EU Exit planning update: DHSC update (27-03-2019)

Letter from Department of Health & Social Care via Care Quality Commission

26 March 2019

Dear colleagues

EU exit contingency planning update for adult social care providers and local authorities

As you will no doubt have heard, the European Council has agreed to extend Article 50. If Parliament is unable to agree a deal, we will leave the EU without a deal on 12 April. If Parliament agrees a deal before 12 April, the European Council has agreed to extend our leave date until 22 May to get the necessary legislation passed.

However, the Department of Health and Social Care (DHSC) has made clear to us that unless and until a Withdrawal Agreement is ratified by the UK and the European Parliament, we must continue to plan for the possibility of a no deal outcome.

Further to the letter from the Minister of State for Care, Caroline Dinenage, on 26 February 2019 and letters from Jonathan Marron, Director General for Community and Social Care, on 15 March, this letter provides additional details about the National Supply Disruption Response. It also gives an update on the supply of a range of non-clinical goods and services.

This letter provides an update on:

  • National Supply Disruption Response
  • The Supply of Non-Clinical Goods and Services:
    • Food
    • Laundry
    • Fuel
    • Data

National Supply Disruption Response

The National Supply Disruption Response (NSDR) will coordinate between suppliers, health services and adult social care organisations and central government. It will monitor the supply situation and coordinate actions to address supply disruption incidents that occur after the UK has exited the EU where normal procedures are unable to provide a resolution.

To ensure we have captured products that are vital to social care, we have worked with the Care Provider Alliance and local government to cover the following categories: medicines; medical devices and clinical consumables; and non-clinical goods and services.

The NSDR includes a 24/7 call centre to record supplies disruption concerns from any source. It will offer logistics trouble-shooting to suppliers whose consignments are stuck in border disruption, including being a gatekeeper for access to the Department of Health and Social Care’s (DHSC) Dedicated Shipment Channel – a priority shipping route for DHSC products. Supply disruption issues that are not purely logistical will be immediately passed to case management teams in the Department that can work with relevant stakeholders to resolve the problem.

What are we asking adult social care providers to do?

If an adult social care provider experiences a problem with supply of a product, in the first instance we ask that providers follow business as usual process, i.e. speaking to the supplier or seeking an alternative. If satisfactory resolution is not possible through these actions then care providers can contact the NSDR. It may not be clear to providers whether the delay is directly related to EU Exit, and that is okay. The NSDR can help, for example by providing the product if it is in a central stockpile of products that have been stockpiled ahead of EU Exit; by working with suppliers to resolve the delays to delivery and/or by working with care providers to identify actions to mitigate impact on care provision. In many cases the supplier may have already contacted NSDR themselves which would help with identifying the best actions to take.

The following table identifies what actions adult social care providers can take locally in the event of experiencing supply disruption to products and services:

Product Actions
Medical Devices

Clinical Consumables

and Non-Clinical Goods and Services

  • In the first instance follow any business as usual processes, check with your supplier or where relevant with other branches in your organisation.
  • Consider if alternative products are available.
  • If you know it’s supplied by the NHS Supply Chain, then check with your usual NHS Supply Chain Contact.
  • If this does not satisfactorily resolve the issue, then contact the NSDR centre.
Medicines
  • You should continue to manage medicines supply issues as per current processes.
  • Any medicines supply issues (regardless of whether or not they are considered to be related to EU Exit) that you are concerned about, or for which you require further assistance, should continue to be reported via your community pharmacist (and they should know the latest on any supply disruptions).
  • If this does not satisfactorily resolve the issue then contact the NSDR centre.
Vaccines
  • With vaccines that are ordered through the ImmForm website (and centrally procured by Public Health England (PHE)), you should continue to use existing channels when you need to replenish stock.
  • For locally procured vaccines you should follow relevant procedures for Medicines (see above).

Care providers can take the following actions to promptly identify and manage supply issues:

  • ensure you have processes in place for monitoring your own stock positions and any supplier issues so that you can identify and escalate issues at the earliest opportunity;
  • ensure you have processes in place for the investigation and management of all supply disruption incidents and for prompt escalation through the appropriate national supply disruption channels;
  • cascade this information on the reporting of supply issues and NSDR arrangements to members of staff as relevant;
  • work at local level with the relevant Director of Adult Social Services, who will be working with their local NHS partners.

For supply issues to be escalated to the NSDR you should have the following information available where applicable when contacting the NSDR:

  • Details of the disruption and causes;
  • Anticipated disruption and causes;
  • Products or services affected;
  • Criticality of products or services for care;
  • Potential alternative products or service providers;
  • The likely impact of the disruption;
  • How many providers and/or people in care that could be affected (by region/country where applicable).

If you experience disruption to your supplies or you feel there is potential for disruption, regardless of the cause and no immediate resolution is available, you can report it to the NSDR centre on:

Tel: Freephone number in the UK: 0800 915 9964, Direct line: 0044 (0) 191 283 6543
Email: supplydisruptionservice@nhsbsa.nhs.uk

Non-Clinical Goods and Services

Non-clinical goods and services include categories of goods/ services such as IT (service agreements/ infrastructure), waste management, facilities management, service maintenance contracts, laundry services and food / catering.

To date, there has been engagement with stakeholders across social care including the Care Provider Alliance and United Kingdom Homecare Association, as well as providers of care, to identify any risks to Non-Clinical Goods and Services that could prevent delivery of services if impacted by disruption in the event that the UK leaves the EU without a deal. This activity has led to subsequent engagement with suppliers of critical goods and services to social care providers to understand if they have contingency plans in place.

We wish to update you on some specific categories:

Food

The letter from the Ministry of Housing Communities and Local Government (MHCLG) and activity by the Department for Environment Food and Rural Affairs (DEFRA) around food has focused on discussions with major food providers and supply chain organisations and discussions with PHE and NHSI regarding nutritional advice in the event of any disruptions to food supply.

Some risks have been identified through our engagement with suppliers. Risks identified include;

  • 30% of food items or ingredients being imported from the EU;
  • a high proportion of EU sourced food items and ingredients being imported via the channel tunnel or ‘roll-on–roll-off’ Dover/Calais ferry crossings;
  • the possible deterioration of fresh/perishable items that may be impacted by border or port delays;
  • limitations in the ability of organisations to stockpile due to a shortage of appropriate storage;
  • potential logistics issues (with respect to both sourcing and delivering / distributing food items or ingredients within the UK).

The health and care system is accustomed to handling short term food shortages as a result of a seasonal variations and as such we expect that a common-sense approach to menu planning will ensure continuous provision of nutritious and balanced meals. The full food guidance document can be found in Annex |A of this letter. Some considerations relating to contract management of any services impacted by the UK leaving the EU can be found in Annex B.

Laundry

DHSC have engaged with a range of laundry suppliers both internally and externally to the health and care system. The engagements have covered linen stocks, detergents, workforce, machinery spares, packaging and logistics. While the assurance work undertaken predominantly relates to secondary care, we have done some complimentary assurance with Social Care laundry suppliers. We encourage providers to continue discussions with their suppliers locally, including maintenance suppliers.

Fuel

The Government believes that the fuel industry is well positioned to respond to disruptions to the supply chain whatever cause.

The Government will continue to work with the fuel industry to ensure that no risks from leaving the European Union impact fuel supplies. I encourage adult social care providers and local authorities to talk to their local resilience forum regarding contingency arrangements.

Data protection

At present, the UK benefits from the free flow of personal data with the European Economic Area (EAA) and adequate third countries. If the UK leaves the EU without a deal, the UK will transitionally recognise all EEA states, EU and EEA institutions, adequate third countries and Gibraltar as though they have been subject to an affirmative adequacy decision by the UK. This means that, for example, personal data will continue to flow freely from the UK to the EU/EEA. However, at the point of exit, EU/EEA law will consider the UK a third country. This will mean the transfer of personal data from the EU/EEA to the UK will be restricted unless appropriate safeguards are put in place.

Adult social care providers and other UK and EU/EEA organisations can take steps to mitigate the potential impact of no deal by implementing appropriate safeguards to send personal data from the EU/EEA to the UK. Details of what the appropriate safeguards available are and how to make sure of them are set out on gov.uk, ICO guidance and European Data Protection Board information note. For further information, adult social care providers can also refer to NHSE guidance.

I have sent a letter to the NHS which covers the same areas.

I hope that you find this update useful and I thank you again for everything you are doing to ensure the health and care system is prepared for the implications of the UK leaving the EU.

STEVE OLDFIELD

CHIEF COMMERCIAL OFFICER

 

Annex A – Food Guidance

  1. In the event of no deal, the EU Commission has made it clear that it will impose full third country controls on people and goods entering the EU from the UK. As a result, the cross-government planning assumption is that we should prepare for the introduction of third country controls by the EU, and for the potential impacts of those controls. In specific terms this could mean significant congestion and disruption at the short strait crossings for a period of up to six months.
  2. DHSC, along with other Government Departments such as DEFRA and agencies such as Public Health England (PHE), have been assessing the impact of EU Exit upon food supplies into the health and social care system, and whilst it seems likely that the supply of some food items may be disrupted, no overall shortage of food is anticipated.
  3. Health and social care providers are accustomed to adapting to seasonal variations and short-term shortages for food items and ingredients (such as those caused by poor harvests). Accordingly, it is anticipated that a common sense approach to the risk of disruption presented by the possibility of no deal, together with the use of sensible mitigating actions (similar to the menu item substitutions used to manage seasonal variations in the availability of produce), will enable care providers to continue to provide a balanced diet to those in its care.
  4. PHE’s advice is that in the short term (e.g. 2-3 months) any disruptions to the supply of specific food items or ingredients are unlikely to result in low nutrient intakes, nutrient deficiencies or significant health impacts for people who do not have specific health-related dietary requirements, because a balanced diet (such as that set out in the Government’s Eatwell Guide) can be made up from a wide range of foods.
  5. Therefore, shortages in single food items are unlikely to be of concern from a nutritional perspective, as there are a number of food sources available in each of the food groups within the Eatwell Guide (which are listed below), and the overall balance of a diet is more important than the nutrient content of individual foods. A varied and balanced diet, which includes plenty of fruit and vegetables in line with the Eatwell Guide (and which follows government advice for vitamin D supplementation) should provide all the nutrients that a healthy individual requires.
    • The main food groups set out within the Eatwell Guide are:
      • Fruit & vegetables;
      • Beans, pulses, fish, eggs, meat and other proteins;
      • Potatoes, bread, rice, pasta and other starchy carbohydrates;
      • Dairy and alternatives; and
      • Oils and spreads.
  6. This guide, with additional Government nutrition advice, can be accessed online at: https://www.gov.uk/government/publications/the-eatwell-guide. A summary of this advice is provided below.
  7. Accordingly, organisations may wish to consider contacting their suppliers to discuss their specific operational requirements with their suppliers with respect to any anticipated supply disruption regarding specific food items or ingredients.

Fruit and vegetables

Eat at least 5 portions of a variety of fruit and vegetables every day.

  • All types of fresh, frozen, tinned, juiced* and dried fruit
  • All types of fresh, frozen, juiced and tinned vegetables
  • One portion of beans and pulses can count towards one of your 5 a Day

*Government advice is to limit fruit juices and smoothies to a combined total of no more than 150ml per day due to the high free sugars content of juices and smoothies, and their ability to deliver large amounts of free sugars quickly. It is also recommended to consume these with meals to reduce the risk of tooth decay.

  • Fruit and vegetables are good sources of many vitamins (including folate), minerals and fibre
  • There is evidence that consuming more than 400g (five portions) of fruit and vegetables every day may reduce the risk of developing chronic diseases such as coronary heart disease and some cancers
  • Fruit and vegetables are very low in fat

Dairy and alternatives

Choose lower fat and lower sugar options where possible of dairy or dairy alternatives (such as soya drinks).

  • All types of milk, including dried milk, reduced fat milk, goat’s and sheep’s milk
  • Cheeses eg cheddar, cottage cheese, cheese spreads, Edam, goat’s cheese, stilton
  • Yoghurt (fruit or plain, whole milk or low-fat), or fromage frais
  • Milk-based sauces, custard and milk puddings

Calcium-fortified soya drinks

  • Milk and dairy products are excellent sources of calcium, which is needed for optimal bone strength as well as a source of protein and vitamin B12
  • The fat content of different dairy products varies, and much of this is saturated fat, so lower fat options should be used where possible
  • Fortified dried milks are a good source of vitamin D
  • Milk, cheese and yoghurt are useful sources of riboflavin

Beans, pulses, fish, eggs, meat and other proteins

Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish every week, one of which should be oily).

  • Meat, poultry, offal, fish, eggs, nuts, beans, pulses, seeds and other non-dairy sources of protein
  • All cuts of beef, lamb and pork, as well as meat and meat products such as ham, bacon, salami, corned beef, beef burgers and sausages
  • Fish includes any fresh, frozen and tinned fish, such as tuna, sardines, pilchards, and mackerel, and fish products such as fish cakes and fish fingers
  • Oily fish includes salmon, sardines, trout and mackerel
  • All eggs (boiled, poached, scrambled, fried, omelettes)
  • Beans and pulses – e.g. baked beans, chickpeas, butter beans, kidney beans and lentils. A good source of protein for vegetarians, low in fat and increase the fibre content of meals
  • Other protein products suitable for vegetarians, such as nuts, tofu and quinoa and textured protein products such as soya and mycoprotein (e.g. Quorn)
  • Meat and fish are a good source of protein, vitamins and minerals such as iron and all the B vitamins except folate. Meat is a particularly good source of riboflavin
  • Oily fish provide long chain omega-3 fatty acids, which may help to prevent heart disease. Such foods are also a source of vitamin D and iron
  • Beans and pulses are sources of protein, fibre and iron
  • Eggs are useful sources of protein, vitamin A, vitamin D and riboflavin (B2)
  • Nuts provide a source of protein, iron, fibre and essential fatty acids

Potatoes, bread, rice, pasta and other starchy carbohydrates

  • Choose wholegrain versions where possible of potatoes, bread, rice, pasta or other starchy carbohydrates
  • Starchy foods should make up just over a third of the food we eat
  • Offer higher-fibre wholegrain varieties wherever possible (Higher fibre options include wholemeal breads, breads made with a combination of white and wholemeal flour with or without added fibre, brown rice, wholewheat pasta and wholewheat/wholegrain breakfast cereals – offer low fat, salt and sugar varieties)
  • Offer potatoes cooked with skins on for more fibre
  • Foods from this group are a good source of energy and the main source of a range of nutrients in the diet
  • These foods supply fibre. Fibre helps to keep bowels healthy and helps prevent constipation. A diet rich in dietary fibre is also associated with a reduced risk of heart disease, stroke, type 2 diabetes and bowel cancer
  • These foods can also provide a good source of folate, riboflavin and iron

Oils and spreads

Choose unsaturated oils and spreads and eat in small amounts

  • Oils and spreads containing unsaturated fats include: reduced and low-fat spreads, cooking oils (eg rapeseed, sunflower and olive oils)
  • Oils and spreads are high in energy and can contribute to excess energy intakes if they are eaten in large amounts
  • Having too much saturated fat can increase the amount of cholesterol in the blood, which increases the chance of developing heart disease

Annex B – Contract Management Guidance

Further to the DHSC guidance published on 21st January 2019, and in accordance with the Department’s ‘worst case’ planning assumption for a possible no deal exit from the EU, this document sets out some contract management advice with respect to health and social care system suppliers.

In the event of no deal, the EU Commission has made it clear that it will impose full third country controls on people and goods entering the EU from the UK. As a result, the cross-government planning assumption is that we should prepare for the introduction of third country controls by the EU, and for the potential impacts of those controls. In specific terms this could mean significant congestion and disruption at the short strait crossings for a period of up to six months.

The Department’s Non-Clinical Goods & Services (NCGS) EU Exit team has been working with suppliers in order to understand both the issues facing them in the event of no deal, and the activities that they are planning or undertaking to mitigate those issues.

The purpose of this appendix is to provide advice and guidance in support of the supply chain management activities that health and social care organisations are already undertaking, highlighting those commercial issues likely to be raised by suppliers in connection with EU Exit for consideration within supply chain contingency planning and management activities.

Relationships with contractors

Effective management of supplier relationships is likely to form a critical component of EU Exit preparation and contingency planning activities, and accordingly as part of their contingency planning work organisations may wish to consider:

  • Reviewing the position with respect to their specific operational requirements with suppliers; and
  • Reviewing their contracts with suppliers to identify any potential EU Exit issues (particularly with respect to no deal).

Given that the market has been aware of the UK leaving the EU and its potential implications for some time now (and that as a result, suppliers have had a considerable period of time to plan and implement their mitigation activities), organisations may wish to consider limiting their response to any contractual performance or pricing issues raised to the extent that they are impacted by extenuating circumstances.

In working with suppliers to mitigate no deal related risks, organisations may wish to consider their approach to managing any contractual performance measures (inc. service credit regimes) or contractual pricing mechanisms that come under pressure as a direct result of EU Exit (e.g. those that are impacted by border delays, increased supply chain costs or WTO tariffs etc.).

In doing so, organisations may wish to consider a pragmatic approach to the performance management of EU Exit related issues, potentially recognising suppliers’ efforts to maintain continuity through substitution etc. by (for example) providing temporary relief from specific performance measures.

Whilst the general advice is that, to the extent possible, organisations should adopt a consistent approach to the management of exit-related risks, the application of relief from specific performance measures (or of changes to contractual pricing mechanisms) should be considered on a case by case basis, and should typically only be applied for a defined period.

Similarly, exit-related pricing changes should only be applied for a defined period, with any longer-term approach being subject to an ongoing review process. Requests to increase pricing should be underpinned by evidence of the additional costs being incurred, and organisations may wish to consider limiting additional payments to those exceptions that sit outside of the normal balance of risk assumed by the contract.

In some circumstances, organisations may also wish to consider their ability to make use of additional or alternative suppliers where contractual performance may be at risk.
Contractual positions with respect to force majeure will depend upon the circumstances and relevant contract clauses in each case. In most cases, however, it will be difficult for suppliers to make a case for relief of performance (under force majeure provisions) or frustration of contract as the likely consequences of the UK leaving the EU have been widely aired in public for some time. Suppliers have had ample time to plan for the continuation of service, and the performance of contracts should still be possible in most cases.

Organisations should seek legal advice with respect to specific contractual queries or risks.

GUIDANCE ENDS