NHS and Social Care: Impact of Brexit

Lord Crisp Excerpts

Thursday 21st July 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I too congratulate my noble friend on securing this debate, on her excellent overview and on the detailed illustration of nursing that she gave us. As she said, there is trouble ahead. The NHS is very vulnerable, but so too is social care. It is too early to be clear about exactly what will happen, but it is evident that there will be both short-term impacts and some very much longer-term implications. It is about future recruitment, as well as about maintaining the current workforce. As many other noble Lords have said, there need to be strong and constant reassurances for health workers from the EU, and from other countries, from Ministers, chief executives, professional bodies and colleagues.

It is particularly sad that, as others have said, the referendum result has released suppressed racism and other anti-social attitudes among some parts of the population, and that it seems to have given permission for them to be expressed. These need to be put very firmly back into the box, but the underlying causes also need to be addressed. The Government have particular responsibility to provide clarity in this respect and not to destabilise the situation by questioning the status of immigrants now coming in from the EU. We need careful and considered public statements and policies.

I am one of the later speakers in this debate, so I shall start from a slightly unusual place by emphasising what is, I think, a potentially positive aspect of the Brexit vote. The UK currently has the most extraordinary strength in health, biomedical sciences and life sciences. Some noble Lords may know that last year the All-Party Parliamentary Group on Global Health, of which I am a co-chair, put together a very large report on this issue, looking at our strengths in four sectors that are all linked: academia, government—by which we mean the work of DfID as well as the NHS—commerce and NGOs. In all those sectors the UK is a real world leader, coming first, second or perhaps third, generally with the US beating us. We argued in that report that we should build the UK as a great health hub or centre for health—rather as we have a great financial centre—for the benefit of the world and the UK.

We have a great tradition. Over the years we have produced many great global public goods in health. I think of the work on malaria, on the genome, on neglected tropical diseases and on a whole range of areas, some of which have no immediate or direct relevance to us in this country. As a result of all that work, we have the most astonishing range of global partnerships. One sees that particularly in our academic work but also in these other areas. All that is good for UK influence and UK commerce—for the UK’s status and economy.

Most obviously, Brexit provides an opportunity as the UK seeks to find a new role in the world. It gives extra emphasis and importance to this vision of an outward-focused country and of a world leader in health and related sciences—influential and respected. It is good for our security and prosperity, for trading, influencing and leading, and for spreading a clear set of values. It seems to me that this is a vision that needs to be given greater energy as a result of the vote. That is very positive but there are also enormous risks, of which I shall draw attention to just four.

First, as has been said by many noble Lords, the NHS is in trouble. The Prime Minister’s vision of working for those struggling and just managing applies very much here. We need to expect the NHS to be there for everyone in the country. The NHS as it stands needs to be given a much higher priority than has been the case. I too applaud the piece by Simon Stevens in the Telegraph and his call for some special treatment for, and indeed infrastructure investment in, the NHS in the future. The NHS needs to be part of the future of our country in the way that it has been in the past.

The second risk is to staffing, which we have talked about very largely in terms of the NHS and social care. However, it applies also to staff in our research teams—our biomedical lifeblood, if you like. Where is the immigration policy that will allow us to sustain those fantastic research and scientific partnerships around the world?

Thirdly, there is a risk that has not yet been mentioned: that we must maintain the UK commitment to the World Health Organization’s code of practice for international recruitment. Many noble Lords will recall that we signed up in 2010 to this global code, following on from earlier UK and Commonwealth codes, which essentially said that we should be recruiting people only from countries where there was not a shortage of health workers and, indeed, in some cases, where the Government were keen for us to recruit people. While we have done reasonably well, others around the world have not. However, one can well imagine the pressures coming from this debate leading to us seeking to recruit in ways that are not consistent with that code of practice and perhaps taking us back to where we were before.

The fourth big risk is to research. We already know anecdotally—I suspect that many noble Lords are aware of the fact—that university researchers applying for EU grants now are being told by their EU collaborators, “Please don’t bother; we don’t actually need you and we certainly don’t need you as the lead partner in this application”. The impact is already being felt in that very important area.

Although I might want to try to paint a vision of us as a great health leader in the world, we are vulnerable, for all the reasons that we have talked about. Not only is the NHS vulnerable, as my noble friend’s debate is leading us into discussing, but so is our place in the world in this developing field. Health is the biggest industry in the world now and one of the fastest growing, at 5.2% annually.

The last comments that I made are all very negative and make it difficult to see how we can alleviate these problems. But let me finish with two points. First, what are we doing to become more self-sufficient in health staffing? What are we doing to boost training? We have been, over many years, on a rollercoaster of increasing and reducing training—for example, of nurses, although I do not just mean of nurses. It seems to me that this needs to be given much more priority so that we can approach being self-sufficient. Secondly, the effect of Brexit and the staffing shortages we can already see starting to happen add extra impetus to the need to be innovative, in both service and staffing models.

I will deal briefly with the latter point, which is about how we deploy and use staff within the NHS and within health and social care more generally. We have heard already about nursing associates—bearing in mind my noble friend Lady Emerton’s strictures, I hope I have got it right when I say nursing associates rather than associate nurses. Another example is one that my noble friend Lady Watkins and I have been working on together in the all-party parliamentary group, looking at the role of nurses. By and large, and not just in the UK but globally, nurses are undervalued and not enabled to operate to their full extent. The extraordinary fact is that we train people up to a certain level and then do not let them operate at that level. There is enormous waste in training people and not using them fully. We will be publishing some proposals about that and hope that the Government will not just listen to those proposals but think even more about how the impact of Brexit is forcing people, or can be used as an impetus, towards greater innovation.

Although I and others have many questions for the Minister, let me finish with the four that I have highlighted already, if I may—as opposed to the 10 that I had written down. First, will the Government maintain their commitment to the WHO code of practice on international recruitment and report on their performance against it? Secondly, what are they doing to develop the UK’s role as a global hub and centre for health, biomedical sciences and life sciences? Thirdly, what are they doing to increase training and move towards self-sufficiency? Fourthly, what are they doing to develop the role of different groups of health workers, and particularly to enable nurses to fulfil their potential?