Health board's emergency no-deal Brexit plan revealed
Routine eye and dental examinations would be among services under-threat at NHS Lothian.
One of Scotland's biggest health boards would consider cutting back swathes of "non-essential" services in the event of no-deal Brexit.
NHS Lothian has drawn up plans to downgrade dozens of services, from routine dental treatment and eye examinations, to a helpline for people suffering from musculoskeletal disorders, to a day-care centre in Midlothian.
In Brexit impact assessments obtained by STV News through freedom of information, services have been divided into those which "must be preserved" and those which "would be deferred first".
The health board stressed these are contingency plans only and that any large organisation needs to conduct "planning that's fit for all eventualities".
Westminster has passed legislation against the government's wishes aimed at preventing a no-deal exit from the EU, with the option to seek a further Brexit delay if necessary.
But Prime Minister Boris Johnson has vowed to take the UK out of the European Union with or without a deal on October 31 - the current departure date in law - and is calling for an election to break the parliamentary deadlock.
If the NHS Lothian contingency plans were ever implemented, services which could lose out include routine cervical screening, routine post-natal examination, minor surgery, insurance and employment medicals, smoking cessation services, alcohol interventions and long-acting contraceptive treatments.
The health board would instead prioritise "vital" services such as GP practices, community nursing, treatment for acute or severe injuries, treatment for acute or chronic illnesses, palliative care, child vaccinations and mental health services.
'Having contingency plans does not necessarily reflect an expectation that we would need to implement all or even part of them. However, it is important to understand how we would prioritise our services and resources if we needed to.'Prof Alison McCallum, NHS Lothian
The assessments even suggests staff computers and staff and visitor catering could be at risk due to the strain a no-deal exit from the EU could cause on food and energy supplies.
Hospitals and surgeries would seek to prioritise patient meals as a matter of necessity, as well as preserve laboratory systems, radiology systems and other computer systems deemed vital to care.
Professor Alison McCallum, director of public health at NHS Lothian, said: "It is important to understand that resilience planning in any large organisation always involves planning that's fit for all eventualities.
"Having contingency plans does not necessarily reflect an expectation that we would need to implement all or even part of them.
"However, it is important to understand how we would prioritise our services and resources if we needed to and be prepared to take mitigating action should that be required."
The sensitive documents shed light on the extraordinary levels of planning health authorities in Scotland are undertaking to mitigate the potential impacts of leaving the EU.
Officials fear a no-deal EU exit could cause shortages of food, medicines and medical supplies, a potential workforce crisis and the return of thousands of UK nationals currently living in EU countries who would need NHS care.
The British Medical Association (BMA) warned earlier this week that a no-deal Brexit could spark the "disintegration" of the health service, exacerbated by the extra strain on the health service as winter approaches.
NHS Lothian's "strategic Brexit management group" has been meeting frequently to discuss contingency planning, as many similar groups have in public authorities across Scotland and the UK.
It has commissioned and considered impact assessments from across the health board, from local health and social care partnerships (HSCPs) as well as from facilities, IT, finance, procurement and primary care departments.
These documents are considered drafts and should be routinely refined and updated in line with developments, internal guidance states.
The guidance also makes clear the options to mitigate potential Brexit effects may never be implemented, with the impact "difficult to assess due to the uncertainty surrounding what form it will take".
But it instructs risk assessors to "provide lists of services which it could defer in order to prioritise other services and services which must be prioritised and maintained in all plausible circumstances".
Midlothian Health and Social Care Partnership (HSCP) breaks down the services it provides into three categories, with level three services most likely to be deferred, followed by level two services.
Included in level three is the Musculoskeletal (MSK) Helpline, a pan-Scottish telephone service NHS Lothian participates in for people who are concerned they could be suffering from muscle, bone or joint disorders.
Midlothian Community Physical Rehabilitation Team (MCPRT) and Highbank day-care centre, both in Bonnyrigg, are also classed as level three.
Two care homes (Highbank and Newbyres) are considered non-essential, categorised as level two, along with Midcare, a rehabilitation service for frail older people.
Services that Midlothian HSCP considers must be maintained include home care, district nursing, duty social work and Midlothian Community Hospital.
NHS Lothian's facilities department cited waste disposal, patient meals, the cleaning of clinical areas and essential transport as services which must be preserved.
But services that could be downgraded include the cleaning of non-clinical areas, staff and visitor catering and lower priority maintenance.
The department's impact assessment raised the risk of supply shortages in fresh food as one that could affect the health board's ability to meet "nutritional standards" needed for patient meals, especially for those on special diets.
The health board's primary care directorate - encompassing services like GP practices, dentists and community pharmacies - details more than 30 potential areas it could sacrifice to protect core services.
These range from travel vaccinations, to DVLA reports, to extended hours services, to an extended service programme for adults with learning disabilities, to collection of unwanted medicines, to treatments for Hepatitis A, B and C.
Services that would be prioritised ahead of these in the event of Brexit disruption include child protection, routine contraception, collection of repeat prescriptions, seasonal flu treatment, home oxygen therapy, emergency dental care and emergency optometry appointments.
It comes as the health service in Scotland prepares for major disruption to the supplies of medicine, equipment, blood and food if the UK crashes out of the EU without a deal.
NHS National Services Scotland (NSS), which coordinates supplies within the Scottish health service, has asked health boards to stockpile up to six weeks' worth of medicines, while the NHS's blood transfusion service has decided to store eight to 12 weeks' worth of "critical consumables" - products such as containers, syringes and bandages.
NSS purchased around £12m - £15m of "additional contingency stock" around spring this year, according to papers obtained by STV, equating to additional orders of more than 4000 products.
Health boards across Scotland have expressed concern at the lack of clarity over Brexit from the UK and Scottish governments.
'It is completely unacceptable that the issue of supplies of medicines and other medical resources should even arise. That is entirely the result of the UK Government's reckless approach to Brexit.'Health secretary Jeane Freeman
Some are concerned at the prospect of an influx of "returners" - UK nationals currently living elsewhere in the European Union who may return within weeks if there is a no-deal Brexit, with a potential estimate of around 300 in the NHS Grampian area alone.
And while the Scottish Government has urged hospitals not to stockpile of their own accord and to leave such planning to health boards, Raigmore Hospital in the Highlands reports it is "holding as close to maximum stock levels as it reasonably can".
Commenting on STV's findings, Scottish health secretary Jeane Freeman said: "It is completely unacceptable that the issue of supplies of medicines and other medical resources should even arise.
"That is entirely the result of the UK Government's reckless approach to Brexit.
"We are working closely with the other UK administrations, NHS Scotland health boards, social care providers and our network of community pharmacies to ensure they are as prepared as possible for all Brexit scenarios we might face.
"However, many of the most important risks, such as new customs controls and delays at the UK border, are outside the control of the Scottish Government."
She added: "It is important to note that Scotland voted decisively in favour of Remain in the 2016 referendum, and the Scottish Government continues to strongly support EU Membership.
"A no-deal Brexit would be particularly damaging and the First Minister made clear the Scottish Government's strong opposition to such a scenario during her recent meeting with the new Prime Minister."
The UK Government said it would ensure the country was "ready to leave the EU on October 31, whatever the circumstances".
Last month, the Treasury announced an extra £434m to boost stockpiling, warehouse and freight capacity for key medicines and medical equipment.
A Cabinet Office spokeswoman said: "Healthcare in Scotland is a matter for the Scottish Government, but the UK Government will continue to work with NHS Scotland and can reassure people across the whole of the United Kingdom that we will be ready to leave the EU on October 31, whatever the circumstances.
"The Chancellor announced another £2bn of funding at the spending round to further accelerate Brexit preparations and help make sure that the supply of medicines and medical products remains uninterrupted both in Scotland and the rest of the UK."
NHS Lothian: Services which could be deferred
Facilities/Digital & IT
- Individual PCs and printers
- Staff and visitor catering
- Cleaning of non-clinical areas
- MSK (The Musculoskeletal Helpline)
- MCPRT (Midlothian Community Physical Rehabilitation Team based in Bonnyrigg)
- Treatment Room Nurses
- Slow stream Ward Rehab
- Highbank Day Care
General Medical Services
- Routine post natal examination
- Routine cervical screening
- Routine child health surveillance
- Travel vaccination and advice
- Insurance/employment medicals
- Clinical coding
- LA reports
- DVLA reports
- Governance activities
Non-essential Enhanced Services
- Alcohol Brief Interventions
- Adult Learning Disability SESP (enhanced services programme)
- HPV LES (local enhanced services)
- Minor surgery
- Extended hours
- HAV / HBV (including HBV foster carers)
- Patient safety
- vLARC (very long acting reversible methods of contraception, eg injections/implants)
- Advice to residential homes
- Collection of unwanted medicines
- Other services - smoking cessation etc.
- Minor ailment service
- Public health service
General Dental Service
- Routine dental treatment
- Advice, self help and routine care
- General ophthalmic services - eye examinations