Immigration and Social Security Co-ordination (EU Withdrawal) Bill

Debate between Baroness Barker and Lord Lilley

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Monday 7th September 2020 Lords Chamber

[Baroness Barker (LD)]

I want to return to the points made by the noble Lord, Lord Hunt of Kings Heath, in his introductory remarks. The important amendment in this group is Amendment 2. All the others could be things that potentially fall out of a review, and so the key is to have that review and then look at the most appropriate way forward.

Many of the issues that have been spoken to in this debate are not new; we have been talking about social care for as long as I have been in the House. We could say many things about the current situation we find ourselves in, and some of the issues are fairly long-standing. One that I talk about a lot, but not many others do, is the fact that there are currently about a million people who are ageing and do not have children. Our health and social care service is predicated on the fact that you have children who will look out for your needs in any health or care setting. We will have 2 million people in that position by 2030. We have, therefore, an acute and growing need for paid social care. Also, at the moment, a number of our biggest care providers are owned by private equity firms, run at very low cost and margins—they are not about to stay in this business if they cannot do that, and to them, it is a business.

At Second Reading, the noble Baroness talked about the need for the United Kingdom to stop colluding in an international trade in low-cost care. I can understand that argument but, at this moment, given where we are, we would be the first affluent western country to take itself out of what is, in effect, an international market in care. No other affluent western country—nor Australia, for that matter—has solved its care problem by suddenly turning off all access to people from other nations. It would be a very bold statement if we were to do that, but noble Lords have today pointed out the dangers of doing so.

The noble Lord, Lord Hunt, is right to argue that, at this moment, there is a case for a review. The Government, if they were not being so ideologically pure on the matter, would want to give themselves flexibility in addressing these issues as they arise. There is no need to do this: it is just government ideology. The Government could bring in a transitionary process, over about five years, that would enable people to get through a period of uncertainty. I therefore commend Amendment 2 to the Minister and ask her to look at some of the other amendments in this group.

[Lord Lilley (Con) [V]]

My Lords, I will focus on Amendments 82 and 93, and particularly their implications for reviewing the need, or otherwise, to recruit nurses and doctors from overseas. I am grateful to the noble Lord, Lord Patel, and the noble Baroness, Lady Jones, for tabling them.

I suspect, however, that these amendments are based on the common fallacy that the NHS needs to recruit doctors and nurses overseas because supposedly not enough British people want to do these jobs. That is simply untrue. The latest year for which UCAS figures are available is 2019; I apologise to the House for giving out-of-date figures at Second Reading. The most recent figures show that 53,000 young British people applied to train as nurses last year, of whom 20,250 were turned away—that is 43% of applicants, or nearly half of those who applied. UCAS unfortunately does not produce figures on the same basis for those seeking to train as doctors, but it is clear that an even higher proportion of those who apply to medical school are turned away.

This is a double scandal. First, it means that tens of thousands of young Brits who aspire to serve their country as doctors or nurses are refused that chance and have to pursue less attractive options. Secondly, we have to recruit tens of thousands of doctors and nurses from abroad, mostly from countries that are far poorer, have fewer medical staff per head of population, and can ill afford to train people who then migrate to the United Kingdom.

This double scandal is compounded by the way this issue is excluded from the national debate. Why do we allow this situation to persist? We allow effectively unlimited numbers of students to study every subject from art history to zoology. The only subjects where places are numerically restricted are medicine, where they are formally restricted, and nursing, where they are de facto restricted.

I will pass over the political reasons why it may have seemed wise to advocates of mass immigration to invoke the needs of the NHS and nurses and doctors to sanctify their cause. The other reason is nakedly economic: we found it cheaper, in the short term, to employ people trained at the expense of foreign taxpayers, rather than pay to train our own citizens. At the same time, relying on nurses and other health workers from abroad, on whom many other noble Lords have focused, helps to keep wages low. What a paradox it is that many noble Lords who have spoken today and railed against the level of inequality in our country pursue a policy whose prime justification, as they have made clear today, is that it depresses the wages of the lowest-paid people in this country and keeps them below what economists call the domestic market clearing rate—the rate at which we could meet our needs from our own employees.

I was at first minded to support these amendments, but, on looking more closely, I note that one thing the reports that they call on the Government to produce do not cover is the scope for training more of those aspiring to become nurses and doctors in the UK, so that we can end the plundering of foreign health services. That is a very significant omission and shows that there is a blind spot in this discussion, which I hope we will not perpetuate in future debates.