Brexit: Reciprocal Healthcare (European Union Committee Report)

Baroness Pinnock Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, it has been a real privilege to be part of this important investigation and I thank the noble Lord, Lord Jay, for his consummate skill in leading us and guiding the committee through to such clear recommendations.

It is no surprise that many noble Lords have focused on reciprocal healthcare as it affects the island of Ireland. The most striking testimonies I heard as a member of the committee were from healthcare professionals from Ireland. Our witnesses came from both Eire and Northern Ireland and they spoke as one, with passion and very deep concern as to the future of healthcare in their countries. As a direct consequence of the Good Friday agreement, the common travel agreement and the EU’s positive support, health provision for the communities on both sides of the border has been significantly improved. We were told of the situation, before all these arrangements came into play, of ambulances stopping at the border to transfer patients. That is a thing of the past and it needs to remain a thing of the past.

We have heard from the noble Lord, Lord Ribeiro, about the joint commissioning of healthcare. Like him, I was very taken by the example we were given about children who suffered from hearing difficulties and the arrangements that were made for ear, nose and throat operations as a consequence. Children were waiting up to four years in the north for their first appointment. Following the EU funding which enabled more ENT surgeons to be employed, those surgeons spent some of their time in the south and some in the north. What a wonderful example of the Good Friday peace agreement it is that children are cared for and get the operations they need in a more timely way. We are putting that at risk. The Royal College of Physicians of Edinburgh warned that Brexit could result in “substantial disruption” of health services. We also heard a witness statement, which I found moving, saying that patients’ lives had been saved because of free movement across the border and free access to both jurisdictions’ healthcare.

Unfortunately, I am sorry to say, the Government’s response to the committee’s report is far from convincing or reassuring. While the Government are clearly committed to retaining the enormous benefits to the healthcare of the people of Ireland there are no hard and fast proposals, let alone plans, to provide any comfort that they are determined to find a solution that retains—and continues—the significant cross-border joint commissioning of healthcare, even if doing so means that one of the famous red lines has to be erased. The Minister has given us a good and full response. However, can he give us any assurance that the priority for health provision in Ireland will be the health and well-being of all its people, regardless of other conflicting political demands?

The second aspect on which I wish to focus is that of the EHIC arrangements. Millions of UK residents take advantage of the insurance that EHIC provides when they take a holiday in an EU member state. The card provides peace of mind to holidaymakers and travellers that they will be able to access healthcare, wherever they are in the EU, if they have an accident or become ill. The Government continue to try to reassure us that they want the EHIC provisions to remain. However, doubts persist, certainly in my mind, because we are constantly reminded that nothing is agreed until everything is agreed. The committee investigated the potential consequences of the loss of the EHIC arrangements. The travel insurance industry told us quite clearly that the only replacement will be higher travel insurance costs. One figure we heard—it was a guesstimate—was that insurance may rise by up to 20% without EHIC. As the report clearly states, for some people with long-term health conditions, insurance costs may well become prohibitive.

In the Government’s response to the report, they state that they will seek continued participation in the EHIC scheme as a non-member state. However, they say:

“The exact nature of these arrangements is a matter that will be discussed during the next phase of negotiations”.


Yet people are already planning holidays for 2019; some retired people take a long period away from the rigours of a UK winter in the warmer and sunnier climes of southern Europe. Their contracts will be signed in the next few months and certainly before the proposed date for Brexit. What are these travellers supposed to do? Should they rely on the continuation of the EHIC arrangement or take out full travel insurance, which will cover the costs of any ill health eventuality? We simply do not know. The Government have a responsibility to provide advice on this matter.

All in all, the Government have acknowledged the soundness of the judgments made on many issues in the report. I am very pleased about that. Unfortunately, they have failed to provide what I would call the copper-bottomed assurances that travellers require, so that they know whether the Government’s Brexit plans will result in higher travel insurance costs and, for the people of Ireland both north and south, whether their cross-border health provision can continue and expand. These are serious questions and they require serious answers. I look forward to the Government’s response today from the Minister and, more significantly, to when clarity is provided—I hope—in the White Paper to be published next week.

NHS and Social Care: Winter Service Delivery

Baroness Pinnock Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, I draw attention to my interests as a local councillor in the borough of Kirklees, and as a vice-president of the Local Government Association.

The stark facts are that in the last winter period, there were an estimated 34,300 excess winter deaths in England and Wales. That is a shockingly high figure and one on which I hope we will seriously reflect. Last October, a joint university research team found that of these excess winter deaths, around 8,000 a year may be caused by “deadly” levels of so-called bed blocking. NHS England regularly reports on delayed transfers, and the latest report cites a number of reasons for them: insufficient capacity in intermediate bed-based so-called step-down care; social care assessments and agreement with families for transfer to residential care; and delays in providing home care support for those who can continue to live in their own homes.

Leaving older people in hospital when they are able to go home has a very high impact on the individual, their family and other patients, as well as additional costs to the NHS, obviously. However, it is hardly surprising that these delays occur with such devastating consequences. Professional bodies and local government have been making it clear for many years that the funding of adult social care is at crisis point. As we have heard, the LGA estimates that there is a £2.3 billion per year shortfall in the funding necessary for adult social care. This figure is confirmed by work done by the King’s Fund. The result is that local authorities have been steadily reducing care costs and defining ever higher eligibility criteria. So across England, spending per adult resident on social care fell by 11% between 2009 and 2016—that is according to the Government’s own figures.

Ten per cent of councils have cut their spending on social care by 25%. Think about what that means to vulnerable older people who need social care in those areas. Councils serving more deprived areas have had to make even deeper cuts to social care budgets, despite clear evidence of efforts to protect social care spending. The more deprived an area, the higher reliance on government revenue support grant, hence the larger the cut in the spending power of these councils, as the Government, year on year, cut the revenue support grant to fund them. Local authorities have had to respond to much reduced budgets by putting pressure on the costs of local authority-funded residential care and home care. The result is not surprising: care homes cross-subsidise by higher payments from self-funders. That is a scandal waiting to hit the headlines.

Rationing has resulted in the number receiving care falling by 25% between 2009 and 2014—and I am sure that that has risen in the couple of years since then. Consequently, older people are struggling for longer on their own and the tendency is for this to escalate into more acute episodes requiring acute care in hospital. It is quite obvious that a significant part of the solution is for the Government to provide adequate funding for adult social care.

The Government’s response to this crisis of funding has been woeful. A much-publicised £2 billion has been added to the social care budget, but that is over three years—in other words, a mere £600 million a year in the face of a need for £2.3 billion a year. The additional £1 billion provision in the 2017 Budget has come with very long strings attached. A lot of it has gone not to adult social care budgets but to the better care fund, which is about collaboration between the NHS and social care services. The Government have decided, in the face of this funding crisis, to put the burden of social care costs on to what they have previously described as “hard-pressed council tax payers”.

Councils are able to charge a 3% social care precept for two years, but council tax is a regressive tax system that takes no account of ability to pay. Furthermore, a council tax rise of 1% raises very different amounts according to the rateable values in the council district. So 1% in my own borough of Kirklees raises £1.6 million, and a 3% rise barely covers inflation. The consequence is that Kirklees Council will, reluctantly, further reduce expenditure on adult social care this year.

The Government have enhanced funding for the NHS and social care through the better care fund but, in my experience, the NHS and local authorities have, quite rightly, used this fund to develop more collaborative approaches, which do not impinge on the immediate crisis. Does the Minister accept that adult social care funding needs to be substantially increased year on year to meet the shortfall predicted by 2020? I look forward to him providing some positive hope in the promised Green Paper of the Government’s willingness to accept the crisis for what it is: a consequence of inadequate funding.