Leaving the EU: Health and Social Care

Patricia Gibson Excerpts

Tuesday 19th March 2019 Westminster Hall

[Brendan O'Hara]

Perhaps the Minister will answer that when he gets to his feet to respond.

How in the name of the wee man did the United Kingdom ever end up in this appalling, self-inflicted mess, in which the sick, the elderly and the vulnerable do not know who will be there to look after them, while healthcare professionals are unable to provide the comfort to their patients that everything will be all right? Only last week, Professor Andrew Goddard, president of the Royal College of Physicians, said that

“the public rightly expects candour from health professionals, and we have ultimately been unable to reassure our patients that their care won’t be negatively impacted by the UK exit from the EU.”

When the BMA wrote to the Prime Minister on 27 February, it left her in no doubt as to its thoughts, stating that

“there is no clearer immediate threat to the nation’s health than the impact of Brexit.”

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

Does my hon. Friend agree that part of the reason why members of the public and our constituents are so concerned is that we have no guarantee against predatory procurement in the NHS or against an interrupted supply of medicines, so how can people be reassured?

[Brendan O'Hara]

I could not have put it better myself. I thank my hon. Friend for that intervention.

Much more could be said on this topic, but I am keen for other Members to have their say. I will conclude with a number of questions, in addition to my earlier one, for the Minister to address when he gets to his feet. What assurances will he offer to each of the 102 organisations that supported my private Member’s Bill that the health and social care sector will not be adversely impacted by the UK leaving the European Union? What plans are being put in place to guarantee that the sector will be able to recruit the workforce it needs post Brexit? Will he support moves to amend the £30,000 minimum income threshold proposed for the immigration Bill, which will be so devastating for those seeking to work in the sector? Will he confirm once and for all that there will be no detrimental impact on the supply of medicines or devices if the UK proceeds to leave the European Union in a catastrophic crashing out? Finally, will he support my call for an urgent, full and independent evaluation of the effects of leaving the European Union on the UK’s health and social care sector?

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[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I thank my hon. Friend the Member for Argyll and Bute (Brendan O’Hara), whose constituency is almost as picturesque and beautiful as mine, for securing this debate.

The debate is extremely important, since we have had no evaluation, independent or otherwise, of the effect of leaving the EU on the UK’s health and social care sector. I heard what the hon. Member for Henley (John Howell) said, but the Royal College of Nursing pointed out that the Brexit process is presenting new and exacerbating existing

“challenges around workforce sustainability, recruitment and retention of the existing and future nursing community”.

That should be of concern to everyone in Parliament.

We know the health and social care sector already faces a recruitment and retention crisis, for a whole host of reasons, including poor pay, the lack of recognition of the important work and professional commitment of those in the sector, and the statutory and voluntary demands of a growing elderly population. We face similar challenges across the UK, but social care in England faces a critical situation, for a variety of reasons. I am therefore extremely disappointed that so few Labour and Conservative Members are present.

The context of this debate is important. The sector relies heavily on workers from the EU, but we have no plan for filling the gaps that are increasingly being left. I have been told in previous debates that no EU workers will necessarily be forced to leave the UK post Brexit if they have been here for a certain number of years and fulfilled certain conditions, but the Minister must recognise that the environment that has been created around Brexit means we will lose many of those workers, in the health and social care sector and beyond. Why should any worker stay in the UK when they can take their skillset and professionalism anywhere they wish in the EU, where they will be welcomed and appreciated? Sadly, that is something they do not feel very often in the current UK environment.

It is deeply concerning, because it is expected that by 2035 we will need 650,000 social care workers in the UK simply to keep pace with rising demand. That is in a sector that, as we heard from my hon. Friend the Member for Argyll and Bute, already faces a range of challenges. The challenges in England are well documented, but we in Scotland are not immune to them. The Care Inspectorate and the Scottish Social Services Council found that more than 38% of social care services report unfilled staff vacancies, even before Brexit has happened. Around 104,000 of the current health and social care workforce are EU nationals, and at any one time around 110,000 positions are unfilled. In addition, about 320,000 of those working in the sector are 55 or older, so they will retire in the next 10 years or so.

The situation is alarming, and the strains are affecting not just our social care sector but our entire national health service across the UK—our nurses, our doctors and our GPs. The situation could throw rural care in particular into real danger. For example, one in five of our rural GPs in Scotland is an EU national, and it seems likely that EU-qualified clinicians are already located disproportionately in hard-to-fill specialisms and shortage occupations such as radiology.

Medical isotopes are used to diagnose and treat cancers. In 2016-17, the NHS used radioactive materials in nearly 600,000 procedures. Those medical radioisotopes have a short half-life and cannot be stockpiled, even if one was minded to do so. The Royal College of Radiologists is preparing for difficulties in accessing radioactive materials by planning a lighter workload for the week following the date of our exit from the EU. However, that will hit patients who need and deserve treatment for their cancer. I mentioned that very point in a debate in the main Chamber two years ago and I was jeered and accused of scaremongering, despite the fact that I was simply quoting the Royal College of Radiologists. The jeering has stopped, but the challenges posed by Brexit are in no way receding; they are growing.

I do not have the relaxed attitude to these challenges that the hon. Member for Henley seems to have. Throw into the mix the UK Government’s inability to guarantee uninterrupted supplies of medicine, and the future looks grim indeed. That inevitably will affect our ability to look after the vulnerable and ill people in our communities in every constituency—the people who need care and the people who need support. Of course, that is in the wider context of NHS services across the UK being open to predatory procurement, which the UK Government refuse to guarantee will not happen.

No evaluation has been undertaken of the effect of leaving the EU on the UK’s health and social care sector. That is an absolute disgrace. The Government of the day have a duty to serve and protect those they seek to represent. Too little attention has been given to the calamitous situation that awaits us unless this Brexit madness, which has been characterised by confusion, incompetence, a complete breakdown of Cabinet responsibility and not a little arrogance, ends. Those who will bear the brunt and pay the price have not featured prominently enough in this unfolding tragedy. Today, their voices and concerns are being set out clearly. The Government should—they simply must—listen and do all they can to protect our health and social care sector, on which we all at some point will rely.

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[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I am grateful to the hon. Member for Argyll and Bute (Brendan O’Hara) for bringing this time-sensitive subject to the Chamber for debate. It is my pleasure to speak on what must be the most important subject of the day.

It is true that in June 2016, the majority of people in the UK voted to leave the EU. However, they did not vote for a worsening of health and social care provision, for reduced access to medicines or for fewer nurses, doctors and care workers. They did not vote to damage medical research or to leave vulnerable people without social care. It is therefore important that we turn to some of the specifics and seek reassurance on behalf of the British people.

The question of medicines has been much talked about, not least this week in this place. Coming from a pharmaceutical background, I am extremely worried about the Government’s complacency. This is not about scaremongering; it is about listening to the real concerns of patients, patient groups and medical professions. Contrary to the comments made by the hon. Member for Henley (John Howell), it is not only helpful but vital for those groups to raise their serious concerns. I agree with the Minister that not only is it not Government advice to stockpile medication, but it is dangerous for patients to do so. One can understand why they might be driven to do so, however; it is an indication of the Government’s failure to provide reassurance on that point.

Medication forms an important part of NHS care. Each year, 1 billion prescriptions are dispensed by community pharmacies. For patients with long-term conditions, such as diabetes, asthma, epilepsy and many more, daily medication is an essential part of staying well. Whether we are talking about medication to treat cancer or heart disease, medication for the management of high blood pressure or the occasional prescription for antibiotics, we take it for granted that the medication that we need will be available when we need it.

The pharmaceutical industry is, by definition, an international business. Key ingredients are often manufactured in India and the far east, and transported to specialist manufacturing plants. Many of the plants that supply the UK are located elsewhere in Europe, and the finished products have to be imported into the UK and distributed to hospitals and pharmacies for use with patients. The entire process has to be carefully managed to ensure that everything happens in a timely way. That is particularly true for medicines with short shelf lives, such as the lifesaving EpiPens needed by those with severe allergies. It is also true for medicines with special storage requirements, such as insulin, which has to be kept refrigerated.

[Patricia Gibson]

A number of us are deeply concerned that because some people in this place are enthusiastic about Brexit, they are wilfully blind to some of the challenges that the hon. Lady is talking about. Does she agree?

[Julie Cooper]

I absolutely agree. We cannot dismiss concerns just because we do not like their implications; it would be irresponsible to do so. Delivery into the UK is currently a just-in-time service for the pharmaceutical industry, for many of the reasons I have mentioned. It is true that in the long term, there is some manufacturing capacity in the UK and we could change the way we get our supplies, but that is not going to happen overnight. It would take a considerable amount of time, given the stringent safety requirements involved in the manufacture of safe medicines, for us to be able to do that.

I am not convinced that we have sufficient supplies or that sufficient steps are in place to ensure an uninterrupted supply. People, including those who rely on insulin, are legitimately worried. Breast cancer care organisations have raised the issue of access to radioactive isotopes needed in the vital treatment of breast cancer. It would be irresponsible of them not to raise that. It is extremely worrying, given that we have only 10 days until the UK leaves the EU, that there are still no arrangements in place. There is no doubt that the UK will need time to establish new supply chains, which is perfectly possible. It is not scaremongering. [Interruption.] I thank the Minister for the comments he has just made from a sedentary position, but we are not convinced. It we were to leave without a deal, the effects would be catastrophic.

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[The Minister for Health (Stephen Hammond)]

It is a pleasure to see you in the Chair this morning, Mr Bone. I will start by addressing the remark by the hon. Member for Burnley (Julie Cooper). She should know that the whole of the Department of Health and Social Care, and indeed the whole of the Government, are absolutely committed to ensuring that there are in place detailed plans, which I hope I will be able to outline and reassure hon. Members about, to ensure that in any post-Brexit scenario the health and social care of our country’s citizens is our top priority.

I thank the hon. Member for Argyll and Bute (Brendan O'Hara) for securing the debate and commend him for his private Member’s Bill. He will know that the Government do not support his Bill—although we support the spirit of it—in part because, as the contribution from the SNP Front Bench showed, it is unnecessary. He is arguing for an independent evaluation and careful analysis of Brexit, but I thought the contribution from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), frequently citing the Health and Social Care Committee, proved that there is a huge amount of independent evaluation, accountability and scrutiny of the plans.

The hon. Member for Argyll and Bute raised a number of questions. I have with me a prepared speech, but I am not sure I will get on to it, because I want to address as fully as I can some of the concerns that hon. Members have raised. He raised a number of concerns about the social care sector, and he is right to do so. Brexit or no Brexit, it is a fragile sector and any event could hinder care provision. That is why, in the light of Brexit, we are working with the sector and local authorities to ensure that we have contingency plans in place.

I will speak more, if I have time, about what we have done regarding EU nationals in the short term, but I want to stress, as the hon. Member for Burnley did, my thanks to all EU nationals who work in either the healthcare system or the social care system. They play a crucial role in delivering high-quality health and social care, and we all recognise that. It is a fact, of course, that the number of EU nationals in adult social care has increased each year, from about 5% in 2012-13 to 8% in 2017-18, but that is no reason to be complacent. That is why we have put in mitigations regarding the EU settlement scheme and are implementing long-term policies to deliver the workforce and address the supply-demand gap that exists.

The hon. Member for Argyll and Bute will of course have noticed the recent recruitment plan, Every Day is Different, which started only last month. As he challenged me directly on this, I can say that we are currently in discussions with the Home Office about the salary threshold for social care.

My hon. Friend the Member for Henley (John Howell) spoke eloquently, as he always does—I have heard him speak in several of these debates—about Henley and other matters. He challenged me to visit Henley, which I would be delighted to do—perhaps on a Friday in July, when other events are on as well.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) asked a number of questions. I made this clear at the start of my speech, and I will make it clear again directly to her: we value all the professionals who work in the national health service and the social care sector. We are putting plans in place, both short term and long term, to ensure that our words are followed by actions and there is practical support, and to ensure that people know how much they are valued. I heard her charge of arrogance, but she might like to reflect on the fact that some might consider it arrogant to suggest in any way that this Government are not putting in place all the necessary preparations to protect the NHS.

[Patricia Gibson]

Will the Minister give way?

[Stephen Hammond]

I will not take an intervention. If the hon. Lady listens carefully to my remarks, she will understand why some of us feel that her charge was unfair.

[Patricia Gibson]

Well, explain it.

[Stephen Hammond]

I am about to, if the hon. Lady will give me time, which is why I will not take her intervention.

The hon. Member for Strangford (Jim Shannon) asked about NHS investment. He knows, of course, about the increase in cash terms of £33.9 billion by 2023-24, which reflects, as I said at the outset, our top priority. He also challenged me about the cancer workforce. Baroness Dido Harding, the chair of NHS Improvement, is carrying out a rapid programme of work for the Secretary of State, engaging with relevant stakeholders across the system to build a workforce implementation plan, which the hon. Gentleman mentioned. We have charged her with making sure that her plan matches the long-term plan’s ambitions. The hon. Gentleman will know that the long-term plan superseded previous plans to establish a larger cancer workforce, and Health Education England is now working with Baroness Harding to make sure that is in place.

I listened carefully to the hon. Member for Glasgow East (David Linden), who asked important questions about insulin and the financial impact of leaving the EU on cancer patients. My officials spoke this morning to insulin suppliers, who have increased their buffer stocks so that they will hold 16 weeks of additional stocks over and above their normal supply. [Interruption.] Yes, it is stockpiling, but it is stockpiling that we have asked the whole pharmaceutical industry to undertake. As the hon. Member for Burnley rightly pointed out, there should be no stockpiling by individuals or pharmacists. I will explain the whole stockpiling issue and why we are rightly putting in place buffer stocks to ensure continuity of supply. The hon. Gentleman asked me whether buffer stocks of insulin are in place, and I can confirm that they are.

The hon. Gentleman also asked me what assessment has been made of the financial impact of EU exit on cancer patients, and what measures are in place to protect services. He will know that the long-term plan contains clear proposals for improving cancer diagnoses. That plan is fully costed. As I just said in response to the hon. Member for Strangford, the workforce implementation plan is putting in place the cancer workforce.

I also listened carefully to the hon. Member for East Kilbride, Strathaven and Lesmahagow, who asked whether my door was open to chairs of all-party parliamentary groups. The answer is yes, of course. If she wishes to contact me, I would be delighted to engage with her, and with chairs of other all-party parliamentary groups.

It is also worth putting on the record the relationship that we are likely to have with the European Medicines Agency post Brexit. The Government are clearly striving for a deal, and in the light of the withdrawal agreement being signed, the political declaration sets out that it is the UK’s intention to explore the possibility of EMA co-operation during negotiations on the future framework. In the event of no deal, we would clearly no longer be any part of the EMA, and the Medicines and Healthcare products Regulatory Agency is ready to carry out EMA functions as a sovereign regulator.

To ensure the continuity of supply, the UK will continue to accept batch testing of human medicines carried out in countries named on a list by the MHRA, including EU, European economic area and European Free Trade Agreement countries, and most third countries with which the EU already has in place a mutual recognition agreement.

[Patricia Gibson]

I thank the Minister for giving way; I know there is a lot that he wants to say. As he is talking about ensuring the supply of medicines, can he reassure the House that that includes medical isotopes?

[Stephen Hammond]

I reassure the hon. Lady that we have been working since last August to ensure that companies understand the routes available to maintain continuity of supply, including air freight routes. We will ensure the potential use of those alternative shipping or air freight routes because, as she rightly points out, these are short-life products. The worst-case scenario—no deal—has been looked at, and routes will be available to ensure that medical isotopes can continue to come into this country.

The hon. Lady referred in her speech to the operationalisation of those plans, which is relevant. Normally, if sea routes are used, it can be ensured that medical isotopes or short-life products are at hospitals by 9 am. She referred to the likelihood that, if air freight routes are used, those products would not arrive until midday, which the NHS advises us would mean that some clinics would be likely to be rescheduled to later in the day. People’s opportunities to undergo treatment will not be interrupted.