The most cataclysmic week in British public life for 70 years has given the majority of predictions the shelf life of the average shadow Cabinet minister. The safest approach is that the short term impact of 23 June 2016 will be over-estimated and vice versa.
For the NHS the implications of the Brexit vote and its fallout can be corralled into three broad categories: economic; political and workforce.
Many who voted to leave the European Union did so in the belief it would benefit the NHS by reducing demand and increasing funding. The public now expect the NHS to receive a meaningful financial injection. In reality, the uncertain economic climate makes that even more unlikely than it was previously. The best working assumption is that the NHS’s cash envelope will stay roughly as planned for the next two to three years.
What will get even tougher is meeting efficiency targets and securing capital funds, thanks to expected increases in inflation and the cost of borrowing.
On a longer term basis a change of prime minister, and possibly opposition leader, appears to be creating the distance from previous policy commitments which could allow a more appropriate response to shortfalls in health and care funding – the state of the economy allowing.
Politically the most significant development for the NHS would be a snap general election during the next nine months.
Both NHS England chief executive Simon Stevens and his NHS Improvement counterpart Jim Mackey have been crystal clear this exact period is the one in which the service must take radical action.
The hard choices contained within the STPs were due to be presented to the prime minister in September
This focus was given its most dramatic demonstration by the two page letter issued by Mr Mackey to trust chief executives last week. In normal times a plan to cut NHS staffing levels and rationalise both clinical and back office services on a national scale would have been front page news.
The disruption of a general election to their plans would be considerable, so the two chief executives must be cheered by suggestions from the Tory leadership hopefuls that they do not favour such a move.
However, even some delay will be problematic. The hard choices contained within the sustainability and transformation plans submitted this week were due to be presented to the prime minister in September. Even with Mr Stevens’ immense authority at Number 10 it might now be hard to get on the new leader’s agenda quickly. And, of course, some careful scene setting and relationship building will also be required before the difficult messages are delivered.
It is in the NHS workforce that shocks from the Brexit vote are being most immediately felt. Jeremy Hunt, Bruce Keogh and numerous NHS chief executives have declared their support for the service’s European staff – and HSJ has launched a special award to celebrate their contribution.
The NHS has become a less welcoming and attractive place to work for overseas staff
The abuse of those staff, and others who have travelled from their countries of birth to work for the NHS, is abhorrent. Their commitment and resilience will protect the NHS from a rapid flight of valued staff. However, there is no doubt the NHS has become a less welcoming and attractive place to work for overseas staff.
The biggest battle the NHS will have to face during Brexit is to secure employment protection for existing and potential EU staff. All of this will be overseen by the newly slimmed down Department of Health, whose new structure is clearly designed to deal with realities of NHS financial and clinical performance and not the intricacies of picking apart EU regulations affecting the service.
Expect negotiations over issues like the working time directive and procurement and competition law to provide a proxy battleground on the future shape and direction of the NHS towards the end of the decade.