Leaving the EU: NHS

Debate between Ben Bradshaw and Justin Madders

Thursday 22nd March 2018 Westminster Hall

[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.