Brexit complexity

by Mark Knight

06 April 2017


The end of last month marked a significant date in our history – the triggering of article 50 and the start of the Brexit process.

The Parliamentary procedure that oversees the construction of about 15 to 20 major pieces of legislation on top of the so-called ‘great repeal bill’ will dominate Parliamentary time for years.  

For the NHS that probably means no time to pass a replacement for the much criticised Health and Social Care Act 2012, which most agree is not fit for purpose in our new cash-constrained landscape. Whatever the merits of competition to fulfil the act’s intentions, additional capacity would be needed. That isn’t going to happen. And the accountable care model we seem to be moving towards is about working together not competing with one another.

The NHS is full of pragmatic people committed to getting on with the job and it seems the system leaders are doing just that. If the NHS wants to create new accountable care organisations or systems, it will just have to do it without a more appropriate legal framework.  

Finance people will be at the heart of this, the unsung heroes keeping the show on the road.  And the HFMA is here to support you as you take this agenda forward. The issues surrounding Brexit are complex and no-one knows how it will pan out.  However, the concerns of the many EU nationals working in the UK are all too real. These concerns stretch from the fundamental ‘can we stay’ to understanding what conditions may be imposed. For example, will a visa or a green card disadvantage them financially? How intrusive will any border force be?  

For the NHS, it is absolutely vital we keep hold of all that talent from overseas to ensure our service can provide the level of care we need.  According to official statistics, more than 90,000 EU nationals were working in the social care sector towards the end of 2016. And on top of this, we also benefit from more than 50,000 EU nationals working in the NHS.

Getting a trade deal is crucial, alongside the right for EU citizens to stay. But you don’t need to look far to find an intimidating list of other ‘must dos’. There are wide-ranging scientific projects and joint working in areas such as medicines management and devices regulation.  The UK is a strong player in these markets and so I would hope we could continue to make a contribution to them, which will in turn help the NHS move its agenda forward.

There are dark noises coming out of Brussels that cherry-picking deals in certain areas will not be allowed, so we hope that our government works closely with the EU.

Working closely together is also a theme for the HFMA this summer when our provider and commissioning faculties host separate conferences, so that we can run a common joint day in the middle of the events. ‘Convergence’ will explore the unique challenges of both, but also the opportunities to reshape the NHS. Have you booked your place yet? You don’t have to be a member of a faculty to do so, but lower rates are available for member organisations.

The NHS is in a difficult financial position at the moment. We are clear at the HFMA that our role is to ensure support is focused on the key issues you are facing in this context and to help you to deliver maximum value.