Brexit Postponed: NHS Sees More of the 'Circus of Uncertainty'

Peter Russell

April 16, 2019

The decision to further postpone the date for the UK to leave the European Union met with mixed sentiments in the health and care sector.

The UK was originally due to leave the EU on 29th March but this was first extended until 12th April. Since then the UK and the EU have agreed a new deadline of 31st October 2019.

The agreement means the UK has six-and-a-half months to decide on a course of action.

'The Risk is Complacency'

If Prime Minister Theresa May can get a deal ratified by Parliament, perhaps through agreement following talks with the Labour party, the UK could leave before the autumn.

However, a 'no-deal' Brexit remains the default outcome at the end of October if no agreement can be reached and there are no further extensions. If the UK does not take part in EU elections on 23rd May, a no-deal Brexit could happen as early as 1st June.

Responding to last week's decision to extend the Brexit deadline, the NHS Confederation said it was "a relief" that the threat of leaving without a deal had gone away – at least for now.

However, its Chief Executive, Niall Dickson, who is also co-chair of the Brexit Health Alliance, said everybody involved in healthcare should continue to prepare for no-deal and maintain contingency plans.

"We are now in a 'phoney war' and the risk is complacency," he said. "The system needs to assume we could crash out and do everything we can to make sure patients are protected if that happens.

"Like everyone else in the UK and Europe we want an end to this circus of uncertainty and we need to see the political will to bring that about."

The Future for EU Healthcare Staff in the UK 

Matt Hancock, the Secretary of State for Health and Social Care, wrote to all health and care staff earlier this month to try to clarify the Government's preparations for leaving the European Union.

The letter covered a number of core issues, including:

  • Continued recognition of EU professional qualifications in the UK

  • Medicines and prescribing in the event of a no-deal Brexit

  • The rights of EU citizens to stay in the UK after it left the EU

The letter, which repeated a familiar mantra that ministers favoured leaving the EU with a deal but had to prepare for all eventualities, emphasised that the Government had put in place legislation that ensured European qualifications, including those gained in Switzerland, would continue to be valid in the health and social care sectors.

The Department of Health and Social Care (DHSC) said the legislation meant that up to 63,000 NHS staff and 104,000 social care workers who qualified in the EU or Switzerland could have their training and experience accepted by all regulatory bodies for the health and social care sectors, including:

  • General Medical Council

  • Nursing and Midwifery Council

  • General Pharmaceutical Council

  • General Dental Council

  • Health and Care Professions Council

Mr Hancock acknowledged "the critical role EU citizens play in delivering our health and social care". The letter said staff had a "secure future" in the UK and that this commitment applied "whether the UK leaves the EU with or without a deal".

The letter clarified that there would be no need for any change to existing employment contracts if the UK left the EU without a deal "and therefore no question of EU staff needing to re-apply for their own jobs because of EU Exit".

The Government said it was also encouraging EU workers to apply to the EU Settlement Scheme which fully opened on 30th March.

Danny Mortimer, chief executive of NHS Employers and chair of the Cavendish Coalition, said: "We have been clear that we must continue to embrace the vital contribution of our talented colleagues from overseas in caring for our patients and communities.

"We very much welcome the news, as will employers and staff, that the UK will recognise the qualifications of EU professionals in a no-deal situation.

"We would hope for similar confirmation of recognition for those with UK qualifications working in the EU."

French doctor, Dr Guillaume Lafaurie, who heads a digestive surgery clinic at the Queen Elizabeth General Hospital in Woolwich, said EU staff working in the NHS remained gloomy about their future prospects.

"Brexit has led to a low morale among European health professionals working in England," he told Medscape's French edition . "I know many nurses, auxiliary nurses, and even doctors who are trying to return back to their countries of origin. Unfortunately, many Europeans feel that the English no longer want them here.

"Often health professionals from the EU come and only settle here for a few years. Brexit has been a trigger for many of them. They have decided to go back."

Medicines and Prescribing

In his letter, Mr Hancock also reminded health and care staff that providers and health professionals should not stockpile additional medicines, beyond their business as usual stock levels.

Pharmacy and prescription only medicines suppliers and manufacturers have been asked to ensure they hold at least an additional 6 weeks of stock – over and above usual buffer stock – in the UK.

Mr Hancock said: "Local stockpiling is unnecessary and could cause shortages which would put those that need medicines at risk."

Blood and Blood Products

The DHSC updated its advice about the import and export of blood and blood components if the UK left the EU without a deal.

It said that although requirements ensuring the quality and safety of blood would remain broadly the same, some administrative changes would be needed by licenced blood establishments to continue to import or export blood and blood components from or to EU countries.

The DHSC said it was working closely with blood establishments and other partners to ensure that the collection, manufacture, and supply of blood and blood components would continue to meet patient demand, regardless of how the UK might leave the EU.

Brexit and Mental Health

As the UK's Brexit process reached another crescendo last week, the mental health charity, Mind, issued wellbeing advice to MPs and their staff following descriptions by some parliamentarians about the effect it was having on their mental health.

It quoted one Conservative MP who said: "I have never seen more frazzled MPs", and another who described Westminster as "a boiling pot of mental ill health".

In a letter to MPs, Paul Farmer, Mind's chief executive, said MPs and their staff were working in a "uniquely pressurised environment", while Louise Rubin, the charity's parliamentary manager, warned: "It's easy to neglect mental wellbeing under these conditions but long-term unmanageable stress can negatively affect physical and mental health, and can lead to or worsen problems like depression and anxiety."

It was not only politicians who were identified as having their mental health affected by the long-running Brexit saga. Last week, the British Association for Counselling and Psychotherapy (BACP) said that 33% of people had been negatively affected by the UK's decision to leave the European Union, while a further 24% said it had affected them 'a little'.

The degree to which mental health was affected differed according to age, household income, and political affinity, according to the public perception survey carried out by YouGov.

Andrew Kinder, BACP governor and senior accredited BACP counsellor, said: "There is uncertainty on whichever side people voted for, whether that is remain or leave, and there is dissatisfaction as well.

"Uncertainty can be stressful for people, and it does impact on their wellbeing."

Louise Tyler, a registered member of BACP, and a counsellor based in Cheshire, said: "I am seeing clients who are grappling with having to prepare for various Brexit scenarios in their jobs or across their business, resulting in stress and anxiety because of increased workload and working hours.

"Many people are worrying about the consequences of Brexit on their jobs and finances."

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