Brexit: Risks to NHS Sustainability

Lord Hunt of Kings Heath Excerpts

Wednesday 12th July 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure for me to congratulate the noble Lord, Lord Warner, on this debate, which I think has been very good and wide ranging. He linked the long-term sustainability of the NHS with the UK’s departure from the EU and demonstrated amply that, even without Brexit, the NHS faces a very difficult challenge in terms of its long-term sustainability. The report of the Select Committee chaired by the noble Lord, Lord Patel, demonstrates very comprehensively some of the questions that we need to consider.

It is abundantly clear that the NHS does not have the required funding. The question we need to put to the Government is: what is their plan for the NHS? Essentially, are they engaged in a wind-down of the NHS’s activities? We know that CCGs are rationing increasingly. We know that the key targets are being missed and I do not know anyone in the health service who thinks that the health service will ever get back to meeting those targets under current circumstances.

A similar question has to be asked of the Government in relation to social care, following the débâcle over the dementia tax. I put it to the Minister that we are still waiting on an answer as to why Dilnot is not being implemented. There has not been a straight answer. We had the report; we had legislation—we spent months taking the Bill through this House. The Government announced the cap at £72,000. They then announced a postponement, but we have yet to hear one reason as to why Dilnot is not being proceeded with. I think we are owed some explanation of why we are in the position we are in.

No doubt the Minister will talk about STPs and the transformation process that is being undertaken in the health service—but there are two things to ask him about that. First, it was the Government’s intention to introduce legislation to amend the 2012 Act to allow the STP process to proceed in a legal way, because clearly it drives a coach and horses through the 2012 legislation. My question for the Minister is: what is now going to happen? I cannot see that the kinds of things that NHS is seeking to do at local level are at all legal in terms of the 2012 Act.

Secondly, the right reverend Prelate put the point very well when he asked: how can it be that in his diocese, in a hospital which is under huge demand, you can justify closing two wards without seeing the commensurate investment in the community, when we are told that if you do that, you will reduce demand on acute hospitals? By the way, I have to say to the Minister that there is no evidence that that will actually happen. No respectable institute has produced any hard evidence that suggests that investing in primary community care reduces demands on acute care. It is much more likely, as Nye Bevan found in 1948, that it deals with unmet demand, but that demand within acute care is likely to continue.

My other question for the Minister is this. The word in the service is that the Government will not support any controversial change in service locally if it will cause angst to local MPs. If that is the case, it is quite clear that the whole STP process will grind to a stop over the next few months as more and more people recognise that it is not the game in town that the Government thought it was going to be.

These are major questions that the Government need to consider. How much worse does the problem become when we come to Brexit? Noble Lords have eloquently described some of the issues that we face—but I put to the Minister the point made by his noble friend Lord Cormack: why are the Government so reluctant to support a Joint Committee of both Houses to consider these matters? After all, part of the debate on Brexit was about the so-called sovereignty of the UK Parliament. Why are the Government so resistant to the UK Parliament exercising sovereignty over the biggest decision this country has faced in 50 years?

The Prime Minister has talked about bringing the country together. How do you bring the country together when your interpretation of a very narrow majority for Brexit is to take an obdurate view that the red lines are around migration and the European court? How on earth is that bringing the country together? Surely a consensus approach would be to find some kind of middle way through the Brexit negotiations, rather than the cul-de-sac the Prime Minister has got herself into—which, of course, in the end she will have to get herself out of because she does not have a majority in the other place for the proposals that she is putting.

We then come to the issues facing the health service. The noble Baroness, Lady Ludford, has already raised the seemingly simple issue of our rights to health treatment in the EU and vice versa. But we are told by the Brexit Secretary that this is now an aspiration. I ask the Minister: what is our policy on this in the future?

We then come to the workforce. We have reached the ludicrous position where the pay policy and the way that professional staff are treated in the health service mean that we have fewer people from this country coming into nursing in the NHS than are actually leaving. We have completely choked off people coming from the EU because of the atmosphere the Government have created with their wretched approach to Europe. My chief exec contacts in the health service tell me that we have dozens of teams in the developing world—India and the Philippines—recruiting nurses to substitute for the nurses we would have had, happily, from the EU. How can that possibly be a sensible approach to the way the NHS is run? It just beats me; it is bizarre. The end of the line is that the Prime Minister will not get anywhere near her immigration target because she will desperately have to approve the recruitment of thousands of nurses from the developing world. Is there any more nonsensical position than that taken by this Prime Minister?

Then there are the life sciences. There are problems around European research. Already universities are losing out on research bids because other European universities will not go into partnership with them. This can have a devastating effect on our life sciences. Our universities are reeling under the ludicrous position taken by the Prime Minister—both as Home Secretary and as Prime Minister—over students coming from overseas to study in our universities. They are a huge earner. Britain has a fantastic reputation. Why on earth are we trying to prevent these people coming to this country? It again defies all understanding.

We then come to medicine regulation. The risk is that if companies continue to develop drugs in this country, they have to have an assurance that when they get a licence from our regulator, the MHRA, it will be recognised throughout the whole of Europe. If they do not get that, we will lose drug development in this country—that is £4 billion of investment. We have seen the letter that the Minister’s right honourable friend the Secretary of State and Mr Clark wrote to the FT a week ago, which makes the right noises in relation to regulation, safety and the interrelationship between what we do in this country and what happens in the EU, but does the Minister agree that in the end the only way forward is an agreement on mutual recognition, even if that involves the European court, as it may well do?

Finally, my noble friend Lord Clark speaks with great authority on Euratom. Why are we risking our energy supply, in many cases, and the safety of patients? For what? It is for some bizarre view that anything with any relationship to the European court is completely out of court.

I fear for the future of the NHS and for the future of this country if this is the Government’s approach. I am confident that Parliament will assert itself to ensure that the Government will have to change course. I hope the Minister will give us a little bit of movement on this in relation to the NHS.