Leaving the EU: Health and Social Care

Brendan O'Hara Excerpts

Tuesday 19th March 2019 Westminster Hall

[Brendan O'Hara (Argyll and Bute) (SNP)]

I beg to move,

That this House has considered the effect of leaving the European Union on the UK’s health and social care sector.

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the Backbench Business Committee for agreeing to the debate, and all hon. Members who have come along to take part in it. I put on the record my sincere thanks to Robert McGeachy of Camphill Scotland, to Craig Wilson and Gareth Jones from the Scottish Council for Voluntary Organisations, and to Andrew Strong of Alliance Scotland, for all their help and support in preparing for the debate.

The debate’s origins are in my private Member’s Bill, which I tabled in November 2018. It sought from the UK Government provision for an independent evaluation of the effects on the health and social care sector of the United Kingdom’s withdrawal from the European Union. Like many others, my Bill will almost certainly fall this Friday, without ever seeing the light of day or being debated. I was always prepared for the likelihood that the Bill would fall because of a lack of time, so that does not surprise me. What did surprise me, however, was my Bill’s impact on the organisations that deliver vital health and social care to so many vulnerable and needy people day-in, day-out right across the United Kingdom.

Currently, no fewer than 102 different third sector organisations, trade unions and charities have publicly supported the measures in the Bill. Not a single one of those organisations believes that Brexit will be good for the health of the people of these nations. Moreover, they all support the idea that an independent evaluation of the effects of Brexit on the health and social care sector should be carried out, and that it should examine the sustainability of public funding, the challenges faced by the workforce, and the efficiencies and effectiveness of the sector.

I will not test everyone’s patience by naming all 102 organisations that have lent their support, but I can assure hon. Members that they cover every part of the United Kingdom. They include the Western Isles Carers, Users and Supporters Network, which is based in Stornoway, the Northern Ireland Council for Voluntary Action, Disability Wales, and the London-based Mentor UK, which does great work with young people on alcohol and drug misuse. Those organisations share my concerns, and I want to put on the record my sincere thanks to each and every one of them for contacting and supporting me.

In the light of the extremely high levels of concern among those delivering services at the sharp end, I did not want this hugely important issue simply to disappear from the radar on Friday, when my private Member’s Bill will almost certainly fall because of a lack of time. I felt that I owed something, not just to those organisations, but to the most vulnerable in our society: those with disabilities; children and young people; older people; unpaid carers; those living with long-term health conditions; and those who rely on the vital contributions made by the highly valued EU citizens who provide for our health and social care needs right across these islands. Their voices are not being heard, or their views properly considered. I felt that I owed it to those people to ensure that the very serious issues that the health and social care sector will face post Brexit are examined and discussed in this place so that, 18 months from now, no one can claim not to have known what the sector or the service users were saying.

Every one of us knows that there is already a crisis in social care across the United Kingdom, with a seemingly relentless pressure on funding. Our population is ageing and has increasingly complex care needs, and we face major challenges in the retention and recruitment of the workforce required to meet those needs. One would have thought that, in the immediate aftermath of the EU referendum in June 2016, the Government would at the very least have made a top priority of safeguarding the health and care of their citizens. Guaranteeing a secure supply of the vital medicines that are manufactured in the EU, or that have to be transited through it, would have been a good starting point, particularly as the Department of Health and Social Care’s own estimate states that two thirds of the medicines that we use in the UK come from or via the European Union.

One would have thought that securing access to the essential pool of labour that we require now, and will increasingly need in future, would have been at the top of the to-do list, or thereabouts. Yet in March 2019, just 10 days from possibly crashing out chaotically, we are still discussing the dangers that the weakest and most vulnerable in our society will face as a result of Brexit, and particularly the type of Brexit that the UK Government have chosen to pursue. It is one in which their ideologically driven, self-imposed red lines will deliberately sever the essential link between the health and social care sector and the pool of labour on which it depends. Exactly two years ago, Professor Ian Cumming, the chief executive of Health Education England, said:

“Our biggest risk in the short term, as a result of Brexit, may be in the non-professionally qualified workforce across health and social care”.

Without exception, every single organisation that offered me support for this debate or prepared a briefing ahead of it highlighted the enormous damage that Brexit, and particularly the end of freedom of movement, would do to their ability to deliver care and undertake essential medical research—every single one. They include Cancer Research, CLIC Sargent, the Local Government Association, the Northern Ireland Council for Voluntary Action, researchers from the University of Birmingham, Macmillan Cancer Support, the British Medical Association and Age UK, to name but a few. They have all said that the health and social care sector values and wants to retain its EU staff, and wants nothing to stop it recruiting more of those hugely valued and important staff members in future.

[Mr Jim Cunningham (Coventry South) (Lab)]

It is timely that the hon. Gentleman is bringing this issue to the forefront once again. On healthcare, one of the things that certainly worries my constituents and me is the potential for the national health service to be open to predators post Brexit. As I am sure he knows, on one hand, the care side of the NHS is vastly underfunded, while on the other hand, people cannot afford care to look after their families, including elderly parents and others. Research and development in medicine and collaboration with Europe are also important, and two universities in Coventry that engage in a lot of that have voiced concerns to me about it. Does he agree with those concerns?

[Brendan O'Hara]

The hon. Gentleman is absolutely right. The fear in the sector and among care users is palpable. A recent article in The Lancet, which backs up his points, states:

“All forms of Brexit involve negative consequences for the UK’s leadership and governance of health, in both Europe and globally”.

For me, that sums up the hon. Gentleman’s point exactly. I hope that he agrees.

We cannot get ourselves into a situation in which there is a barrier between the health and social care sector and that pool of labour. Age UK recently said that

“our care workforce is in no position to withstand the loss of good…care workers, wherever they come from.”

The King’s Fund said:

“Widespread and growing nursing shortages now risk becoming a national emergency and are symptomatic of a long-term failure in workforce planning, which has been exacerbated by the impact of Brexit and short-sighted immigration policies.”

The message from the sector to the Government is therefore clear and unambiguous: we simply cannot afford to cut ourselves off from the labour markets on which we have become so reliant and on which we will depend more and more in future. One look at the frontline of the health and social care sector and its delivery, and it is easy to see how heavily it depends on workers from outside the United Kingdom. Without access to those workers, the UK home market will be required to fill the gaps, but people are not queuing up to fill the vacancies that exist now, so do the Government believe that somehow post Brexit people will suddenly become available for work in the care sector?

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on securing the debate. He talks about the workforce, but is it not natural that as the economies of other countries get stronger, the workers who would have come here will be lost to natural erosion as they no longer want to come to the UK? The emphasis needs to be placed on training our own young people and making it advantageous for them to join the health service.

[Brendan O'Hara]

The hon. Gentleman makes a valid point, but we have to compete for workers and to have an attractive package for people to come here to work, but if we take ourselves out of the game, we are no longer in the competition—we will have cut ourselves off. There are issues relating to retraining and getting people into the sector, but unfortunately the demographics are incredibly skewed against that happening, certainly in the short and medium term. I will come on to some of the statistics.

At the end of June 2018, NHS England had more than 100,000 unfilled posts. The NHS regulator has stated that such vacancies will become even more commonplace during the remainder of 2018-19. Both the Care Inspectorate and the Scottish Social Services Council have found that 40% of social care organisations report unfilled staff vacancies. There is no professional analysis out there that does not estimate that the demand for care will only increase in future. The King’s Fund, the Health Foundation and the Nuffield Trust have predicted that NHS England staff shortages could rise from 100,000 to almost a quarter of a million by 2030. That is more than one in six of service posts. At the end of last year, Care England estimated that by 2035 an additional 650,000 care jobs will be required just to keep pace with the demands of our ageing population.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing the debate. On the statistics, did he establish whether it was also estimated what the level of vacancies was likely to be were we to remain in the EU over that 10-year period, given that there are 100,000 vacancies now, despite the UK being a member for 40 years?

[Brendan O'Hara]

I realise that many things have been blamed on the European Union, but the demographics and the population outcome of the UK cannot be blamed on it. What one can say about the present situation, however, is that we can predict that it will not get any better in the short or medium term. I think that Skills for Care has calculated that a quarter of the health and social care workforce are aged 55 and over. They will be due to retire sometime in the next 10 years, which will mean another 320,000 vacancies that need to be filled.

Let us not kid ourselves: we are facing a looming crisis. Equally, it is a crisis of the UK Government’s making, because they chose to go down this road of a hard Brexit. They want to take us out of the single market and the customs union; they chose to end the freedom of movement that has done so much to enhance the social, economic and cultural wellbeing of the UK over the past 40 years; and they did so knowing the consequences that such actions would have.

I therefore look forward to the Minister explaining exactly why the Government allowed that to happen and what their long-term plan is to fill those hundreds of thousands of vacancies facing health and social care in the coming years. If that plan includes yesterday’s launch by NHS England of the campaign to encourage GPs to come out of retirement, then heaven help us.

The primary purpose of this debate is to focus on the enormous challenges that will face our biggest asset, the people, whether they work in or rely on the sector, but as important as recruitment, retention and the level of care we provide is the issue of medicines and access to research. As I said, I have been inundated with representations from charities and third sector organisations, which are all extremely worried about the future of medical research and the ability to source vital drugs and treatment, particularly if we have a chaotic crashing out of the European Union. Who would have believed that in 2019 we would have a UK Government advising people to stockpile medicines? Those medicines might be life-saving, but we all took it for granted that they would be there if and when necessary. Now people are stockpiling, in 2019—it beggars belief.

[The Minister for Health (Stephen Hammond)]

The hon. Gentleman ought to be absolutely clear: we are not advising people to stockpile medicines. That is alarmist, and he should not be saying it. That is not what the Government are doing.

[Brendan O'Hara]

I will rephrase that. The Government are advising the stockpiling of medicines—perhaps not by individuals, but the Minister and the Government have advised the stockpiling of medicines.

[David Linden (Glasgow East) (SNP)]

Through my hon. Friend, I ask the Minister this: if the Government are not stockpiling, why on earth are they ordering all those extra fridges?

[Brendan O'Hara]

Perhaps the Minister will answer that when he gets to his feet to respond.

How in the name of the wee man did the United Kingdom ever end up in this appalling, self-inflicted mess, in which the sick, the elderly and the vulnerable do not know who will be there to look after them, while healthcare professionals are unable to provide the comfort to their patients that everything will be all right? Only last week, Professor Andrew Goddard, president of the Royal College of Physicians, said that

“the public rightly expects candour from health professionals, and we have ultimately been unable to reassure our patients that their care won’t be negatively impacted by the UK exit from the EU.”

When the BMA wrote to the Prime Minister on 27 February, it left her in no doubt as to its thoughts, stating that

“there is no clearer immediate threat to the nation’s health than the impact of Brexit.”

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

Does my hon. Friend agree that part of the reason why members of the public and our constituents are so concerned is that we have no guarantee against predatory procurement in the NHS or against an interrupted supply of medicines, so how can people be reassured?

[Brendan O'Hara]

I could not have put it better myself. I thank my hon. Friend for that intervention.

Much more could be said on this topic, but I am keen for other Members to have their say. I will conclude with a number of questions, in addition to my earlier one, for the Minister to address when he gets to his feet. What assurances will he offer to each of the 102 organisations that supported my private Member’s Bill that the health and social care sector will not be adversely impacted by the UK leaving the European Union? What plans are being put in place to guarantee that the sector will be able to recruit the workforce it needs post Brexit? Will he support moves to amend the £30,000 minimum income threshold proposed for the immigration Bill, which will be so devastating for those seeking to work in the sector? Will he confirm once and for all that there will be no detrimental impact on the supply of medicines or devices if the UK proceeds to leave the European Union in a catastrophic crashing out? Finally, will he support my call for an urgent, full and independent evaluation of the effects of leaving the European Union on the UK’s health and social care sector?

--- Later in debate ---

[John Howell]

The hon. Gentleman has much more leisure time than me, as he can still watch the BBC. I cannot remember when I last watched it, but I am pleased to join him in condemning its attitude. He makes a strong point. During the Brexit campaign, the health sector was dominated by the promise on the side of the famous bus, but equally, the remain campaign has lied through its teeth in saying many things. I have no real confidence that, if we were to have a second referendum, we would at any stage be able to have a debate free of exaggeration.

A constituent contacted me to say that he had been to a local hospital and was astonished to see that as a result of Brexit—although it has not happened yet—the ward was closing and had lost a large number of staff. I decided I would not let that go, but would find out the facts. I spoke to the matron who ran the ward in question. She said to me, “That is absolute rubbish. We have a full ward; this is a normal cycle of people’s leave and it has nothing at all to do with Brexit.” If we make Brexit arguments we need to ensure we have a rational and objective discussion, which so far we have not been able to have.

[Brendan O'Hara]

To have a rational and objective discussion, we have to rely on experts and take evidence from the people in the field. The contributors are objective: Macmillan Cancer Support, the British Medical Association, Cancer Research UK and CLIC Sargent have come to us to say there is a major problem. I presume the hon. Gentleman would not say that they are partisan players.

--- Later in debate ---

[Stephen Hammond]

Had the hon. Lady joined me in walking through the Lobby to vote for the withdrawal agreement—so that Brexit would happen on 29 March and leaving without a deal would be impossible—she would know that all the arrangements currently in place would pertain. We are talking about arrangements for a no-deal situation, which I and the Government certainly hope will not happen. These arrangements are specifically designed to ensure that arrangements are in place for no deal.

In the short time I have left, I will stress the continuity of supply. It is essential that any responsible Government, even if they wish for a different outcome, should prepare for the outcome that they do not want, which in this case is no deal.

[Brendan O'Hara]

Will the Minister give way on that very quickly?

[Stephen Hammond]

Very quickly.

[Brendan O'Hara]

I want to give the Minister the opportunity to answer the question I asked about the long-term plan to fill those hundreds of thousands of vacancies now and in future, and to reassure supporters of my Bill that health and social care will not be adversely affected by the UK leaving the EU. I would be hugely grateful if he did so in the next three minutes.

[Stephen Hammond]

There are so many issues that I could tackle in the next three minutes. However, as the hon. Gentleman will have seen, the long-term plan has ambitions to ensure that there are new routes into nursing and that there are extra doctor training places. I said in response to the hon. Member for Strangford that we have commissioned Baroness Harding to start a workforce implementation plan. I assure the hon. Member for Argyll and Bute that driving down the number of vacancies is a priority for the Government. However, he will recognise that several of those vacancies are not necessarily unfilled posts, because they are usually filled by staff from the temporary staff bank. We need to be clear about what we are talking about. Recruitment into our national health service and our social care system is absolutely a key priority.

My Department has overall responsibility, on behalf of the devolved Administrations, for ensuring the continuity of supply of medicines and medical products. All supply arrangements take into account the whole of the United Kingdom. We have had significant support from, have given reassurance to and are constantly working with the pharmaceutical industry, the whole of the medical supply industry, clinicians and patients, and I am delighted to say that last week we held a roundtable with the devolved Administrations, so that their concerns could be listened to and directly addressed.

Several Members commented on stockpiling. We recognise that if we leave the EU without a deal, the medical supply chain will come under a lot of pressure. Around three quarters of the medicines and more than half the clinical consumables that we use come from the EU. Since last August we have been working with the industry to ensure that, before 29 March, there is at least an additional six weeks of stock over and above the usual buffer stocks in the UK.

We have also advised companies that if they are likely to face difficulties in their supply routes, there are ways of bringing in supplies outside the normal short straits route, either by using existing services or by making use of the additional capacity that the Government have procured. We are reliant on transport and freight being re-routed, but I am confident that, if everyone—including suppliers, freight companies, the health and care system and international partners, all of whom we have worked with since last August—does what they need to do and have committed to doing, the supply of medicines and other medical products will be uninterrupted.

I had intended to deliver a rather longer speech this morning, but I thought it was important to try to answer directly the questions put to me by hon. Members. There is no doubt that many areas of the health and care system will be directly affected by EU exit. We do not have time to address those today. However, it is important that the country knows that the Government are committed to ensuring that, whether we leave with or without a deal, we have in place the contingency plans needed to meet those challenges.

[Brendan O'Hara]

I thank everyone who has taken part in the debate. The shadow Minister said that this is the most important issue of the day, and she is right, so where are her colleagues? Every constituency in the country will be badly affected by this issue.

[Mr Peter Bone (in the Chair)]

Order. I apologise to right hon. and hon. Members, but time has beaten us. I place on the record my particular thanks to the Minister for not reading a prepared speech and for dealing with the questions that Members asked.

Motion lapsed (Standing Order No. 10(6)).