Association of Anaesthetists and Royal College of Anaesthetists statement on Brexit supply pressures

The Department of Health and Social Care has written to health and social care providers on what they need to consider in the period leading up to March 2019 in case of a no deal Brexit.

In response, the Association of Anaesthetists and the Royal College of Anaesthetists have decided to issue a joint statement for our specialty as a no deal scenario is something that may affect the levels of staff, medicine and equipment supplies required by anaesthetic departments to deliver a safe service. The statement aims to give guidance to anaesthetists, clinical and non-clinical managers when making decisions if resources are in limited supply or absent.

In the event of a no deal Brexit it is reasonable to expect at least some disruption to supplies of medicines and equipment in the run up to and aftermath of 29 March 2019, although the scale is obviously unknown.

Therefore, we urge local solutions where Trusts and Health Boards make proactive  enquiries of their supply chain and make decisions about service priorities ahead of time. These potential shortages may affect the anaesthesia team, the anaesthesia technique and overall anaesthesia practice.

Existing guidance already provides clarity on safe practice for individual clinicians, managers and organisations and we advise that these principles should apply in the event of a no deal Brexit:

• The anaesthesia team – The primary focus of every member of the anaesthesia team should be the safety of the individual patient under their care. If any member of the anaesthesia team is concerned that safe care may not be delivered because of issues relating to drugs, equipment, facilities or staffing, they are duty bound to address these issues before initiating care (except in the presence of life-threatening emergencies), and this may include a decision to postpone surgery.
• The anaesthesia technique - When offering patients alternative techniques because of drug or equipment constraints, anaesthetists should at all times act in the best interests of the patient and be satisfied that it is better to proceed in these circumstances than to delay surgery. The patient should be fully informed so that they have opportunity to give or withhold consent to any alternative plans, as they may prefer to delay surgery if this is appropriate.
• Anaesthesia practice - Constrained resources may mean that service priorities need to be redefined. Rationing care in this situation will require clinicians, managers and commissioners to justify their decisions and be accountable. Any decisions should be communicated to patients in a transparent way.