Brexit: Health and Welfare

Lord Brooke of Alverthorpe Excerpts

Thursday 29th March 2018 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Brinton, for securing this debate and for her persuasive arguments. I am grateful to all others who have contributed to what has been a very comprehensive debate. I will say something on the impact of Brexit on health inequalities.

I am sure that many of your Lordships are aware of the work by Michael Marmot, who has highlighted that there is a social gradient in health—that is, the lower a person’s social position, the worse his or her health. People living in poorer neighbourhoods in England have lower expectancies and spend more of their shorter lives with a disability, compared with people in wealthier neighbourhoods. For example, the longest life expectancy in the country is in the richest borough, quite close to us, Kensington and Chelsea, where it is 83 for men and women there live to the age of 86. By contrast, the lowest life expectancy is in the north of England, where many people voted for Brexit. For example, in Blackpool we have life expectancy for men down at 74; in Manchester, it is only 79 for women.

Health inequalities stem from avoidable inequalities in society—inequalities in income, education, employment and neighbourhood circumstances. Inequalities present before birth set the scene for poorer health and other outcomes throughout the course of an individual’s life. Action on health inequalities requires action across all the social determinants of health. Marmot made a number of recommendations in his 2010 review to reduce health inequalities, which included giving every child the best start in life; enabling people to maximise their capabilities and have control over their lives; creating fair employment and good work for all; ensuring a healthy of standard of living for all; creating and developing healthy and sustainable places and communities; and strengthening, in particular, ill-health prevention.

The Government’s performance on these since 2010 has been very varied indeed. It is true that unemployment has gone down, but there are still very large question marks about the quality of the work that many people now undertake. We have of course seen of late that income has become virtually static. That is a cause for great concern. Efforts continue to try to make basic changes in education. Communities, through local grants and local authorities, have been starved of funding, with some councils now in dire financial straits, which is having a knock-on effect on social care in particular. Care and health services have generally faced increasing demands, with more patients, more people going into A&E, and people living longer.

In relative terms, while more cash has come in—it is true that the Government have put more money in—this has not matched what has been required, either in terms of the difference between GDP and inflation rate annually or the cost of the growing demand generally. Notwithstanding the defence that the noble Lord and his predecessor have put up that the Government are doing the maximum they could in regard to health, we have learned in the past week, with statements by the Prime Minister and the Secretary of State, that when many of us said for many years that not enough cash was going in and that more was needed, we did have a case. We now have the promise that more money is going to come. To a degree, I suspect that that makes the noble Lord’s response today somewhat easier than it might have been if that statement had not been made, because Brexit, the NHS and money was a central issue in the debate that led to people voting in particular directions. It is welcome news, but like others I hope that we are not going to have to wait too long to see the outline of the plans that the Government will draw up or have to wait too long before we start to see the extra money.

I believe, examining the poll results, that people in the areas of the country that voted for Brexit were influenced to a very substantial degree by the issue of immigration. They were also influenced greatly by the claim on the battle bus about money that would be available to be spent on the NHS. I think they also voted to a fair degree on the somewhat nebulous issue of taking control back from Brussels and being in charge their own country. The Government have to some degree started to answer the question on costs and the NHS but there is another worry and concern about where the NHS may end up, which will hit people in the Brexit areas if it works its way through, and that is that after we come out of Europe we will start to negotiate trade deals. In this speech I focus primarily on the topic which the noble Baroness opened on and wrote about in the House Magazine last week, which is the danger that we will not have the control over the NHS at the end of the day that we have at the moment when we are within the European Union.

All the rumours indicate that talks have been taking place on deals, particularly with the Americans, that the Government need to secure if Brexit is to be seen to be working in the fundamentals of our trade with the rest of the world. America is a very big part of that. There are concerns that the NHS will be on the agenda as part of the negotiations that may take place. If the NHS is on the agenda, it will be there for a purpose. From our angle it will not be improving matters; instead there will be a risk that the Americans want to make greater inroads into the NHS than they have been able to do so far, because of the protection we have had from the EU.

We had a short debate on this last week during which we raised questions about the American trade deal. The noble Viscount, Lord Younger of Leckie, responded for the Government. It was quite a wide-ranging debate within the eight minutes open to each of us and at the end of it we went away feeling we had had a good debate but that the noble Viscount had not been able to answer the points that had been raised by many participants from all sides of the House. We wanted to know why the NHS will be on the agenda and some of us had particular concerns that it may become part of the negotiating deal. If the Government are saying, “It is safe in our hands”, they can give us complete security by giving an undertaking that it will not be on the agenda and that therefore there will not be a risk of any changes, loss of control or damage to the interests of the people of this country. My question, which I put to the Minister last week, is a very simple one: in order to protect the NHS, could we not remove it totally from any agenda for negotiations with the Americans?