Leaving the EU: NHS

Paul Williams Excerpts

Thursday 22nd March 2018 Westminster Hall

[Dr Paul Williams (Stockton South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer, for the first time, I believe. I congratulate my right hon. Friend the Member for Exeter (Mr Bradshaw) on securing this debate and I thank all other hon. Members who have contributed and will contribute.

I have to declare many interests in this debate. Not only am I a patient of the NHS—not too frequently, I hope—but I also work in the NHS. I began my career as a medical student in 1991 in Newcastle and I spent thousands of days working in NHS hospitals, worked for many years as a GP, seen thousands of babies born in the NHS, helped to manage hundreds of good deaths and worked with thousands of colleagues, who are some of the most committed people one could ever hope to meet. My mum worked in the NHS as a nurse. My dad still works in the NHS, managing a practice. My partner works in the NHS and many of my friends work in the NHS. Tomorrow morning, I will be doing a GP surgery at the beginning of the day before working in my constituency and ending the day with an MP surgery.

My experience has taught me that it is the people who make the NHS, Mr Stringer. It is not just the ones whom politicians always talk about—doctors, nurses, paramedics and midwives. The NHS has amazing people working as laboratory technicians, physiotherapists, speech and language therapists, pharmacists, medical secretaries; people working in finance, planning, leadership, estates management, catering and cleaning. Add to that all the people who work in social care, providing care and support to people in their own homes, and in nursing and residential homes, and we have an army of people all dedicated to health and care.

Many of the people in that army do not begin their lives in the UK. We have always welcomed people—particularly, but not exclusively, doctors, nurses and midwives—from other parts of the world. In the last 20 years, the migration into the NHS from other EU countries has been significant, so that EU migrants now make up more than 5% of nurses, one in 10 of all hospital doctors and more than 5% of midwives. There are more than 60,000 EU citizens working in our NHS, giving their lives to helping our NHS. There are another estimated 90,000 EU citizens working in our social care system. Joan Pons Laplana, a Spanish nurse who has worked in the NHS for 17 years and just won the nurse of the year award, says that the uncertainty over Brexit is leading to EU citizens leaving the NHS. Whatever the Government say about EU citizens’ rights, their message is not yet getting through and it is not being believed. People are not hearing them.

Some 10,000 EU health workers have left the NHS since the Brexit vote. As my right hon. Friend the Member for Exeter has mentioned, there are enough EU midwives working in the NHS to staff around 12 maternity units. Between them, EU midwives provide care for around 40,000 mothers in England each year. There are 1,388 EU midwives as of September 2017, representing 5.4% of the workforce. But since the Brexit vote, the number of EU midwives coming has reduced and the number leaving has increased. There was a net loss of 183 EU midwives between October 2016 and September 2017. At that rate there would be no EU midwives left in the UK within a decade. This is happening right here, right now. It is a direct consequence of the Brexit vote.

Whichever way we look at it, the situation is bad. Between September 2016 and September 2017, there was a fall of 89% in new EU registrations to the Nursing & Midwifery Council, a drop from 10,000 people registering to just 1,000 in just one year.

It might be said that we should train our own nurses, not rely on nurses from overseas. I say to that yes and no: yes, we should provide more nursing and midwifery training placements, but changes to nursing bursaries have not led to any increases in placements offered by universities. At the moment, one in 10 nursing posts is vacant. What does that lead to? It leads to wards that might be a nurse down, putting pressure on the other staff, and hospitals having to spend billions of pounds on bank staff to fill the gaps. What does it mean for patients? It means having to wait longer for their appointment, no nurse being available when they are in pain and press their buzzer, and midwives being unable to give the one-to-one care that women deserve when they are in labour. When there are thousands of nursing and midwifery vacancies across the UK, we cannot afford to lose any staff.

The Government might say that they will guarantee the rights of EU staff already here, but that is not enough. Brexit is already making it less desirable for EU clinicians to come to the UK to practise. To limit the damage as much as possible, we need to keep the door open to EU staff and, more than that, we need to actively encourage them to keep coming.

This is not just about nurses; it is about doctors, too. The General Medical Council surveyed more than 2,000 European economic area doctors practising in the UK last year. More than half of them are considering leaving the UK, and 91% of those say that our decision to leave the EU was a factor in their considerations. Those are doctors, nurses, midwives and other important frontline clinical staff from EU countries doing an amazing job for our NHS whom we cannot afford to lose when the NHS is already under immense pressure.

Staff are important, but so is the money to pay them. We have already seen a slump in the value of the pound, making it less attractive for EU nationals to come and work here. That slump has also made it more expensive for the NHS to buy supplies and medicines; the Health Service Journal has estimated £900 million of extra costs each year. We have already seen our economic growth fall from the best in the G7 to the lowest. That reduction means less money for our country and less money for our NHS. Let us be honest: the NHS is not getting the money that it needs from the Chancellor of the Exchequer because when he looks at growth forecasts, he sees downward curves. He sees not enough money coming in to meet the growing needs of our ageing population. The lost growth that has already happened as a result of the Brexit vote is the equivalent of £350 million a week. That has already happened, and the future looks worse.

For the north-east of England—the part of the country that I represent—the Government’s own analysis of the impact of Brexit on the economy shows a reduction in economic output over the next 15 years. The Government’s analysis predicts that if we left the EU but stayed in the single market and customs union, we would grow by 2% less than if we stayed in the EU. It predicts 11% less growth even with a comprehensive trade deal and, if we end up with a no-deal Brexit, 16% less growth. That all means much less money for the NHS, not only now but for the next 15 years.

We have to ask, is it all worth it? This is not the deal that people thought they were getting when they voted to leave the EU. It is not the deal that my constituents in Stockton South, some of whom are here today, wanted, whichever way they voted.

If it were not enough that we have a staffing crisis being made worse by Brexit and a huge hole in our finances, we also need to look at the companies that work so hard to provide drugs and supplies for our NHS. Much of our medical research takes place together with European partners. More than 340,000 patients are enrolled in EU-wide clinical trials, with the UK leading the way in Europe for conducting clinical trials. We have the same set of rules for research as our European partners, and the same set of rules for adoption of new medicines. Together, we form a formidable partnership, representing almost one quarter of the global market for pharmaceuticals; alone, we are only 3%. If we separate from the European Medicines Agency but keep what the Government call “close regulatory alignment”, we will lose our influence and our leadership role in developing these systems and processes. We could end up a rule taker, not a rule maker. If we set our own rules that are different from those of the EU, we risk becoming de-prioritised for new medicines. As my right hon. Friend the Member for Exeter said, on average, Swiss patients get new drugs almost six months later than EU patients. We risk being excluded from clinical trials, for which data is held and co-ordination takes place at an EU level.

The supply chain for medicines and medical devices works now, but there is a risk that it will be disrupted if we leave the customs union. Do not just take my word for it; ask the members of the Association of the British Pharmaceutical Industry, made up of small and medium-sized enterprises working in our med-tech sector, which makes products that cross borders. They say they risk being put out of business by rising charges and more complex customs arrangements.

I am not doom-mongering about the future; this is happening now. The European Medicines Agency is already leaving the UK, taking with it 900 staff, about £300 million in taxable turnover each year, and the UK’s prestige from hosting such an esteemed organisation. The Committee asked Phil Thomson, president of global affairs at GlaxoSmithKline, how much his company had already spent on preparing for Brexit. He said that it was £70 million, which GSK would much rather have spent on cancer research. Those are the costs of Brexit to our NHS.

I know that nobody intended to harm the NHS by voting to leave the EU, but it is time to tell the truth: the NHS, which was already struggling, is now on its knees because of the Brexit vote. Brexit represents a threat to its very existence. Brexit should carry a health warning. Medical health experts—60 former presidents and chairs of medical royal colleagues, more than two dozen patient groups and healthcare unions—warned before the Brexit vote that this would happen. We are already experiencing a worsening of the staffing crisis and less money. In the future, less access to drugs and significant extra unnecessary challenges to research will collectively harm the NHS. Is it all worth it?

[Philip Davies in the Chair]

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[The Minister for Health (Stephen Barclay)]

It is always a pleasure to serve under your chairmanship, Mr Davies. May I begin my joining colleagues in remembering PC Keith Palmer and all those injured in the attack this time last year?

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing the debate. He is a former Minister of State for Health. It is always interesting to hear from him both in his capacity on the Committee and with the experience he brings to the House on health issues. I also pay tribute to the Chair of the Health and Social Care Committee for the very informative report that was published this week.

I will start by addressing workers’ rights, which were raised by the shadow Minister. The Government have made it very clear that there is a commitment to protect workers’ rights and to ensure that they keep pace with changing labour markets. We do not need to be part of the EU to have strong protections for workers. The Government have a very strong commitment on that.

One of the key points raised by colleagues during the debate was the workforce. I am happy to respond constructively to the challenge set by the shadow Minister to send a strong message to EU staff within the NHS on how valued and essential they are. Healthcare professionals are internationally mobile. They are a key component of the NHS. There is consensus across the House on how valued they are as a part of the NHS, and that is very much part of the Government’s approach.

The NHS is a people business. Two thirds of what we spend in the NHS is on staff costs, so it is absolutely essential that there is a clear message to NHS staff. That extends to the people who are trying to re-run the referendum debate and go back to past arguments, who ignore the fact that, according to the latest figures, which go up to September 2017, there are 3,200 more EU nationals working in the NHS than at the time of the referendum.

[Dr Paul Williams]

There might be more EU nationals working in the NHS, but the number of EU clinicians has reduced. I believe that our points about doctors, nurses and midwives are still valid.

[Stephen Barclay]

There has been a slight reduction in nurses; the situation is more textured for clinicians as a whole. The hon. Gentleman did not touch on the fact that there are almost twice as many doctors from the rest of the world than from the EU. The NHS recruits internationally, and that will still be the case after Brexit. The Prime Minister has signalled repeatedly that the UK will be open to the brightest and best, and that will continue to be the case regardless of the deal we do.

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[Stephen Barclay]

I do not know the precise date but, having come to the House from a corporate career, I know that decisions can usually be stopped if there is a concern. The gestation is often for a longer period, but that does not mean that the decision cannot be stopped. The right hon. Gentleman may be able to point to one or two decisions, but there have been a number of significant decisions in the life sciences industry. I look at the investment in Oxford and Cambridge and, for example, the commitment of the Bill and Melinda Gates Foundation and its significant investment in the life sciences industry. I also look to the work that my hon. Friend the Member for Mid Norfolk (George Freeman) has done on the life sciences industry in terms of the golden triangle of London, Oxford and Cambridge. This is a sector that we should be championing, not talking down.

There has been significant investment in the life sciences industry in the past 12 months. It is perfectly valid for colleagues to raise concerns and to recognise the need for the Department to reassure and address specific issues as part of our planning for Brexit. However, it is misleading to suggest that this industry is not thriving when we see the highest investment in Europe coming to the UK, we see 3.5% of the global market coming into the UK and we see Oxford and Cambridge—the golden triangle, as it is termed—thriving in the way we have seen in recent months. Kent Council has been getting in on the act with NCL Technology Ventures, which has put further money into forward-looking medical technology. Even local authorities are recognising the benefits of investment in the life sciences. International and domestic investors are coming together in this area. It is beholden on us in these debates to better reflect the reality of what is happening.

I am always keen to listen to the hon. Member for Stockton South (Dr Williams), who always speaks with authority on medical matters, not least as he is a practising clinician. However, on this occasion I fear he strayed into Treasury matters when he started to talk about the UK growth forecast diminishing. As a former Treasury Minister, I was particularly interested in his remarks, and I gently point out that they were at odds with the Office for Budget Responsibility. The OBR is clear that the growth forecast for 2019 and 2020 is 1.3%. That rises to 1.4% in 2021 and to 1.5% in 2022. The OBR recently improved its growth forecast.

[Dr Williams]

I agree that I am straying into Treasury matters, but I have read the IMF’s forecasts for the UK economy for 2019, which were downgraded from 1.6% to 1.5%, when many of our closest partners, including the United States, Germany and Canada, were upgraded. I have also seen that the UK’s economic growth has fallen from the highest in the G7 to the lowest. That has all happened since our decision to leave the European Union. Is it not true that the IMF predicts that our economic growth will be less than it would have been if we had not made that decision?

[Stephen Barclay]

We can see the variability of forecasts, but the OBR’s forecast, which is the one that really matters—there is consensus that the Government rely on it and that Government planning is undertaken on the basis of it—shows a clear trajectory of improvement that is not reflected in much of the doom and gloom that we have heard in recent weeks. The debate is better informed if we tie it into the benchmarking that the Government use when setting fiscal policy.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) commented on the fact that her constituents are bored by the length of the Brexit debate. I am sure that if anyone is watching the debate, that will resonate with them. That is why it is so important for us to look forward. We should look at the areas of real concern where the Department needs to focus, such as maintaining the regulation and considering the mutual recognition of qualifications, which is a real issue that we want to make progress on with the European Union, because it is of concern to people. To look constructively at how we address some of those issues is far better than having groundhog day on the same areas.

--- Later in debate ---

[Stephen Barclay]

I am a former member of the Public Accounts Committee. The then Chair, the right hon. Member for Barking (Dame Margaret Hodge), would always talk about following the public pound. The National Audit Office has considerable reach in doing that.

My point is that subsidiary companies are within the NHS family. They are 100% owned by the NHS foundation trust that sets them up. They are a better vehicle than the alternative of contracting out, which gives far less grip over how services are provided. The legislation passed by a Labour Government is welcome. We should not re-write history and suggest that legislation that was fine in 2006 should suddenly be presented as privatisation.

That goes to what we sometimes see in the Brexit debate—I will bring this back to the Brexit debate, Mr Davies—in terms of a trade deal with the US. We are sometimes told that a trade deal with the US in a Brexit context is alarming and somehow a threat to the NHS, often by the same people who are very positive about the EU. When TTIP was being debated, the EU lead negotiator said TTIP was not a threat to the NHS.

[Dr Williams]

If there is no threat from a trade deal with the United States, will the Minister rule out the possibility of United States pharmaceutical companies gaining the ability to market directly their products to UK patients in any future trade deal?

[Stephen Barclay]

My point is that we will have control of our trade deal. The Prime Minister has made it clear that there will be no change in the protections afforded to the NHS. The subject of the debate is Brexit, and we are talking about the difference between being inside and outside the EU. The regulatory controls as they would have been under TTIP will be no different in the new landscape.

I remind the hon. Gentleman, who was very critical of Brexit, that more than 61% of people in Stockton voted to leave the EU. He might think that his voters are misguided and wrong, and that they made a huge error in how they voted, but I hope he agrees that it is right that the Government respect that democratic decision and deliver control over our trade policy.