NHS and Social Care: Impact of Brexit

Baroness Tyler of Enfield Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I too thank the noble Baroness, Lady Watkins, for securing this very important debate. Indeed, I cannot think of a more pressing and urgent subject on which to finish our sitting.

As we have heard in the debate, the UK’s vote to leave the EU will without doubt have major implications for health and social care, not least because it has ushered in a period of major economic and political uncertainty at a time when the health and care system faces huge operational and financial pressures, as we have debated so many times in this Chamber. The NHS faces an extremely challenging set of circumstances. Demand, particularly from our ageing population, continues to grow faster than funding, putting further pressure on an already strained service. Fundamental change in how we provide care is urgently needed if the NHS is to be successful in meeting the twin challenges of providing high-quality services while balancing the books. To do this it is vital that we have the right numbers of staff with the right skills in the right place, and ensure that they feel valued, welcome and engaged in the work that they do—hence the debate we are having this afternoon.

The EU’s policy of freedom of movement coupled with mutual recognition of professional qualifications within the EU means that many health and social care professionals working in the UK come from other EU countries. I know we have already heard these figures but it is important to emphasise that these are big numbers. This is not something at the margins: it is 55,000 of the NHS’s 1.3 million workforce and some 80,000 of the 1.3 million workers in adult social care.

As we have heard this afternoon, the NHS is struggling to recruit and retain permanent staff. Indeed, there was a shortfall of some 6% in 2014 between the number of staff that providers of healthcare services said they needed and the number in post, with particular gaps in nursing, midwifery and health workers. As we heard very powerfully from the noble Baroness, Lady Howarth, similar problems exist in the social care sector. I will not repeat those numbers but I am particularly worried about the very high vacancy and turnover rates in domiciliary care services, which provide care to some of the most vulnerable people—the elderly and the disabled—in their homes. Given the current shortfalls in both health and social care that we have heard about, surely the Government must urgently clarify their intentions on the ability of EU nationals to work in health and social care roles in the UK, not least to avoid EU staff in the NHS deciding to leave to work in other countries where they may feel that they are made more welcome.

Initially in the days after the referendum, it sometimes felt as if all EU nationals were being used as pawns in a negotiating game, and that was quite wrong. Since then, we have heard slightly more reassuring statements from Bruce Keogh, NHS England’s medical director, and Jeremy Hunt, the Secretary of State, who has sought to assure European staff working in the health service. We have also heard Simon Stevens call for more assurances, which are needed, and that is the right thing to do. However, we need to go a lot further. Providers of NHS and social care services must be able to retain the ability to recruit staff from the EU when there are not enough resident workers to fill vacancies. As others have suggested, this could be done by adding specific occupations to the Migration Advisory Committee’s shortage occupation list, which currently enables employers to recruit nurses and midwives from outside the European Economic Area. What steps will the Government take on this front?

I want to say a brief word about nursing staff. I am very conscious that I do not have anything like the expertise that we are so lucky to have in this Chamber in the noble Baroness, Lady Watkins, and, of course, the noble Baroness, Lady Emerton. However, I acknowledge the huge contribution that EU nurses make to the vital work of the NHS and, indeed, the health of the nation. Currently, some 33,000 EU nurses are registered to work in the UK. There has been a very large rise in this number since 2010. These numbers show that the UK has an ever-increasing reliance on nurses from the EU, who plug serious gaps in the nursing workforce. This is due to government cuts since 2010 to nurse education commissioning in the UK, which has drastically reduced the supply of nurses coming into the system. There will be serious consequences for patient care if EU health professionals are forced to leave the country or, indeed, are made to feel unwelcome and so decide to leave.

It is often the personal anecdote that brings this situation home. Yesterday, I had a very long day—about 15 hours—with my mother in a central London hospital. She is very elderly and frail and she needed an operation. But during that long day all her other complicated care needs had to be dealt with. The nurses in the hospital clearly came from all over the world. I cannot thank them enough for the care they gave my mother during that long and difficult day. It is absolutely clear to me that the NHS simply would not be able to function without staff from other countries; we just have not invested enough to grow our own. It takes four years to commission extra places and train nurses; it is not something that you can do overnight.

Where does all this leave us? I have to be honest and say that it leaves me feeling quite gloomy. I recently read a very good article in the Guardian, written by Richard Vize. He said that:

“The most insidious effect of the current anti-European climate will be to discourage EU talent from working in our health and care system”.

He went to say—and I think that this is the critical point—

“It is not just a question of the rules about who can work here, but the perception. With social and mainstream media in Europe already reporting incidents of racial abuse and a more general anti-immigrant feeling, and uncertainty about the future legal position of living and working in the UK, talented people from other EU nations have good reason to consider alternatives. There is a chronic global shortage of clinical staff, so the UK is part of a worldwide marketplace for talent. We have just made it more difficult to attract the best”.

It gives me no pleasure to say so but, frankly, I could not agree more.

I usually like to end on a fairly upbeat or positive note, as I know the noble Lord, Lord Crisp, does. He managed to do so extremely well, as always, but on this occasion I have failed. I end by raising an issue that the noble Lord, Lord Bilimoria, also mentioned. It is about that lie—that most flagrant and disgraceful lie—of the leave campaign. I have to say that there was very stiff competition for that particular accolade, but it is the lie where we were told that £350 million extra per week would be available for the NHS—it was plastered all over the campaign buses. Then of course it was retracted, even before the ink was dry on the results. But the public, quite understandably, now have an expectation that NHS spending will rise after the UK leaves the EU. I have never been very good at maths but I just made a little calculation. It is four weeks now—to the day, I think—since the referendum, so my calculation tells me that, four weeks on, £1.4 billion is now owed to the NHS. Can the Minister tell us whether that money has yet been received and, if not, how quickly he expects that money to be in the Department of Health coffers?