Comment / Uncertain times ahead

So there we have it. After all the electioneering and punditry,
the UK has set a course to leave the European Union.  For many of us 23 June 2016 will be one of the historically defining days in our lives and it has sharply polarised the country.

The EU has been part of our world for so long, affecting almost every aspect of our existence, and we now have to take hold of any opportunities that present themselves to smooth any economic effects of leaving.

For the NHS, the implications could be very significant.  If the consensus view of the economists prevails, the UK will be a poorer place economically, at least in the short to medium term. In that context, appeals for a fair share of gross domestic product to be spent on healthcare, even if heeded, would not necessarily lead to increased spending. After all, 8% of not very much is not very much. 

Another uncertainty is over the workforce. Free movement of labour has helped to attract and retain staff from the EU at every level. A significant number of those employed in the social care sector are from within the EU. 

There has been talk about an Australian-style points system to control immigration. But again, it is not clear how that would work with some of our caring roles. And what of those who are here already and performing much-needed roles in health and social care. Even if rules do not change, will the statement made by UK citizens encourage some to look elsewhere – Germany, for example – for a more welcoming place to work? These are all considerations, policy makers will need to have in the future.

Even without actual change, the uncertainty surrounding major areas such as reciprocal healthcare arrangements, standards and research could itself have an impact. Many agreements and arrangements are embedded in laws and legal documents, and that will take years to plough through. 

However, my main worry lies elsewhere.  The UK is a fabulous country. It has traded and taken a leading role in the world for centuries. There is a chance we will recover from this economically and take advantages of opportunities that come our way. I’m more worried about the schism the referendum has caused and the disaffection of young people hostile at the apparent actions of the older generation. England and Wales are both ‘leave’ places, whereas Scotland and Northern Ireland are ‘remain’ – although, ironically, the result could trigger further attempts by Scotland to leave the UK. 

These are disturbing long-term issues and ones that will need to be handled carefully by our political leaders. But it has a knock-on effect to our own part of the system because day and night our NHS will still need to deliver.

The NHS itself faces an uncertain time. A new prime minister means a new cabinet, which could have implications for the health secretary. And that has implications for the transformation programme in the NHS – which is attempting to deliver a more collaborative, health economy-wide approach to service delivery despite the legislation set out in the 2012 health act.

The NHS is facing its biggest ever challenges. It is hard to see the current political uncertainty easing these pressures in the short-term.