Leaving the EU: Health and Social Care

Alison Thewliss Excerpts

Tuesday 19th March 2019 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is an absolute pleasure and a privilege to serve under your chairmanship, Mr Bone. I thank my hon. Friend the Member for Argyll and Bute (Brendan O’Hara) for his thorough and passionate account of why a clear focus on the health and social care system is so important. That will be true beyond Brexit, but Brexit is our immediate concern, which is why we must give it serious attention.

The NHS does fantastic work. I had the privilege of working for four years in Argyll and Bute, covering the hospital there as a forensic psychologist. Rural hospitals in Argyll and Bute are excellent and innovative in their practice. Even 10 to 15 years ago, when I was working there, we were grappling with the internet and how to engage in therapy on timescales that would best suit patients. The use of technology in those rural areas was innovative, and I commend the NHS staff I worked with, many of whom still work there, for their work to provide fantastic patient care.

Two weeks ago there was an extraordinary meeting when seven all-party parliamentary groups came together to look at health and social care. I am fortunate enough to have been the chair of the all-party parliamentary group on disability since the 2015 general election. The chairs of the all-party groups were there and we brought in carers and service users to speak about their concerns. There is growing concern in Parliament about the NHS, and about the implications of a no-deal Brexit, particularly on medicines regulation and our ability to staff hospitals and provide excellent care, as we always have. It was an important and informative meeting and I suggest to the Government that a further meeting might come out of it, with the all-party group chairs, to hear the views of the service users and carers who attended, and to take forward some of their recommendations. They are on the frontline and know what happens day to day in our services. I am sure that they will be extremely informative and constructive if they have an opportunity to meet the Minister.

When I was a member of the Health and Social Care Committee, we conducted an inquiry into Brexit, medicines, medical devices and substances of human origin. A particular concern was raised about our ability to lead on research trials, and about patients’ ability to participate in trials, particularly on diseases that are perhaps less common but where there is a need to pull in subjects or participants from a huge area such as the EU. Currently, patients here can participate in such trials, and we can also lead on some of them. That has brought some of the best scientists and researchers to the United Kingdom. I would be interested to hear from the Minister how we will ensure that continues. Also, how will our constituents continue to have access to such important trials, rather than having to wait until some way down the line to get new and innovative medications?

During that inquiry, the Select Committee urged the Government particularly to look at regulatory alignment and the implications of no deal. We raised concerns about the lack of references to Brexit in the Department’s single departmental plan. It would be useful to have an update from the Minister on that work, which I am sure is ongoing. There was also some concern about protecting the UK’s position globally in relation to pharmaceuticals. On the matter of full membership of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, reassurance was sought that that matter would be taken up at the earliest opportunity. It would be extremely helpful if the Minister gave an update on that.

The Select Committee recommended negotiating a close relationship with the EU, including associate membership of the European Medicines Agency, and supported the Government’s intention in that respect. Our report stated:

“Failure to achieve an ongoing collaboration would signal the triumph of political ideology over patient care.”

I say firmly to everyone involved, from all parties in Parliament, that patient care must be placed firmly before political ideology. The NHS is one of our most prized institutions—for everyone across the United Kingdom—and must remain so. Our overriding message was that almost all the evidence received suggested that

“the UK should continue to align with the EU regulatory regimes”

for medicines and devices. An update from the Minister would be helpful.

The hon. Member for Coventry South (Mr Cunningham), who is not currently in his place, made an interesting intervention about predatory procurement. I understand that we do not want to be alarmist in Parliament, but patients bring such concerns to us, so reassurance from the Minister would be helpful. The hon. Member for Henley (John Howell) spoke eloquently about his constituency and talked about diabetes and cystic fibrosis. Many constituents go to their Member of Parliament seeking reassurance about the implications of Brexit for their medicinal needs. The hon. Gentleman also spoke about mental health, which we cannot speak about enough in Parliament, because for many years it was never broached. I am the Scottish National party’s spokesperson on mental health, so I thank him for raising it, because I consider it important for it to be mentioned in as many debates as possible. It has an impact in every part of our lives, and if we are to provide holistic care it must have parity with physical health in all we do.

My hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) spoke about medicinal isotopes. There is a huge pharmaceutical industry presence in my constituency, and I have been in touch with those businesses in the past month. There continue to be grave concerns about alignment and regulation for the industry. I think it is the continuing uncertainty that puts such a burden on businesses.

My hon. Friend the Member for North Ayrshire and Arran also said that one in five GPs are EU nationals and talked about our heavy reliance on workers from the EU, who do a fantastic job in the NHS. A number of witnesses to the Health and Social Care Committee told us just the same. We of course do not want to lose their valuable skills and expertise. They have built bonds with patients—or, if they work in the social care sector, with the people they care for—over a long period of time, and that cannot be overestimated. We must never undervalue their contribution. They need their place to be secure. Many of those workers do not earn over the £30,000 threshold, so we need a specialist case to ensure that the expertise stays in the country to support those vulnerable constituents of ours who need it.

Something that was repeatedly raised with the Select Committee—the hon. Member for Strangford (Jim Shannon) also mentioned this—is the fact that we have come to rely on high levels of staffing from the EU and elsewhere. It has been mooted that if we cannot attract staff from the EU, we could attract them from India or perhaps Africa. Those places in particular need their trained staff, and something must be done about training for young people in this country who want to go into health and social care settings.

[Alison Thewliss (Glasgow Central) (SNP)]

My hon. Friend makes a good point, but she will be aware that many people who have qualifications are currently not allowed to work by the Home Office. Two of my constituents worked in a care home and it would have loved to have them back, but the Home Office says no. Does she share my frustration that the Government say one thing on the one hand, and then something else on the other?

[Dr Cameron]

My hon. Friend makes an excellent point. Things have to be joined up exactly so that we can provide the continuity of care that patients need so much. There are thousands of excellent, high-achieving students who particularly want to study medicine, as well as psychology, occupational therapy and other occupations that are badly needed to support our NHS and our community health services. We must invest in these young people as we go forward. That point was made strongly by the hon. Member for Strangford, who is always an extremely good advocate for his constituency.

I look forward to the Minister’s response on social care, on medicines regulation and on the other issues we have spoken about. My hon. Friend the Member for Glasgow East (David Linden) also expressed concern about social care and those working in care homes. We must make that a more attractive occupation for people coming from school. I did it for a few years before going into clinical psychology; it is a rewarding occupation where carers build a real bond with those they care for. I ask the Minister to meet the APPGs, and I say to him very sincerely that we want to collaborate in a constructive way.

--- Later in debate ---

[Julie Cooper]

I absolutely agree. We cannot dismiss concerns just because we do not like their implications; it would be irresponsible to do so. Delivery into the UK is currently a just-in-time service for the pharmaceutical industry, for many of the reasons I have mentioned. It is true that in the long term, there is some manufacturing capacity in the UK and we could change the way we get our supplies, but that is not going to happen overnight. It would take a considerable amount of time, given the stringent safety requirements involved in the manufacture of safe medicines, for us to be able to do that.

I am not convinced that we have sufficient supplies or that sufficient steps are in place to ensure an uninterrupted supply. People, including those who rely on insulin, are legitimately worried. Breast cancer care organisations have raised the issue of access to radioactive isotopes needed in the vital treatment of breast cancer. It would be irresponsible of them not to raise that. It is extremely worrying, given that we have only 10 days until the UK leaves the EU, that there are still no arrangements in place. There is no doubt that the UK will need time to establish new supply chains, which is perfectly possible. It is not scaremongering. [Interruption.] I thank the Minister for the comments he has just made from a sedentary position, but we are not convinced. It we were to leave without a deal, the effects would be catastrophic.

[Alison Thewliss]

The hon. Lady is absolutely right that we should be worried. Just last night, the Government made changes to the human medicines regulations to bring in a serious shortage protocol, under which Ministers would be able to add medicines to a list and designate a shortage. In practice, it will mean that pharmacists can replace prescribed drugs with others at the pharmacy if there is a shortage. Does that not illustrate what she is saying?

[Julie Cooper]

The hon. Lady makes a really important point. I would be the first to speak up for the skills of community pharmacists, but that measure is a passing of the buck. It does not put the interests of patients and their safety first and foremost, which is very worrying.

I move on to the life science industry and research, which several Members have touched on. The UK is a world leader in life sciences and a major centre for research. The sector employs 220,000 people and attracts some of the finest research talent in the world. Four of the world’s top six universities for the research and study of clinical and health topics are based in the UK. Biotech company clusters and partnerships are found across the country, making up the largest biotech pipeline in Europe. It is a fact that the UK has been the recipient a bigger share of EU research funding than any other EU nation. It is hard to overstate the importance of the EU to the biomedical sector in the UK and the health outcomes for British patients. Shared initiatives—such as the “New Drugs for Bad Bugs” programme, which aims to tackle antimicrobial resistance—in which pharmacologists from across the EU work together for mutual gain are incredibly important for the future. As we leave the EU, we risk losing the benefits that arise from being a hub for world-class research. The investment, the talent and the infrastructure, including jobs, are all at risk. The removal of those benefits has begun, and arrangements are already in place to relocate the European Medicines Agency from London to Amsterdam.

Time is short, and there are many issues of concern about this subject. One key concern is workforce. I agree with the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), and I thank our NHS staff for the tremendous work that they do. I pay tribute to the excellent service that we still enjoy, in spite of the many challenges. It is because of that excellent service that we feel so passionate today; we do not want to lose it. I also put on record my thanks to the care workers, especially those who have helped me to look after my mum. It just so happens that they come from Poland and Latvia, and they are amazing, but their status is at risk.

Hon. Members have talked about the existing challenges in the workforce, and rightly so. We already have a workforce crisis in the NHS and in social care. There are many reasons for that, including some that have already been mentioned: we do not train enough staff; we put up barriers to training, including the removal of bursaries; and working conditions and pay are often not what they should be, as the hon. Member for Strangford (Jim Shannon) said. There is no doubt that making it more difficult for EU health professionals and EU carers to work in the UK will not help the situation we face.

The scale of the contribution from the EU cannot be underestimated: 5.6% of the total NHS workforce come from the EU. In addition, we already have 100,000 care workers from the EU working in this country, and we know to our shame that we currently have 1 million vulnerable people with unmet care needs. I appreciate the points that the hon. Member for Henley made about the excellent work in his constituency, but I point out to him that the majority of care for vulnerable people is delivered in their homes—or not delivered, in many cases, which is a massive problem for us.

To replace the EU NHS staff and the contribution that social care workers from the EU make would be extremely costly to the NHS. It certainly will not be a saving to the nation. The worst situation we could face would be if the Government failed to prevent a no-deal situation. There are ways of coping with all the other areas, given time and a transition period. I am keen to stress to the Minister that this is not about scaremongering, but about sensible concerns and a reassurance that sensible provision is in place.

I want to touch on future trade deals. People rightly raise concerns that many of the current problems experienced in both health and social care have arisen as a direct result of the fragmentation and privatisation of provision following the Health and Social Care Act 2012. There is a risk that future trade deals will add to the problem of privatisation.

In the months leading up to the referendum, the people of this country were promised that there would be a Brexit dividend for the NHS, and the figure of an additional £350 million per week—surely the biggest exaggeration of the Brexit campaign—was irresponsibly promoted. However, the reality is that in the light of the Government’s own predictions of low economic growth, there will be less funding for the NHS after we leave the EU. The Government are also very clear that if we leave the EU next week with no deal, the economic cost to our nation will be even greater.

It is our duty to respect the result of the referendum, but as public servants it is our highest duty to ensure that our constituents’ standards of health and wellbeing are protected. The NHS is regularly cited by the British public as one of the greatest achievements of—I have to say—a Labour Government. Brexit was sold as a way to protect the NHS, and no matter how misguided that promise was, as servants of the people we must deliver on it. Protecting the NHS is also the will of people, as they have shown in many elections.

To protect the NHS and to respect the will of the people, can the Minister provide assurances on the specific points that have been raised today? Can he confirm that the Government will rule out no deal and minimise the potential for negative impact on the NHS and social care sectors? Can he demonstrate that he is not ignoring the legitimate concerns raised today and out there in the community, from Members of this place, from patients and their representatives and from healthcare professionals? Can he demonstrate that the Government are listening and have sensible provisions in place, and that they will take every step to avoid a no-deal Brexit next week?