Welcome to About that bus… our new blog bringing you up to date news and views, and 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.

30 10 19 NHS Brexit chief tells trusts “preparations for a no deal outcome must continue”

NHS EU exit strategic commander chief Keith Willett has written to local leaders. The letter, dated 29, October, says: “If ratification [of a Brexit deal] has not happened by 31 January 2020 the legal default is that the UK will leave the EU without a deal.

“This means that preparations for a no deal outcome must continue, adjusted to the new timescales. The current daily EU Exit SitRep therefore will be paused from today (Tuesday) until we approach the next no deal date.” Read full letter here.

28 10 19 The ‘About that bus…?’ newsletter is out! This week: our bitesize guide to the new deal

The NHS must ignore the political mayhem and remain geared up for a no-deal Brexit. But here’s our bitesize guide to what Boris Johnson’s proposals would mean for the NHS if he can get them through parliament, by James Illman. Read more here.

The Brexit process was thrown into fresh chaos last week after the government’s attempts to bulldoze its deal through parliament were thwarted.

As this briefing was written on Friday, MPs were scheduled to vote today on the government’s demand for an election on 12 December and the EU was deciding if they would sanction an extension to the 31 October deadline.

23 10 19 New Brexit plan worse for NHS than May’s deal, experts warn

The NHS will be exposed to more risk by the government’s latest Brexit deal than by Theresa May’s original agreement, health service experts and lobby groups have told HSJ. Experts have raised a series of concerns around the impact on the continuity of medical supplies which could result from potential trade friction, and the impact on the NHS of the UK’s growth prospects being downgraded by experts under the new deal.

One senior NHS figure also said the shorter transition period attached to the latest deal means the UK has less time to broker a new trade deal with Europe before it could face another potential fresh “no-deal” cliff edge in December 2020.

23 09 19 The Nuffield Trust’s analysis on Johnson Brexit deal

The Nuffield Trust’s resident Brexit expert Mark Dayan has identified the key differences between what the Johnson and the May deals mean for the NHS in a concise blog here.

22 10 19 Exclusive survey: NHS bosses’ Brexit concerns at final planning stage revealed

Local NHS leaders remain concerned about several wide-ranging issues which could be unleashed on the service if there is a no-deal Brexit, from continuity of medical supplies to transport problems. But an NHS Confederation survey suggests the sector has undergone a robust planning process and is “generally well-prepared”. The lobby group’s head of international relations Layla McCay analyses the results further.

14 10 19  Ministers announce 400,000 extra doses of flu vaccine ordered for winter

The Department of Health and Social Care has ordered 400,000 extra doses of the adult flu vaccine for the winter period, which it said would “ensure there is enough vaccine supply in England ahead of Brexit on 31 October”.

The move follows Oseltamivir, brand name Tamiflu, being put on a list of 24 medicines which exporting restrictions have been placed on in the approach to the Brexit deadline. The DHSC said: “Based on the vaccine uptake in 2018-19, there will be sufficient stock across all providers to meet the expected demand.”

14 10 19  The ‘About that bus…?’ newsletter is out! This week: Brexit fatigue is no joke for the NHS

A large hospital trust which will likely encounter severe challenges if there is a no-deal Brexit later this month has identified “EU exit fatigue” as one of the key risks facing its organisation. Brexit fatigue is no joke for the health service and treating it will require an early down payment on the NHS People Plan by system leaders, writes James Illman. Read more here. 

11 10 19 Ministers signs freight capacity contracts worth £87m for after October Brexit deadline

The government has signed contracts collectively worth £86.6m with four ferry operators to ship medicines into the UK following the 31 October Brexit deadline.

Transport Secretary Grant Shapps announced the deal today and said it was in place whether the UK exited the European Union with or without a deal.

Mr Shapps revealed ferry operators Brittany Ferries, DFDS, P&O and Stena Line had secured contracts. They “will be ready to deliver capacity equivalent to thousands of heavy goods vehicles per week from 31 October,” he said.

A Department for Transport statement said: “Contracts will be in place for six months and are the first to result from the government’s freight capacity framework. Collectively they are worth up to £86.6m.”

“The firms will operate on routes which have been assessed as less likely to face any potential disruption, if the UK leaves the EU without a deal

“In order to bid for contracts all firms had to already be on the government’s freight capacity framework – a shortlist of experienced and capable freight operators.”

The DfT said it had also invested £30m “to bolster the country’s ports so that they can help continue the smooth flow of trade and transport after 31 October”, which was announced over the summer.

02 10 19 LIVE FROM 2:30 – MPs grill NHS and DHSC chiefs on Brexit

The public accounts committee is taking evidence on the NHS’s Brexit preparedness from key government and health service leaders following the National Audit Office’s report last week.

You can watch it here.

The witnesses are:

  • Department of Health and Social Care permanent secretary Sir Chris Wormald
  • DHSC chief commercial officer Steve Oldfield
  • NHS England EU Exit strategic commander Professor Keith Willett
  • Department for Transport permanent secretary Bernadette Kelly
  • Department for Transport director general for international and security group Gareth Davies

30 90 19 Ambulance trust faces multimillion pound bill for no-deal Brexit

A source has told HSJ South East Coast Ambulance Service Foundation Trust has held internal discussions focused on additional costs, which could run into millions of pounds, if no-deal Brexit leads to severe traffic disruption, reveals HSJ’s south east correspondent Alison Moore.

The bill consists of costs linked to staff – such as paying overtime if journeys take longer to complete and having to put some staff up in hotels – as well as potentially calling on other ambulance trusts for help and hiring more private ambulance services.

30 09 19 The ‘About that bus…?’ newsletter is out! This week: Ministers’ tactics to see off threat of a Brexit drugs sell-off revealed

Ministers are opting for a ‘watchful waiting’ approach to addressing concerns that drugs stockpiled for a no-deal Brexit could be sold off by wholesalers if there is a deterioration in the pound ahead of 31 October, senior sources have told HSJ. But do the arrangements go far enough? Read more here.

27.09.19 NAO report lays bare fundamental Brexit preparedness concerns

Fundamental concerns have been raised by MPs and health policy experts about how prepared the health and social care system is for a no-deal Brexit next month following a report by the government’s auditor published today.

The report on no-deal preparations highlights concerns about gaps in medical stockpiles, alternative transport routes and freight capacity for medical supplies having not been identified, and a lack of information about how prepared social care providers are.

MPs on the Public Accounts Committee said the National Audit Office’s report, Exiting the EU: supplying the health and social care sector, on how well prepared the sectors were for a no-deal Brexit was “deeply concerning”.

The report acknowledged the Department of Health and Social Care had done “a great deal of work to prepare for a no-deal Brexit” but it said there remained a “significant amount to do” before 31 October.

The key areas of concern highlighted by the influential committee – continuity of medical supply, both in terms of stockpiling and transport arrangements, and social care sector readiness – were highlighted in an exclusive report by HSJ earlier this month.

But the NAO report reveals previously unpublished details about what proportion of the medicines suitable for stockpiling had been secured, and the “alarming” lack of grip the government has on the social care sector’s preparations.

On continuity of medical supply, it said some 91per cent of products have been stockpiled before the last Brexit date – but this still leaves nine per cent unaccounted for, which the Nuffield Trust said was “too high”.

The Nuffield Trust also said it was “very troubling” that suppliers have found new alternative routes into the UK away from the short Channel crossings for only 25 per cent of medicines.

“There is little here to reassure us that they are ready for shortages or supplier failure,” the think-tank’s Brexit expert Mark Dayan said.

On the lack of preparedness of social care sector, the report said the DHSC does not know what preparations have been made and whether needs will be met by the sector’s providers.

NHS Confederation’s director of international relations Layla McCay said: “alarm bells should be ringing loudly about the fact the government knows very little about the readiness of the 24,000 social care providers in England alone”.

PAC chair Meg Hillier said: “The independent NAO report is deeply concerning and highlights the real risks of a no deal exit on 31st October.

“The DHSC still doesn’t know whether all stockpiles are in place, it has no idea whether social care providers are ready and it is still not certain whether all the freight capacity government needs will be in place on time.”

A DHSC spokesman said: “We want to reassure patients we are doing everything we can to make sure they can access the medicines they need after Brexit on 31 October, whatever the circumstances.”

24 09 19  No-deal Brexit could close down practices, says RCGP chair

The non-pharmaceutical supply chain post-Brexit must be addressed by the government or it could risk the closure of practices “up and down the country”, according to the RCGP chair.

According to a report by Pulse, RCGP chair Professor Helen Stokes-Lampard voiced her concerns about the supply chain of basic non-medical supplies in general practice at a Labour party conference fringe session. She said in her practice in the Midlands, she worries about products such as printer paper running out, which could lead to surgery closures and asked the panel for answers.

She said: ’My challenge and question to the panel is not about pharmaceuticals, it’s about the non-pharmaceuticals supply chain. We’ve 12,500 medicines and we’ve got twice that number of non-medicine supplies.”

23 09 19 The ‘About that bus…?’ newsletter is out! This week: Not just Kent – The troubled health economies facing a no-deal jam

Some of the NHS’ most troubled health economies could face unprecedented port-related transport chaos under a no-deal Brexit. And it was revealed last week ministers may have downplayed the potential disruption expected beyond the south east coast. James Illman examines some of the potential problem areas.

20.09.19  Shortlist for extra freight capacity revealed

Eurotunnel, Brittany Ferries, P&O and Stena are among transport companies on a UK government shortlist to provide up to £300m of additional international freight capacity in the event of a no-deal Brexit, the Financial Times has reported.

The government will now hold “mini competitions” to see which companies on the shortlist can provide the best service and price — with a deadline of early October. The Department for Transport is scrambling to secure providers so that capacity is in place ahead of October 31, the date by which Boris Johnson has said the UK must leave the EU with or without a deal.

17.09.19 Listen to HSJ’s Brexit correspondent James Illman discussing the potential impact of a no-deal Brexit on the NHS on BBC Radio 4’s World at One last week (starting at 10 minutes 50 seconds).

“There are concerns around the medical supply and the both the NHS and social care workforce…[but[ it’s [also] wishful think to think you can ‘Brexit proof’ the NHS through planning alone because the unknown variable are the ones which could turn out to be the biggest problems.”

16.09.19 The ‘About that bus…?’ newsletter is out! This week: The NHS’ biggest no-deal Brexit threat   

The Yellowhammer documents released last week should focus NHS minds on the need to ratchet up lobbying efforts. Avoiding the social care crisis likely to materialise after a no-deal Brexit – which will need improved funding and policy change – is the most pressing issue, writes James Illman

13.09.19 Which drugs could be vulnerable to shortage if there is a no-deal Brexit?

An online pharmacy has identified a wide range of 59 drugs which its suppliers have expressed supply concerns about, some of which could be driven by patients stockpiling ahead of a potential no-deal Brexit.

The wide range of drugs varies from over-the-counter medicines like aspirin, to antipsychotics, blood pressure and cancer medicines, and even Viagra.

The list, by online doctor and pharmacy e-Surgery, represents the drugs “which [it’s] suppliers have expressed concern about, either because there are worries around availability or because the prices are already rising as a result of stockpiling; leading to real concerns over post-Brexit costs and supply”.

The list does not say whether the concerns are driven by general availability concerns or are directly by Brexit. See the full list here.

12.09.19 Exclusive: NHS chiefs want latest no-deal plans from government

NHS chiefs have urged ministers to publish their up-to-date plans for a no-deal Brexit, in the wake of the release of Project Yellowhammer documents.

Ministers published the short but controversial five-page document on the possible impact of a no-deal Brexit, titled Operation Yellowhammer “HMG reasonable worst case planning assumptions” last night.

NHS Confederation’s director of international relations Layla McCay told HSJ: “What we really need is not to be working off a document that’s five weeks old.

“We need to see the most up to date planning assumptions and work out where we are up to now.” Read more here.

12.09.19 Government publishes Yellowhammer document

The government last night published the now much-publicised document on risks around a no-deal Brexit titled Operation Yellowhammer “HMG reasonable worst case planning assumptions”.

The document is identical to the one leaked to the Sunday Times last month except a couple of crucial differences.

The version the Sunday Times saw, which ministers had wrongly insisted was “old”, was titled “base scenario” not worst case scenario. Secondly, there were some reductions in the published, although the point does not relate to the NHS.

The five-page document sets out well-publicised concerns about continuity of supply of medicines and medical devices and the fragility of the social care workforce. But the Department of Health and Social Care is facing calls to publish all the documents prepared in support of what represents a very high-level summary of concerns.

10.09.19 NHS Employers chief says he’s “very concerned” by tone of government’s comments on immigration

The chief executive of NHS Employers has warned the tone of the government’s comments on immigration is unwelcome.

Danny Mortimer said: “We are very concerned about the tone of the messaging about what will happen if someone is not registered with [an immigration] scheme by December 2020, with threats of ‘enforcement action, detention and removal as an immigration offender’.

“The welcome words about valuing our current EU colleagues working or living in the UK need to be followed up with positive action that enables the attraction of the workforce desperately needed across social care and health, not the aggressive approach that has caused so much distress in the past.”

09.09.2019: OUR FIRST ‘ABOUT THAT BUS…’ NEWSLETTER IS OUT! ‘About that bus…’: Preparing for ‘Armageddon’ and intense political scrutiny

Our first edition of ‘About that bus…’ newsletter 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.

06.09.2019: NHS Brexit chief tells trusts to get charging plans sorted – ministers “will want to see a visible change”

The NHS’ Brexit chief has said trusts should grow teams to be ready to charge some European Union patients in the event of a no-deal, as government “will want to see a visible change”.

The warning came as part of wide-ranging address to managers at the Expo conference NHS England’s EU exit strategic commander Keith Willett. He also said his top no-deal concerns were around the loss of social care staff and “behavioural change”. Read more here.

05.09.2019: Hello and Welcome to About that bus…

HSJ’s new blog will give you up-to-date news and views, and the inside track on how the fallout from Brexit is affecting the NHS at national and local level. This blog will be updated in real time as events unfold. You can also sign up for our About that bus… weekly newsletter here which will wrap up the week’s developments with further exclusive content and expert analysis from our team. You can sign up to receive this by subscribing to Daily Insight

Today, we exclusively revealed Kent health services 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”. Read more here.

Meanwhile, fresh concerns have been raised that drugs stockpiled for a no-deal Brexit could be sold off before the 31 October deadline unless ministers intervene. The Association of the British Pharmaceutical Industry warns 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.  Read more here.