The referendum result has shifted the ground under what are already a tough set of challenges faced by NHS and social care managers. The health and care system is experiencing some unprecedented pressures – and uncertainty about the impact of Brexit will add to the complexity.
Money for the health service (nobody mentioned social care – they hardly ever do) was given a high profile by the Leave campaign and has been the subject of much commentary since last Friday morning. Of course, any additional money for the NHS may eventually help to bring down the deficits running in the acute part of the system – but whichever prime minister ends up running the Brexit negotiations, that additional money (if it comes from savings in contributions to the EU) is not likely to arrive any time soon. Not before the mechanism for leaving the EU is triggered, not for at least the two years of negotiations, and maybe not for considerably longer. But the NHS and social care don’t have the luxury of time – and the acute sector is only one challenge amongst many.
In the meantime, there are already signs of implications for the health care workforce, for example the Daily Telegraph reports that the Nursing and Midwifery Council plans to change its policy on English language tests for overseas nurses amid fears it may be difficult to retain nurses from outside the UK. Local authorities and social care providers must also be thinking about the impact on non-UK care workers.
All of this has implications for system planning and comes just at the time local system leaders are submitting their Sustainability and Transformation Plans (STPs) to NHS England – it’s probably just as well today’s deadline for submission was changed to a checkpoint about potential.
Mentioning STPs leads me to raise concerns about scrutiny and accountability as checks and balances in the process. My colleague Ed Hammond has recently blogged about Brexit, devolution and scrutiny and many of the same points may be relevant in the context of Brexit, STPs and scrutiny (you’ll see what I did with the blog title there).
Actually, I could probably pinch much of what Ed has blogged about devolution and re-cast it in the light of the multi-agency, super geographic footprint STP process. So I will – just like devo deals, there appears to have been little input in to STPs so far from patients and the public and little engagement with council health scrutiny (or other parts of local government?) about how these plans will change health and care services across a number of population areas. Maybe the plans are too high level at this stage? Maybe it’s the local stuff that will matter? Of course how the pattern of services changes locally will get the interest (and indeed may require the interest) of council health scrutiny, but that may be too late in the process to begin a conversation.
Perhaps we can use this moment, when everything is being refocussed through a different lens, to get the conversation started now? CfGS recently hosted a group of sector experts to discuss governance, scrutiny and public voice in the health and care system – what emerged was a strong consensus that these are vital to good decisions and good outcomes that need continued investment at a time of very significant change. CfGS will be working hard to promote and support the role of scrutiny and public voice as part of good governance – we are currently working with national partners to establish what support is available to give health scrutiny and other involvement mechanisms real influence.
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