NHS and Social Care: Impact of Brexit

Baroness Ludford Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Ludford (LD)]

I, too, thank the noble Baroness, Lady Watkins, for initiating this important debate. I declare that I am married to a health trust chairman.

As if the current pressures on the NHS’s finances and ability to cope were not bad enough, they now have the hammer blow of impending Brexit. Clearly, there needs to be much better workforce planning and support. But at present we absolutely need EU staff and it is as a result of the shortage that the Migration Advisory Committee recently advised the Government to keep nurses on the shortage occupation list. Everyone is calling out for EU workers to get the clarity and reassurance they deserve regarding their future status in the UK. This is particularly vital in key public services such as the NHS to aid workforce planning and ensure that safe staffing levels are maintained. It was reported last November that eight in 10 hospitals missed their target for day and night nurse staffing.

The Health Secretary himself said on 5 July in the other place:

“It is fair to say that the NHS would fall over without the incredible work”—[Official Report, Commons, 5/7/16; col. 730.]

that EU workers do in the NHS. I am not sure I heard that from his lips or those of any other Minister before 23 June. In a similar vein, the chairman of the Tavistock and Portman Foundation Trust, Paul Burstow, said:

“Without EU care professionals our NHS and social care sector would struggle to function”.

So we are not talking about a contribution from EU nationals at the margin. It is core. This is one of the many reasons why I am not a Brexiteer now and remain a remainer.

Some of the facts have been cited. Overall, 5% of NHS staff in England are from EU countries but in London they represent 10% of the NHS workforce. While 10,000 doctors from other EU countries are reported to be working in the NHS across England, the GMC says there are 30,000 EU doctors in this country altogether; perhaps they are working as locums or in private practice or are registered but not practising. There is an interesting extra 20,000 doctors somewhere. There are 6,500 scientific and therapeutic staff across England from other EU countries.

EU staffing is particularly significant for London and for specialist trusts. The Royal Brompton & Harefield NHS Trust has over 15% of its workforce from other EU countries, while for Great Ormond Street Hospital the figure is 11%. The top 10 all have between 11% and 15 %. But those proportions are for all staff. At Great Ormond Street, a quarter of doctors, 16% of nurses and nearly a quarter of research staff are from the EU. No wonder its chief executive has expressed deep concern about the impact of Brexit. He said that the rare and complex diseases seen in children treated at his hospital required clinical and research collaboration across Europe and, of course, worldwide.

Last but certainly not least, 6% of the social care workforce in England is from other EU countries—80,000 people in England alone. According to the King’s Fund, there are also regional variations: the figure is 12%, or 20,000 jobs, in London and 10%, or 21,000 jobs, in the rest of the south-east.

In the light of the catastrophic risk to the NHS from losing EU workers, it is frankly not good enough for the Health Secretary to say, as he did on 5 July in the other place:

“As long as the UK is subject to EU law, current arrangements remain in place”.—[Official Report, Commons, 5/7/16; col. 728.]

Yes, they do, but if he expects us and the staff to be reassured by statements by the Foreign Secretary and Home Secretary that the Government want to find a way of allowing those people to stay in the UK for as long as they wish to, we are not reassured at all by this promise of possible jam tomorrow. Staff are very unsettled, trusts report.

The Health Secretary also acknowledged that the issue of whether or not the £500 health surcharge on non-EU migrants on long-term visas would apply to EU nationals currently living in the UK,

“would obviously be subject to the negotiations”.—[Official Report, Commons, 5/7/16; col. 729.]

What kind of clarity, certainty and reassurance is that?

The NHS Confederation is surely right to insist that immediate steps should be taken to assure staff from other EU countries who are currently working in the NHS and social care that they will be able to remain in the UK indefinitely. I add that this should be on current conditions, including free access to healthcare. The uncertainty created about our ability to recruit from other EU countries in future is also deeply worrying NHS leaders, given current staff shortages. We have an immediate and pressing need for clinical staff, which cannot be met from our domestically trained market. It is a disincentive to EU staff when they do not have certainty on their future residence. The drop in the pound means less purchasing power to send money back to families, which is demotivating as well. It is also predicted to increase the NHS bill by £900 million, as suppliers will have to increase their prices to account for the drop in the pound.

The message from NHS and staff bodies is a united one: given the length of time taken to train a nurse, and even more a doctor, a failure to offer staff from the EU certainty about their future status risks not only undermining workforce planning in the NHS but the ability of the health service to maintain safe staffing levels and patient safety. If social care struggles to deliver services, the knock-on demand for NHS care will increase still further. Mencap has advised that there are already established and well-known difficulties in recruiting and retaining a sufficient number of doctors, nurses and care staff and that any disincentive or impediment to recruiting staff from EU countries will serve only to stretch these services further.

This House has on many occasions expressed its worry about the impact of Brexit on all scientific research, both staffing and funding, and that applies not least to the medical and life sciences sector. The BMA says it is concerned that as a result of the ongoing uncertainty, there is a significant risk of a loss of capacity within the UK medical research community. It is also aware of anecdotal evidence that people are turning down job offers because of the lack of security following the referendum.

Many of us want to hear the Government not only give that certainty which the NHS and others are crying out for but to articulate loud and clear an acknowledgement of the contribution made by highly skilled migrants, including doctors, nurses and researchers, in delivering and sustaining public services and the public good. Incredibly and despicably, there have been xenophobic attacks by patients—the noble Baroness, Lady Watkins, mentioned this—who have taken the referendum result as a green light to attack the NHS staff who care for them. The Government need to send a very clear message condemning such appalling attacks.

Recruitment through EU or EEA free movement is much less burdensome in bureaucracy than for migrants from non-EU countries, so those Brexiteers who claimed that EU red tape was stifling us were barking up the wrong tree on this topic, as on so many others. The chief executive of the Nursing and Midwifery Council, Jackie Smith, said recently that there would be a major impact on the regulator’s ability to process applications if it were required to apply its current approval procedures for nurses from the rest of the world to those coming from the EU, and that it would create greater costs for her organisation in verifying documentation, securing visas and administering the skills test. The mutual recognition of professional qualifications actually speeds up recruitment and training. Would EU staff in future have to go through the tier 2 process and if there is a salary threshold of £35,000, how are nurses whose average pay is £30,000 to be treated under that system?

I read the same remarks as the noble Viscount, Lord Bridgeman, quoting the president of the Royal College of Surgeons, Clare Marx. She said that Brexit would help patient safety by toughening language tests, enabling the UK to enforce a higher quality of surgical tools and instruments than EU standards and boosting surgeon training, which she claims is impeded by the working time directive. Does the Minister agree with those comments and know whether the Royal College of Surgeons agrees, as a body, with its president on them? The working time directive and its protections against overwork will of course cease to apply if we leave the EU and the EEA.

The Government keep telling us that they cannot give guarantees to EU citizens until there are negotiations which also encompass Brits abroad. But they have unilaterally replaced our European Commissioner—appointing a civil servant in place of a politician and relinquishing the key financial services dossier—and they have renounced our presidency of the European Council next year.

When they want to, the Government are perfectly capable of taking unilateral action outwith any carefully prepared Brexit strategy, so the case against unilateral and unconditional guarantees for EU staff in the NHS and elsewhere gets weaker by the day. I want to hear such unconditional guarantees. As an early win, we need to give a commitment to staff from other EU countries very quickly that they will be afforded indefinite leave to remain, with no new red tape or health surcharge; a message about how valued staff from other EU countries working in health and care are; and a commitment that nurses, and other health-related occupations as and when relevant, will remain on the shortage occupation list.

I am sure there will be other occasions when we might have to discuss a longer-term approach to migration policy, but in the immediate term we need that certainty and that reassurance. We need guarantees for the EU staff we have currently and those whom trusts are seeking to recruit, as well as similar guarantees on the funding and staffing of medical and scientific research. I hope the Minister will be able to give those.