NHS and Social Care: Impact of Brexit

Baroness Howarth of Breckland Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Howarth of Breckland (CB)]

My Lords, when one gets to this point in the list—and it seems to happen to me quite regularly—most of the statistics have been quoted and the arguments made, but it is worth repeating quite a number of them. I will concentrate particularly on social care, rather than the health service, because that is the area of my expertise.

The Minister knows that, before we get to the Brexit question, it is quite clear that social care services—and the health service—are in crisis in relation to the demand that is being produced and the number of staff and resources there are to meet that crisis. I am not saying that that is anyone’s fault, but it is a reality that the Government will have to grasp. Looking at the settlement in relation to health, I notice they are beginning to grasp it, but unless we look at the two together, which seems to be being delayed, we will not make a great deal of progress.

Because it is useful to say something different, I will start with where we are now. If we are going to face the Brexit staffing crisis, we have to be sure that we are doing everything now to make sure that we get staff in post. One tiny example of what we seem to be incapable of doing is that we have to wait 130 days at the moment for the police to clear safeguarding checks. For those 130 days, staff are not in post in care homes or local services—and I speak from experience of this—which means that there is bed-blocking at the other end, because patients cannot be moved out of beds into appropriate facilities. That is a microcosm of a number of issues that I will not go through, but if we are not doing very well at that sort of issue, how much more difficult will it be if we find the worst scenarios in relation to Brexit?

The Skills for Care national minimum dataset for social care holds information on about 23,000 care-providing establishments and 730,000 adult social care jobs. In 2015, 82% had British nationality, 12% had non-EU nationality and Skills for Care estimates that workers with EU nationality made up 6% of the adult social care workforce—which is about 80,000 jobs, as the noble Baroness, Lady Ludford, quoted. We should hold that number in our minds very clearly. Add to that the 5% of social workers who come from the EU—about 900 in total—which is another area where there are already severe shortages. It is often these staff who are making home and residential assessments as well as being responsible for safeguarding, so that is another area where we will find difficulty.

Immediately after the Brexit vote, the National Care Forum convened a meeting of a wide range of sector leaders and providers to consider five core issues: workforce; older and disabled people and their carers; funding; costs; and development. But central to their concern was what might be called soft issues. It is essential that the leadership in organisations address the concerns of staff who are becoming extremely anxious—these are people who are employing the staff, so they have direct experience. Staff are already questioning their right to stay. On the other side of the coin, those who are receiving services fear that the services might cease because the staff will have no rights. Will the Minister give leadership and support in ensuring a really clear message about ongoing entitlements and legal rights? We know that we will not leave for two years or more, but unless we reassure people now, two years will be too late.

At this point, I want to congratulate my noble friend Lady Watkins on securing this debate. Not only that, she has made an extraordinary contribution in her first year and I have learned a great deal from her. Her sheer enthusiasm for the needs of NHS staff and how they should be acknowledged, valued and reassured is something that is very clear.

If the workforce is to be maintained, the anxiety about the right to stay must be addressed; otherwise, people will not be willing to join the sector, as was indicated by the noble Lord, Lord Crisp. In addition, the fall in the value of the pound may well make working in the UK social care sector less attractive than working in other European countries. There are a number of risks that we have not looked at. Moreover, there is a less obvious financial issue. Many residents in care homes are self-funders. The financial shocks to the stock market may have a significant impact on their pensions and investments, and thus their ability to pay for their care. That is something which we have not really looked at and indeed have not felt the impact yet.

During the referendum debate, many voices were not heard. Much of the fear of immigration might have been more balanced had information from organisations like the National Care Forum been heard. The kind of statistics that we did not hear about were as follows. In London and the south-east, more than 10% of all jobs are filled by EU workers—and London voted remain. By contrast, only 1% of jobs in the north-east—around 1,000 in total—are filled by EU workers, yet most of the region voted to leave. The disunity in some communities has been widely reported. The Government must take their safeguarding role seriously at this time, when the elderly and disabled who are non-EU citizens become easy prey. Other noble Lords have given examples, and I have heard about a number of incidents where people have attacked the staff who are caring for them. Who, I would ask, do they think is going to care for them in the future if they are so unpleasant to those who are caring for them now? Many already complain about their eligibility for adult social care being removed or reduced for financial reasons, and if staff costs rise due to shortages, there will be an even deeper crisis.

There are also implications for legal rights, as a significant proportion of the UK’s law comes from the EU, including laws covering the employment rights of the care workforce and the rules and regulations which govern how services are conducted. In theory, the UK Government could repeal some or all of those laws once the exit takes place. Can the Minister confirm that this is unlikely and that EU law will continue to exercise significant influence, recognising that disentangling the UK from its EU commitments will be a lengthy process? These include matters such as rest breaks, statutory leave, compliance with night working limits and the 48-hour working week. Again, theoretically, following Brexit, the Government could change some of the working time legislation. Does the Minister think that this is likely, in view of his party’s search for better conditions, including the living wage for these staff?

In the worst-case scenario, some 55,000 health workers could face leaving the UK, but, as has been said, there are 88,000 such workers in our care services. Residential homes would cease to function and ongoing home care would be at an even higher premium. As I said earlier, discharges from hospital and community care are inextricably linked, so hospitals would be full of the elderly and disabled in entirely inappropriate care. Those who have fuelled some of the racial tension by saying that EU nationals are taking British jobs should remember that active recruitment has taken place over the years because vacancies could not be filled from the pool of existing UK citizens.

Sorry, I apologise for my cough. I did see the doctor this morning—he was a very nice Indian.

The charity Livability, which provides services for disabled people and for which I serve as a senior vice-president, currently has 50 vacancies. That is one medium-sized provider.

Nor is the Australian system the answer. Basic health and social care workers often start their careers in low-paid caring jobs and gain qualifications and promotion along the way. Can the Minister say where this pool of workers will come from, and will the demographic crisis we face be matched by an even bigger crisis in care? In my view, Brexit was bad news for most of us, but it could be fatal for those in need unless we deal with the issues of confidence and employment at speed.