Brexit: Risks to NHS Sustainability

Lord O'Shaughnessy Excerpts

Wednesday 12th July 2017 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, I thank the noble Lord, Lord Warner, for obtaining this debate, and I assure him and your Lordships’ House that this Government are committed to making leaving the EU a success for the health and social care sector as well as for the UK as a whole. I thank all noble Lords who have contributed to the debate.

I have to say, as noble Lords probably expect, that I do not share the gloomy prospectus that has been set out for the NHS in the years ahead or for Brexit. My noble friend Lord Cormack asked for a bit of optimism and hope. He might be interested to know that my youngest daughter is called “Hope”, so I am a great optimist. I will explain why I am an optimist about how the years ahead will pan out for this country and for the NHS.

The sustainability of the NHS is, of course, a timely issue, not least because of the excellent report The Long-term Sustainability of the NHS and Adult Social Care, which the noble Lord, Lord Warner, produced earlier this year. I pay tribute to how well that was marshalled by the noble Lord, Lord Patel, who was in his place earlier. I reassure noble Lords that the response to that report is being drafted, so work is in progress and the response will be coming shortly.

As noble Lords will know, the organisation and delivery of healthcare is a member state competence, and this means that the vast majority of the work to implement the NHS five-year forward view will remain relatively unchanged and will continue to have the full support of this Government. While I am on the subject of policy, the noble Lord, Lord Hunt, asked what happened to Dilnot and social care. As he will know, and as I have said before on the Floor of the House, we intend to consult on both a cap and a floor within the social care funding sector, which is in essence what is at the heart of Dilnot. We will be coming forward with proposals that build on that later this year.

The ongoing work of the department and of the entire health sector is to transform how the NHS delivers care to ensure that it is properly configured for the future and that it remains both sustainable and fit for purpose after we exit the EU, and for many years after that. I completely concur with the statement made by the noble Lord, Lord Clark, that not only is it the most efficient healthcare system in the world but that it delivers wonderful care. Despite the ageing and growing population, it has had a number of successes in recent years: real-terms increases in funding, a greater share of public spending, more people being seen in A&E and seeing specialists for cancer, more doctors and nurses, and rising life expectancy. Public perception as measured in a ComRes poll at the start of the year shows support of the statement that the NHS provides a high standard of care to patients was up 13 points to 71% compared to 2014.

The noble Lord, Lord Clark, who speaks with experience on this, is quite right to point out the issue with sources of information. I can reassure him that I have plenty of friends who are either doctors or nurses, so I do hear from the coalface, if you like, and I know that it is not an entirely rosy picture at times. I pay absolute tribute to the work that our NHS staff and staff in social care do, often in very challenging circumstances. I reassure him that I try to expose myself to the realities of life in the NHS as much as I can.

As noble Lords know, following the publication of its Next Steps on the Five Year Forward View, NHS England is working with local areas to develop them into sustainability and transformation partnerships—moving beyond plans to develop tangible delivery organisations with clear partnerships between local organisations, fairly appointed leaders and clear governance structures. I welcome the support of the right reverend Prelate the Bishop of St Albans for this process, which has been backed by Treasury capital funding announced in the Budget. This is enabling the most advanced STPs, as they are known, to evolve into accountable care systems, which will provide joined-up, better care, breaking down the barriers between GPs and hospitals, physical and mental healthcare, and social care and the NHS.

The noble Lord, Lord Hunt, asked what the legislative framework for this is. I am sure that in the long run, the creation of ACSs, or ACOs as they are sometimes known, may require legislative change, but it is not currently necessary, and we can move ahead with the kind of integration that we all want to see. We are serious about improving care for local communities, and these steps towards integration and collaboration provide a mechanism to do just that.

By redesigning services to make it easier for patients to access health and social care at the right time, in the right place, we can make real progress in improving care for local communities. We can begin to move beyond sterile debates about reorganisation, while making sure—in response to the question asked by the noble Lord, Lord Hunt—that the five principles of when reorganisations should happen stay in place. Of course that became five recently with the addition of patient safety, which I think was a point raised by the right reverend Prelate and others.

As this debate has helped highlight, our work will need to be supported by a strong outcome from the Brexit negotiations. Since the result of the referendum, the Department of Health has worked hard to identify areas of the NHS that will be affected and to put in place plans to mitigate any risks and seize any opportunities. I completely agree with my noble friend Lord Cormack on the importance of working together. The Prime Minister has said just that, and it was rather disappointing to hear the leader of the Labour Party be so scornful of such an approach—I am sure that noble Lords on the Opposition Benches would not share their leader’s dismissal of the idea of working together.

The noble Lord, Lord Warner, described in his speech what could be rightly called the doomsday scenario. I think he is perhaps allowing his own beliefs and views of the referendum to cloud the reality. There is a strong desire to have a positive new relationship, and that is shared by the UK and the European Union. That is one that respects the nature of the European Union. That is precisely why the Lancaster House speech set out the position on the ECJ, the single market and the customs union: to respect the nature of the European Union, rather than to have our cake and eat it. It is important to note that more than 80% of votes in the most recent general election were cast for parties that support the process of leaving the European Union.

One of the main areas that noble Lords have highlighted is the ability to maintain our superb NHS workforce. I reassure noble Lords that we are doing our best to provide as much certainty as possible to the 3 million EU citizens in the UK, including the many who dedicate themselves to the work of the NHS and the wider social care system. It is simply not true that we do not value them; we do, and I never miss an opportunity to say so at this Dispatch Box.

Noble Lords will have seen that the Prime Minister has put forward a fair and serious offer on the rights of EU nationals already residing in the UK, and we expect it to be reciprocated by member states for UK nationals in the EU. There are approximately 150,000 staff from the EU doing a vital job for patients, and we expect and are confident that we will be able to negotiate for them to continue to do so post Brexit.

My noble friend Lord Cormack and the noble Baroness, Lady Ludford, asked about the impact of Brexit on recruitment from EU countries. As we have discussed in this House before, the introduction of the language test has been a much more significant factor affecting the flow of EU nationals into the health service. It is important to note that there are more EU nationals than ever working within the NHS.

In the same vein, we intend to protect the current healthcare arrangements for EU citizens who are ordinarily resident in the UK, an issue highlighted by the noble Baroness, Lady Ludford. We are confident that we can reach an agreement on this important issue early in negotiations. Indeed, there is already much common ground between the UK and EU positions. That is in respect of both the EHIC programme and pensioner benefits. The aim here is to achieve reciprocity, as my right honourable friend the Brexit Secretary, David Davis, has set out.

More broadly on immigration, we will continue to welcome the contribution that EU migrants make to our economy and society. We are considering options for a future immigration system very carefully. New UK immigration rules will be decided taking into consideration the prevailing social and economic circumstances, aiming to recruit the brightest and the best for our life sciences industry and to fill any skills gaps. It is important to state—and I state it to the noble Lord, Lord Hunt, and others—that the purpose of leaving the European Union is not to end immigration; it is to get control of immigration and to build public trust in the immigration system. Any immigration system will clearly need to take account of the economic and social needs of the country.

Turning to medicines, the UK is committed—through the FT article by my right honourable friends Jeremy Hunt and Greg Clark, as many noble Lords have noted—to continue a close working relationship with the EU on matters such as public health and medicines regulation. Indeed, we are planning an ambitious life sciences industrial strategy to make sure that we are one of the three global hubs for medical innovation. Our aim is to ensure that patients in the UK and across the EU continue to be able to access the best and most innovative medicines and to be assured that their safety is protected through the strongest regulatory framework. I point out to noble Lords the three principles set out in that letter: that patients should not be disadvantaged; that innovators should be able to get their products into the UK market as quickly and simply as possible; and that we continue to play a leading role in promoting public health. Whatever happens, as I said, we have set out our desire for a strong and positive relationship with the EU. Those will be our guiding principles.

Of course, that must be backed up by excellent research. As a nation, we have a proud history of leading and supporting cutting-edge research. Indeed, many of the innovations that take place in health systems around the world come from research that took place in the UK. I reassure noble Lords that the Treasury is honouring all Horizon 2020 and other EU-based research funding beyond the time horizon of leaving the European Union.

Finally, I turn to the issue of Euratom, which was raised by several noble Lords—the noble Lords, Lord Warner, Lord Clark and Lord Hunt. I understand that this evokes strong feelings, but it is simply wrong to say that cancer patients will be at a disadvantage after we leave Euratom, because it places no restriction on the export of medical isotopes to countries outside the EU. I acknowledge, in particular, the wisdom and experience of the noble Lord, Lord Clark, in this area, and I would be delighted to discuss it with him in person if he were able to make the time.

I now want to return to the beginning of the theme and talk about optimism. Uniquely, possibly, in the history of the negotiation of free trade agreements, we start from the position of regulatory equivalence. So we can do harm only by deciding to go our separate ways. I do not believe that there is any desire on behalf of the UK and the EU to do that. There are, of course, lots of questions to be resolved, and they have been highlighted in the debate today. I think they can be resolved if we take a positive view of what can be achieved as we go about honouring the decision of the British people to leave the European Union.

I can assure noble Lords that the Department of Health is working hard with a large range of stakeholders, and indeed with Members of this House, to work through the upcoming changes. We remain committed to ensuring that we have a sustainable NHS, free at the point of use, which continues to deliver high-quality care now and after Brexit.

House adjourned at 6.51 pm.