NHS and Social Care: Impact of Brexit

Lord Bilimoria Excerpts

Thursday 21st July 2016 Lords Chamber

[Lord Bilimoria (CB)]

My Lords, the NHS is Britain’s national treasure. It is something we are all proud of in this country, something we all benefit from and rely on from cradle to grave—yet it is an institution that is constantly under pressure and which faces enormous challenges. It is the largest employer in the country and the sixth-largest employer in the world. Across the board, with doctors, nurses and administrative staff, the NHS has always relied on huge numbers of foreign staff, from within the EU and from outside it. Today there are nearly 60,000 EU nationals working in the NHS. Jeremy Hunt, the Health Secretary, voiced concerns about the impact of a leave vote, stating that, “Another issue”, alongside the potential impact on NHS investment,

“is the damage caused by losing some of the 100,000 skilled EU workers who work in our health and social care system. Uncertainties around visas and residency permits could cause some to return home, with an unpredictable impact on hard-pressed frontline services”.

Simon Stevens, the chief executive of the NHS, said:

“We’ve got about 130,000 European Union nurses, doctors, care workers in the NHS and in care homes. And we should surely miss the benefit they bring were we to choose to leave”.

I thank the noble Baroness, Lady Watkins, for initiating this debate. It is widely acknowledged that the NHS is struggling to recruit and retain staff. In 2014, there was a 50,000 shortfall between the number of staff that providers of healthcare services said that they needed and the number of posts, with particular gaps in nursing, midwifery and health workers. Yet the coalition and Conservative Governments set themselves a target to reduce net migration to a level of tens of thousands, which they have completely failed to achieve, with the current level running at 330,000. Just this week, the Foreign Secretary and the Home Secretary distanced themselves from that target, discussing sustainable levels of migration rather than specific targets. The Prime Minister has now been forced to accept that it will take some time to reduce migration to the tens of thousands. Will the Minister confirm that it is still the Government’s policy to reduce net migration to the tens of thousands and clarify when exactly that ambition is likely to be realised—particularly keeping in mind how the Government will achieve that when the NHS and care sector alone employs 130,000 migrants?

I remind the House of the widespread fear created last year when the Home Office announced that nurses would have to leave the UK if they were not earning £35,000 within six years of living here. I remember how appalled the public were on hearing that. Nursing is one of the noblest professions; nurses work extremely hard, long and unsociable hours, and have always been significantly underpaid for what they do. Many nurses who have come here from the EU and outside would have been forced to leave the country. People who have contributed to our country and who have helped to save lives would have been uprooted from families through a draconian, ruthless and uncaring move. Thankfully, though a public outcry and the nursing professions’ emphasis on the severity of the UK’s nursing shortage, the Government did a U-turn and nursing was added to the shortage occupation list at the end of last year, meaning that nursing was exempt from these rules—thank God.

The Government’s thinking is what is so worrying here. It has led to ill-thought-out policy decisions previously, with the Government committed to Brexit and with Vote Leave’s campaign focused mainly on reducing migration. We are again in danger of implementing draconian measures that would cause untold damage to our most prized public service. The Government want to reduce migration, but here we have our treasured NHS reliant on that same migration. We are told that it is business as normal until Britain leaves the EU, but it is not. Every day of uncertainty risks skilled EU nationals leaving our country and the NHS. We need to give them reassurances to ensure that does not happen. Will the Minister give us that reassurance?

Quite apart from Vote Leave’s constant claim that EU migration is putting pressure on our public services, in this case, without EU migration, the NHS, the jewel in our crown, would collapse. People speak about migrants making it more difficult to see their doctor, but more than a third of doctors working in the NHS were born abroad. The whole campaign in the build-up to this wretched referendum was toxic, and much of what people voted on was nothing to do with the European Union. In fact, the King’s Fund said clearly that the tension between staffing levels and the financial pressures felt by care services is nothing to do with the EU.

A member of my team, who moved to this country 16 years ago and is married to an Englishman, went to the emergency room on the weekend after the EU referendum with a bloody finger which was broken in four places. She was told by somebody sitting next to her in the waiting area that she was a burden on this country. She has worked hard, paid taxes and contributed hugely to this country but was called a burden. That is just one of the many reported sad cases of racism and hate crime that have exploded since the referendum result.

During the EU referendum, there were many cases in which the NHS was used, as it has been used so many times in history, as a political football. There was the infamous Vote Leave battle bus, which had emblazoned on it:

“We send the EU £350 million a week, let’s fund our NHS instead”.

Then there was the infamous Vote Leave campaign film showing the fate of the NHS inside and outside the EU, ending with the words:

“Every week the UK pays £350 million to be part of the EU. That’s £350 million that could build one new hospital every week, £350 million that could be spent supporting our doctors and nurses. Now is your chance to take back control and spend our money on our priorities, like the NHS”.

Those were absolute lies. The £350 million was incorrect. We contribute £150 million net a week, which is £8 billion a year, and even if the £8 billion was all spent on the NHS, it is a department with a budget of well over £100 billion. Nobody put the £8 billion into the context that it is 1% of annual government spending. It would not even shift the needle, but the Pied Pipers of Hamelin fooled the British people. I have heard of individuals saying that they voted to leave the EU to save the NHS. That is sickening, gut-wrenching. Does the Minister agree?

We are meant to be a first-world country. What was the Electoral Commission doing allowing a campaign bus bearing false information to drive around for months and feature as the backdrop of TV interviews day after day? When my business, Cobra Beer, advertises on TV, it is regulated by the Advertising Standards Authority. We cannot make claims that are untrue or misleading as the ASA would make us take down the ads immediately and we would face the possibility of fines and a loss of reputation. However, I am told that in the referendum the ASA had no control. What is going on? Will the Minister explain why he and fellow Ministers stood by and allowed false statements to be made without holding the perpetrators to account? Does he agree that we need elections to be supervised by an Electoral Commission with teeth? In India, which held the largest democratic elections in the world, with 800 million voters, the Chief Election Commissioner is the most powerful person in country at election time. He is more powerful than the Prime Minister.

The pressures on the NHS and its staffing are because of many other factors that are nothing to do with the EU or migration, such as our ageing population. Even before the EU referendum, the causes of the current nursing shortage were identified: the Government had not funded enough student nursing places; the nursing workforce was ageing; and gaps were not being filled. Since the Francis report, safe staffing levels and increasing healthcare demands on NHS services have pushed up the demand for nurses, while at the same time trusts have faced greater financial difficulties which have made recruiting more difficult.

After the EU referendum result, Jeremy Hunt told EU workers:

“You do a brilliant job for your patients, you are a crucial part of our NHS and as a country we value you”.

Underlying all this is uncertainty surrounding what will happen to EU nationals in the UK while we are negotiating with the EU and whether Parliament will be fully involved in the decision on whether or when to invoke Article 50. Will the Minister tell us that it will go through Parliament and will not be a government decision alone, in the way the Government decided to withdraw from the presidency of the EU in the second half of 2017 without consulting Parliament?

Hours after the EU referendum result, Nigel Farage stated that the official Vote Leave campaign’s call to spend £350 million a week extra on the NHS with money saved from contributions to the EU was a mistake and could not be guaranteed to happen. What hypocrisy!

There are further, broader implications of leaving the EU—for example, for companies seeking to conduct clinical trials. The UK will lose influence over the European Medicines Agency. Simon Stevens, the chief executive of the NHS, wrote recently of his blueprint for the NHS to survive life after Brexit, including acting on prevention and health inequalities. He says that how NHS healthcare is provided needs a major overhaul, and that if GP services fail, the NHS fails. He even says that there is no need to “take back control”, in the words of Vote Leave, as:

“We already make the big decisions about our health system largely as we please, as do the Germans, the French and the rest”.

He says that the Government need to invest in NHS infrastructure and,

“as the largest employer in Europe, the NHS needs to do a better job training and looking after our own staff”.

He says that while the NHS is the cheapest health system in the developed world, there are still major inefficiencies to be tackled, and the time for change is now.

To conclude, here we have the three Brexiteers that the PM in her wisdom has appointed to take us out of Europe. Their motto must be, “All for one and none for all”. David Davis has said that his target is removing the UK from the EU on 1 January 2019 and pressing the button on Article 50 by 1 January 2017. I say to him, “Dream on”. The PM says, “Brexit means Brexit”. I ask her, “What does ‘Brexit’ mean?”. It is still very much up in the air. This debate is just one example of the drastic impact of Brexit.

The NHS, the heart of this country and of everyone’s lives in this country, is reliant on EU migrants to keep us alive—and we want, in the words of Vote Leave, to “take back control”? We are losing control day by day.