Managing EU withdrawal in health and social care in Wales: Frequently asked questions

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1 Managing EU withdrawal in health and social care in Wales: Frequently asked questions 1. Does the Welsh Government consider no-deal Brexit preparations to be part of NHS Wales normal business continuity planning, or will there be a standalone process? The Welsh Government has written to NHS and social care leaders to set out the collective actions and measures that it expects individual organisations to take in preparation for EU withdrawal to ensure the smooth and effective running of services for our patients and service users. Preparations at this stage must necessarily focus primarily on preparedness for the impact of a potential no-deal Brexit on 29 th March 2019 and should be undertaken under the auspices of business continuity planning, in conjunction with local and regional partners, including through local resilience forums. 2. How is the Welsh Government working with the UK Government to influence trade deals and ensure that health is considered a key priority in these negotiations? The UK Government is consulting devolved administrations on proposed trade deals and the Welsh Government has already signalled opportunities and risks in respect of health. 3. The Welsh NHS Confederation and others are making representations on procurement, supplies and recruitment, but what are the known gaps in this work in relation to individual Health Boards, and what areas of risk should be independently evaluated and addressed locally? The latest correspondence from Dr Andrew Goodall sets out the key actions currently required from individual organisations, focusing on resilience and continuity, continuity of supply and critical machinery and equipment. 1

2 On recruitment and retention, while we are not currently experiencing any significant change to the numbers of EU nationals on the NHS Electronic Staff Record, individual organisations should consider any local workforce issues. On social care, Social Care Wales has commissioned research to understand the numbers of EU workers in social care. High level findings will be published in January In the meantime, social care organisations should also consider any local workforce risks. Health and social care employers are encouraged to emphasise the Welsh Government s commitment to EU nationals working in health and social care in Wales both now and in the future. Further information on settled status is available here. Health and social care employees will have early access to the Home Office Settled Status application process from 29 th November until the 21 st December If EU laws and Directives no longer apply directly to the UK post-brexit, is the Welsh Government looking to introduce legislation to maximise opportunities for health and equity? The agreement between the four UK countries is that the immediate period following EU withdrawal will be used to to regularise the UK statute book. It is unlikely that any significant change in policy will take place in the short term. However, the Welsh Government recognises that there may be opportunities in the future to make Wales-specific legislation that could have positive impacts for health and wellbeing, particularly in public health. 5. There has been talk of increased costs for equipment and supplies sourced from or through Europe. Some estimates have suggested a 15-20% increase. Has the Welsh Government or the Welsh NHS Confederation had any reasonably substantiated information on this? Has a cost impact analysis of a no-deal scenario been carried out? The UK Government is working with the pharmaceutical industry to ensure a continuity of medicine supply in the event of a no-deal and to minimise any increase in prices. The UK Government has confirmed that it will meet any additional costs associated with delivering these measures. The process for ensuring continuity in the supply of medical devices and clinical consumables is being undertaken on a national basis by each of the four UK 2

3 countries. This is a complex programme and the financial implications are still being worked though. As with medicines, a co-ordinated process of engagement between the four UK countries with suppliers, in whatever form that takes, is intended to manage and minimise any potential increase in costs. 6. What will the impact be on medical equipment services in terms of consumables (spare parts and equipment); services (contracts, spares associated with the contracts, technical support); and regulations associated with medical equipment? The Welsh Government is working with the National Procurement Service, NHSWSSP, and local government procurement colleagues to understand the national and local risks. The Welsh Government is also developing contingency plans in conjunction with colleagues across the UK. This assessment is due to be completed before the end of Should patients/pharmacists start stockpiling medicines? / My child lives with a long-term condition that requires him/her to take five different types of medicine every day. What can I do to make sure that he/she never runs out? The UK government is putting in place arrangements to protect the supply of medicines across the UK. Therefore, patients, GPs and pharmacists are advised not to stockpile medicines. 8. How can the health and social care system in Wales best support mitigation of any negative impacts of Brexit on health equity as a result of any economic downturn or loss of structural funds? It is too early to predict the impact that Brexit will have on population health and health equity. Public Health Wales is undertaking a public health impact assessment which will be available before the end of 2018 and this will be kept updated as further detail of the EU withdrawal process becomes clear. A key issue for Wales will be the potential loss of EU structural and investment funds. The Welsh Government is engaged in active discussions with the UK Government on the future nature and operation of a proposed UK Shared Prosperity Fund (see here), including the extent to which Wales will be able to control how and where funds are directed. 3

4 9. What is the impact on information management and technology (IM&T) with regard to EU regulatory and network structures, particularly with medical equipment? The exact nature of future regulatory environments will depend on the final outcome of any deal. The UK Government has issued a series of technical notices which set out information on what to do in the event of no-deal, which includes guidance on data protection (see here) and medical equipment (see here). 10. Some supply chains of medical devices and equipment originate outside the EU but pass through Europe before reaching the UK. Post-Brexit, will the continuity of this supply chain be maintained so that medical devices and equipment can enter the UK in a seamless manner? Products supplied from countries outside the EU but arrive in the UK via mainland Europe (or are combined with other goods and services before entering the UK) then the chain will be maintained. This includes devices and parts of technical pieces of equipment such as MRI scanners. The Welsh Government is continuing to work on this area as part of the contingency planning work. 11. What central plans are in place in relation to stockpiling medical equipment and spares? There are national plans being developed to identify the levels of stockpiling necessary to address six weeks of potential supply disruption in the event of a nodeal scenario. This is the current UK Government s planning assumption and the Welsh Government is proceeding on this basis. Further information is available here. Should individual organisations identify the need for additional mobile equipment, then this should be highlighted to the National Procurement Service (see here). 12. What is the position of EU nationals (and their families) currently working in health and social care in Wales? We want EU health and social care staff across Wales to stay. We value each person and the jobs they do for our patients and clients. We are pleased that they have the opportunity to apply to the Home Office pilot Settled Status Scheme from 29 th November 2018 to 21 st December

5 The pilot is primarily about testing the technology and will not be available to family members. The full Settled Status Scheme, which will be open to all EU nationals, is scheduled to open on 29 th March 2019 (see here). Individual organisations should consider any local workforce issues and emphasise to staff our national commitment to EU nationals working in health and social care in Wales both now and in the future. 13. What steps are being taken to develop the workforce that is required to meet current levels of demand, particularly in relation to recruiting more Welsh graduates into medical school in Wales? Health Education and Improvement Wales (HEIW) and Social Care Wales have responsibility for developing a joint strategic workforce strategy for health and social care in Wales. This needs to address: the implications of EU withdrawal workforce planning; workforce intelligence; education and training; workforce development and modernisation; leadership development; careers; and promoting health and care careers in Wales. 14. There is concern that oversees staff may lose eligibility to remain in the UK after Brexit, leading to gaps in the workforce that cannot be filled. What is being done to address this? There will be no change to the rights of EU citizens living in the UK until From 29 th March 2019, EU citizens and their families living in the UK will be able to apply for settled status to continue living in the UK after June In the meantime, the Home Office will be running a pilot Settled Status Scheme for health and social care employees (but not their family members) from 29 th November 2018 to 21 December. 15. I am an EU national working in NHS Wales. I have recently obtained UK residence documents. Will these documents be valid post-brexit? See question 14. 5

6 16. Could there be an impact on the number of EU nationals employed by NHS Wales after we leave the EU? It is too early to determine what impact EU withdrawal will have on the health and social care workforce. A recent report published by the Cavendish Coalition and the National Institute of Economic and Social Research s report (available here) contains some projections. Health and social care employers want to reassure EU nationals working in Wales that they are valued members of the workforce and we very much want them to stay. We hope that the UK Government will develop an immigration policy post-brexit that will enable us to retain and attract talented individuals from all over the world to work in our health and social care services. 17. Is the NHS in Wales prepared to cover the costs of applications to the Home Office s Settled Status Pilot scheme? For those employed by NHS Wales, the application fee for the Settled Status pilot scheme will fall on individual applicants as is the case with all long-term residency application processes. 18. I have a Masters degree in Healthcare Science from the University of Paris. Will this qualification still be recognised by UK universities post-brexit? The Welsh Government s advice is to refer to the UK Government s technical notices (available here). In the event of a no-deal, general qualifications that have already been mutually assessed will continue to be recognised for a period to be determined. Further information on this issue will be added to these pages as it becomes available. 19. I am a Public Health Practitioner. Will the UK s membership of early disease warning systems be compromised by Brexit? If so, how can I keep up to date with the latest emerging threats to public health across the EU? Continued access to European early warning systems may be impacted depending on the nature of deal. There are four nations in the working group, led by Public 6

7 Health England, assessing the impact and identifying contingency and mitigation actions. Further information on will be added to the pages as it becomes available. 20. I am an academic and researcher at Swansea University. I have been working with colleagues in Universities across the EU to support research on precision medicine. The research is funded partly by my University and partly by Horizon Will this be impacted by Brexit? Existing and pipeline Horizon 2020 projects are covered by a HM Treasury guarantee and should not be affected. There is a strong commitment from the UK and EU to continue to collaborate on research and innovation in programme such as Horizon Europe, but the exact nature of this will be subject to any deal. 21. I am a pharmacist. Post-Brexit, how can I be sure that the medicines I prescribe to patients are safe? What regulations will be put in place? Patient safety will continue to be a fundamental priority. The UK Government has issued guidance through its technical notice here. 22. What are we considering about Easter holiday and annual leave agreements could there be a national direction? In the event of a no-deal Brexit, individual organisations should consider any workforce risks as part of their local emergency planning arrangements and develop contingency arrangements where appropriate. 23. What is the situation for hospital food, given that it has a shelf life of approximately 3.5 days? Continuity of the supply of hospital food is being considered as part of the national civil contingency plans on a UK level. In the meantime, individual organisations should consider the management of hospital food as part of their local resilience planning processes. 7

8 24. How can the EU transition fund (ETF) be accessed, and how is it being prioritised and administered? The ETF can be accessed by submitting a bid to the Welsh Government s Department for Health and Social Services via HSS-Brexit@gov.wales. Bids are administered, assessed and prioritised by a Welsh Government Cabinet subcommittee. Details of the criteria and application process can be found here. 25. What is the arrangement for communicating key messages to NHS Wales staff and the wider public? The Welsh Government is developing a communications plan which will be applicable to health and social care workers as well as the general public. Further information on this will be added to these pages. In the meantime, individual organisations are communicating and engaging their staff on specific issues, such as the Settled Status Scheme. 26. What steps are being taken to increase engagement among NHS Wales staff about the Settled Status pilot scheme and where they can apply for it? NHS Wales Employers is working closely with NHS organisations across Wales to ensure that EU nationals working with the NHS are aware of the pilot scheme and the Home Office portal through which they can apply. 27. Will the Welsh Government fund administrative support for the additional work being asked of NHS organisations? There are no plans for the Welsh Government to fund administrative support on behalf on individual organisations. Welsh Government is providing support through its EU Transition Fund to the Welsh NHS Confederation, the Welsh Local Government Association (WLGA), the Association of Directors of Social Services Cymru (ADSSC) and Public Health Wales. These organisations will support Welsh Government in supporting, communicating and engaging public, independent and third sector health and social care organisations to prepare for EU withdrawal. 8

9 28. Given that intrauterine contraception and implants are manufactured entirely outside of the UK, will there be shortages of these devices post-brexit? At-risk goods are being considered as part of the continuity of supply contingency planning arrangements. If you are aware of supply risks for specific medicines, medical equipment parts or clinical consumables, then please contact your local procurement officer. 29. What implications could Brexit have for NHS patients in Wales? The Welsh Government is working closely with the NHS and social care partners to avoid any impact on NHS patients or social care clients. The immediate priority is to prepare for a no-deal scenario, but planning is also in development to deal with longer term challenges and opportunities that will emerge when the UK leaves the EU in whatever form that takes. 30. I am a British citizen. Will I still be able to use my European Health Insurance Card (EHIC) to access healthcare in the EU post-brexit? This will depend on the nature of the deal. The UK Government s preferred outcome is to maintain the existing system. 31. What is continuous residence and am I eligible to apply for it? Currently, non-eu citizens can apply to settle in the UK if they have been in the UK legally for ten continuous years (known as long residence). Further information from the Home Office is available here. 32. What is settled status? How do I apply for it? Is there any guidance to support me throughout the process? How long will this process take? Having settled status (or pre-settled status) means EU citizens can continue to live and work in the UK after 31 st December An EU citizen with settled or presettled status is able to use the NHS, work in the UK and travel in and out of the UK. Further information from the UK Government is available here. 9

10 33. Will I still be able to take part in EU-wide Clinical Trials? This will depend on the nature of any deal. The UK Government has issued a technical notice which outlines the position in the event of a no-deal. 34. Will my rights under the Working Time Directive be protected post-brexit? Yes, an individual s rights under the Working Time Directive will continue to be protected. There is no intention from the UK Government to change this. 35. How will the UK s involvement with European Reference Networks be impacted by Brexit? This will depend on the nature of any deal. Any questions about this briefing should be directed to BrexitFAQs@welshconfed.org Last Updated: 8 th November

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