Welcome to the ‘About that bus…’ weekly newsletter: giving you the inside track on how the fallout from Brexit is affecting the NHS at national and local level, edited by James Illman Contact me in confidence.

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Our first edition of  ‘About that bus…’ brings you the latest orders to trusts from the NHS’ Brexit chief; warnings of Armageddon from Kent; and considers the risks of an unstable currency market on the NHS’ drug stockpiles for a no-deal Brexit.

We start with NHSE’s EU exit strategic commander Keith Willett’s rare public outing last week at the Expo conference, where he gave some crucial steers for trusts on what to prioritise in their preparations.

He revealed the NHS can expect new operational planning assumptions and a health-related government communications campaign to begin in the next fortnight.

As we also reported, commander Willett told trusts to grow their administrative teams overseeing the charging of some EU patients in the event of no deal, as government “will want to see a visible change” in this area.

The demand will not be welcomed. Trusts have long been legally obliged to charge some overseas patients who are not eligible for free healthcare. But many have often been reluctant to do so due to the significant administrative burden required for a relatively low volume of patients, and the lack of a charging culture in the NHS.

Prevailing wisdom has been that many trusts will simply ignore the guidance on charging EU nationals if there is a no-deal Brexit. And they may well do so. But Professor Willett’s comments suggest those who do will be playing a dangerous game.

The warning around charging formed part of a golden thread running through the talk to trust bosses at the conference in Manchester. That was a warning – if it wasn’t already abundantly clear – to expect intense scrutiny from the government every step of the way.

The professor said: “If we do have a no-deal exit, then the NHS as a jewel in the crown will also be of political interest and [we] would anticipate a lot of government scrutiny over what’s happening in the NHS and how we’re supporting services.”

Another key order was that trusts must communicate better with their frontline staff – who will be a crucial vessel for disseminating correct information in an increasingly febrile environment.

A comprehensive comms strategy with frontline staff will help keep staff reassured and in the loop, but arguably more importantly, it will ensure frontline clinicians are well-placed to reassure and give accurate information to the public.

He said: “When we did our reflections of last time round [before the March Brexit deadline] one of the key aspects were that although we had communicated well to organisations, we didn’t get the communications out to the level we would like to frontline clinicians and staff, GPs, district nurses…

“People don’t realise just how much trust the public put into their frontline staff. Those words of reassurance are very powerful.”

Bearing in mind Professor Willett said the biggest risk in a no-deal scenario was posed by problems triggered by people changing their behaviour unnecessarily, the issue of this frontline communication strategy looks of critical importance.

“We’re starting to see behavioural changes in public, staff, organisations and industry that we didn’t actually see ahead of the March [exit] deadline [because a no-deal Brexit is far more likely this time around].”

He said this was concerning because behavioural change, such as stockpiling, risked eroding the government’s mitigation plans.

“We need to remain calm and steady and make sure we get information to our frontline clinicians, managers and commissioners so they can reassure people they’re working with, and the right behaviour then follows,” he added.

Meanwhile, NHS trusts in Kent are block-booking hotel rooms for staff and planning with police to get workers and patients through “gridlocked roads” to hospitals as part of preparations for a no-deal Brexit “Armageddon”, as revealed exclusively by HSJ.

Kent’s major ports at Dover, Folkestone and Ramsgate are all predicted to struggle with processing incoming vehicles under a no-deal Brexit, which is expected to cause havoc on the county’s strained road infrastructure.

One senior figure in the planning of Kent’s response to a no-deal Brexit told HSJ: “Hotel rooms have been booked for people in the command teams and if it is no deal then we are planning for Armageddon, which I guess is better than not planning for Armageddon.”

While developments in Westminster in recent days suggest a no-deal Brexit is now less likely, preparations in Kent appear eminently sensible. Anyone who has travelled on the county’s major motorway – the M20 – in recent years will tell you the traffic can be horrific at the best of times.

There were also fresh concerns last week that drugs stockpiled for a no-deal Brexit could be sold off before the 31 October deadline unless ministers intervene, as revealed by HSJ.

The Association of the British Pharmaceutical Industry warned a sell-off of stockpiled medicines could be triggered if the pound devalues against the Euro on currency markets, which finance experts say is likely if traders fear the UK will crash out without a deal.

The ABPI has refreshed its call for ministers to introduce temporary restrictions on certain drug export deals, so-called “parallel exports”, to protect the stockpiles.

The industry body also made a similar warning before the March Brexit deadline, but the government did not respond. Of course, there was no problem in March because Brexit was postponed.

But it’s puzzling why the government persists in leaving the barn door wide open on this issue when continuation of supply of medicines is policymakers’ number one NHS-related concern in a no-deal Brexit scenario.

The pound surged to a five-week high last week after lawmakers voted to prevent prime minister Boris Johnson taking the UK out of the European Union on 31 October without a transition agreement.

But there is no certainty on any front in the present environment, and as leading health and pharma policy expert Mike Birtwistle pointed out, the pound will need to strengthen considerably before this risk is eliminated.