Leaving the EU: NHS

Lisa Cameron Excerpts

Thursday 22nd March 2018 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure and privilege to serve under your chairmanship, Mr Stringer. I thank the Backbench Business Committee for enabling this important debate, and the right hon. Member for Exeter (Mr Bradshaw), my friend and colleague from the Health and Social Care Committee, for his detailed and valuable contribution. He outlined the grave concerns that most of the Committee have heard and feel themselves on some of the issues relating to Brexit and the NHS. It is important to our Committee that the Minister is listening, that the report is taken seriously and that our recommendations are taken forward.

This is a solemn day. I echo the sentiments of other Members who have spoken. It is a year since we lost PC Keith Palmer, who sacrificed his life in preserving our democracy here at Westminster. My thoughts are very much with his family and with everyone who has been affected by that horrific attack on Westminster and our democracy. It is important that we also remember Jo Cox and her extremely poignant words: we do have much more in common than sets us apart. I wish to take those sentiments forward. No matter what happens, if we work together and take things forward constructively, there is always a positive way ahead to defeat extremism and terrorism.

I come to the topic of the debate. My constituents are finding it difficult to have continued interest in the Brexit debate, given how lengthy it has already been, but when it comes to the NHS that is entirely different. The NHS is fundamental to our values. I have never met anyone who has tried to say that it is not such a valuable institution or the bedrock of our society, or who does not greatly admire and understand the dedication of the NHS staff who serve us all so well. We all—our friends, family and ourselves—rely on the NHS at the most vulnerable points in our lives. The NHS is therefore different for most of our constituents across the United Kingdom. It must be treated with priority and preserved, and all steps must be taken to ensure that any impact of Brexit on our NHS is fully mitigated. We rely on the NHS, and we will continue to do so. The first point I make to the Minister is to emphasise the importance of our NHS.

My second point is on the workforce, which has already been touched on by many Members. I have been sent a report by the British Medical Association. I refer the House to my background as a psychologist, having previously worked in the NHS. There are real concerns about the workforce and Brexit. The BMA highlights in its report its concerns that highly skilled doctors and professionals will choose to leave the UK because of the ongoing uncertainty in the negotiations. Like other hon. Members, I think it is important that the Department reassure those staff about how valuable they are and about how much their contribution is wanted and needed moving forward. It is imperative that we continue to retain their services for our populations.

Quite astoundingly, nearly half of EEA doctors—45% of them—surveyed by the BMA in November 2017 said that they were considering leaving the UK following the referendum vote. Those are critical numbers. I believe that in England 7.7% of the workforce, or 12,029, are EEA graduates. The figure I have been given in Scotland is 5.7%, or 1,339—it is 8.8%, or 550, in Northern Ireland, and 6.4%, or 624, in Wales. These are high numbers of people working right on the frontline to preserve our healthcare and we need to make sure that they can continue to do that.

Some might say that there has been a shortage or a short-termism in our own training of medical staff, and that issue also has to be addressed in the future. However, it takes a very long time to train doctors and nurses. We must therefore consider the much-needed and valued services that we have at this time and at least for the next decade in relation to our staffing model.

The next issue I will talk about is mutual recognition of professional qualifications. The BMA is calling for the maintenance of reciprocal arrangements, such as mutual recognition of professional qualifications, after Brexit, which would enable professionals who qualified in one member state to practise their profession in another. So what are the Minister and his Department doing in relation to that issue? It seems crucial for the next decade or so that we maintain the workforce that we have and that we ensure we can continue to attract highly skilled professionals to come to the UK to work.

Reciprocal healthcare and the European health insurance card, or EHIC, have already been mentioned. It seems very important, particularly for people who have the most chronic illnesses and who are moving from the UK to the EU, or who are on holiday, and for those coming here from the EU, that we have some form of arrangement in that regard for the future. I must say that I have had some difficulties with the EHIC in the past, with my own family, in being able to utilise it appropriately in some countries. However, it is not until something is lost entirely that its merit and value are realised. I do not think that it has been a perfect system by any means. However, it is certainly something that we want to retain and ensure is still available to us in future, particularly for some of the most vulnerable people, who still wish to be independent and to travel but who may find it extremely difficult to afford insurance, and therefore might otherwise put themselves at risk.

The Committee heard a lot of evidence about life sciences when producing this report. I have been astounded by the evidence we have been given about just how world-leading our life sciences are. I have to say that that is not something I was acutely aware of, even given all my years in the NHS, but we have world-leading life sciences. We have some of the top researchers and we have been involved in, and leading, some of the most crucial clinical trials. We must ensure that we hold that position in future. That is a real issue, because there is a concern that if those who are very much at the top of their game in research are unable to continue to lead on clinical trials from the UK, they might seek to leave. We cannot allow that to happen, because it would plunge our world-leading life sciences sector into the depths.

I would really appreciate it if the Minister spoke about how we will maintain our life sciences at their current level and how we will ensure that our fantastic university hospitals—I have one in my constituency: Hairmyres hospital—continue to support the great research work they do alongside their clinical work, and that they have all the amenities and the top professionals they need in the future.

It was Rare Disease Day just a few weeks ago, and I took part in it. We sang outside Westminster tube station to raise awareness of rare diseases. Rare diseases are of course rare, so many people do not experience them. However, there are many types of rare disease, so it is quite usual that some of us will know at least someone who has experienced or is living with a rare disease. It is crucial that people with rare diseases participate in clinical trials, because we need them in order to make progress on prognosis and find the best treatments. We need to ensure that we maintain that collaboration with the EU, because otherwise patients on the ground will suffer.

Patients with rare diseases might already feel quite isolated; they will have few other people they can speak to who are experiencing the same difficulties or have the same diagnosis. However, they need to be included in clinical trials, which cannot be conducted in the UK alone. Will the Minister comment on how we will ensure that that collaboration continues, particularly on rare diseases?

On medications, the Committee heard evidence about time-sensitive supply chains and the potential risks to them. The need to ensure that sufficient stock is on the UK market could mean the stockpiling of those products, and manufacturers might not supply certain products to the UK until only a few weeks before they are needed, so the supply chain is crucial. This work is time limited. Distributors of medicines in the UK usually keep about 10 days’ worth of stock, but many manufacturers can stock medicines for up to four months in wholesale warehouses. How will that work, depending on the negotiated arrangement? We need to get medicines timeously to patients who need them—particularly, as has been mentioned, radioisotopes for those who suffer from cancer and other illnesses.

These issues are crucial. When I speak to constituents, Brexit seems like a hypothetical thing, way in the distance. However, as soon as we start to home in on what it will mean in their day-to-day lives for their health and wellbeing and that of their families, and for our NHS, Brexit comes to the front of their minds. That is why the Minister has the weight of the world on his shoulders, because he is required to take forward these vital issues for everybody who depends on the NHS and our services. I look forward to his reply. On medical radioisotopes, I led on the cancer strategy in the main Chamber just a month or so ago. It is vital that we get this right for our cancer strategy, to ensure that all the other work that it underpins can move forward in the way it is supposed to.

I will finish by briefly speaking about qualified persons, which is something I did not know much about before the inquiry. I am led to believe, from the evidence that we heard, that they are already a scarce resource. There has to be mutual recognition of the training of qualified persons between the EU and the UK, so that these qualified persons, who we need to ensure the safety of medications, remain in the country and can do that vital work. What progress has the Minister made on work relating to qualified persons?

I do not want to take up any more time, because other Members wish to speak, so I will end where I started. Brexit can seem like a concept that is not linked to our everyday lives. When it comes to the NHS, however, that is entirely different. It is crucial to all patients—it is crucial to all constituents, actually. It therefore falls to the UK Government to ensure that the very best outcome for clinical care is negotiated and achieved.

--- Later in debate ---

[Stephen Barclay]

We can see the variability of forecasts, but the OBR’s forecast, which is the one that really matters—there is consensus that the Government rely on it and that Government planning is undertaken on the basis of it—shows a clear trajectory of improvement that is not reflected in much of the doom and gloom that we have heard in recent weeks. The debate is better informed if we tie it into the benchmarking that the Government use when setting fiscal policy.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) commented on the fact that her constituents are bored by the length of the Brexit debate. I am sure that if anyone is watching the debate, that will resonate with them. That is why it is so important for us to look forward. We should look at the areas of real concern where the Department needs to focus, such as maintaining the regulation and considering the mutual recognition of qualifications, which is a real issue that we want to make progress on with the European Union, because it is of concern to people. To look constructively at how we address some of those issues is far better than having groundhog day on the same areas.

[Dr Cameron]

Given the evidence we heard, and given that I have emphasised how critical the NHS is to the public and that it is a key priority for Brexit, I am perplexed that the Secretary of State for Health and Social Care does not have a place at the Brexit table in Cabinet. Far be it for me to try to elevate him even further, but the NHS is crucial and pivotal and deserves to be at the core of Brexit.

[Stephen Barclay]

The hon. Lady is right to recognise the skills and talent that the Secretary of State brings to this debate as to many others. It is no coincidence that he is the second-longest serving Secretary of State for Health. It would be recognised across the House that it is a demanding job. It is to his great credit that he has been in post for such a period and that he has championed patient safety in the way that he has, which the shadow Minister has generously recognised on occasion.

The Secretary of State’s role in Government was further signalled and underscored by the Prime Minister in the recent reshuffle, when the responsibility for social care was added to the Department. As the debate has reflected, social care, and how we address it from an immigration perspective, and from a training and upskilling perspective, is one of the key legitimate areas of the Brexit debate. We are focused on that in our discussions with the Home Office and others.

The hon. Member for Motherwell and Wishaw (Marion Fellows) picked up on the need for a transition period. That point reflects the fact that the Government are listening and have responded constructively. I know from my previous role in the financial services sector in the City that there is a strong desire for a transitional period. That point was also raised by many in the healthcare sector. It is to the great credit of the Secretary of State for Exiting the European Union that those discussions have been conducted in such a constructive way. There has been a lot of doom-saying and negative commentary—“Nothing will be agreed; it won’t work.”—but he has assiduously stuck to his task. While there are some formal processes still to be completed, significant progress has been made on a transition deal, and there is reasonable consensus that it is constructive.

Several colleagues mentioned the impact of leaving Euratom. I simply remind the House that there is nothing in the Euratom treaty that prevents materials from being exported from an EU member state to countries outside the EU, nor do those materials fall into the category of so-called special fissile material, which is subject to nuclear safeguards. We very much recognise the short half-life of medical radioisotopes and the need for rapid delivery, but again there is much that can be constructively done.

The shadow Minister mentioned subsidiary companies. I do not want to incur your displeasure by straying too far from the subject of Brexit and into subsidiary companies, Mr Davies, but as the shadow Minister raised that point, I feel it is appropriate to address it. He asked what TUPE protections there will be. There are TUPE protections now and the Government have absolutely no intention to change that.

For those who sometimes suggest, as Opposition Members occasionally do, that subsidiary companies within the NHS is a form of privatisation, I merely remind the House that this legislation was passed in 2006 under a Labour Government. I was not in the House at the time, but I do not recall—this may be one for those connoisseurs of Hansard—that it was presented by Labour Ministers as a way of achieving privatisation in the NHS. Subsidiary companies are 100% owned by their parent company, which is the NHS family, so they stay very much within that.