Leaving the EU: NHS

Tom Brake Excerpts

Thursday 22nd March 2018 Westminster Hall

[Mr Bradshaw]

I absolutely agree with my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes). I will develop that argument in more detail in a moment.

Our Committee also recognised that the Government have ruled out, so far, continued membership of the customs union and the single market. In the absence of a change of mind from the Government, the Committee concluded that the least damaging Brexit for our NHS will be for us to keep the closest possible regulatory alignment with the rest of the EU in the long term. A majority of the Committee would probably have liked our recommendations to be stronger on that and to include keeping open the option of an European economic area-type relationship in the long term. However, as Committee members we recognised that it is much more powerful for a Select Committee to agree a unanimous report, which ours is, rather than to disagree on a contested one.

[Tom Brake (Carshalton and Wallington) (LD)]

Is the right hon. Gentleman able to say whether his Committee found anything that was positive about Brexit from a health perspective?

[Mr Bradshaw]

Not that I recall. Maybe when the Chair of the Committee, the hon. Member for Totnes (Dr Wollaston), contributes she will have better recall than me. The unanimity of the evidence we heard was very striking indeed.

As well as pursuing the closest possible regulatory alignment, one of our strongest recommendations to the Government is that they must be much more open and clearer about their Brexit contingency planning for a no-deal scenario.

We note and welcome the Prime Minister’s most recent statement that the UK will seek associate membership of the European Medicines Agency—although, given that, it is tragic that we are losing the EMA headquarters from London to the Netherlands. We also welcome the recognition shown by both the Health Secretary and his Lords Minister in their evidence of the importance of continued regulatory alignment with the rest of the EU. We noted that that was in contrast to the Foreign Secretary’s statement that medicines regulation is one of the areas where he would like to see the UK diverge from the EU. I am pleased that the Health Secretary at least won that argument.

However, we have serious concerns about the Government’s lack of a strategy for a no-deal scenario. The Government are still saying that they want a pick-and-mix, cake-and-eat-it relationship with the EU in the future. The image the Prime Minister used in her speech was of three baskets: full alignment in some areas, full divergence in others and something in between for the rest. But if the other 27 EU countries have made anything clear throughout this process, it is that that option is not available. We can have a Norway-style relationship, or we can have a Canada-style relationship, but we cannot have Canada-plus-plus-plus or Norway-minus-minus-minus. It is our choice.

I wish the Government well in their endeavours to achieve their pick-and-mix deal, but given the strong likelihood, if not certainty, that we will not get that, either Ministers will need to do the sensible thing and concede on the customs union and single market, or we will face the danger of crashing out on World Trade Organisation terms. Let me just spell out what our witnesses told us that would mean.

First, it would mean the seizing up of our medicines and medical equipment supply chains. We export 45 million patient packets of medicines a month to other EU countries and import 37 million. Any customs, regulatory or other barriers to this trade will affect supplies. Radioisotopes, for example, are vital in the diagnosis and treatment of cancer. They have a very short lifespan. Their smooth importation from the continent is time critical. The British Medical Association has warned that any disruption to this trade could lead to the cancellation of patient appointments, operations and vital radiotherapy treatment for cancer. Medicines and medical equipment would also become more expensive and there would be delays in getting them licensed and available for British patients. Switzerland gets access to new drugs 157 days later than the EU; Canada, six to 12 months later.

Secondly, we would suffer a further haemorrhaging of NHS staff who are EU nationals, exacerbating the staffing crisis that the NHS and social care face.

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[Tom Brake (Carshalton and Wallington) (LD)]

I join other hon. Members in paying tribute to PC Keith Palmer. It is a privilege to serve in this place, and an even greater privilege to be protected by courageous, selfless public servants such as PC Keith Palmer. It is tragic that he had to give his life to defend those working in and visiting the Palace. We will remember him, and are doing so today.

What the Government are doing in relation to Brexit, and what the prominent supporters of Brexit have inflicted on this country, is unpardonable. I get angrier and angrier as the ramifications of the decision become clearer. Hon. Members mentioned customs. If we do not get the seamless, frictionless deal that is promised, and small and medium-sized enterprises in this country that export to the EU are required to fill in a customs form, the Institute for Government estimates that that will cost them £30. That cost will add nothing whatever to those businesses.

The UK has been a major player in the European Aviation Safety Agency, but we are at risk of coming out of it. If we go back in, we will be subject to the European Court of Justice.

To bring the debate back to the NHS, what will Brexit do to the Institute of Cancer Research in Belmont, in a neighbouring constituency, and its ability to recruit staff and work co-operatively with other EU countries and institutions? I think this is unpardonable.

Yesterday, the Government made one of the very few of their announcements I have welcomed—the pay increase for staff. I intervened on the Secretary of State for Health and Social Care and asked about its impact on the recruitment and retention of EU staff, among others. Of course, as several hon. Members have mentioned, the NHS has been hit by a triple whammy. First, the UK is much less welcoming. That is a direct consequence of Brexit. Those who supported it, who say we are creating a global Britain, need to go out and talk to people and find out that we have left a perception of the UK as an insular country that does not welcome people from abroad. The value of the pound has gone down. Because the pound has crashed, it is much more attractive, particularly for nursing staff who used to come from places such as Portugal, Spain and Italy and remit money to their home countries to support their families, to work in Germany or France. Of course, we are in the bizarre position of choosing to make our trading arrangements with the EU much harder at a point when it seems that every single EU economy is growing faster than ours. We are at the bottom of the pile, so many of the citizens who would have come to this country to work in the NHS will see that their economies are growing faster than ours and that many more jobs are available in their home countries. Therefore, there is less inclination to come here. The NHS, like many other sectors, has been hit by that triple whammy.

Many Members have mentioned the impact on staffing levels, qualifications and retention, but I want to focus on one issue that I do not think other Members have mentioned. The Minister supported Brexit, and I want to understand whether he took into account the impact of our leaving the EU with respect to the falsified medicines directive. I suspect that there was not much small print behind that £350 million extra for the NHS every week, and it certainly did not include a reference to the impact of the UK coming out of the EU in relation to the directive. For those not familiar with it, an EU-wide system ensures that medicines used in the NHS are known to be genuine, rather than being something created in a sweatshop in India, which is not what the packet says. The system is about making sure that everything used in the health service in the EU is genuine, not falsified.

As I understand it, partly as a result of Brexit, the UK has not started building the database required. I see the Minister sending a note back to his officials. I hope that they know the answer. The work has not yet been started on the UK database, but it needs to be in place by February 2019. If it is not, we shall not have the guarantee that the medicines we use here are safe. The Government have apparently said that they definitely want to be part of the database or this arrangement, which is welcome, but it is not clear whether they want to be part of it after Brexit. We need to know immediately from the Minister whether they do want that, and whether the database will be in place by February 2019. If it is not, we shall be at risk of not being able to supply medicines that we are certain are safe.

This may of course be one of those cases when one of the famous red lines on the role of the European Court of Justice may have to be smudged a little bit. My understanding is that the database, and certainly the data within it, would be subject to the ECJ, and therefore if we want to be part of it we will have to swallow the fact that the ECJ will rule over the use of the associated data. That is just one small example of the many—probably millions—of different impacts that Brexit has had where we gain nothing. What we gain is additional cost. We are putting burdens on business. We are certainly not going to get any health benefits. The Minister will be alone in this debate, I think, in trying to find some silver lining in the Brexit cloud in relation to the NHS, because no one else has. He does not have any supporters there in his ranks weighing in behind him, saying “Brexit is brilliant for the NHS; Brexit is what we want for our healthcare.” It is solely on his shoulders. Of course, Mr Davies cannot weigh in, although I know he might be tempted to, but the Chair is not allowed to. So the Minister is alone. Even though he was a Brexit supporter, I suspect that even he does not actually believe that there is anything whatsoever to be gained by Brexit for the NHS.

[Mr Bradshaw]

Does the right hon. Gentleman think that it is significant that the only Conservative Back Bencher to come and speak in this debate focused his remarks almost entirely on the benefits he saw of importing Chinese and Indian homeopathic medicine to this country? Does that not give the impression that there is such a paucity of positive arguments that they were the only ones that anyone could come up with?

[Tom Brake]

I think neither the right hon. Gentleman nor I would like to read too much into that contribution. I doubt very much whether it is established Government policy. The hon. Member for Bosworth (David Tredinnick) is very much an outlier in terms of his approach towards the health service generally.

Now that the Minister has had time to get some information on the falsified medicines directive, I hope he can provide some assurances that the UK will play a part, and will have a database up and running in time for us to be part of that, and he will swallow—although no doubt he was one of the people who said that over his dead body would the ECJ have any impact on us here—the role of the ECJ so that we can be a participant in something that is clearly beneficial from a health point of view, beneficial to patients and to the United Kingdom.

My final point is that the Department of Health and Social Care has asked Ernst and Young to conduct an assessment of the potential implications for the supply of medicines following the UK’s withdrawal from the European Union. As I understand it, that was started in March last year and I believe the work was finished in June. I may be wrong and I am sure the Minister will take pleasure in correcting me if I am, but if I am right, we are entitled to know when this is going to be published. We have a nasty suspicion, just as we did with the sectoral analyses and the impact assessments, that the Government are more interested in hiding the impact of Brexit from us than they are in making these reports public.

I am sure that that report would have gone into extensive detail about the potential implications for the supply of medicines following our withdrawal from the EU, and I doubt very much that it will have found anything very positive about those implications. If that report has been published and I missed it, I apologise, but if it has not, I hope the Minister will be able to set out when it will be published, and published in its entirety, so that we can all assess the impact of Brexit on the supply of medicines.

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[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.