Brexit: Risks to NHS Sustainability

Baroness Ludford Excerpts

Wednesday 12th July 2017 Lords Chamber

[Baroness Ludford (LD)]

My Lords, I warmly thank the noble Lord, Lord Warner, for initiating this important debate. As he said, we are very reliant on EU workers in the NHS and social care, which includes around 10% of doctors and 7% of nurses. Sadly, there is already evidence that they are leaving or not coming to the UK. As well as the alarming drop in nurses cited by the noble Lord, more than half of the 10,000 European doctors working in the NHS are now considering leaving, according to a survey conducted by the General Medical Council.

In social care, 7% of staff, or 90,000 people, are from elsewhere in the EU, but numbers are already dropping. The Brexit squeeze on social care workers is likely to hit the elderly hardest, as it is predicted that there will be almost 3.5 million more over-65s by 2030. That figure could be supplemented by many UK pensioners returning from places like Spain if their rights to residence, public services and especially to healthcare are not safeguarded. We could be losing fit, younger skilled workers just as the pressure of more older people needing the NHS and social care builds ever higher. The exodus of EU staff exacerbates the shortage of doctors, nurses and care staff, which puts a heavy workload on current staff, causing many to leave the service. So we absolutely need to attract EU workers into the NHS and social care rather than deterring them in order to fill the vacancies.

The Liberal Democrats regard the Government’s proposals on EU citizens’ rights as inadequate, and in particular are calling on the Government to guarantee an immediate “NHS passport” for the 60,000 EU nationals who work directly for the NHS. In the future under Conservative plans, the NHS faces an “immigration skills charge” of £2,000 a year for each doctor, nurse and health worker that it brings in from the continent. Will the Government exempt the NHS from this charge?

Then there are all the teachers and academic staff in universities helping to train the next generation of medical professionals. We are already short of STEM specialists and Brexit is going to make this even worse. We will also be outside the EU systems for mutual recognition of qualifications, which will make it more difficult to recruit as well as more difficult for our UK citizens to get experience in other EU countries. As was said by the noble Lord, Lord Warner, both the NHS and social care are already underfunded and they both need immediate injections of cash as well as long-term sustainable funding. Brexit puts this at risk because of the threat to the British economy and the tax take. You cannot have a hard Brexit and a strong NHS.

Some 190,000 pensioners live in other EU countries and can use local health systems thanks only to reciprocal EU arrangements. If those arrangements fall away, UK citizens will have to pay for their treatment abroad, and many may choose to return to the UK. The cost to the NHS of the return of all UK citizens of pension age would be nearly half a billion pounds a year.

As soon as the result of the referendum was announced, there was an immediate effect on international collaborative research projects involving UK researchers. Our scientists were asked to withdraw from funding applications, as it was seen that their presence in a team could put an application at risk. The UK has done extremely well from EU funding for life sciences research, receiving almost €9 billion between 2007 and 2013. How do the Government plan to replace all this money in the future? Apart from the money, the medical, scientific and industry benefits from international collaboration are enormous and I do not know one single scientist who is other than deeply unhappy about Brexit.

I am associated with the Juvenile Diabetes Research Foundation, which has told me that:

“Without EU funding a number of vital research programmes would not exist, as comparable funding, especially to support consortia, is not available elsewhere”.


The foundation participated in a €6 million award for immunotherapy to treat type 1 diabetes, which involved small and medium-sized firms as well as research institutes. It also said that researchers,

“depend on personal funding from the EU, including Fellowships, to enable them to pursue a career in research and start-up their labs”.

I understand that the European Research Infrastructure Consortium, which facilitates cross-border research partnerships, requires that all signatories have to accept the jurisdiction of the European Court of Justice for arbitration. How will our researchers continue to participate in this consortium post Brexit? How will British researchers and those coming here from the rest of the EU be able to move seamlessly across borders in an era without free movement? The then Minister, the noble Viscount, Lord Younger of Leckie, told us in March about a high-level stakeholder working group for universities, research and innovation that the Minister, Jo Johnson, had established to look at the risks and opportunities of Brexit—although no one has actually suggested any opportunities to me. What are the conclusions so far of that working group?

There is great concern that Brexit will mean increased cost, reduced access for UK patients to new medicines and medical devices, reduced patient safety and damage to business prospects. Leaving the customs union will cause delays and extra costs in medical devices and access to medicines. Most of these products cross country borders several times during the process of development, clinical trials, licensing and regulation. The single market has built up a complex and detailed web of protection.

The coalition Government carried out reviews on the balance of EU competences. The review on health noted how collaborative action at European level on medicines and medical devices can be more effective and thus beneficial for patient safety because the EU can,

“effectively tackle … counterfeit medicines, which involve complex global supply chains; share safety information on medicines once they are on the market and quickly detect”,

risks to safety. Far from wanting to pull out of this system, industry welcomed it, stressing,

“the advantages of the common regulatory framework for ensuring a high level of patient safety and secure supply”.

Not only are we losing 2,000 jobs through the loss of the European Medicines Agency, but, as the Association of British Pharmaceutical Industry told that review in 2012:

“The introduction of the centralised procedure, along with the creation of the EMA, not only greatly simplified”,


the processes,

“but also resulted in a system where medicines information such as the patient information leaflet are consistent across all EU Member States, which is good for public health protection”.

How do the Government plan to recreate the regulations that will allow us to buy and sell medicines in the EU? What system will be put in place to ensure that UK regulations keep up with those in Europe? Can the Minister explain more fully what the Secretaries of State for Health and for Business had in mind in their wish expressed in a letter to the Financial Times last week for,

“deep, broad and dynamic cooperation”?

The MHRA chairman, Professor Sir Michael Rawlins, has warned that withdrawing from the EMA could put the UK behind Japan, the US and EU nations in the queue when new drugs are introduced.

Brexit will mean that dangerous or defective drugs that pose a threat to patient safety may be available to British consumers for longer than on the continent. Leaving the EU medicine safety system means the UK will be slower to respond to safety issues, putting patients at risk. Relevant to research and clinical trials is the framework for data protection. How will the Government ensure that UK law keeps up with the future development of EU regulation and ECJ case law, without which we could be excluded from collaboration?

I will not mention Euratom as other noble Lords have done so and we are fortunately going to have a debate, initiated by my noble friend Lord Teverson, next week, but I will mention the business opportunities for our pharmaceutical and life sciences industries, which not only EU research collaboration but EU common regulation open up. They have been very vocal in insisting on those opportunities in improving competitiveness and exports. What will the effect be of the UK losing the life sciences section of the EU patent court if we can no longer participate?

How will all these benefits of being part of the single market in health be replicated if we are outside the EU? No free trade agreement will cover the myriad networks and systems that 45 years of EU membership has created. Finally, the Brexit Secretary, David Davis, says it is an aspiration to keep the benefits for individual travellers of the European health insurance card. A lot of people will realise just how useful European red tape is if they lose the EHIC.