Covid-19: Care Homes

Lord Bilimoria Excerpts

Wednesday 20th May 2020 Lords Chamber

[Lord Bethell]

My noble friend raises one of the key features of our social care system. It is provided by 12,000 different care home providers—or 16,000, depending on how you measure it—many of whom have very different business models. This creates a rich and diverse tapestry of provision, but it is also extremely difficult to engage with from a central campaign provision. That is one of the challenges that we have faced when rolling out support such as PPE and testing. We do not believe that the business models are inappropriate, but undoubtedly we have challenges when we are trying to reach all the care homes with an equal and central format.

[Lord Bilimoria (CB)]

My Lords, the Statement says that 27% of coronavirus deaths in England have taken place in care homes, whereas in Europe the average is around half—but does the Minister agree that in Hong Kong, Singapore and South Korea there were zero deaths in care homes, and in Germany, a country with a population of 90 million people, 3,000 deaths? Also, can he confirm that no patients were ever sent from a care home to a hospital and then back from a hospital to a care home without being tested? Can he reassure us, as the Statement says, that the testing of all care home residents and staff, with and without symptoms, is now taking place? That is 2.5 million people. When will it be done by, and will it be done on a regular basis? Some care homes are saying that it will be necessary to test many times a week.

[Lord Bethell]

The statistics which the noble Lord refers to are correct. It is probably more appropriate to compare the British care home statistics with those in Europe rather than Asia, which had previous experience and different models. With regard to care home testing, not everyone needs to be tested every day. Not every care home has an outbreak, and we must focus our resources on those that do. Regular testing may be necessary for them, but it is not correct that, for example, 2.5 million people need to be tested every week. That is not the advice from the scientists or the CMO. We want to focus our tests where Covid-19 has been found, and we must use our testing resources to expunge the disease from those locations.

Covid-19: Response

Lord Bilimoria Excerpts

Tuesday 19th May 2020 Lords Chamber

[The Deputy Speaker]

I do not think that the noble Lord, Lord Hunt of Kings Heath, is with us this evening, so I call the noble Lord, Lord Bilimoria.

[Lord Bilimoria (CB)]

My Lords, the Minister said that isolation is essential for those who have symptoms. It was only yesterday that the Government finally included the loss of the senses of smell and taste as a symptom. I fell ill with coronavirus on 15 March and lost my senses of taste and smell. At the time, it was not an official symptom. I could not even get tested then—indeed, not even doctors and nurses could—yet the WHO has been saying since the middle of March that we should “Test, test, test”. Eventually we have come around to doing it now and we are ramping it up. As the noble Baroness, Lady Thornton, pointed out, the WHO said eight weeks ago that the loss of taste and smell should be considered a symptom. How many hundreds of thousands of people have now been infected and have infected others because this was not an official symptom? The WHO has also said that social distancing should be one metre, but we say two metres. Why are we not listening to the WHO, or only eventually listening to it? Why are there these inconsistencies?

[Lord Bethell]

I am very sorry that the noble Lord had coronavirus, and it is good to see him on such fine form and in characteristically enthusiastic shape. The bottom line is that lots of people do not lose their sense of smell or taste, and the addition of this symptom was delayed because we did not want to put off those who had not lost their sense of smell and taste from declaring their symptoms. The WHO is right about many things but not about everything.

Covid-19: Government Response

Lord Bilimoria Excerpts

Wednesday 6th May 2020 Lords Chamber

[Lord Bethell]

The Government have gone about the Covid crisis with a great amount of transparency; a very large number of figures are published every single day. I am afraid that some of the questions my noble friend asks are beyond the reach of measurement in our statistical accountability at the moment, but I completely take on board and celebrate her call for transparency. We are working as hard as we can to get as many numbers out to the public as possible.

[Lord Bilimoria (CB)]

My Lords, tracking, tracing and isolating can be effective only if there is adequate testing. It was reassuring to hear the Prime Minister say today that the target was to be 200,000 tests a day by the end of this month. Earlier, he referred to 250,000 tests a day. Can the Minister confirm that millions of tests a week will be available, not just to patients and staff in hospitals and care homes but to the whole British public? In particular, they should be available to workers so that they can get tested and have the confidence to go to work, while consumers can have the confidence to go to restaurants and hotels, bars and venues. Can he also confirm whether pin-prick antibody tests will be available in the millions later this month to the whole British public so that people such as me, who have had Covid-19, can get tested? This would show that we have the immunity to go out to work and participate in the economy without infecting people or getting infected ourselves.

[Lord Bethell]

“Track, test and isolate” does not necessarily depend on doing millions of tests. South Korea, which has an extremely effective regime, does only 20,000 tests a day. That is because its whole society has worked hard to get the prevalence of the infection as low as possible. I celebrate the fact that the British public have committed to the lockdown, but I cannot disguise from the House the fact that the lockdown needs to continue to get the prevalence rate lower.

Covid-19: Social Care Services

Lord Bilimoria Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bilimoria (CB)]

My Lords, just today, Dr Hans Kluge, the WHO regional director for Europe, said:

“According to estimates from countries in the European region, up to half of those who have died from Covid-19 were resident in long-term care facilities. This is an unimaginable human tragedy.”


In her excellent opening speech, the noble Baroness, Lady Wheeler, said that the social care sector was overwhelmed, undervalued and underpaid. The noble Lord, Lord Alton, said that we have just heard today that, sadly, 400 people a day are now dying of Covid-19 coronavirus in care homes. It appears to be sweeping through the council and privately run care homes, with some estimating that up to two-thirds of their residents are infected.

I am an association member of Bupa, which has several care homes. Paula Franklin, its chief medical officer, said that it was only last week that,

“the effect of Covid-19 on those who live and work in Britain’s … care sector has been in the headlines.”

Until then, we did not even know whether they were being counted in the sad daily death rates being told to us; now they are. Of this attention on care homes, she continued:

“In many ways, this is welcome and long overdue. Social care is something of a ‘Cinderella sector’ within the public health system. And yet the NHS could not function without it”,


much as we are thankful for and admire the NHS.

“Covid-19 has now intensified this. Right from the start, although there was a lot that wasn’t yet known about the virus, it was clear our society’s most elderly, frail and fragile were at the greatest risk from the virus … So, while the spotlight was on the … ICU … those working in social care”


are now also in the spotlight. They are the second front line in our battle against Covid-19.

There are 1 million people in care—in care homes, in their own homes and in the community—and some 1.5 million or 1.6 million people looking after them. Can the Minister confirm how many people from ethnic minorities work in the care sector and how many from the European Union? Will we be able to recruit sufficiently after the Government bring in their new immigration policies?

As has been mentioned by many noble Lords, it is shambolic that the care sector has not had an allocation of PPE. Will that now be available? Will the Minister confirm that extra funding will also be made available?

When it comes to testing, the social care sector has been at the back of the queue. Will the Minister now confirm that all patients in care homes and all workers in care homes will be tested? This is a sector in which many workers are elderly themselves. They need to be protected and shielded as much as the residents, yet so many of them are now living in the care homes because they do not want to bring in the virus—but we hear stories of care home patients who go into hospital being sent back without being tested. Will the Minister confirm that there will be regular testing for all 2.6 million people in the care sector—every one of the 1.6 million people who work in it and the 1 million patients?

In conclusion, the 1.6 million people who work in the care sector deserve the same recognition and thanks as the 1.5 million people who work in the NHS. Tonight, when we stand on our doorsteps and applaud the NHS, we will also be applauding our care home heroes.

Health and Social Care

Lord Bilimoria Excerpts

Thursday 24th November 2016 Lords Chamber

[Lord Bilimoria (CB)]

My Lords, as I have said before, the National Health Service is Britain’s national treasure, yet it is an institution that is constantly under challenge and pressure. It is the largest employer in the country and the sixth largest employer in the world. I thank the noble Baroness, Lady Finlay, for initiating the debate.

We have heard that there is a shortfall between the numbers of staff that the providers of healthcare services said that they needed and the number of posts, with huge gaps in nursing, midwifery and health workers. In 2014, there was a 50,000 shortfall, yet the Government continue to insist on this net immigration target, to bring it down to the tens of thousands. How will they achieve this when in the NHS and care sector alone, as we have heard, there are over 130,000 just from the EU alone?

We know that in 2015, the NHS recorded its largest deficit ever, of £2.4 billion. And yet, as the noble Baroness, Lady Brinton, has just said, there was no mention in the 72-page Autumn Statement document of the words “NHS”, “mental health”, “public health” or “social care”. May I ask the Minister why was the NHS missing from the Autumn Statement?

We know that the NHS needs more money; we spend less as a percentage of our GDP on health compared with many of our European Union counterparts. Of the original 15 EU countries, we are 13th in healthcare spending. There were some figures released today in the press. In terms of doctors per 1,000 people, we come 25th in the EU, with 2.8; the EU average is 3.5. For hospital beds per 1,000 people, we are 25th with 2.7; the EU average is 5.2 and Germany has 8.2. Our average maternity stay in days is 1.5; the EU average is 3.2. What does the Minister have to say about these rankings?

More than 30,000 doctors from the EEA are currently registered with the GMC to practise medicine in the UK. According to the Royal College of Paediatrics and Child Health,

“In paediatrics, 5.6% of consultants and 5.5% of speciality and associate specialist … grade doctors qualified in EU nations outside the UK … 30% of paediatric consultants and 45% of specialty and associate specialist grade doctors in the UK qualified from other non-EU overseas countries”.

I am chancellor of the University of Birmingham and we have one of the highest-rated medical schools in the country, and one of the largest—we take in almost 400 undergraduates per year. The Secretary of State has said that the Government’s intention is to introduce 1,500 new undergraduate medical school places to make the NHS in England self-sufficient by 2020. Are 1,500 new places going to make us self-sufficient? I do not think that that is possible. Can the Minister confirm that this is the reality?

The Royal College of Nursing, in talking about priorities, says that we have 33,000 EU-trained nurses. There are 58,823 staff with EU nationality working in NHS hospitals and community health services, of whom 10,000 are doctors, 22,000 are nurses and health visitors and 1,369 are midwives. One in three nurses is due to retire in the next 10 years. Clare Marx, the president of the Royal College of Surgeons, said that:

“Twenty-two per cent of registered surgeons trained in European countries, with a further 20 per cent from outside the EU … the main risk of any changes to migration rules is not to highly qualified medical professionals—which the Government has already pledged to protect—but to the tens of thousands of administrative, clerical, and support staff from overseas that the NHS and social care fundamentally rely on for delivery of the service”.

If you look at the statistics it is in every area: in medicine, 14% are from the EEA and 20% from the rest of the world; in something like obstetrics and gynaecology, 40% are non-EU and 15% are from the EEA—that is over 50%. That is how reliant we are on foreign staff and doctors in the NHS.

While we are waiting for Article 50 to be triggered, all our research funding is under threat, as was mentioned earlier. The thing about our research funding is that it is not enough for the Government to say that we are going to compensate for the lack of research funding because we will not be paying into the EU. It is the power of collaboration that we will lose. At the University of Birmingham we collaborated with the University of the Punjab, and during the Prime Minister’s recent visit to India we highlighted that when we do research on our own, the factor is about 1.6 and for the University of the Punjab it is about 1.3; when combined, it is 5.3. When we do combined research with Harvard University, it is 5.6. That is the power of collaborative research that we risk losing if we leave the EU. Higher education and research and the translation of that research into commercial breakthroughs and drug discoveries is huge. All that is under threat.

Elisabetta Zanon, the Director of the NHS European Office, said that:

“A prolonged economic fallout could indeed have a chilling effect on the NHS budget, which in turn could impact on patient care. It could potentially lead to longer waiting times, or reduced access to innovative, expensive medicines and health technologies, or in a lowering of quality”.

This is really serious. The scale of deficit, as we have heard, is up to £2.7 billion. The Institute of Public Care has forecast that the number of people aged over 65 who are unable to manage one or more self-care tasks will increase by 44% by 2030. Are 1,500 extra doctors going to cope with this? Eighty-four thousand of England’s social care workforce are EEA migrants. Head Medical, the largest UK-based international firm specialising in doctors, has said that overseas doctors are deciding not to work in the UK since the country voted to leave the EU, with an increase in the number of EU doctors rethinking their plan to come here. This is really serious.

When I was in India at the time of the Prime Minister’s visit there, she spoke of returning people from here to India. She did not mention higher education once. She did not even meet the 35 higher education leaders who were there with Jo Johnson at the time of the visit and did not even talk about international students. The Indian Prime Minister spoke about the importance and mobility of Indians and Indian students and of foreign education. I remind the House of the fear that arose when nurses who did not earn £35,000 within six years were going to be thrown out of the country. The public backlash was so strong that the Government rowed back on that.

Reducing migration will damage this country. The race and hate crime which I personally have experienced is absolutely shocking. I have met many people who voted to leave the European Union because they believed that slogan on the back of buses which said:

“We send the EU £350 million a week, let’s fund our NHS instead”,

and that hugely misleading Vote Leave campaign film which ended:

“Every week the UK pays £350 million to be part of the EU. That’s £350 million that could build one new hospital every week, £350 million that could be spent supporting our doctors and nurses. Now is your chance to take back control and spend our money on our priorities, like the NHS”.

Those were absolute lies. We contribute to the EU £150 million net a week, which is £8 billion a year. That is 1% of our government expenditure.

In conclusion, this debate is so serious and crucial because it is about the NHS and the care sector. However, it is also about immigration, our vital research, and about what lies at the heart of what makes this country so great, which is in threat and jeopardy.

--- Later in debate ---

[Lord Prior of Brampton]

We have voted to leave the European Union. We now have to make the most of it. We can make the most of it and we can make a success of it. We can use Brexit as a catalyst for change. Even though most people, like me, wanted to stay in the EU, none of us felt that the EU was perfect. Most of us felt that it was a deeply flawed institution. Now that we will be outside the European Union there are huge opportunities that we can take.

The third theme is immigration. Immigration has been hugely beneficial for our country, not least for the NHS but for our country as a whole, and we should celebrate that. But that does not mean to say that uncontrolled, high levels of immigration cannot do damage to our country. The tone of the debate, both in the US around the election and here around Brexit, was often deeply shocking, deeply unhelpful and, as many others have mentioned, deeply deplored.

However, let us not pretend for one minute that all the difficulties around immigration in this country stem from those two debates. No one can say that the “Black Lives Matter” campaign in the US suddenly started when Donald Trump became President-elect. No one can say that the problems which people from BME backgrounds have with the criminal justice system, or have in the NHS, suddenly stemmed from Brexit. Many of these issues are much more profound, much deeper and much more fundamental than that. Controlled levels of immigration can undoubtedly enrich this country materially and culturally, but uncontrolled immigration runs the risk of damaging both those things. Those were the three big issues that ran through this debate.

I turn to the scale of the issue that confronts us. There are 57,000 colleagues from EU member states working in the NHS and about 90,000 working in the social care system. As we heard from my noble friend Lord Colwyn, there are 7,000 dentists from the EU. We know that the proportion of overseas and EU staff is much higher in some parts of the country, especially London. We also know that there is a huge impact on our life sciences industry—I took note in particular of the comments of the noble Lord, Lord Bilimoria, on this—from EU nationals and people from other parts of the world. The collaborative work we do across the EU in life sciences is extremely important. Cancer Research UK says that between 30% and 40% of all its research is done in collaboration with EU nationals. As we put together our strategy for the life sciences, as part of the industrial strategy, I assure the noble Lord that access to the world’s best talent will be absolutely centre-stage and critical.

There should be absolutely no doubt that the UK benefits from immigration, but reducing net migration is compatible with continuing to attract hard-working and skilled people who come here to study and to work. The immigration system will always have a role to play in supporting growth and meeting the needs of UK businesses. People from overseas fill vital gaps in our labour market in social care, nursing, medicine and science.

The Prime Minister has been absolutely clear that she wants to protect the status of EU nationals already living here—incidentally, this was also the view of her predecessor, David Cameron—and that the only circumstances in which it would not be possible is if British citizens’ rights in European member states were not protected in return. Some degree of reciprocity does not seem unreasonable. Personally, I regard the chances of that happening as being so remote as to be almost inconceivable. My right honourable colleague the Secretary of State for Exiting the EU, David Davis, also made this clear when he said:

“We will always welcome those with the skills, the drive and the expertise to make our nation better still. If we are to win in the global marketplace, we must win the global battle for talent. Britain has always been one of the most tolerant and welcoming places on the face of the earth. It must and it will remain so”.

[Lord Bilimoria]

Can the Minister explain this one fact? We have had uncontrolled immigration from the European Union, and we have heard from all quarters in this debate that the NHS and the care sector are highly dependent on those people. We have more than 3 million people from the EU living and working here, yet we have the lowest level of unemployment and the highest level of employment in living memory. How would we have managed without these people? If people voted to leave because of the burden of immigrants on the public sector, we have just proved in this debate that without those immigrants they would not have the public sector.

[Lord Prior of Brampton]

I repeat what I said earlier: the contribution made by people coming into this country from the EU and elsewhere has been enormous. It was clear in the Statement yesterday that one of the great fundamental problems we face in this country is low levels of productivity. If we are to afford the kind of social care system and health system that we want, we have got to increase levels of productivity. It has been too easy for us in this country to rely upon people coming from overseas rather than training our own people.

I strongly believe that that is why we must focus on areas such as life sciences, for example, where we have huge strength in research and high levels of productivity. That is the only way that we are going to be able to afford to have the kind of health and social care system that we need. I agree with David Davis. The Conservative Party is unashamedly internationalist, outward-looking and global in its outlook. There is no place for jingoistic, xenophobic or little England views in our party. On the contrary, we look out to the world, a world that includes Europe, but is not defined by Europe. Noble Lords deplored the xenophobia that appears to have increased since Brexit, and I entirely share their views. There can never be any excuse for that kind of attitude.

We recognise that we cannot continue to rely on people from overseas to maintain the level of staff that is required within our health and care system, nor is it right to do so. If we are honest with ourselves, we knew this before Brexit. We must become more self-sufficient. Indeed, this is consistent with our commitment to the World Health Organization’s priorities on human resources for health. It cannot be morally right for a rich country such as the UK to recruit skilled doctors, nurses and other workers from countries whose need is so much greater than ours, so we will take a range of actions to increase the supply of domestically trained staff and to increase efficiency through better use of technology and skill-mix solutions.

In respect of the NHS, we have already increased the number of key professional groups being trained. For example, since 2013 the number of nurse training commissions has increased year on year by some 15%, and we expect to have 40,000 more nurses by 2020 than we had in 2015. We are committed to ensuring that there will be 5,000 more doctors working in general practice by 2020. From September 2018, the Government will fund up to 1,500 additional undergraduate student places through medical schools in England each year. This is in addition to the 6,000 medical school places currently available in England. That is a very significant increase. It is 1,500 places each year on a five-year course, so that is an extra 7,500 doctors coming through the system. The recent reforms to the funding of training for nurses and allied health professionals will further increase supply by removing restrictions on the number of training places, so that universities are enabled to deliver up to 10,000 additional nursing, midwifery and allied health training places over the course of this Parliament.

Nevertheless, it is important to recognise that it takes time to train skilled health and care professionals, and therefore we have introduced initiatives to improve retention and to encourage trained staff to return to practice. We are also working to increase the efficiency with which we use our existing staff and to improve productivity by changing the skill mix through the introduction of new roles, such as physician associates and nursing associates. This will ensure that highly trained professional staff are properly supported and more productive. We will also see over the next five years a huge increase in the use of digital technology to enable more people to be looked after outside hospital settings.

We all recognise that social care is a vital service for many older and disabled people. The Department of Health is working with Skills for Care, employers and Health Education England to support activity to recruit and, importantly, retain our caring and skilled workers who work in social care. In many ways, these people are the unsung heroes of the health and social care system, delivering very personal care to very vulnerable people at very low salary levels. Since 2010, we have seen more than 340,000 new apprentices into the workplace in the care sector, which is more than any other sector. So we are taking action to increase our home-trained workforce in medicine, nursing and social care.

I do not want anyone in this House to think for one minute that we underestimate the challenges that Brexit presents to the health and social care system, but I think it also presents huge opportunities. It behoves us in this House just occasionally to look on the slightly more optimistic side, and not to be quite as depressing as we sometimes are.

NHS and Social Care: Impact of Brexit

Lord Bilimoria Excerpts

Thursday 21st July 2016 Lords Chamber

[Lord Bilimoria (CB)]

My Lords, the NHS is Britain’s national treasure. It is something we are all proud of in this country, something we all benefit from and rely on from cradle to grave—yet it is an institution that is constantly under pressure and which faces enormous challenges. It is the largest employer in the country and the sixth-largest employer in the world. Across the board, with doctors, nurses and administrative staff, the NHS has always relied on huge numbers of foreign staff, from within the EU and from outside it. Today there are nearly 60,000 EU nationals working in the NHS. Jeremy Hunt, the Health Secretary, voiced concerns about the impact of a leave vote, stating that, “Another issue”, alongside the potential impact on NHS investment,

“is the damage caused by losing some of the 100,000 skilled EU workers who work in our health and social care system. Uncertainties around visas and residency permits could cause some to return home, with an unpredictable impact on hard-pressed frontline services”.

Simon Stevens, the chief executive of the NHS, said:

“We’ve got about 130,000 European Union nurses, doctors, care workers in the NHS and in care homes. And we should surely miss the benefit they bring were we to choose to leave”.

I thank the noble Baroness, Lady Watkins, for initiating this debate. It is widely acknowledged that the NHS is struggling to recruit and retain staff. In 2014, there was a 50,000 shortfall between the number of staff that providers of healthcare services said that they needed and the number of posts, with particular gaps in nursing, midwifery and health workers. Yet the coalition and Conservative Governments set themselves a target to reduce net migration to a level of tens of thousands, which they have completely failed to achieve, with the current level running at 330,000. Just this week, the Foreign Secretary and the Home Secretary distanced themselves from that target, discussing sustainable levels of migration rather than specific targets. The Prime Minister has now been forced to accept that it will take some time to reduce migration to the tens of thousands. Will the Minister confirm that it is still the Government’s policy to reduce net migration to the tens of thousands and clarify when exactly that ambition is likely to be realised—particularly keeping in mind how the Government will achieve that when the NHS and care sector alone employs 130,000 migrants?

I remind the House of the widespread fear created last year when the Home Office announced that nurses would have to leave the UK if they were not earning £35,000 within six years of living here. I remember how appalled the public were on hearing that. Nursing is one of the noblest professions; nurses work extremely hard, long and unsociable hours, and have always been significantly underpaid for what they do. Many nurses who have come here from the EU and outside would have been forced to leave the country. People who have contributed to our country and who have helped to save lives would have been uprooted from families through a draconian, ruthless and uncaring move. Thankfully, though a public outcry and the nursing professions’ emphasis on the severity of the UK’s nursing shortage, the Government did a U-turn and nursing was added to the shortage occupation list at the end of last year, meaning that nursing was exempt from these rules—thank God.

The Government’s thinking is what is so worrying here. It has led to ill-thought-out policy decisions previously, with the Government committed to Brexit and with Vote Leave’s campaign focused mainly on reducing migration. We are again in danger of implementing draconian measures that would cause untold damage to our most prized public service. The Government want to reduce migration, but here we have our treasured NHS reliant on that same migration. We are told that it is business as normal until Britain leaves the EU, but it is not. Every day of uncertainty risks skilled EU nationals leaving our country and the NHS. We need to give them reassurances to ensure that does not happen. Will the Minister give us that reassurance?

Quite apart from Vote Leave’s constant claim that EU migration is putting pressure on our public services, in this case, without EU migration, the NHS, the jewel in our crown, would collapse. People speak about migrants making it more difficult to see their doctor, but more than a third of doctors working in the NHS were born abroad. The whole campaign in the build-up to this wretched referendum was toxic, and much of what people voted on was nothing to do with the European Union. In fact, the King’s Fund said clearly that the tension between staffing levels and the financial pressures felt by care services is nothing to do with the EU.

A member of my team, who moved to this country 16 years ago and is married to an Englishman, went to the emergency room on the weekend after the EU referendum with a bloody finger which was broken in four places. She was told by somebody sitting next to her in the waiting area that she was a burden on this country. She has worked hard, paid taxes and contributed hugely to this country but was called a burden. That is just one of the many reported sad cases of racism and hate crime that have exploded since the referendum result.

During the EU referendum, there were many cases in which the NHS was used, as it has been used so many times in history, as a political football. There was the infamous Vote Leave battle bus, which had emblazoned on it:

“We send the EU £350 million a week, let’s fund our NHS instead”.

Then there was the infamous Vote Leave campaign film showing the fate of the NHS inside and outside the EU, ending with the words:

“Every week the UK pays £350 million to be part of the EU. That’s £350 million that could build one new hospital every week, £350 million that could be spent supporting our doctors and nurses. Now is your chance to take back control and spend our money on our priorities, like the NHS”.

Those were absolute lies. The £350 million was incorrect. We contribute £150 million net a week, which is £8 billion a year, and even if the £8 billion was all spent on the NHS, it is a department with a budget of well over £100 billion. Nobody put the £8 billion into the context that it is 1% of annual government spending. It would not even shift the needle, but the Pied Pipers of Hamelin fooled the British people. I have heard of individuals saying that they voted to leave the EU to save the NHS. That is sickening, gut-wrenching. Does the Minister agree?

We are meant to be a first-world country. What was the Electoral Commission doing allowing a campaign bus bearing false information to drive around for months and feature as the backdrop of TV interviews day after day? When my business, Cobra Beer, advertises on TV, it is regulated by the Advertising Standards Authority. We cannot make claims that are untrue or misleading as the ASA would make us take down the ads immediately and we would face the possibility of fines and a loss of reputation. However, I am told that in the referendum the ASA had no control. What is going on? Will the Minister explain why he and fellow Ministers stood by and allowed false statements to be made without holding the perpetrators to account? Does he agree that we need elections to be supervised by an Electoral Commission with teeth? In India, which held the largest democratic elections in the world, with 800 million voters, the Chief Election Commissioner is the most powerful person in country at election time. He is more powerful than the Prime Minister.

The pressures on the NHS and its staffing are because of many other factors that are nothing to do with the EU or migration, such as our ageing population. Even before the EU referendum, the causes of the current nursing shortage were identified: the Government had not funded enough student nursing places; the nursing workforce was ageing; and gaps were not being filled. Since the Francis report, safe staffing levels and increasing healthcare demands on NHS services have pushed up the demand for nurses, while at the same time trusts have faced greater financial difficulties which have made recruiting more difficult.

After the EU referendum result, Jeremy Hunt told EU workers:

“You do a brilliant job for your patients, you are a crucial part of our NHS and as a country we value you”.

Underlying all this is uncertainty surrounding what will happen to EU nationals in the UK while we are negotiating with the EU and whether Parliament will be fully involved in the decision on whether or when to invoke Article 50. Will the Minister tell us that it will go through Parliament and will not be a government decision alone, in the way the Government decided to withdraw from the presidency of the EU in the second half of 2017 without consulting Parliament?

Hours after the EU referendum result, Nigel Farage stated that the official Vote Leave campaign’s call to spend £350 million a week extra on the NHS with money saved from contributions to the EU was a mistake and could not be guaranteed to happen. What hypocrisy!

There are further, broader implications of leaving the EU—for example, for companies seeking to conduct clinical trials. The UK will lose influence over the European Medicines Agency. Simon Stevens, the chief executive of the NHS, wrote recently of his blueprint for the NHS to survive life after Brexit, including acting on prevention and health inequalities. He says that how NHS healthcare is provided needs a major overhaul, and that if GP services fail, the NHS fails. He even says that there is no need to “take back control”, in the words of Vote Leave, as:

“We already make the big decisions about our health system largely as we please, as do the Germans, the French and the rest”.

He says that the Government need to invest in NHS infrastructure and,

“as the largest employer in Europe, the NHS needs to do a better job training and looking after our own staff”.

He says that while the NHS is the cheapest health system in the developed world, there are still major inefficiencies to be tackled, and the time for change is now.

To conclude, here we have the three Brexiteers that the PM in her wisdom has appointed to take us out of Europe. Their motto must be, “All for one and none for all”. David Davis has said that his target is removing the UK from the EU on 1 January 2019 and pressing the button on Article 50 by 1 January 2017. I say to him, “Dream on”. The PM says, “Brexit means Brexit”. I ask her, “What does ‘Brexit’ mean?”. It is still very much up in the air. This debate is just one example of the drastic impact of Brexit.

The NHS, the heart of this country and of everyone’s lives in this country, is reliant on EU migrants to keep us alive—and we want, in the words of Vote Leave, to “take back control”? We are losing control day by day.

Southern Cross Care Homes

Lord Bilimoria Excerpts

Tuesday 12th July 2011 Lords Chamber

[Earl Howe]

My noble friend is quite right to say that it is indeed possible that landlords may not wish to take the properties back, but in that scenario it has been agreed that those landlords will look to partner with a reputable care home operator. So it might well be that a care home will join a consortium run by one of the major care home operators which is now in discussions.

[Lord Bilimoria]

My Lords, the Minister said that Southern Cross’s business model was unique, but surely it is not since so many care homes have been following the Opco/Propco model. Does the Minister therefore agree that it was possibly not just mismanagement that was responsible for this situation, but the fact that the business model which worked in the good times—the previous owners did very well out of it—is not working now? As the noble Baroness, Lady Thornton, said, several care homes are in difficulties. Does the noble Earl think that the cuts that are being made might have a role to play as well? Have the Government made a full analysis of the dire situation in the care home sector?

[Earl Howe]

Clearly, my Lords, before the Government produce a White Paper on social care a thorough analysis will be done, and we have the Law Commission report that will guide us in part. Southern Cross developed a business model that worked during times of increasing prosperity, when property values were buoyant and occupancy levels were similar, but it entered into contracts with its landlords which are proving unsustainable in the present climate. Demand for residential care is reducing generally. Not only are councils purchasing fewer care home places, but people are also opting for greater personalisation and more innovative approaches to providing care services, including being looked after at home. My advice is that the Southern Cross business model is unique. That may be—the noble Lord has considerable knowledge in this area—an overstatement and perhaps there are some care homes which are similarly structured, but it is certainly the largest and most significant model of its kind that we are aware of. From the advice I have received, I do not think we should be unduly concerned that other instances on a par with Southern Cross are likely to occur.