Brexit: the implications for health and social care

Brexit has major implications for health and social care in England. In this ‘long read’, the Kings Fund looks at some of the latest developments that could impact the health and care system in England.


The deadline of 29 March 2019, set when Article 50 was triggered, is rapidly approaching but many important issues are still to be resolved. Brexit has already had an impact, especially on the recruitment and retention of EU nationals in some parts of the workforce which is contributing to shortages of key staff. In addition, the ongoing debate in parliament and uncertainty about whether a deal can be agreed mean considerable work has gone into preparations for a no-deal Brexit.

The Department of Health and Social Care has published guidance for organisations to prepare contingency plans and has established a national operational response centre to lead on responding to any disruption to the delivery of health and care services.

This long read, originally written by Helen McKenna and published on 13 December 2017, has been updated by Beccy Baird on 22 February 2019 and explores the following topics:

  • Staffing
  • Accessing treatment
  • Regulation
  • Cross-border co-operation
  • Funding and finance

Full detail at the Kings Fund

NHS financial sustainability 

National Audit Office | January 2019 |  NHS financial sustainability

The National Audit Office (NAO) has produced its annual report into the financial sustainability in the NHS. It concludes that the existence of  substantial deficits in some parts of the system, offset by surpluses elsewhere coupled with growing waiting lists and year-on-year increases in waiting times, does not paint a picture that is sustainable. 


The current funding flows in the NHS are complicated and do not support partnership working, integration and the better management of demand. Trusts also told the NAO that Sustainability and Transformation Fund payments made by NHS England have encouraged trusts to prioritise short-term gains over long-term sustainability which also resulted in reduced collaboration with other local bodies.

The NAO has made a number of recommendations to the Department, NHS England and NHS Improvement to ensure additional funding is spent wisely. This includes testing whether local plans to manage demand are realistic; ensuring key risks to delivery of the long-term plan are identified; and developing a sustainable long-term plan to support trusts in severe financial difficulty (Source: NAO).

Full report – NHS financial sustainability

Summary – NHS financial sustainability

ePub – NHS financial sustainability

NHS financial sustainability [press release]

How do you ensure robust system risk management arrangements?

HFMA |December 2018 | How do you ensure robust system risk management arrangements?

HFMA- the professional body for the healthcare finance profession- has issued its latest briefing in its series on system governance. The briefing explores how to support robust system risk management arrangements.

Each health and care system is different and one size does not fit all. However, there are some common essential ingredients to developing good system-wide finance and governance arrangements. This briefing considers the key challenges, shares experiences from across the country and draws out the top tips to help readers as they think about how to develop their own governance arrangements. governance elements
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The briefing is intended to be particularly helpful for health and care system leaders, finance officers, non-executive directors and lay members (Source: HFMA).

The briefing can be downloaded from HFMA

Of interest:

How do you align resource plans across the system?

How do you support effective system decision-making?

Mental health funding squeeze has lengthened waiting times, say NHS finance leads

The King’s Fund | December 2018 | Mental health funding squeeze has lengthened waiting times, say NHS finance leads

Eight out of ten NHS trust finance directors say that funding pressures have led to longer waiting times for people who need mental health treatment, according to The King’s Fund’s latest quarterly monitoring report.


New analysis for the report also shows that despite NHS England meeting its commitment to increase its investment in mental health, nearly a quarter of mental health trusts recorded a reduction in income between 2016/17 and 2017/18. An analysis of mental health trusts’ financial accounts carried out for the report found that, while mental health trusts as a whole reported an overall increase in funding, 21 per cent recorded a reduction in income last year, up from 13 per cent the previous year.

The report is published ahead of NHS England’s long-term plan, which was recently delayed amidst political turmoil over Brexit and is now expected early in the new year (Source: The King’s Fund).

Read the full press release from The King’s Fund

70 years of the NHS in Wales: the changing role of the NHS finance function

HFMA  | October 2018 | 70 years of the NHS in Wales: the changing role of the NHS finance function

HFMA has released a briefing, which reflects on what has changed for the NHS in Wales since its inception 70 years ago; it reviews some of the advancements and challenges faced; and explores how this might inform the direction of travel for the NHS policy framework in Wales and the role of NHS finance.


Read the full briefing at HFMA

Looking ahead: the NHS at 100

Looking ahead: the NHS at 100 | Healthcare Financial Management Association

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The challenges facing the NHS are significant. Waiting lists are increasing, A&E attendances are rising and access to GP
appointments can be difficult. Alongside this is a growing population who are living longer and developing more complex conditions, which increases demand on an
already overstretched service.

This report explores the key challenges the HFMA think will have the biggest impact on the financial future of health and social care.  It highlights the likely direction of travel and provides insight to help inform current decision-making.

Full report: Looking ahead: the NHS at 100


Tackling the nursing shortage

The Open University | May 2018 | The Open University: Tackling the nursing shortage

Tackling the nursing shortage, the  new publication from The Open University considers the financial impact of temporary staffing to address the shortage, which the report describes this as “an expensive, short-term approach to plugging the gaps – [as] it costs the NHS nearly £1.5 billion a year.”  It also outlines many of the factors driving the shortage, suggesting that new routes into the profession, like apprenticeships, can help to plug the gap and future-proof the nursing workforce in the long-term (Open University).

The Open University
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Using data obtained by The Open University under the Freedom of Information Act, the report calculates that if the hours  currently worked by temporary staff were instead covered by permanent nurses, the NHS could save as much as £560 million a year. This funding could otherwise be used to pay for continuing professional development or improved services.  

The report can be downloaded from The Open University 

In the media:

The Telegraph Nurse shortages cost the NHS up to £2.4 billion last year

The Independent NHS spending £1.5bn a year on temporary nurses as staff leave in droves, study reveals