Drink and Drugs News DDN October 2019 | Page 9

In an open letter to MPs, The King’s Fund, the Health Foundation and Nuffield Trust summarised the four major areas where the impact of a no-deal Brexit could be felt most sharply in health and care. 1. A RISK OF INTENSIFYING THE STAFFING CRISIS The NHS has serious workforce shortages, with nearly 100,000 vacancies in English NHS trusts and a further 110,000 in social care. With 116,000 EU nationals working in health care and 104,000 in social care, even a small trend towards European migrants leaving the United Kingdom due to a fall in the pound or uncertainty around being granted settled status will worsen this situation. 2. SHORTAGES AND PRICE RISES FOR VITAL SUPPLIES BREXIT to pharmacists, is a worrying sign of the government’s approach and values. Obviously much of the above is guess work. Brexit and its impact is highly fluid with many variables and possibilities, but its impact on substance misuse is particularly hard to evaluate because an aura of silence exists around the subject and now, at the eleventh hour, we’re surrounded by what Dick Cheney would refer to as ‘known unknowns’ and ‘unknown unknowns’. Or to put it another way, we know sod all about the short- or long-term impact of any form of Brexit on substance misuse due to the state’s lack of interest or inability to research the area. After years of cuts, services are reactive and lack the ability to enact a proactive approach. U ncertainty clouds most areas of life post-Brexit, but attempts have been made to assess risk, from Operation Yellowhammer to specific sector analysis. As an example, there are several pieces of research on Brexit’s impact on the fishing industry. Research has been done, maps have been drawn – some thought has been put into fishing post-Brexit and there are 10,000 fulltime fishermen in the UK. So the fact that so little has been done to evaluate the possible impacts of Brexit on substance misuse and substance misuse treatment – fields that have a direct impact on around 270,000 people in treatment and a damn sight more out of treatment – a little larger cohort than the fishing industry, not to mention a more vulnerable cohort, is sad if not surprising. It’s hard to see much positive in Brexit for substance misusers. The good people at The King’s Fund have done some actual research on the impact of Brexit on general public health and social care, and although substance misuse is a unique field there are enough commonalities to make their findings disturbing. Most likely, Brexit will lead to poorer services and more suffering, but one positive outcome is that it’s highlighted the indifference of the state to the whole subject. Brexit has made it clear that the state’s primary aim is to protect wider society from substance misusers, not help substance misusers themselves. Accepting we’re an afterthought in policy makers minds is a valuable realisation, and the gaping hole where the state’s Brexit preparation should be is a timely reminder of our role in their scheme of things. Nick Goldstein is a service user www.drinkanddrugsnews.com Despite plans for stockpiling and creating new supply routes, the large amount of new paperwork and regulatory hurdles that a no deal Brexit would create for imports is likely to increase shortages of medicines and medical devices. Although it is difficult to judge the magnitude of the problem, the leaked Operation Yellowhammer document emphasised the vulnerability of supply chains in the sector. We can be certain that these additional burdens will mean companies face higher costs to get their products into the UK – costs that will ultimately be passed on to the NHS. 3. THE NEED TO CARE FOR RETURNING EMIGRANTS A no deal Brexit will mean UK emigrants to the European Union do not have guaranteed rights, and they may have to return to the United Kingdom to live and receive treatment if they become ill. Around 200,000 people using the special EU scheme that guarantees health care rights to retirees abroad would face losing that protection. It is unclear how many of the roughly 800,000 other UK nationals in Europe might also be unable to access or afford care. While we would have a duty to help these individuals, it would add considerably to the already high demand pressures on the NHS and social care. 4. FUNDING SHORTFALLS AT A TIME WHEN HEALTH AND CARE NEED IT MOST Although an extra £20.5bn has been pledged to the day-to-day budget of the NHS in England, this does not cover other areas of spending such as investment in buildings, equipment and staff training budgets, which have been reduced in recent years. Creating real improvements for patients will also require repairs and upgrades to buildings and equipment, increased public health funding, and a stable social care system. In particular, analysis by the Health Foundation estimates that £1.0bn extra in 2020-21 and £2.1bn in 2021-22 are needed just to stabilise the adult social care system. Yet the Office for Budget Responsibility’s assessment is that the United Kingdom’s public finances would be around £30bn worse off each year in a no deal scenario of medium disruptiveness. This sum is more than the total spent on adult social care plus investment in NHS buildings and equipment across the whole of the United Kingdom in 2017-18. Health and care services are already struggling to meet rising demand for services and maintain standards of care, not least in advance of an expected difficult winter. The potential consequences of a no deal Brexit could significantly impede services’ ability to meet the needs of the individual patients and service users who rely on them. The impact of a no deal Brexit on health and care: an open letter to MPs at www.kingsfund.org.uk October 2019 | drinkanddrugsnews | 9 Join the debate, have your say: www.drinkanddrugsnews.com