the transitional period means all EU citizens who were resident in the UK by 31 December 2020 will need to apply to the EU Settlement Scheme (EUSS) to continue to live, work and study by 30 June 2021: “This also applies to their family members including children and non-EU citizens. You may be asked to provide relevant documents to confirm your status in the UK in order to establish your entitlement to free NHS hospital care.”

With three quarters of the medicines used by the NHS and half of all medical devices for the UK coming from the EU, many experts, industry leaders, health bosses and even members of the Government, have acknowledged that disruption at the border will be an inevitable consequence of the UK leaving the EU.

The letter to health and social care leaders from Health Minister Edward Argar admits the probability of delays:

“we are working with suppliers to help ensure adequate mitigations are in place for non-clinical goods and services (for example, hospital food, laundry, IT contracts etc). … Adult social care providers … should continue to get COVID-19 PPE via the PPE portal. You should allow more time for non-clinical goods to arrive – an extra 72 hours where you rely on ‘just in time’ supply chains.”

The trade deal only covers goods, not services, leaving doubts over many high technology products such as medical scanners which are supplied as a bundle with operating or maintenance contracts. Any disruption of maintenance or supply of components could threaten the ability of hospitals to deliver care.

Meanwhile more decisions made by the British negotiators are likely to limit and delay British awareness and response to further health threats. While the UK and EU will “collaborate/cooperate in warning each other and tackling health threats,” the NHS Confederation warns that the UK “will not normally have access to EU databases and will not retain membership of the European Centre for Disease Prevention and Control (ECDC).” And the UK will in future need to “request access to the EU’s Early Warning System” to tackle a specific threat. Nobody has explained these perverse British decisions.

The government also decided to pull out of the European Medicines Agency (EMA) which used to be based in London: as of last February no one representing, appointed by or nominated by the UK can participate in any EMA scientific-committee or working-party meetings, or in the Agency’s Management Board. Now it is no longer part of the EU or its pharmaceutical regulatory structure it’s likely Britain will no longer be seen as a first priority launch market for new drugs.

So while the worst aspects of a no deal exit have been avoided, there is little if any sign of any up-side to Brexit for the NHS, and the full implications have yet to unfold. As NHS Confederation Chief Executive Danny Mortimer summed up:

“NHS leaders will be flooded with new rules, guidance and information and be required to make significant adjustments at breakneck speed – all while dealing with unprecedented COVID-19 and winter pressures. Whilst the preparations for the NHS are as good as can be, the circumstances could not possibly be worse.”

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John Lister

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