NHS and Social Care: Impact of Brexit Next

21 July 2016

Motion to Take Note

Moved by Baroness Watkins of Tavistock

That this House takes note of the implications of the European Union referendum result for government policies on ensuring safe staffing levels in the National Health Service and social care services.

Lord Bilimoria 

 

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.

 

A video of his speech is available here

EU Referendum and EU Reform (EUC Report)

15 June 2016

Motion to Take Note

Moved by Lord Boswell of Aynho

That this House takes note of the Report from the European Union Committee The EU referendum and EU reform

Lord Bilimoria:

My Lords, there is a great deal I do not like about the European Union. No one knows who their MEP is. MEPs have no connection with the people they represent and are not accountable or representative. The EU Parliament moving from Brussels to Strasbourg every month for a week is a ridiculous waste of time and money. The euro is a complete failure—one size will never fit all. It is surviving ​only because it is more difficult to dismantle than keep together. I used to think we lost out on tourism and business visitors by not being in Schengen; now we are fortunate, given the migration crisis and security concerns, not to be in Schengen. I am a true Eurosceptic.

However, given a choice, I have no hesitation in saying that we should remain in the EU. I thank the noble Lord, Lord Boswell, and his committee for producing their reports. I came to this county from India as a 19 year-old student and I have seen the immense change in this country from the time I arrived in the early 1980s, when it was the sick man of Europe, to today being the envy of Europe. The transformation is remarkable. Back in the 1980s, this country had a glass ceiling. Today it is a country of aspiration and opportunity where anyone can get to the top, regardless of race, religion or background. We have seen the highest cumulative GDP growth rate in the European Union since the single market began in 1993. For the United Kingdom it is 62% versus Germany, for example, at 35%. On this point alone, the well-known economist David Smith said in the Sunday Times:

“Britain succeeds in the EU: we’d be daft to leave it”.

This country, with its flexible labour market and open economy, has given me the opportunity to build Cobra Beer from scratch. When we first exported Cobra we chose European Union countries to export to because it was so easy. Now we have exported to more than 40 countries.

I cannot believe that Vote Leave could put out a TV advertisement that states the UK pays £350 million into Europe every week, and then states the purported health spending that this could result in. This is complete nonsense. It should have been taken down by the Advertising Standards Authority. The Vote Leave campaign cannot even get its sums right. We get a rebate from Europe that brings it down to about £150 million a week. If we leave, our current growth rate of 2% a year might flatline or even go into recession. That would be a drop of well over £30 billion —four times our net contribution to the EU.

This country has to wake up and smell the coffee. The Vote Leave campaign is based on a number of bogus claims. Brexit bogus claim number one is about loss of sovereignty. What loss of sovereignty? We are in the EU, but not in the euro; we are in the EU, but not part of Schengen; we are in the EU, but we drink our beer in pints not litres; we are in the EU, but measure our roads in miles not kilometres. No one can tell this country what to do. We have total sovereignty.

Brexit bogus claim number two concerns the lack of democracy. There are elected Members of the EU Parliament. The EU Commission is appointed by elected representatives from each country. We are having a referendum on EU membership right now and we can pull out of the EU whenever we want. Where is the lack of democracy?

Brexit bogus claim number three: Vote Leave says EU regulations cost British businesses £600 million a week. Where has this figure come from? It is completely subjective to try to quantify the impact of red tape. The claims are made by people who have never run a business in their life. Of course there are unpopular regulations, but there are good regulations that protect ​workers’ rights. I can assure noble Lords that when you run a global business, as I have, you do not thinking about EU red tape, you just get on with it. The biggest barriers to business are the UK’s own overly complex, vast and continually increasing taxation, housing and planning laws. These are self-inflicted by the Government of the day and are nothing to do with the European Union whatever.

Brexit bogus claim number four concerns migration. Immigration has benefited this country over the decades. EU immigration has been continually demeaned and vilified by Brexiteers. There are 3 million EU migrants working in the UK. This has built up over a number of years and we know how hard-working they are. For example, surveys show that the Polish community is respected and appreciated by the British public and seen as contributing to our country. We have one of the highest levels of employment on record. We have one of the lowest unemployment levels ever seen—in fact, in practical terms we have full employment, despite 3 million EU migrants. Where is the problem? There are a few bad apples trying to take advantage of our welfare state, but, on the whole, EU migrants have helped us to become the fastest growing country in the EU and they contribute to this economy five times more than they take out.

People talk about a drain on public services. If we need 3 million people to boost our economy, our Government have failed if they have not been able to provide the necessary accompanying public services. In fact, our public services would collapse without the contribution of those 3 million people. Our country needs migration due to our ageing population. Misleading nonsense is proliferating from the Vote Leave campaign about immigration, which states that if we leave the EU we will be able to take in immigrants from elsewhere. Michael Gove has said that he wants to bring net migration down to the tens of thousands. We have net migration of 330,000 now, of which half—about 180,000—is from outside the EU. Even if EU immigration stops dead on Brexit, we still have well over the tens of thousands. Their argument is illogical and the public should not fall for it.

Brexit bogus claim number five is that we could negotiate more trade deals with other countries and we would be in control of our destiny if we left the EU—that we could engage in trade deals with India and America. We are the second-largest recipient of inward investment in Europe. Some 60% of companies operating in the EU have their headquarters in the UK. Would they continue to if we leave? Of course not. Our inward investment would dry up and London would no longer be the number one financial centre in the world. Other countries see the UK as the gateway to Europe. As a professor from the Harvard Business School, of which I am an alumnus, said, we would be mad to leave the EU. If we were to have a deal like those of Switzerland or Norway, we would still have to agree to free movement of people and we would still have to contribute—maybe not £8 billion, but maybe £4 billion.

The Brexiteers tell us that those advising against leaving the EU should not be listened to: “Who are they to tell us? They’ve been wrong in the past”. We do ​not live in a vacuum. We are an integrated member of the global economy. We are not a superpower, but a global power—we sit at the top table of the world: the UN Security Council, the G7, G8, G20, NATO and the EU. If we leave, we jeopardise our standing in the world and our future investment. I did not think I would ever quote the Prime Minister’s wife, but she said:

“I want my children growing up with the advantage of starting their careers in a country that is a big fish in a big pond, leading the way in Europe”.

If we leave the EU we will be a tiddler in an ocean.

Brexit bogus claim number six is that the EU is in a mess and our share of trade with it has been falling. That is quite obvious because we are trading more with emerging markets, but the EU still accounts for 44% of our exports and 55% of our imports. It is too big to jeopardise.

Brexit bogus claim number seven is that there will be further integration, leading to a superstate, and we will be dragged into EU bailouts. There will never be a united states of Europe. I come from India, a country that is a true federal state. Europe will never look like that. The Prime Minister’s negotiations have ensured that we are not committed to further unification and bailouts in the future.

Brexit bogus claim number eight is that there will be an EU army that will subsume the British Army. This is complete fantasy. This will never ever happen. It is also claimed that peace in Europe has been brought about by NATO. It has been brought about by NATO and the European Union.

Brexit bogus claim number nine is that Turkey will become a member of the EU and we will not be able to stop 75 million people coming here. Turkey is light years away from joining the European Union—this is scaremongering.

Lastly, Brexit bogus claim number 10 is that the EU is an economic mess, with youth unemployment up to 50% in countries such as Spain, Italy and France. These countries have been in a mess since 2008-09, when the financial crisis began. We, on the other hand, because of our flexibility and control of our destiny, have thrived. The fate of these EU countries has not prevented us succeeding and getting our economy back on track. Even if the economies of Europe absolutely implode and Europe breaks up, I would rather we were at that table trying to help out and knowing what is going on. As has been said, I do not want to jeopardise our own United Kingdom in a Brexit situation, where Scotland might want to leave. Then there is the huge number of years it has taken to get to the present Northern Ireland situation, which would be jeopardised.

Brexiteers try to say that they are the ones who are proud of Britain. I am proud of Britain—a country that has given me everything, that is not isolationist, selfish or blinkered. What speaks more about a country than anything else is its spirit and values. British people are respected around the world for their values. If we Brexit, we will be sleep-walking over the cliffs of Dover into huge uncertainty and instability. Even Brexiteers are saying that it will take years to renegotiate our position with Europe. A protracted period of ​negotiations, a possible recession, the loss of jobs—we have a fragile recovery and huge debt. We have a current account deficit and a budget deficit. Why risk all this when we do not have to? It is far wiser and far more productive for us to try to reform the EU from within. Why destroy the growth we have achieved? Why risk our standing as the fifth largest economy, with the highest growth rate in the EU and the largest amount of investment in the EU?

There is an African proverb: “If you want to go fast, go alone; if you want to go far, go together”. We are in control of our destiny and we have our sovereignty. I conclude with a very short poem—my favourite poem—written by the Indian Nobel laureate Rabindranath Tagore, which is so pertinent to what we are speaking about:

“Where the mind is without fear and the head is held high

Where knowledge is free

Where the world has not been broken up into fragments

By narrow domestic walls

Where words come out from the depth of truth

Where tireless striving stretches its arms towards perfection

Where the clear stream of reason has not lost its way

Into the dreary desert sand of dead habit

Where the mind is led forward by thee

Into ever-widening thought and action

Into that heaven of freedom, my Father, let my country awake”.