Andy Cowper discusses the government’s recently released Brexit operational readiness guidance for the health and care system in England

I had genuinely hoped to be writing something Christmas-y and gentle, about how universal healthcare is an expression of a basic faith we have in one another as citizens. You know: that sort of column.

I can’t write that column, though I believe it to be true. Or at least trueish… and we are living through a time when we need to tell ourselves positive (yet credible) stories about ourselves, to counteract the darker and baser narratives that the “professional” propogandists of the left and right are retailing with gay abandon.

A new use for an old phrase

Readers old enough to be able to recall the days of stranding terraces at sporting stadiums may recall an expression whose genesis lies in the combined tendencies of sports fans to pre-load on beer, and of stadium owners to pack in as many people as legally safe (if not more) and provide inadequate toilet facilities.

The phrase “don’t piss down my back and tell me it’s raining” has slightly fallen into disuse, which is a pity.

What is at the heart of this latest political FUBAR

Why, Brexit. Of course.

Not only has the government imposed 26 non-disclosure agreements on pharmaceutical companies involved in making plans for the peak stupid outcome of a no-deal Brexit, it has cut public health funding by £240m in the current financial year, as analysis by the Health Foundation revealed.

The Health Foundation’s work suggests that “an additional £3bn a year is required to reverse the impact of government cuts to the public health grant and ensure that it is re-allocated according to need”.

Oh, and the government also slipped out its Brexit operational readiness guidance for the health and care system in England on the Friday afternoon before Christmas.

‘Appless ’Ancock’s cool with this

Fridge magnate Matt Hancock will be thrilled by this. As I wrote elsewhere, Mr Hancock is currently a very frightened man indeed. He has, of course, had the full briefings on what a no-deal Brexit will cause. He thus has good reason to be frightened.

And the eyes have it, as they say in the House of Commons.

Connoisseurs of shit public policy will find much to enjoy in Brexit operational readiness guidance for the health and care system in England. Not least of which is its beautiful confusion between the meaning of the word “guidance” and the implication that this is in some way, shape or form mandatory.

(It’s the old “mandatory guidance” issue, as discussed previously.)

The Magnificent Seven

These “no-deal” plans focus on the magnificent seven areas of:

  • supply of medicines and vaccines;

  • supply of medical devices and clinical consumables;

  • supply of non-clinical consumables, goods and services;

  • workforce;

  • reciprocal healthcare;

  • research and clinical trials; and

  • data sharing, processing and access.

Easy stuff, you know. No sweat for an undermanaged, overregulated healthcare system that’s been under high demand pressure for years without the resources required to start to meet them, and which is staring down the barrel of years more of much the same.

What could possibly go wrong?

In parts, it is a modestly honest document, stating that “the EU Commission has made clear that, in a ‘no deal’ exit, it will impose full third country controls on people and goods entering the EU from the UK. The cross-government planning assumption has therefore been revised to prepare for the potential impacts that the imposition of third country controls by member states could have. The revised assumption shows that there will be significantly reduced access across the short straits, for up to six months”.

In other parts it is profoundly dim, stating that “The current expectation is that there will not be a significant degree of health and care staff leaving around exit day. Organisations can escalate concerns through existing reporting mechanisms to ensure there is regional and national oversight”. How profoundly reassuring.

Likewise its language is profoundly loose at key points, where it asserts that “In a ‘no deal’ scenario, UK nationals resident in the EU, EEA and Switzerland may experience limitations to their access to healthcare services”. For “may”, read “unquestionably will”.

Expensively, it also notes that “if UK nationals living in the EU face changes in how they can access healthcare, and if they return permanently to the UK and take up ordinary residence here, they will be entitled to NHS-funded healthcare on the same basis as UK nationals already living here. It is not possible to quantify how many people might return due to changes in reciprocal healthcare, and it is important to note that people might return to the UK for many other reasons such as changes in legal status or costs of living.”

On the rather important subject of clinical trials, the document is a clue free zone.

Professionals, not propagandists

Its finest moment is found on page 18, where it tells “all health and adult social care providers to… direct staff to promote messages of continuity and reassurance to people who use health and care services, including that they should not store additional medicines at home”.

Oh dear. The whole point of this document is to make it clear and plan (as best possible) for the racing certainty that there will be disruption; quite possibly huge disruption. Trying to “direct” NHS staff to “promote messages of continuity” and reassurance is not going to work because these staff know that they are professionals and not propagandists.

Then there is the appetiser for the new 2019-20 planning guidance, of which my colleague Dave West astutely noted, “key thing… is really what is still missing - deliverables (ie ‘the ask’) for 2019-20; target expectations/ trajectories; allocations & financial rules”.

‘Don’t piss down my back and tell me it’s raining’

So here it is: Merry Christmas.

Oh yes, and you know that wet feeling spreading down your back? It’s not rain.