Deal or no deal, Brexit spells potential danger for the already fragile adult social care sector. The absence of any robust coordinating mechanisms makes contingency planning tough too.
Ahead of the recent government technical papers on the implications of a no deal scenario, NHS Providers, a trade association, warned there has been no practical engagement with NHS Trusts on the implications for the NHS. In response the Department of Health and Social Care has played down the likelihood of this outcome.
So far, I can see no public evidence of any national action for the social care sector, though most councils and provider associations have rated the manner of exit from the EU as a significant risk.
The most urgent risk for care homes and nursing homes is the continued availability of medicines and equipment currently sourced from EU countries. The NHS is likely to take priority in the event of delays or shortfalls, but the sector will need to ensure continuity of supply and to plan for increased costs from new tariffs or market volatility.
Equipment needed for lifting and handling faces potential issues, and we could see trouble around replacement parts for lifts and other machinery bought from the wider EU.
Similarly, any shortages of fresh food and unexpected price increases could impact on the sector immediately.
There has been more attention on the implications for the social care workforce. According to Skills for Care, a workforce development charity, 7% are EU citizens not from the UK. There are also restrictions on what are deemed to be low-skilled workers being recruited from outside the EU.
With average turnover at over 20% per year for the social care sector, and an ongoing vacancy rate of over 6%, ending freedom of movement for current or future EU workers will hit hard. This could be exacerbated by competing recruitment of existing care staff by the NHS, supermarkets, or the hospitality sector.
There is uncertainty too for social care commissioners. Providers locked into fixed price contracts, but facing rising costs, may hand them back.
Some social care schemes receive funding from the European Structural and Investment Fund. While the government has promised to underwrite this funding until 2020, commissioners will want to ensure there is no gap or variation in eligibility.
There will be uncertainty on procurement issues that start after March 2019. They will be conducted under EU laws, but commissioners may want to see if there are any benefits post-Brexit from greater flexibility on state aid, social benefit, or local partnerships with providers.
The combination of these factors will present real challenges to councils and the NHS in meeting their public health, continuity of care and market stability responsibilities. Their local contingency planning needs backing with strong, national leadership from the government and wider sector leaders.
Andrew Cozens is an independent social care and health specialist