Brexit: Health and Welfare

Baroness Jolly Excerpts

Thursday 29th March 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I am very grateful to my noble friend Lady Brinton for calling this debate—and very timely it is, too. The repercussions of the UK’s decision to leave the European Union spread far and wide. That is why it is especially important that we are here today to debate the critical subject of UK health and social care in a post-Brexit world. The issue of health touches the lives of every citizen, and the gravity of our situation just cannot be denied. I shall mention some of the issues I raised in Committee on the EU withdrawal Bill, but we should not forget the huge role that EU workers play in both the health and the care sectors. I am going to look at some numbers too. Mine are not quite the same as those given by the noble Baroness, Lady McIntosh of Pickering, but they are all really big numbers.

My research has suggested that 5% of the UK’s health and care workers now come from the EU. Five per cent might seem a small number, but 5% of 4.5 million is considerable: 225,000 doctors, dentists, nurses, dieticians, therapists, care workers and cleaners—I could go on. According to a November 2017 survey conducted by the British Medical Association, nearly one in five EU doctors working here had actually taken steps towards the possibility of leaving the UK. The NHS, with its already existent staff shortages and funding cuts, really cannot afford to lose any more numbers or expertise within its hard-working personnel. Royal College of Nursing chief executive Janet Davies said that the NHS “cannot afford” to lose EU staff, with 40,000 nursing vacancies in England alone. She said:

“The Government is turning off the supply of EU nurses at the very moment the NHS is in a staffing crisis”.


I understand that the Minister has said previously that the number in training is considerable, but it is sadly not enough to fill the gap. It is a fact that merely the decision to leave the UK, and the agonising uncertainty that has accompanied that decision, moulds the future nature of our health workforce. The Minister has addressed this issue at the Dispatch Box many times, but I would be grateful if, for those who neither hear it nor believe it, he would send a message that they are still welcome to remain, and remind the House of other avenues of recruitment that are being considered.

I mentioned earlier that I put my name to several probing amendments to the EU withdrawal Bill, and I express my continuing support for the public health “do no harm” amendment, as tabled by the noble Lord, Lord Warner, to be included. It is based on Article 168 of the Lisbon treaty, which is longer than “do no harm”, but we are just calling on the Government to consider health issues and make sure that any decisions made at any government level do not impact on the health of our nation. At the recent meeting of Peers, Ministers and officials to discuss the withdrawal Bill, it even gained the support of the noble and learned Lord, Lord Mackay of Clashfern. He is a really good ally to have.

The desire to ensure the level of progression and sustainability of public health in our nation is not a divisive issue. There is no pro-remain or pro-leave precedent required to support the universal notion that the protection of our citizens’ health is, and must always remain, supreme. No Member of the House would deny the key three prongs of this proposal: first, ensuring the well-being of UK citizens; secondly, protecting citizens in times of public health hazards and crises; and, thirdly, continuing the drive towards equality of healthcare and access. This amendment would offer us a great opportunity. We have the chance to express to the people of the UK that we care about the well-being of each individual member of society and, more importantly, we will prove that commitment through legislation.

Moving to over-the-counter medicines, general sales lists or GSL medicines are thoroughly integrated into the EU model of research—design, production, packaging and distribution, just like cars. Any one product may pass through several borders before finding its way on to the pharmacist’s or the local supermarket’s shelves. The noble Lord, Lord Callanan, on the second day of the Committee the Bill, assured me, when I asked about the implausible timeline for changing regulations on these medicines and the practice I have just described, that the Government are indeed working hard to ensure that research groups and trade industries are offered,

“sufficient time to implement any changes necessary”.—[Official Report, 26/2/18; col. 451.]

The notion that the Government desire to continue a close relationship with pharmaceutical and trade industries on exit is understood. The issue, then, is simply that time is running out. The Minister claimed that industries will be given sufficient notice to recognise, address, deliberate and solve any licensing or manufacturing issues that may arise. Yet the time to offer sufficient notice was yesterday. Will the Minister today clarify these issues for the House? Is there a detailed timeline for ensuring that over-the-counter medicine licensing, manufacturing and trading issues that have arisen from Brexit can be clarified, and that no patient will suffer as a result of this quandary? Can he share the rationale for excluding GSL medicines from the Department of Health and Social Care’s ongoing review of the implications of EU exit on the continuity of medicines supply to the UK, and what plans the Government have to explore those implications?

To help the Minister, I wonder whether he would be happy to meet me and the relevant trade body, the Proprietary Association of Great Britain. The PAGB represents the manufacturers of branded over-the-counter medicines, self-care medical devices and food supplements —they would all be household names.

Under the European health insurance card scheme, British tourists and residents in the EU can access free healthcare, as can EU citizens when visiting the UK. I cannot imagine—I am still struggling with this issue—what it would be like to go on holiday without the EHIC in my wallet alongside my passport, tucked away in case of an emergency. However, as the EU Home Affairs Sub-Committee stated in its report published the day before yesterday, if the Government insist on bringing an end to free movement,

“it follows that one of the fundamental rationales for reciprocal healthcare arrangements … will disappear upon Brexit”.

The loss of the EHIC would create enormous barriers for UK nationals abroad and hurdles for EU nationals living in the UK. It is critical that UK and EU patients do not lose out on access to the best treatments and medical devices as we leave the EU.

We want to make sure that patients continue to benefit from early access to new health technologies and cutting-edge medicines, and that includes being able to take part in international clinical trials. For this reason, the Government must prioritise alignment with the new EU clinical trial regulation and commit to adopting it when implemented in March 2019.

The UK’s health and social care sector has benefited enormously from our EU membership. As British tourists and residents across the EU, we rest assured that our healthcare will be covered. At home in the UK, we take for granted the host of hay-fever tablets, cold and flu treatments, painkillers and indigestion remedies that line the shelves of our local pharmacies. We benefit from the latest in health technologies and cutting-edge medicines, as well as the dedicated care of over 60,000 NHS staff in England who are EU nationals. Exactly a year from now, on 29 March 2019, how many of these benefits will remain available to us? Will we be denied access to free healthcare in the EU? Will Calpol and Strepsils—other medicines are available—be available only on mainland Europe? As regards clinical trials, what confusion! At the meeting with Ministers and officials this week, I confess that I left feeling that the situation was about as clear as mud, so clarity from the Government on this and all these issues would be appreciated.