Leaving the EU: NHS

Ben Bradshaw Excerpts

Thursday 22nd March 2018 Westminster Hall

[Mr Ben Bradshaw (Exeter) (Lab)]

I beg to move,

That this House has considered the effect on the NHS of the UK leaving the EU.

It is a great pleasure to serve under your chairmanship, Mr Stringer. I thank the Backbench Business Committee for supporting the debate and the thousands of our constituents all over the country who pressed for it.

The debate is very timely. We are hopefully on the brink of a formal agreement on a transition deal, which will, over the next few months, very much set the scene for the vital negotiations on our long-term future relationship with the rest of the EU. It is also extremely timely given yesterday’s publication of the Health and Social Care Committee’s second report on the impact of Brexit on our health and social care system. I thank my colleagues on the Committee for the work they put in and all the individuals and organisations that provided us with invaluable evidence.

As you will remember, Mr Stringer, the NHS featured prominently in the EU referendum campaign. We well remember the famous—or infamous—bus that was taken around the country promising £350 million extra for the NHS if we left the EU. Most commentators, and several leave campaigners themselves, have credited that since discredited claim with taking the leave campaign over the line. Our health and social care systems also face one of the most significant impacts from Brexit, so it is absolutely right and imperative that Parliament has the time to focus on and debate the subject before final decisions are taken.

The headlines from our Committee report from yesterday are that, if Brexit goes wrong and there is no deal, or if we have too hard a Brexit, the results will be extremely damaging for patients; our health and social care services; Britain’s important and successful pharmaceutical industry; the supply and costs of medicines and vital medical equipment; our world-renowned scientific research base; the status of EU staff, who help to keep our health and social care services running; and UK nationals living or working on the continent, including British retirees, who depend on reciprocal arrangements to access healthcare.

It is fair to say that the majority of our Committee would rather we were not leaving the EU at all, or that, if we do, we stay in the single market and customs union. That was the near unanimous preference of all our witnesses, whether patients groups; charities; doctors, nurses and their representatives; the drugs companies, which do such vital work to develop and make available life-saving therapies and contribute so much to our economy; the manufacturers of vital medical equipment such as radioisotopes, which are used in the treatment of cancer; and our world-renowned medical research centres.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I thank my right hon. Friend for bringing this debate to the Chamber today. As many Members will know, my predecessor Baroness Tessa Jowell is campaigning, in the face of the cancer that she is dealing with, for greater international research and access to dynamic trials and new treatments for patients suffering from brain tumours. Does my right hon. Friend agree that Brexit puts at risk exactly that kind of international collaboration—that access to data sharing and to international scientific research—that patients suffering from brain tumours and many other conditions need to see move forward, not backwards? This is a grave threat from Brexit.

[Graham Stringer (in the Chair)]

Before I call Ben Bradshaw, let me say that we have sufficient time, given the number of people who want to speak, but may I please ask that interventions are to the point and brief?

[Mr Bradshaw]

I absolutely agree with my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes). I will develop that argument in more detail in a moment.

Our Committee also recognised that the Government have ruled out, so far, continued membership of the customs union and the single market. In the absence of a change of mind from the Government, the Committee concluded that the least damaging Brexit for our NHS will be for us to keep the closest possible regulatory alignment with the rest of the EU in the long term. A majority of the Committee would probably have liked our recommendations to be stronger on that and to include keeping open the option of an European economic area-type relationship in the long term. However, as Committee members we recognised that it is much more powerful for a Select Committee to agree a unanimous report, which ours is, rather than to disagree on a contested one.

[Tom Brake (Carshalton and Wallington) (LD)]

Is the right hon. Gentleman able to say whether his Committee found anything that was positive about Brexit from a health perspective?

[Mr Bradshaw]

Not that I recall. Maybe when the Chair of the Committee, the hon. Member for Totnes (Dr Wollaston), contributes she will have better recall than me. The unanimity of the evidence we heard was very striking indeed.

As well as pursuing the closest possible regulatory alignment, one of our strongest recommendations to the Government is that they must be much more open and clearer about their Brexit contingency planning for a no-deal scenario.

We note and welcome the Prime Minister’s most recent statement that the UK will seek associate membership of the European Medicines Agency—although, given that, it is tragic that we are losing the EMA headquarters from London to the Netherlands. We also welcome the recognition shown by both the Health Secretary and his Lords Minister in their evidence of the importance of continued regulatory alignment with the rest of the EU. We noted that that was in contrast to the Foreign Secretary’s statement that medicines regulation is one of the areas where he would like to see the UK diverge from the EU. I am pleased that the Health Secretary at least won that argument.

However, we have serious concerns about the Government’s lack of a strategy for a no-deal scenario. The Government are still saying that they want a pick-and-mix, cake-and-eat-it relationship with the EU in the future. The image the Prime Minister used in her speech was of three baskets: full alignment in some areas, full divergence in others and something in between for the rest. But if the other 27 EU countries have made anything clear throughout this process, it is that that option is not available. We can have a Norway-style relationship, or we can have a Canada-style relationship, but we cannot have Canada-plus-plus-plus or Norway-minus-minus-minus. It is our choice.

I wish the Government well in their endeavours to achieve their pick-and-mix deal, but given the strong likelihood, if not certainty, that we will not get that, either Ministers will need to do the sensible thing and concede on the customs union and single market, or we will face the danger of crashing out on World Trade Organisation terms. Let me just spell out what our witnesses told us that would mean.

First, it would mean the seizing up of our medicines and medical equipment supply chains. We export 45 million patient packets of medicines a month to other EU countries and import 37 million. Any customs, regulatory or other barriers to this trade will affect supplies. Radioisotopes, for example, are vital in the diagnosis and treatment of cancer. They have a very short lifespan. Their smooth importation from the continent is time critical. The British Medical Association has warned that any disruption to this trade could lead to the cancellation of patient appointments, operations and vital radiotherapy treatment for cancer. Medicines and medical equipment would also become more expensive and there would be delays in getting them licensed and available for British patients. Switzerland gets access to new drugs 157 days later than the EU; Canada, six to 12 months later.

Secondly, we would suffer a further haemorrhaging of NHS staff who are EU nationals, exacerbating the staffing crisis that the NHS and social care face.

[Ms Karen Buck (Westminster North) (Lab)]

My right hon. Friend has made a powerful case about the risks of crashing out with no deal. Does he agree that uncertainty is a crucial factor in the NHS’s problems? Individuals want to plan their own lives, and the NHS wants to plan its staff. Many staff have said to me that they are concerned about the settled status process—when it will go live, what it will involve and whether it will be able to process applications quickly—and are making decisions on that basis.

[Mr Bradshaw]

My hon. Friend is absolutely right. The uncertainty not only bedevils business decisions, but is having a huge effect on the NHS, the pharmaceutical industry and the staff in all these sectors.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I represent the most remote constituency on the UK mainland. The recruitment and retention of qualified staff is a huge issue in my constituency. Does the right hon. Gentleman agree that a crash out, and the problems he outlines, will be even more emphasised in the north of Scotland?

[Mr Bradshaw]

Coming from a peripheral region, I completely understand the challenges that the hon. Gentleman and his constituents face and the difficulty that our health and social care systems already have in recruiting and retaining staff.

I will give the example of midwives. EU midwives provide care for 40,000 mothers in England every year. The Royal College of Midwives has reported that the number of EU midwives registering to practise in the UK has fallen “off a cliff’ since the referendum, and that at the current rate of loss there will be

“no EU midwives left in the UK within a decade.”

We must have a clear assurance from the Government that, whatever the deal or no deal, the vital flow of EU medical and other staff to this country will not be affected. EU nationals already here also need an absolute assurance that their current status and that of their families will not change.

Thirdly, we would suffer the relocation of significant parts of our pharmaceutical industry—one of Britain’s most important and successful sectors—to the continent. Indeed, as part of our inquiry we were told by GlaxoSmithKline and other companies that they have already spent tens of millions of pounds moving research and medicines licensing work to other EU countries as part of their contingency planning for a hard Brexit. That money would otherwise be spent on medical research in this country. It is investment that they told us will not come back.

Fourthly, UK citizens visiting or living in the rest of the EU, including a large number of British pensioners, could lose their eligibility for reciprocal free health care. If they could not afford to pay, they would be forced to fall back on our health and social care system. The average cost to the UK of a British citizen being treated in the rest of the EU is £2,300. The cost of treating a pensioner in Britain is almost double that at £4,500.

Our report highlights a lot of other areas where there will be a serious impact if we get Brexit wrong: the potential loss of European Reference Networks, access to and participation in clinical trials, research funding, the mutual recognition of qualifications and data sharing. The loss or diminution of any or all those areas would damage Britain’s leading role as a medical research centre and the cross-fertilisation of knowledge and expertise that is so important for medical advances and patient safety.

I know that many other hon. Members want to speak, so I will bring my contribution to a close. Before I do, it is important to note that there are areas that the Health Committee’s latest report does not cover: concern that future trade deals with countries such as America could open up the NHS to wholesale privatisation; the possible impact of diverging from EU standards on the environment and food safety on public health, which the Committee plans to return to later this year; and, most significantly, the economic and fiscal impact of Brexit and the knock-on effect on health and social care funding as whole.

We know from the Government’s leaked impact studies that all Brexit options will hit Britain’s GDP over the next 15 years by between 2% and 8%—that is, 2% if we stay in the single market and customs union, 5% for the Government’s preferred option, and 8% in the case of a no-deal scenario. Unless the Government propose to significantly increase taxes or borrowing, or to cut other public services to move money to the NHS and social care, that can mean only that there will be less money available for health and social care, and not the extra that was promised on the side of that bus.

All in all, the next few months of Brexit negotiations will be absolutely critical for the future of our NHS for years to come. Our constituents expect us to hold the Government closely to account, and we will.

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[Tom Brake (Carshalton and Wallington) (LD)]

I join other hon. Members in paying tribute to PC Keith Palmer. It is a privilege to serve in this place, and an even greater privilege to be protected by courageous, selfless public servants such as PC Keith Palmer. It is tragic that he had to give his life to defend those working in and visiting the Palace. We will remember him, and are doing so today.

What the Government are doing in relation to Brexit, and what the prominent supporters of Brexit have inflicted on this country, is unpardonable. I get angrier and angrier as the ramifications of the decision become clearer. Hon. Members mentioned customs. If we do not get the seamless, frictionless deal that is promised, and small and medium-sized enterprises in this country that export to the EU are required to fill in a customs form, the Institute for Government estimates that that will cost them £30. That cost will add nothing whatever to those businesses.

The UK has been a major player in the European Aviation Safety Agency, but we are at risk of coming out of it. If we go back in, we will be subject to the European Court of Justice.

To bring the debate back to the NHS, what will Brexit do to the Institute of Cancer Research in Belmont, in a neighbouring constituency, and its ability to recruit staff and work co-operatively with other EU countries and institutions? I think this is unpardonable.

Yesterday, the Government made one of the very few of their announcements I have welcomed—the pay increase for staff. I intervened on the Secretary of State for Health and Social Care and asked about its impact on the recruitment and retention of EU staff, among others. Of course, as several hon. Members have mentioned, the NHS has been hit by a triple whammy. First, the UK is much less welcoming. That is a direct consequence of Brexit. Those who supported it, who say we are creating a global Britain, need to go out and talk to people and find out that we have left a perception of the UK as an insular country that does not welcome people from abroad. The value of the pound has gone down. Because the pound has crashed, it is much more attractive, particularly for nursing staff who used to come from places such as Portugal, Spain and Italy and remit money to their home countries to support their families, to work in Germany or France. Of course, we are in the bizarre position of choosing to make our trading arrangements with the EU much harder at a point when it seems that every single EU economy is growing faster than ours. We are at the bottom of the pile, so many of the citizens who would have come to this country to work in the NHS will see that their economies are growing faster than ours and that many more jobs are available in their home countries. Therefore, there is less inclination to come here. The NHS, like many other sectors, has been hit by that triple whammy.

Many Members have mentioned the impact on staffing levels, qualifications and retention, but I want to focus on one issue that I do not think other Members have mentioned. The Minister supported Brexit, and I want to understand whether he took into account the impact of our leaving the EU with respect to the falsified medicines directive. I suspect that there was not much small print behind that £350 million extra for the NHS every week, and it certainly did not include a reference to the impact of the UK coming out of the EU in relation to the directive. For those not familiar with it, an EU-wide system ensures that medicines used in the NHS are known to be genuine, rather than being something created in a sweatshop in India, which is not what the packet says. The system is about making sure that everything used in the health service in the EU is genuine, not falsified.

As I understand it, partly as a result of Brexit, the UK has not started building the database required. I see the Minister sending a note back to his officials. I hope that they know the answer. The work has not yet been started on the UK database, but it needs to be in place by February 2019. If it is not, we shall not have the guarantee that the medicines we use here are safe. The Government have apparently said that they definitely want to be part of the database or this arrangement, which is welcome, but it is not clear whether they want to be part of it after Brexit. We need to know immediately from the Minister whether they do want that, and whether the database will be in place by February 2019. If it is not, we shall be at risk of not being able to supply medicines that we are certain are safe.

This may of course be one of those cases when one of the famous red lines on the role of the European Court of Justice may have to be smudged a little bit. My understanding is that the database, and certainly the data within it, would be subject to the ECJ, and therefore if we want to be part of it we will have to swallow the fact that the ECJ will rule over the use of the associated data. That is just one small example of the many—probably millions—of different impacts that Brexit has had where we gain nothing. What we gain is additional cost. We are putting burdens on business. We are certainly not going to get any health benefits. The Minister will be alone in this debate, I think, in trying to find some silver lining in the Brexit cloud in relation to the NHS, because no one else has. He does not have any supporters there in his ranks weighing in behind him, saying “Brexit is brilliant for the NHS; Brexit is what we want for our healthcare.” It is solely on his shoulders. Of course, Mr Davies cannot weigh in, although I know he might be tempted to, but the Chair is not allowed to. So the Minister is alone. Even though he was a Brexit supporter, I suspect that even he does not actually believe that there is anything whatsoever to be gained by Brexit for the NHS.

[Mr Bradshaw]

Does the right hon. Gentleman think that it is significant that the only Conservative Back Bencher to come and speak in this debate focused his remarks almost entirely on the benefits he saw of importing Chinese and Indian homeopathic medicine to this country? Does that not give the impression that there is such a paucity of positive arguments that they were the only ones that anyone could come up with?

[Tom Brake]

I think neither the right hon. Gentleman nor I would like to read too much into that contribution. I doubt very much whether it is established Government policy. The hon. Member for Bosworth (David Tredinnick) is very much an outlier in terms of his approach towards the health service generally.

Now that the Minister has had time to get some information on the falsified medicines directive, I hope he can provide some assurances that the UK will play a part, and will have a database up and running in time for us to be part of that, and he will swallow—although no doubt he was one of the people who said that over his dead body would the ECJ have any impact on us here—the role of the ECJ so that we can be a participant in something that is clearly beneficial from a health point of view, beneficial to patients and to the United Kingdom.

My final point is that the Department of Health and Social Care has asked Ernst and Young to conduct an assessment of the potential implications for the supply of medicines following the UK’s withdrawal from the European Union. As I understand it, that was started in March last year and I believe the work was finished in June. I may be wrong and I am sure the Minister will take pleasure in correcting me if I am, but if I am right, we are entitled to know when this is going to be published. We have a nasty suspicion, just as we did with the sectoral analyses and the impact assessments, that the Government are more interested in hiding the impact of Brexit from us than they are in making these reports public.

I am sure that that report would have gone into extensive detail about the potential implications for the supply of medicines following our withdrawal from the EU, and I doubt very much that it will have found anything very positive about those implications. If that report has been published and I missed it, I apologise, but if it has not, I hope the Minister will be able to set out when it will be published, and published in its entirety, so that we can all assess the impact of Brexit on the supply of medicines.

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[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I join other Members who have expressed their remembrance and condolences to the families of those who died last year, particularly PC Keith Palmer. There was a very moving service in Westminster Hall this morning, which was a very fitting tribute to those who lost their lives this time last year.

I thank the Backbench Business Committee for securing this extremely important debate on one of the aspects of our exit from European Union that has not received the attention that I believe it warrants.

I congratulate my right hon. Friend the Member for Exeter (Mr Bradshaw) on the extremely clear way he introduced the subject. As someone who has served in the Foreign Office and as a Health Minister, before becoming a member of the Health Committee, he is perhaps more qualified than most to address many of the issues that we have discussed. He talked about the Select Committee report and how the wrong deal or no deal at all will be extremely damaging to the NHS in a series of ways, most of which I will touch on. It was also clear from his comments that there is a need for the Government to have a strategy in place to deal with the potential impact of no deal. It would useful to hear from the Minister on that.

I agree with my right hon. Friend about the loss of the European Medicines Agency to Amsterdam. It was a matter of great regret that we lost that wonderful institution. The fact that there were so many countries bidding to take it over shows how important it is to individual member states. My right hon. Friend set out some of the risks of no deal, leaving us on World Trade Organisation arrangements, with the potential risk of the seizing up of the medical supply chain. He also talked about staffing, which most hon. Members touched on. He gave the stark example of the number of midwives from the EU. If the current rate of attrition continues, we will have no EU midwives left in a decade. I remind hon. Members that we already have 3,500 midwife vacancies. He also talked about research and gave some clear examples of how investment is being lost now, before we have actually left the EU, and the impact on reciprocal care.

My right hon. Friend also touched on several things that were not in the report, but which are also important, such as the fiscal impact of our leaving, the potential risk to food standards and, of course, the risks from future trade deals. It is ironic that the NHS and other public services are specifically exempted from trade deals at the moment, as a result of agreements that we have with the EU.

We also heard from the hon. Member for Bosworth (David Tredinnick). I commend him for the ingenious way he got subjects of great importance to him into the debate, but I think that is probably the best I can say about the contribution, so I will move on. I am sure he will continue to fight for those things that are extremely important to him.

My hon. Friend the Member for Hammersmith (Andy Slaughter) spoke from his experience as a passionate campaigner on health issues in his constituency. He set out the importance of the NHS is in his constituency and his pride in what it has achieved. I would characterise what he said about the current situation for services in his constituency as a damage limitation exercise. He gave a startling figure about the number of EU staff who have already taken legal advice on their positions. That should be a very clear warning that uncertainty is still very much in the forefront of people’s minds. He set out well how staffing will be affected in London more than in other regions.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) set out powerfully how important the NHS is and how people feel strongly about it in their hearts. She is right that we need to show staff how much we value them. She also set out the importance of reciprocal arrangements for qualifications and, indeed, for healthcare. She raised the importance of clinical trials, particularly in relation to rare diseases. I am sorry I did not get the chance to hear her singing the other week. She was absolutely right that there are particular risks for rare diseases and the development of new medicines. She was also right when she said that Brexit can seem a little abstract to people, but she and other hon. Members have set out in tangible ways how Brexit will affect many of the things that we hold dear.

It was a pleasure to hear from my hon. Friend the Member for Stockton South (Dr Williams), as always. He is one of those people whom we rely on in the NHS to keep the service going, and he rightly paid tribute to the whole range of professions, and the services provided by NHS staff. Of course, it is the staff who make the service what it is. He was right to say that the message is not getting through to EU staff about the future. We need to do more to reassure them. He clearly set out the gravity of the situation, in relation to the impact on staff. He was right to say that some impacts of Brexit are being felt now. GlaxoSmithKline provides evidence of that: about £70 million that could have been spent on cancer research being spent on preparations for Brexit was certainly a startling figure, and not one that we might expect to see on the side of a bus.

The right hon. Member for Carshalton and Wallington (Tom Brake) raised an important point about protections that we need to maintain against bogus medicines. I hope that the Minister will be able to provide reassurance about the falsified medicines directive. The hon. Member for Motherwell and Wishaw (Marion Fellows) talked about the importance of the Scottish life sciences sector and, in particular, its distinctiveness in relation to the sector in the rest of the UK. She also raised important issues about staff.

I want to say something about those from whom we have not heard today. As several hon. Members have observed, not one Back Bencher who campaigned to leave has come to speak in the debate. That is the same as in November when we discussed the future of the European Medicines Agency. No Back Benchers who advocated leave came along and spoke. There is a lack of ownership, candour and realism from people who campaigned to leave about the consequences of the vote and I would have welcomed a contribution from those Members.

The issues are, as we have discussed, of central importance. We have heard today how almost every aspect of the NHS could be affected by Brexit. Those issues were not articulated in the referendum, but whatever side of the debate people were on, no one, I believe, voted with the intention of causing damage to the NHS. It is our duty to vote according to our conscience, but we must make sure that when we leave the EU we do so in a way that protects and defends the NHS, which is so valued by so many, and that the Government will be held to account for the decisions that they take in the process.

Last year, more nurses and midwives left the profession than joined. Much of that is attributable to the way morale in the health service has plummeted in recent years. The exodus is even more pronounced among staff from the European economic area. As Members have mentioned, according to the Nursing & Midwifery Council, the number of EEA nurses and midwives joining the register decreased by 89% in the past year, while the number who left increased by 67%. That is exacerbating an already parlous situation. The NHS has about 40,000 nursing vacancies at the moment. To put things in terms that the Foreign Secretary might understand, we are missing enough nurses to fill 450 double-decker buses.

It is not just in nursing and midwifery that we face those issues. Figures from the Royal College of Physicians show that 9.3% of doctors working in the NHS are from EU member states, while, according to the General Medical Council, the number of new doctors coming from the EU fell by 9% last year. As the hon. Member for East Kilbride, Strathaven and Lesmahagow said, a survey of doctors showed that 45% of EU doctors were now considering leaving, with a further 29% saying they were unsure about the future. Given that 60% of junior doctors already report working on a rota with a permanent gap, and 45% of advertised consultant posts are not being recruited to, that is an extremely worrying position. A number of surveys have shown that one of the key reasons EU citizens are leaving is that they believe there is uncertainty about their future status. It is simply not good enough that the Government’s plans for migration will not be available until the end of this year.

I would be grateful if the Minister updated us, if he is able to, about when the immigration White Paper and Bill will be introduced. I also urge him, as I am sure other Members will, to be as loud and as clear as he can in reassuring EU staff in the NHS that they are valued and have a right to stay.

We welcome the fact that EEA citizens and their family members will be able to apply for settled status. How that will work in practice remains unclear and it is concerning that the new system will have issues, because when we look at the way the current tier 2 system operates, we see that it is hardly an exemplar of perfection. The Royal College of Physicians has stated that it is aware of 44 examples under the existing system whereby junior doctors have had certificates of sponsorship refused, due to increases in salary requirements. Will the Minister let us know what representations he is making on this particular issue and what the Government will do to try to solve this particular difficulty? Can he also reassure us that the new system that we have for EEA residents will not have similar problems?

In addition to the issues that I have raised about the potential impact on recruitment and retention, many hard-working NHS workers have also spoken about their concerns about impacts on their terms and conditions. As the Minister knows, at Health questions recently we discussed the increasing trend in NHS trusts setting up subsidiary companies. Of course, staff in those companies should be protected by TUPE regulations—legislation that is, of course, derived from the acquired rights directive. So I hope that the Minister can reassure those staff that there are no plans or intentions to water down TUPE regulations, and that they will be implemented in UK law in the form that they take now.

There is also a concern about other EU legislation and the possible threat to the working time directive, which provides safeguards not only for staff but for patients. I understand that last December various royal colleges wrote to the Prime Minister, asking for assurances that the directive would be implemented in UK law, but they have not had any such assurances.

We know from the most recent survey that around 60% of staff have concerns about their work-life balance, and they said that they were working unpaid additional hours, along with the increasing reliance on overtime in hospitals. It is important that we get a clear and unambiguous statement that the working time directive in relation to weekly hours will not be amended or watered down in any way.

Of course, the impact of Brexit will not just be on staff. If we do not secure the best outcome in the negotiations, there could be implications for access to treatments and reciprocal healthcare. As I said earlier, last November I spoke in Westminster Hall in a debate on the European Medicines Agency and it is fair to say that at that time there was some way to go before we had clarity about what the future arrangements will be, so I would be grateful if the Minister updated us today on any progress in that regard.

The Office of Health Economics recently set out just how stark the impact could be if a solution is not found in this area, because it warns that the average lag in submission for a marketing authorisation in the UK could be up to three months, that up to 15% of applications could be submitted more than a year after the EEA submission, and that some products may not be marketed in the UK at all. At the time of its analysis in January, the OHE found that 45% of applications had not been submitted to Australia, Canada or Switzerland following submission to the EMA, so can the Minister give us assurances that we will not be left behind when it comes to gaining early access to medicines and technologies?

In November, I also asked the Minister to confirm that Department of Health budgets would not be used to fund any additional Medicines and Healthcare Products Regulatory Agency costs. Again, we have not had any confirmation of that and again I would be grateful if the Minister provided reassurance in that respect today, as we know that NHS budgets are already extremely stretched.

As we also know, there are risks arising from the decision to withdraw from Euratom, simply because it falls under the jurisdiction of the European Court of Justice, because of course Euratom facilitates a free trade in nuclear material, including radioisotopes, and, as my right hon. Friend the Member for Exeter said, those materials degrade very quickly. They cannot be stockpiled, so it is essential that there are no delays to imports.

[Mr Bradshaw]

Is my hon. Friend able to say whether we will support the Euratom amendment that was passed in the House of Lords two days ago when it comes back to the House of Commons? That would be warmly welcomed on both sides of the House.

[Justin Madders]

That is slightly outside my brief, but I understand the intention behind the question and hope that we will be able to come back on it positively.

There are concerns about the risks to patient care. Will the Minister set out how he expects us to address those?

The free movement of people was presented very much as a one-way street during the referendum. We know that about 1.2 million UK citizens live in other EU member states. There is a risk that if a similar arrangement on reciprocal healthcare is not implemented after we leave, that could impact on the arrangements those people enjoy. This could cause a huge amount of disruption for patients and health services. It will probably affect those with the most serious conditions most, in particular those with kidney failure who may not be able to travel in future if assurances are not gained. I would be grateful if the Minister updated us on that.

Finally, I would like to say a few words on the impact on social care. According to NHS Digital, it is estimated that about 7% of people in the social care sector, or 95,000 people, are EU citizens. That figure varies for different parts of the country. Recent estimates suggest that the social care sector will face a considerable staff shortage if EU migration is limited, particularly if visas are restricted on the basis of income. Projections from the Nuffield Trust suggest that there could be a shortfall of as many as 70,000 social care workers by 2025. Again, will the Minister set out what steps the Government plan to mitigate the potential impact on social care and staff? Can he assure us that we will have an immigration system that addresses staffing needs in the future?

Nobody voted to leave the NHS worse off. Nobody voted to reduce their access to treatments. Nobody voted to make themselves less safe if they require treatment. Nobody voted to reduce the number of staff in our hospitals. Yet all those scenarios are possible if the Government do not get the negotiations right. Members of all parties have expressed their concerns and the need for clarity. I hope that the Minister can now provide that.

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[Mr Bradshaw]

I thank all colleagues who took part in this extremely important and valuable debate. The Minister suggested that the contributors had a rather doom-and-gloom approach, but all we were doing was reflecting the evidence we heard in the Committee’s inquiry. Other Members were reflecting the concerns that had been raised with them by a wide range of professional health organisations, staff bodies, royal colleges and so forth. We are simply the conduit of their concerns.

If I may criticise the Minister, I found what he said a little Panglossian on the dangers and threats, and people’s worries, that we highlighted in our report. I should have liked to hear him say a little more about the vital importance of regulatory alignment. I hope he will think about that and study the report carefully.

Like the Chair of the Committee, I would like the Government to be much more transparent about their contingency planning. The Minister may feel confident that the UK Government will achieve their desire of a pick-and-mix, cake-and-eat-it deal with the European Union, but not many people share that confidence, so in the end we shall have one of two stark choices. It is important that the public should know the choices before Parliament and that the public take a final view.

The Minister has been in the job only a couple of months. I have huge respect for his ability and his record in other Departments, so I hope he will spend some of the Easter recess reading not only our report, if he has not read it already, but some of the evidence given to us by organisations. I hope that will inform him and his ministerial colleagues in fighting the NHS’s corner in the context of the negotiations in the next few months. I hope he will listen to and engage with some of the organisations that have been speaking to us.

The Minister is right: the Government have listened on transition, which we welcome. The sectors we have been talking about today welcome it too. Of course, the transition is basically a status quo. Essentially, nothing is going to change. What worries me is that we are simply delaying. We are putting off the evil day when the difficult choices, hard decisions and potential damage have to be faced. It is a delay rather than a solution. In the next few months, we will have to have much clearer answers from the Government about the final end state and solution. Otherwise the concern and uncertainty will go on.

I thank the Minister for his response, other hon. Members for taking part, and you, Mr Davies, for being in the Chair. I am grateful that the Backbench Business Committee gave us the time for the debate.

Question put and agreed to.

Resolved,

That this House has considered the effect on the NHS of the UK leaving the EU.