Leaving the EU: NHS

Steve Barclay Excerpts

Thursday 22nd March 2018 Westminster Hall

[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.

[John Grogan (Keighley) (Lab)]

Looking to the future, doctors from outside the EU are currently subject to a strict regime, and at the moment the demand for sponsorship certificates showing that an NHS trust wants to employ a doctor seems to exceed the supply. Will doctors from the EU who want to come to our country post Brexit be subject to the same regime, or does the Minister envisage a different regime? What representations is he making to the Home Office about that matter as we look forward to the immigration Bill?

[Stephen Barclay]

Of course we are making representations to the Home Office, but the Prime Minister has signalled our commitment to attracting the brightest and best, and that will continue. What has been negotiated so far probably gives the hon. Gentleman the best signal. What the Prime Minister announced in December and what my right hon. Friend the Secretary of State for Exiting the European Union announced this week about a transition deal actually protects the rights of EU citizens. That underscores the Government’s commitment to ensuring that a positive message is sent to EU staff in the NHS.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the Minister for giving way and apologise for not making a fuller contribution to this important debate; I had a long-standing commitment as Chair of the Health and Social Care Committee that could not be delayed.

On the workforce, will the Minister comment on a small area that the Committee highlighted in its report but which many people are not aware of: the role of qualified persons? That is the individuals who are legally responsible for batch-testing drugs before they are released on to the market or made available for clinical trials. Will he pay close attention to the problems that will arise and the impact on clinical trials and the safety of medicines if qualified persons are no longer recognised in the UK after it leaves the European Union? That workforce is in great demand, and there is clear evidence that many of them will have to leave to the EU if that happens, leaving Britain short.

[Stephen Barclay]

I am very happy to recognise my hon. Friend’s point, which is well made. As she knows, I am keen to have close discussions with her about such issues. However, through our adoption of the acquis into UK law, our desire for a transition deal, our protection of workers’ rights and our clear signal to EU citizens, the Government have signalled that we are committed to working collaboratively with the EU and to maintaining high standards. Indeed, science and healthcare is one of the areas where collaboration is best and where the EU has the strongest desire to maintain that collaboration. We work from firm foundations as we take on some of these specific issues, which the Department will continue to explore.

At the same time as attracting talent from overseas—from both the EU and beyond—we should not lose sight of the importance of growing our own workforce. Again, the Government have clearly signalled our intention in that regard, with a 25% expansion of undergraduate places for nursing and our announcement earlier this week of five new medical training centres, in Sunderland, Lincoln, Lancashire, Chelmsford and Canterbury. There is a clear desire to strengthen training for the existing workforce.

That sits alongside other initiatives, such as apprenticeships and ensuring that there are different pathways for people to progress in the NHS. That will ensure that people can develop their careers at different stages, so that someone who enters the system as a healthcare assistant, for example, is not trapped in that role but is able to progress through the nursing associate route and go on to be a qualified nurse. There are myriad ways in which we need to ensure that the NHS has the right skills.

That brings me to my hon. Friend the Member for Bosworth (David Tredinnick), who talked about broadening the base of practitioners, an issue on which he has campaigned assiduously for many years. I agree that we do need to broaden the base. That must always be addressed in an evidence-based manner. He cited an interesting BMJ report. However, initiatives are already under way to look at how we have a broader base and more of a multidisciplinary team, for example with physician assistants working alongside GPs in addition to nurses. The issues he raised speak to that.

The hon. Member for Hammersmith (Andy Slaughter) referred to people leaving. In fact, he said that people are voting with their feet, but that is slightly at odds with the fact that there is a net increase in EU staff. It is important that we in this House do not give a sense of negativity or rerunning past arguments on the referendum but start to look forward and reassure people on how much they are welcomed.

A point that came out of remarks by the right hon. Member for Exeter and a number of colleagues in the debate was about the life sciences industry. Again, one did not really get a sense of the reality. The reality is that last year London secured the most investment of any city in Europe—that is post-referendum. Therefore, the doom and gloom and sense that everything is drifting from our life science industry—

[Tom Brake]

Would the Minister like to speculate on when decisions on that investment were made?

[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.

[Dr Cameron]

Given the evidence we heard, and given that I have emphasised how critical the NHS is to the public and that it is a key priority for Brexit, I am perplexed that the Secretary of State for Health and Social Care does not have a place at the Brexit table in Cabinet. Far be it for me to try to elevate him even further, but the NHS is crucial and pivotal and deserves to be at the core of Brexit.

[Stephen Barclay]

The hon. Lady is right to recognise the skills and talent that the Secretary of State brings to this debate as to many others. It is no coincidence that he is the second-longest serving Secretary of State for Health. It would be recognised across the House that it is a demanding job. It is to his great credit that he has been in post for such a period and that he has championed patient safety in the way that he has, which the shadow Minister has generously recognised on occasion.

The Secretary of State’s role in Government was further signalled and underscored by the Prime Minister in the recent reshuffle, when the responsibility for social care was added to the Department. As the debate has reflected, social care, and how we address it from an immigration perspective, and from a training and upskilling perspective, is one of the key legitimate areas of the Brexit debate. We are focused on that in our discussions with the Home Office and others.

The hon. Member for Motherwell and Wishaw (Marion Fellows) picked up on the need for a transition period. That point reflects the fact that the Government are listening and have responded constructively. I know from my previous role in the financial services sector in the City that there is a strong desire for a transitional period. That point was also raised by many in the healthcare sector. It is to the great credit of the Secretary of State for Exiting the European Union that those discussions have been conducted in such a constructive way. There has been a lot of doom-saying and negative commentary—“Nothing will be agreed; it won’t work.”—but he has assiduously stuck to his task. While there are some formal processes still to be completed, significant progress has been made on a transition deal, and there is reasonable consensus that it is constructive.

Several colleagues mentioned the impact of leaving Euratom. I simply remind the House that there is nothing in the Euratom treaty that prevents materials from being exported from an EU member state to countries outside the EU, nor do those materials fall into the category of so-called special fissile material, which is subject to nuclear safeguards. We very much recognise the short half-life of medical radioisotopes and the need for rapid delivery, but again there is much that can be constructively done.

The shadow Minister mentioned subsidiary companies. I do not want to incur your displeasure by straying too far from the subject of Brexit and into subsidiary companies, Mr Davies, but as the shadow Minister raised that point, I feel it is appropriate to address it. He asked what TUPE protections there will be. There are TUPE protections now and the Government have absolutely no intention to change that.

For those who sometimes suggest, as Opposition Members occasionally do, that subsidiary companies within the NHS is a form of privatisation, I merely remind the House that this legislation was passed in 2006 under a Labour Government. I was not in the House at the time, but I do not recall—this may be one for those connoisseurs of Hansard—that it was presented by Labour Ministers as a way of achieving privatisation in the NHS. Subsidiary companies are 100% owned by their parent company, which is the NHS family, so they stay very much within that.

[John Grogan]

Since the Minister has gone in that direction, I ask him again specifically: if it is such a good idea, would it be a good idea for NHS trusts that propose setting up subsidiary companies to publish their business plans so we can see what is happening with that public money?

[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.

[Martin Docherty-Hughes]

The Minister will appreciate that Northern Ireland voted to remain in the European Union. He seemed to hop, skip and jump over the issue of the border. Will he clarify today, or in writing to Members who are participating in this debate, that the common travel area will extend to a member of NHS staff working in Northern Ireland who happens to be a Romanian or French citizen but lives in the Republic of Ireland, and that they will not be forced to become a citizen of the Republic of Ireland or the United Kingdom after Brexit?

[Stephen Barclay]

I am very happy to write to the hon. Gentleman about that. The question of the border is for deep negotiation with our European partners. There is a desire on both sides for us to get it right, particularly given the sensitivities in Northern Ireland.

[Dr Wollaston]

Will the Minister comment on the need for contingency planning, which is one of the central themes of our report? As he knows, nothing is agreed until everything is agreed, and there is genuine concern that we could have a last-minute no-deal scenario, which would have major implications for supply chains in the life sciences industry. Will he confirm whether he will publish a detailed list of the areas in which contingency planning is taking place? Will he also publish the detailed contingency planning?

[Stephen Barclay]

The Chair of the Committee is absolutely right about the importance of contingency planning. In the Scottish context, on the steps of No. 10 recently, a critic of the Government as fierce as the First Minister praised the level of discussion between the devolved Government in Scotland and the UK, and her discussions with the Prime Minister.

It may reassure my hon. Friend to hear that the Department has secured additional funding from the Treasury—more than £20 million—as part of our preparation for Brexit. The right hon. Member for Exeter has previously asked in the House whether the Department’s preparation and staff resource are at the level that he and other colleagues seek. That is a fair observation, and the situation is continually being improved. Alongside that, considerable work is going on within the wider NHS family—in NHS England, NHS Improvement and elsewhere.

Like the Prime Minister and the Secretary of State, I emphasise once again the importance of EU staff within the NHS. They are hugely valued and will continue to be so, and we are keen to protect their workers’ rights. That is reflected in the agreements reached by the Prime Minister in December and those reached earlier this week by the Secretary of State for Exiting the European Union. Alongside that, considerable work is going on within the Department to address a number of these issues as part of our contingency planning. We continue to seek a very close co-operative deal with our partners in the European Union. In areas such as science, there is a long and strong tradition of working in such a collaborative manner. As part of continuing those preparations, this debate and the Committee’s informed report provide much material on which we can work.