NHS and Social Care: Impact of Brexit

Baroness Greengross Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Greengross (CB)]

My Lords, it is even later in the debate so I have been crossing out more and more of what I was going to say, which is probably good. I start by declaring my interests as registered, and in particular my heading up of the International Longevity Centre-UK and the fact that I am co-president of the International Longevity Centre Global Alliance.

The noble Baroness, Lady Watkins, has introduced an extremely timely debate, obviously, and she has emphasised the importance of ensuring safe staffing levels. I think that the word “safe” is very important, both in the NHS and social care sectors. For that to happen, we need NICE to produce indicators to ensure that those safe levels are guaranteed, as Francis recommended back in 2013. I very much hope that that will happen.

We obviously cannot afford to lose the 5% EU staff who are currently working in both the health and social care sectors in the UK. As the noble Baroness, Lady Howarth, said, Skills for Care calculates that the vacancy rate in the social care sector stands at 5.1%, which is significantly higher than the UK’s labour force as a whole, and up from 4.8% just last year in 2015. That sector also faces ever-increasing demand, as the number of people aged over 80, the most vulnerable group, is expected to double in size to more than 5 million people by 2037, which is not actually very far away. That number is significant.

Social care providers also find it very difficult to retain staff, as has been said. The International Longevity Centre calculates that the sector experiences a staff turnover rate of 24.3%, which is quite shocking. So the contribution of the 77,000 social care workers from other countries in Europe is absolutely invaluable. The safety and well-being of our population is undoubtedly at risk because of that.

Indeed, the ILC estimates that there are between 30,000 and 35,000 European-born social care workers across London and the south-east alone, providing a vital public service to our rapidly ageing society. Social care workers born in Europe, working in England today, are also younger on average than social workers born in the UK, with around one in three aged between 25 and 34. They represent a huge source and a huge potential, and they need to be fostered and trained to address the skills shortages across the adult social care sector.

The NHS Confederation also calculates that a total of 57,604 NHS staff in England alone—I love the precision of that number—come from other EU countries. As 19,000 of these people work in London, both 10% of London’s NHS workforce and 10% of London’s social care workforce were born in other European countries. So it is crucial that the Government reassure the 77,000 social care workers and the 57,604 NHS staff born in other countries of Europe, working here now, that they are free to continue to care and to provide some certainty to a sector which is in a situation of crisis.

Also, in case EU citizens are ever required to meet the demands of the Migration Advisory Committee’s shortage occupation list, I urge the Minister and the Government as a whole to consider placing senior care workers in the tier 2 category and to open tier 3 for all other care workers to ensure the social care sector has the staff and skills to care for our ageing population.

Very briefly, demand for this type of care is growing as the number of older people and people with long-term conditions more broadly—with learning disabilities and mental health conditions—increases. It is estimated that at least 1.7 million more adults will require social care over the next 15 years. This could require an increase in its workforce to between 2.1 million and 3.1 million by 2025.

Some 47% of the NHS workforce is aged over 45, compared with an average of 40% for the English working population. Only 5% of the NHS workforce is under 25. Some 1.2 million people aged 65 and over are in work in England. Perhaps more should be brought into the care workforce. That is another thought: we could bring in some of those older people. I know of a very big American home care company that makes a point of employing older people because they are very good at providing that type of care.

Let us look just for a moment at what the Royal College of Surgeons has said: doctors from the EU make up about 10% of the NHS doctor workforce. We already face significant recruitment problems because 40% of advertised consultant posts remain unfilled. We know that the number of medical trainees has decreased by 2.3%, just in the last year.

In numbers, 21,000 nurses across England come from other EU countries, more than half of them work in London and the NHS has this huge shortage of nurses. We have to keep nurses on the shortage occupation list. One of the Health Select Committee’s key recommendations in its report this month is that the Government should urgently assess and set out publicly,

“the additional costs to the NHS as a result of delayed transfers of care, and the wider costs … associated with pressures on adult social care budgets more generally”.

Our ageing population presents us with huge challenges—it is good, but it is very challenging—as does the result of the referendum, which we have been talking about. These must be faced and we must overcome them if our common humanity and the values we hold dear in this country are to be safely retained. I hope the Minister will reassure us that the Government will act appropriately to avoid a tragedy that will affect the most vulnerable people in our society.