It’s said that ‘defence of the realm is the first duty of government’. And, despite apparent agreement that this is the primary duty, there never seems to follow a list ranking the other ‘lesser’ duties of government – a sort of political Ten Commandments.

Of course, with hammer and chisel in hand, we could have a bash at drafting a Decalogue of our own (perhaps a fun experiment for another day). Probably near the top of the list would be a duty to ensure the health and wellbeing of citizens – which makes the complete lack of assessment and planning around the impact of Brexit on health and social care services look like a genuine dereliction on the part of the UK Government.

Last week, at an event organised by Voluntary Health Scotland I joined a panel with representatives from SPICe, Camphill Scotland, Changing Faces and the Royal College of Physicians of Edinburgh to explore this very issue. It would be no exaggeration to say that the evidence and opinions being aired were disturbing and suggest the outcomes will be bleak for a great many people.

As you’d expect, much of the conversation focussed on workforce, medicine and research. Some of the more hair raising points being:

  • Failure to retain membership of EURATOM, will see the supply of radioactive medical isotopes curtailed; meaning a return to invasive surgery for cancer treatments and longer waits for test results.
  • 73% of pharmaceutical imports in the UK come from the EU.
  • 12,000 non-UK EU nationals work in health and social care in Scotland (approx. 4% of workforce); meaning staff shortages if some choose to leave.
  • The Nursing and Midwifery Council reported that the number of newcomers from EU countries in 2017 dropped by 89% as compared with the previous year – leading to an increase in unfilled vacancies.
  • Only seven local authorities hold information on the number of EEA nationals they employ.
  • Around 190,000 British pensioners live on the continent. If they can’t access healthcare in the EU and returned to the UK it is estimated NHS England would require £1bn additional funding, 900 more beds and a further 1,600 nurses – with Scotland facing similar challenges.

From a third sector point of view, the concerns regarding health and care will be wider than we might think – and are currently obscured by much more pressing and obvious concerns like those listed above.

I’d argue that most of the work the third sector carries out is in some way health related. That’s because we’re in the business of creating healthy and resilient communities – focussing on preventative approaches to the societal challenges we’re most familiar with:

  • Helping people to live independently at home for longer
  • Helping people who struggle with addiction and preventing others from getting there
  • Providing community transport and tackling social isolation
  • Helping people of all ages stay fit, active and sporty
  • Providing pre and post-natal advice and support
  • Offering sexual health advice
  • Maximising incomes and benefit uptake to allow people to live better
  • Providing food security and nutrition
  • Delivering social care services
  • Advocating for and supporting people living with a disability.

Therefore, any threat to the third sector (and Brexit is as big as they come) is, by extension, going to pose a risk to the health and wellbeing of people in Scotland. If the capacity of the sector is reduced, there will inevitably be a knock on effect and we will begin to see communities that are less active, less connected, less informed, more isolated, more addicted, poorer and hungrier. All of this will quickly manifest as tangible and observable physical and mental health conditions and it will fall to already overstretched NHS and social services to try and deal with it.

Brexit really does seem to represent a perfect storm. Experience shows us that a dent in public spending means the sector no longer receive a slice of the pie, but the crumbs of what’s left. At the same time, an economic downturn and stretched household incomes (benefits are no longer linked to inflation) will see more people turning to the sector for support. In short, the sector will be expected to do much more with a lot less.

The chaotic nature of the Brexit negotiations makes it difficult for the sector to gain any concessions or clarity. However, along with colleagues we are pushing the UK Government to properly assess the impact of Brexit on our health and wellbeing; to ensure volunteers and workers can continue to contribute to the sector and our communities and to ensure human rights and protections are guaranteed. With so much at stake, it is surely their duty to do so.