Brexit: Risks to NHS Sustainability

Lord Warner Excerpts

Wednesday 12th July 2017 Lords Chamber

Asked by

[Lord Warner]

To ask Her Majesty’s Government what assessment have they made of the risks to NHS sustainability arising from the United Kingdom’s departure from the European Union.

[Lord Warner (CB)]

My Lords, we now come down to earth from outer space. This debate combines two public policy areas with what I would say are well above average risks of disaster and on which there seems to be a collective governmental denial of the seriousness of the challenges and dangers we face in both areas. Even without Brexit, the NHS has to cope with major challenges to its sustainability, which is why this House set up the Select Committee on this subject. I was a member of that committee which, after collecting and analysing a massive amount of evidence, published on 5 April its report, The Long-term Sustainability of the NHS and Adult Social Care.

Let me start with what that evidence revealed. We have unrealistic and inconsistent funding for both health and social care, relative to the demands placed on both by the disease profile of an ageing population. The UK has historically spent less per capita on health than France, Germany, the Netherlands and Sweden. There is no long-term strategy to secure an appropriately skilled, well-trained and committed workforce. We have expected staff to work, for approaching a decade, under a system of unrealistic pay restraint; and we are overdependent on EU-trained staff for whom, since the Brexit result, the Government have shown little appreciation.

The NHS performs poorly on many acute area indicators compared with similar European countries in terms of survival rates from stroke, heart attacks and cancer. We are on a trajectory of worsening service access and increased rationing of that access. There are wide variations in provider performance; and the NHS is often a slow adopter of innovative technologies that could save money and improve patient care. Significant health inequalities persist, and we have failed to protect public health and prevention budgets in the middle of an obesity epidemic that could easily overwhelm us—and we are still restricting those budgets.

The provision of publicly funded adult social care is now at a tipping point, which presents the biggest immediate threat and challenge to the NHS. The Government’s proposed funding increases to 2020 are at least £2 billion too little, and they come too late; service providers are leaving the publicly funded care market in big numbers; and quality is falling, often to unsafe levels. A longer-term solution looks as far away as ever after the election fiasco on social care, and the Government will not even commit to a Dilnot cap on personal liability for social care costs, despite having the powers to do so.

The British public still strongly support a tax-funded NHS, free at the point of clinical need, and the Select Committee could find little international evidence to change fundamentally this funding system. But the public are losing heart and now 55% of them expect the NHS to deteriorate. Both these services—health and social care—need a much more consistent funding system, agreed on a more long-term basis, with a stronger real-terms link to GDP growth, which in turn requires an economy that is growing.

There is strong evidence that the way in which we deliver health and care services has to change radically and rapidly if the NHS and publicly funded adult social care are to be sustainable. We have to integrate fully health and care, with much more care delivered in primary and community care settings, and with a greater focus on public health and prevention, especially with our obesity epidemic. All this requires investment and the Government paying attention quickly to the kind of changes set out in the Select Committee’s report, with 32 significant recommendations for the changes required. Crucial to that service transformation are service transformation plans, which are now at various stages of development and implementation around the country. Many are controversial with local communities in terms of closure of hospital beds and services. They often need a supportive and robust Government to amend the failed Health and Social Care Act 2012, which all too easily hampers local reforms. A weakened Government now lack the authority and capacity to do this, as the Queen’s Speech made clear.

I am not going to discuss the Select Committee’s recommendations now. They are matters for debate another day, when the Government finally get around to responding to our report. What I am trying to do today is demonstrate that our health and care system is not in a good place. It requires a lot of political investment of time and money, preferably on a cross-party basis. It also requires a buoyant economy over the next few years to provide the investment that these critical and publicly supported services need. Yet the Office for Budget Responsibility last year projected a £15.2 billion hit to the public finances by 2020-21 after the UK leaves the EU, which would mean a loss of about £2.4 billion a year to the NHS—and even more if there is a more severe economic downturn than the OBR thought.

The harsh Brexit reality is that we face an exit from the single market, with poor transitional arrangements, the loss of trade with our near neighbours, fewer tax-producing financial services jobs, higher inflation and a shrinking economy. We have a dysfunctional Government with no credible plan for leaving the EU without serious damage to our economy over the coming years and not even any agreement on a sensible transitional arrangement. This Government continue to delude themselves about the willingness of the EU to compromise on its fundamental, treaty-prescribed principles.

I do not usually quote trade union leaders, but the head of the Transport Salaried Staffs’ Association seemed to me to sum things up rather well when he said:

“If Brexit goes ahead, future historians will look back and see a carpet-bombing of the British economy and the freedoms enjoyed by people living here”.


This set of circumstances does not bode well for our already fragile health and care system, and the prospects could become worse as a result of other things the Government seem willing to sacrifice in their rush to the EU exit. We have already virtually lost the EU pharmaceutical regulator—the EMA—from London, with the loss of high-quality jobs and the adverse impact on our life sciences sector that this brings.

The Government’s obsession with escaping from the European Court of Justice’s jurisdiction has led to the bizarre and ill-considered decision to quit Euratom, with no credible alternative civil nuclear regulator in prospect and—by the Government’s own admission, it would appear—without any proper assessment of the impact of quitting Euratom. Leaving Euratom now poses another threat to the NHS and its patients, as the Royal College of Radiologists has pointed out. Thousands of NHS cancer patients rely for diagnosis and treatment each year on radioactive isotopes imported from EU countries. The safety regulator for this activity is Euratom, governed by an EU treaty. The best interests of the UK and its citizens would be served by us remaining a member of Euratom, but the ideologues in No. 10 seem to have decided otherwise—despite the European Court of Justice never having made a ruling on Euratom.

On top of this, the health and care system depends on about 150,000 doctors, nurses and other care staff from the EU, because of our failure to train and retain enough home-grown staff. About 7% of our doctors are EEA-trained, and 40% of social care staff in London are from the EU. But the biggest problem may well be a shortage of nurses, because we import about 10,000 nurses a year from the EEA. Already the number of EU nationals registering as nurses in England has dropped by over 90% since the referendum. All this is becoming a serious problem. Because of the Government’s failure to move quickly to reassure EU nationals of their right to remain here after Brexit, many of these EU nationals no longer trust the Government’s belated assurances—in part because EU political leaders do not trust them, either.

In conclusion, this is a hell of a mess. A fragile health and care system badly needing reform and new investment from a growing economy is now facing economic retrenchment, political uncertainty, loss of a key staffing source and collateral damage from ideological obsessions with the ECJ. This is today’s reality, in contrast with the leave campaign’s lies on its red bus about Brexit providing £350 million a week more for the NHS. In the coming months, more people will realise where the Government’s approach to Brexit is taking this country economically and its implications for public services. Then we will see how committed they really are to Brexit. I ask the Minister: what plans do the Government have to protect our fragile health and care system over the next two or three years of great political uncertainty?