Health and Social Care

Lord Bilimoria Excerpts

Thursday 24th November 2016 Lords Chamber

[Lord Bilimoria (CB)]

My Lords, as I have said before, the National Health Service is Britain’s national treasure, yet it is an institution that is constantly under challenge and pressure. It is the largest employer in the country and the sixth largest employer in the world. I thank the noble Baroness, Lady Finlay, for initiating the debate.

We have heard that there is a shortfall between the numbers of staff that the providers of healthcare services said that they needed and the number of posts, with huge gaps in nursing, midwifery and health workers. In 2014, there was a 50,000 shortfall, yet the Government continue to insist on this net immigration target, to bring it down to the tens of thousands. How will they achieve this when in the NHS and care sector alone, as we have heard, there are over 130,000 just from the EU alone?

We know that in 2015, the NHS recorded its largest deficit ever, of £2.4 billion. And yet, as the noble Baroness, Lady Brinton, has just said, there was no mention in the 72-page Autumn Statement document of the words “NHS”, “mental health”, “public health” or “social care”. May I ask the Minister why was the NHS missing from the Autumn Statement?

We know that the NHS needs more money; we spend less as a percentage of our GDP on health compared with many of our European Union counterparts. Of the original 15 EU countries, we are 13th in healthcare spending. There were some figures released today in the press. In terms of doctors per 1,000 people, we come 25th in the EU, with 2.8; the EU average is 3.5. For hospital beds per 1,000 people, we are 25th with 2.7; the EU average is 5.2 and Germany has 8.2. Our average maternity stay in days is 1.5; the EU average is 3.2. What does the Minister have to say about these rankings?

More than 30,000 doctors from the EEA are currently registered with the GMC to practise medicine in the UK. According to the Royal College of Paediatrics and Child Health,

“In paediatrics, 5.6% of consultants and 5.5% of speciality and associate specialist … grade doctors qualified in EU nations outside the UK … 30% of paediatric consultants and 45% of specialty and associate specialist grade doctors in the UK qualified from other non-EU overseas countries”.

I am chancellor of the University of Birmingham and we have one of the highest-rated medical schools in the country, and one of the largest—we take in almost 400 undergraduates per year. The Secretary of State has said that the Government’s intention is to introduce 1,500 new undergraduate medical school places to make the NHS in England self-sufficient by 2020. Are 1,500 new places going to make us self-sufficient? I do not think that that is possible. Can the Minister confirm that this is the reality?

The Royal College of Nursing, in talking about priorities, says that we have 33,000 EU-trained nurses. There are 58,823 staff with EU nationality working in NHS hospitals and community health services, of whom 10,000 are doctors, 22,000 are nurses and health visitors and 1,369 are midwives. One in three nurses is due to retire in the next 10 years. Clare Marx, the president of the Royal College of Surgeons, said that:

“Twenty-two per cent of registered surgeons trained in European countries, with a further 20 per cent from outside the EU … the main risk of any changes to migration rules is not to highly qualified medical professionals—which the Government has already pledged to protect—but to the tens of thousands of administrative, clerical, and support staff from overseas that the NHS and social care fundamentally rely on for delivery of the service”.

If you look at the statistics it is in every area: in medicine, 14% are from the EEA and 20% from the rest of the world; in something like obstetrics and gynaecology, 40% are non-EU and 15% are from the EEA—that is over 50%. That is how reliant we are on foreign staff and doctors in the NHS.

While we are waiting for Article 50 to be triggered, all our research funding is under threat, as was mentioned earlier. The thing about our research funding is that it is not enough for the Government to say that we are going to compensate for the lack of research funding because we will not be paying into the EU. It is the power of collaboration that we will lose. At the University of Birmingham we collaborated with the University of the Punjab, and during the Prime Minister’s recent visit to India we highlighted that when we do research on our own, the factor is about 1.6 and for the University of the Punjab it is about 1.3; when combined, it is 5.3. When we do combined research with Harvard University, it is 5.6. That is the power of collaborative research that we risk losing if we leave the EU. Higher education and research and the translation of that research into commercial breakthroughs and drug discoveries is huge. All that is under threat.

Elisabetta Zanon, the Director of the NHS European Office, said that:

“A prolonged economic fallout could indeed have a chilling effect on the NHS budget, which in turn could impact on patient care. It could potentially lead to longer waiting times, or reduced access to innovative, expensive medicines and health technologies, or in a lowering of quality”.

This is really serious. The scale of deficit, as we have heard, is up to £2.7 billion. The Institute of Public Care has forecast that the number of people aged over 65 who are unable to manage one or more self-care tasks will increase by 44% by 2030. Are 1,500 extra doctors going to cope with this? Eighty-four thousand of England’s social care workforce are EEA migrants. Head Medical, the largest UK-based international firm specialising in doctors, has said that overseas doctors are deciding not to work in the UK since the country voted to leave the EU, with an increase in the number of EU doctors rethinking their plan to come here. This is really serious.

When I was in India at the time of the Prime Minister’s visit there, she spoke of returning people from here to India. She did not mention higher education once. She did not even meet the 35 higher education leaders who were there with Jo Johnson at the time of the visit and did not even talk about international students. The Indian Prime Minister spoke about the importance and mobility of Indians and Indian students and of foreign education. I remind the House of the fear that arose when nurses who did not earn £35,000 within six years were going to be thrown out of the country. The public backlash was so strong that the Government rowed back on that.

Reducing migration will damage this country. The race and hate crime which I personally have experienced is absolutely shocking. I have met many people who voted to leave the European Union because they believed that slogan on the back of buses which said:

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

and that hugely misleading Vote Leave campaign film which ended:

“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. We contribute to the EU £150 million net a week, which is £8 billion a year. That is 1% of our government expenditure.

In conclusion, this debate is so serious and crucial because it is about the NHS and the care sector. However, it is also about immigration, our vital research, and about what lies at the heart of what makes this country so great, which is in threat and jeopardy.

--- Later in debate ---

[Lord Prior of Brampton]

We have voted to leave the European Union. We now have to make the most of it. We can make the most of it and we can make a success of it. We can use Brexit as a catalyst for change. Even though most people, like me, wanted to stay in the EU, none of us felt that the EU was perfect. Most of us felt that it was a deeply flawed institution. Now that we will be outside the European Union there are huge opportunities that we can take.

The third theme is immigration. Immigration has been hugely beneficial for our country, not least for the NHS but for our country as a whole, and we should celebrate that. But that does not mean to say that uncontrolled, high levels of immigration cannot do damage to our country. The tone of the debate, both in the US around the election and here around Brexit, was often deeply shocking, deeply unhelpful and, as many others have mentioned, deeply deplored.

However, let us not pretend for one minute that all the difficulties around immigration in this country stem from those two debates. No one can say that the “Black Lives Matter” campaign in the US suddenly started when Donald Trump became President-elect. No one can say that the problems which people from BME backgrounds have with the criminal justice system, or have in the NHS, suddenly stemmed from Brexit. Many of these issues are much more profound, much deeper and much more fundamental than that. Controlled levels of immigration can undoubtedly enrich this country materially and culturally, but uncontrolled immigration runs the risk of damaging both those things. Those were the three big issues that ran through this debate.

I turn to the scale of the issue that confronts us. There are 57,000 colleagues from EU member states working in the NHS and about 90,000 working in the social care system. As we heard from my noble friend Lord Colwyn, there are 7,000 dentists from the EU. We know that the proportion of overseas and EU staff is much higher in some parts of the country, especially London. We also know that there is a huge impact on our life sciences industry—I took note in particular of the comments of the noble Lord, Lord Bilimoria, on this—from EU nationals and people from other parts of the world. The collaborative work we do across the EU in life sciences is extremely important. Cancer Research UK says that between 30% and 40% of all its research is done in collaboration with EU nationals. As we put together our strategy for the life sciences, as part of the industrial strategy, I assure the noble Lord that access to the world’s best talent will be absolutely centre-stage and critical.

There should be absolutely no doubt that the UK benefits from immigration, but reducing net migration is compatible with continuing to attract hard-working and skilled people who come here to study and to work. The immigration system will always have a role to play in supporting growth and meeting the needs of UK businesses. People from overseas fill vital gaps in our labour market in social care, nursing, medicine and science.

The Prime Minister has been absolutely clear that she wants to protect the status of EU nationals already living here—incidentally, this was also the view of her predecessor, David Cameron—and that the only circumstances in which it would not be possible is if British citizens’ rights in European member states were not protected in return. Some degree of reciprocity does not seem unreasonable. Personally, I regard the chances of that happening as being so remote as to be almost inconceivable. My right honourable colleague the Secretary of State for Exiting the EU, David Davis, also made this clear when he said:

“We will always welcome those with the skills, the drive and the expertise to make our nation better still. If we are to win in the global marketplace, we must win the global battle for talent. Britain has always been one of the most tolerant and welcoming places on the face of the earth. It must and it will remain so”.

[Lord Bilimoria]

Can the Minister explain this one fact? We have had uncontrolled immigration from the European Union, and we have heard from all quarters in this debate that the NHS and the care sector are highly dependent on those people. We have more than 3 million people from the EU living and working here, yet we have the lowest level of unemployment and the highest level of employment in living memory. How would we have managed without these people? If people voted to leave because of the burden of immigrants on the public sector, we have just proved in this debate that without those immigrants they would not have the public sector.

[Lord Prior of Brampton]

I repeat what I said earlier: the contribution made by people coming into this country from the EU and elsewhere has been enormous. It was clear in the Statement yesterday that one of the great fundamental problems we face in this country is low levels of productivity. If we are to afford the kind of social care system and health system that we want, we have got to increase levels of productivity. It has been too easy for us in this country to rely upon people coming from overseas rather than training our own people.

I strongly believe that that is why we must focus on areas such as life sciences, for example, where we have huge strength in research and high levels of productivity. That is the only way that we are going to be able to afford to have the kind of health and social care system that we need. I agree with David Davis. The Conservative Party is unashamedly internationalist, outward-looking and global in its outlook. There is no place for jingoistic, xenophobic or little England views in our party. On the contrary, we look out to the world, a world that includes Europe, but is not defined by Europe. Noble Lords deplored the xenophobia that appears to have increased since Brexit, and I entirely share their views. There can never be any excuse for that kind of attitude.

We recognise that we cannot continue to rely on people from overseas to maintain the level of staff that is required within our health and care system, nor is it right to do so. If we are honest with ourselves, we knew this before Brexit. We must become more self-sufficient. Indeed, this is consistent with our commitment to the World Health Organization’s priorities on human resources for health. It cannot be morally right for a rich country such as the UK to recruit skilled doctors, nurses and other workers from countries whose need is so much greater than ours, so we will take a range of actions to increase the supply of domestically trained staff and to increase efficiency through better use of technology and skill-mix solutions.

In respect of the NHS, we have already increased the number of key professional groups being trained. For example, since 2013 the number of nurse training commissions has increased year on year by some 15%, and we expect to have 40,000 more nurses by 2020 than we had in 2015. We are committed to ensuring that there will be 5,000 more doctors working in general practice by 2020. From September 2018, the Government will fund up to 1,500 additional undergraduate student places through medical schools in England each year. This is in addition to the 6,000 medical school places currently available in England. That is a very significant increase. It is 1,500 places each year on a five-year course, so that is an extra 7,500 doctors coming through the system. The recent reforms to the funding of training for nurses and allied health professionals will further increase supply by removing restrictions on the number of training places, so that universities are enabled to deliver up to 10,000 additional nursing, midwifery and allied health training places over the course of this Parliament.

Nevertheless, it is important to recognise that it takes time to train skilled health and care professionals, and therefore we have introduced initiatives to improve retention and to encourage trained staff to return to practice. We are also working to increase the efficiency with which we use our existing staff and to improve productivity by changing the skill mix through the introduction of new roles, such as physician associates and nursing associates. This will ensure that highly trained professional staff are properly supported and more productive. We will also see over the next five years a huge increase in the use of digital technology to enable more people to be looked after outside hospital settings.

We all recognise that social care is a vital service for many older and disabled people. The Department of Health is working with Skills for Care, employers and Health Education England to support activity to recruit and, importantly, retain our caring and skilled workers who work in social care. In many ways, these people are the unsung heroes of the health and social care system, delivering very personal care to very vulnerable people at very low salary levels. Since 2010, we have seen more than 340,000 new apprentices into the workplace in the care sector, which is more than any other sector. So we are taking action to increase our home-trained workforce in medicine, nursing and social care.

I do not want anyone in this House to think for one minute that we underestimate the challenges that Brexit presents to the health and social care system, but I think it also presents huge opportunities. It behoves us in this House just occasionally to look on the slightly more optimistic side, and not to be quite as depressing as we sometimes are.