NHS and Social Care: Impact of Brexit

Lord Hunt of Kings Heath Excerpts

Thursday 21st July 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, we all look forward to hearing the answer of the noble Lord, Lord Prior, to that question. I, too, thank the noble Baroness, Lady Watkins, for an excellent speech and introduction to this crucial debate. The noble Lord, Lord Shinkwin, also made a very moving speech and it was very good to hear his contribution.

There is obviously a lot of concern about the impact of Brexit on NHS staffing but we have a crisis today. We cannot fill posts. The Department of Health has, in my view, tried to deal with the issue of agency costs but it has not gone upstream to deal with the real issue, which is that we are not actually training enough doctors, nurses, care workers and other staff and we are certainly not retaining them. The antics of the current Secretary of State in relation to the junior doctors, and the impact that this has had on the medical profession, threatens to ensure that we have even fewer staff in the future. It is also becoming clearly apparent from the posturing of the various regulatory agencies and NHS England that the emphasis on safety and staffing since the Francis inquiry has gone and that the pressure on the NHS is on money. We have a double whammy of a shortage of staffing and pressure, undoubtedly from the centre, for staffing ratios to be reduced, not increased.

The noble Baroness, Lady Tyler, is right; clearly this £350 million is a fantasy—but the Government’s approach to NHS funding is a fantasy. They were exposed yesterday by the Health Select Committee. They claimed £8 billion but then it went up to £10 billion because they added an extra year. As the Health Select Committee has shown, over half of that has been retained by the department because it nicked other budget heads. The actual money is pathetic. It is a less than 1% real-terms increase. The health service has never had such a parsimonious amount over such a long time. The regulators and NHS England have this fantasy that somehow the NHS can provide better services on less money. We are facing a crisis. The care sector, as the noble Baronesses, Lady Howarth and Lady Tyler, said, is even worse. The Brexit decision comes on top of a very serious situation for our health and care system.

Before I come on to Brexit, in relation to the point made by the noble Baroness, Lady Emerton, about nursing associates, it would be helpful if Health Education England agreed to come and speak to noble Lords on this issue. I am worried that it is making a decision that properly ought to be made by Parliament in creating essentially a second-tier professional nursing grade. It may be right, it may be wrong, but it should not do it itself. This needs to be shared through a parliamentary process.

I also very much agree with the noble Baroness, Lady Watkins, that the Department of Health needs a lot of advice from professional advisory people. The decision to do away with the nursing, midwifery and allied health professions policy unit has been a very big mistake and I hope it will now be put into reverse.

The noble Lord, Lord Bilimoria, asked the Minister a series of questions which, again, we look forward to hearing the answers to. The question I want to ask is: what preparation did his department make for the result being in favour of Brexit? I suspect the answer is none. This morning the Foreign Affairs Select Committee of the other place said:

“The previous Government’s considered view not to instruct key Departments including the FCO to plan for the possibility that the electorate would vote to leave the EU amounted to gross negligence”.

Anyone who has read the Chilcot report, or the summary, will know that one of its key points was that the then Government refused to let the military plan for the intervention, and the consequences were very serious indeed. When we had the Statement on Chilcot, we were told that the lessons were going to be learned, but this Government went through exactly the same process. On the day after the referendum it was clear that neither the people leading the leave campaign nor the Government had a clue what to do. In fact, were it not for the much-maligned Governor of the Bank of England, I hate to think what would have happened on that day.

My main question for the Minister is: what work is now being undertaken by the department? Obviously, the fundamental issue is the trade-off between free movement of labour and open access to the EU market, as well as the need to protect workers’ rights. But what about the important issues in relation to health? Is the department now going through a process of working through the issues where we need to reach a decision? What needs to be negotiated and what will be the advantages of coming out of EU legislation? Will the department be consulting with the public and with Parliament on that matter?

Other issues go more widely than staffing. The noble Lord, Lord Crisp, raised the question of our participation in EU-wide research projects. Is an emergency task force being established to try to get this right so it is accepted that British universities should be part of collaboration in the future, or are we going to go into a three- or four-year downturn in research, which would devastate our universities?

The second is the life sciences sector, which is a huge asset to this country. What are we doing to ensure that that sector will be able to contribute to our economy and that the innovation it introduces will be enhanced in the future? The failure of the NHS to invest in innovation is one of the most depressing sights that I have seen in the last few years. If we are to enhance the life sciences and pharmaceutical sectors—I am proud of the research-based pharmaceutical sector and I applaud people who work in it; they have contributed a huge amount to this country—we have no chance of retaining R&D in the pharmaceutical sector unless the NHS starts to adopt innovative new medicines. The problem is that a huge amount of rationing is taking place. My concern is that the pharmaceutical industry, and the life sciences sector as a whole, will conclude that the combination of Brexit and the failure of the NHS to invest will lead to a deinvestment. We have to try to sort this through in the next few months.

My final point before I come on to staffing is on the position of the MHRA and clinical trials. I founded the MHRA, in the sense of naming it from its old form, and I am very proud of its work. But its situation is at huge risk unless we can reach an agreement that the relationship it has with the European agency will continue in future. Will that be the Government’s intention? Clinical trials is another area, however.

As far as staffing is concerned, I do not have time to raise many issues but, first, the big ask is for a commitment that staff from other EU countries who work in the NHS and social care will be afforded indefinite leave to remain in the UK. Secondly, will the NHS be instructed to take action against members of the public who abuse staff in the way that we have heard about? We need action; it is no good just tut-tutting. I would like to see whether it is possible to prosecute people. I suspect that it is in certain cases but we have to be very tough on patients. If they expect to be treated in our hospitals, then we can expect our staff to be entitled to respect from them.

The GMC produced a very interesting and detailed note on the impact on the medical profession. Will the Minister assure me that the Government are in discussions with the GMC and the other bodies that are concerned about staffing levels?

Finally, there is a big question. Because the Government have decided that immigration controls are more important than anything else, should we lose a lot of mutual recognition and full access to the free market then one implication is that we will have to train—and retain—more of our own health service staff in future. Is the Minister’s department working on a strategy to do that?