How Brexit will harm our NHS and social care

So, I’m drifting back to LDV slowly and gradually. My husband is now recovering from his heart surgery at home. It’s still quite incredible to think that only 10 weeks ago, he was enjoying his best health in years. All that changed with what we thought was Flu but turned out to be an infection in his heart which damaged one of his heart valves – a pretty complex one, too. My gratitude to the surgical team who sorted this out is unrivalled.

I have been more scared during this time than I have ever been in my life. That late-night phone call from Intensive Care when they said they needed to take him back into theatre was the point that I thought I really was going to crumble. The election of Donald Trump, terrifying as it is, 24 hours later was far from the most stressful thing I had to face that week.

The frenetic running about to and from the hospital and the intrinsic terror of the situation have now been replaced with a much less stressful but still very busy routine of drugging people, feeding people, cleaning, washing and other elements of domesticity which are a bit of a learning curve for me. My slovenly ways have been replaced by scrubbing everything in sight with anti-bacterial potions.

I tell Bob that I am basing my nursing style on Kathy Bates in Misery. He wasn’t really meant to agree that I was doing that well, but never mind.  Yesterday was a bit of a milestone when he had his first wee walk outside in 9 weeks.

I’m clearly going to be pre-occupied with looking after him for a while yet. The likelihood is that I’m still going to be a bit slow to get back to people  and not really engaged full time in the site until the New Year, so please continue to be patient with me.

My thanks go to the team who have had to do well more than they ever signed up for over the last nine weeks. Without them, there would have been no LDV at all. They have been absolutely brilliant.

I’ve observed much about our NHS and the stresses at its frontline. Bob had the most excellent care in hospital, but it was very clear to us how hard everyone was working and how there was so little give in the system. It’s a theme I will return to. For today, though, I want to think about the effects of Brexit on the NHS. The Leave Campaign’s jolly assertion that leaving the EU would mean £350 million a week extra for the NHS was consigned to history almost before the votes had been counted.

Recently, Liberal Democrats have been highlighting the risks to health care that Brexit poses. Scottish Lib Dem health spokesperson Alex Cole-Hamilton made a very good point, arguing that the NHS could be brought to the point of collapse if doctors and nurses from across the EU had to leave as a result of Brexit. I’d take it a bit further, though. At least two of the leaders of the surgical team who performed Bob’s lifesaving operation were from other EU countries. They have helped to make Edinburgh one of the best, if not the best, centres for cardiothoracic surgery in the UK. Their skills and those of other specialists, give prestige to our institutions and hospitals, contributing to their international renown.

I worry as much about these highly skilled professionals choosing to leave because of their perception of the prevailing culture as about May’s Brexit government deporting them to satisfy her own right-wingers.

Protecting EU workers’ rights was always important to me and I was always going to do everything I could to secure them. Now it’s personal.

This is what Alex had to say:

Our health and social care services could not function without the pool of talent we are currently allowed to recruit from. No one voted in the EU referendum on the basis that their local GP would be deported and the NHS cannot afford to suffer a Brexit-induced staffing crisis.

EU citizens are our friends, neighbours and colleagues. They are saving lives in our NHS, delivering world-leading research in universities and making a huge contribution in their local communities. It is utterly shameful that anyone should consider them as cards to be played as part of some grand Brexit strategy.

No-one who voted to Leave will have done so on the basis that their local GP would be deported. The UK Government needs to confirm as a matter of urgency that the rights of those EU citizens who have chosen to make their life here will be protected. The approach that Theresa May and her gang of Brexiteers are taking will cripple our NHS and will only alienate us from our friends and partners in Europe.

The Lords debated the effect Brexit will have on NHS and social care workers and the service. Sal Brinton warned that if the Government achieved their immigration targets, there would be a shortfall of 750,000 workers in the social care sector. The best case scenario was that we would be 300,000 short. Think what that means to the people actually needing that care. Who is going to look after them?

Here is her speech in full (with the text below)

My Lords, I add my gratitude to that of other noble Lords to the noble Baroness, Lady Finlay, for nominating this debate on a vital matter. For me, it does not matter that we have debated this issue already this month; until the Government start to hear and understand the serious concerns, we shall be repeating it regularly.

Although most of my comments will be on social care, I want to start with a conversation I had with two nurses at St Thomas’ Hospital yesterday as I was leaving. They said to me, “You work over the road, don’t you?”. I said that I did, and they continued by saying, “We are just struggling to understand what on earth Brexit is all about. We knew during the campaign that that £350 million a week was not real, but we do not understand why people believed it”. Patients still talk to them about the extra money that the NHS is going to get. They said that they see crisis after crisis going on around them in what is an absolutely excellent hospital. I make no more comment than that, but it is clearly something that is troubling the workforce.

Others have commented on the size of the social care sector—a 1.3 million workforce. As other speakers have already outlined, struggling with the demography alone in Great Britain would put it under pressure, but it is facing a perfect storm. We need to add in the cuts to local government funding, the inability of the Government to commit to delivering Dilnot to really harmonise health and social care, and the Government’s relentless focus on reducing immigration. That is before we even start to consider the financial consequences of Brexit, as outlined yesterday by the OBR.

Independent Age and ILC UK research has looked specifically at social care workforce issues and their modelling shows that the closing off of migration will have a dramatic effect. There will be a social care workforce shortfall of 750,000 people if the Government achieve their objectives of only tens of thousands of immigrants into this country. Even under the high migration scenario, a shortfall of 350,000 is likely purely because of our ageing population. London and the south-east would be worst hit, because one in nine of the capital’s care workers are at risk of losing their right to work here.
There is a further problem in the sector of a very high turnover rate of around 25%, and an estimated vacancy rate of 5.4%, which rises to 7.7% in domiciliary care. The King’s Fund paper, Five Big Issues for Health and Social Care after the Brexit Vote notes that, immediately after the referendum,

“Bruce Keogh, NHS England’s Medical Director, and Jeremy Hunt, the Secretary of State for Health, have both publicly sought to reassure European staff working in the health service”.

They said:

“We endorse these views but would go further: providers of NHS and social care services should retain the ability to recruit staff from the EU when there are not enough resident workers to fill vacancies”.

Can the Minister provide encouragement not just to doctors, nurses and other clinical healthcare professionals but to those who absolutely fill the important jobs in the healthcare sector who have either low or no skills, such as healthcare assistants, cleaners and catering staff, so that they will also have the facility to come to work in the UK to provide vital services?

I turn to the specific experience of people in the social care system, which at the moment is really struggling with seven older people per care worker. By 2037, the projections show that that figure will almost double to 13.5 older people per care worker. That is very alarming, especially as we are relying on the care sector to relieve the pressure on hospitals. How on earth we expect the service to be able to be delivered with even fewer staff is quite extraordinary. London, as I have already mentioned, is especially reliant on migrant care workers. Nearly three out of five of its social care workforce were born abroad and, in recent years, the percentage of EEA workers has increased. Although the overall average does not look particularly large, EEA migrants now make up more than 80% of new entrants to the profession. With the turnover rates to which I have referred of one in four, the consequence of any restriction on EEA workers will be severe and rapid.

On the effect already of the pressures in the social care system, Age UK says that the number of older people in England who do not get the social care that they need now has soared to 1.2 million, up by 48% since 2010. Nearly one in eight older people are struggling with the help that they need to carry out everyday tasks, such as getting out of bed, going to the toilet, washing and getting dressed. Among that 1.2 million, nearly 700,000 do not get any help at all because, as we know, the moment there is pressure on services, the criteria for accessing help keep getting harder and harder.

My right honourable friend Norman Lamb has said that the health and social care systems are “living on borrowed time”, with more providers moving from publicly funded systems to focus entirely on private care. He said:

“The social care system always loses out in comparison with the NHS, and that’s the case even when the money was flowing”.

Under the later years of a Labour Government, there was a real disparity between the NHS and social care; in one Budget, the NHS was awarded 4% and social care just 1%. That is why the Liberal Democrats continue to call for a cross-party commission to address the problems of health and social care funding. We need to address that, and the impact of Brexit on both sectors.

The better care fund, in the coalition, was a small but helpful start, but it remains only a small contribution. Implementing Dilnot is urgent and overdue. Yesterday’s Autumn Statement failed completely to mention health and social care funding. The Alzheimer’s Society in its very helpful briefing made the very important point that, regardless of any changes in migration policies, the Government must make social care an attractive career pathway. Shortfalls in staffing are leading to social care providers failing. Already there is evidence, not just in the health and social care sector but more widely, that EU and EEA workers are leaving the UK because of the uncertainty following the referendum results. With a rapid turnover in the workforce, the consequences will be felt very quickly.

Finally, after all the doom and gloom, I wanted to end on one positive note about the diversity of social care staff. My mother, after one of her strokes, suddenly started speaking French—she had spent a lot of time in France in her childhood. The home went out of its way to find a French healthcare assistant to be moved to her ward and, as a result, she understood them and, importantly for her, someone understood her, and she was able to communicate easily. That is the social care system at its best. We need as a nation to understand that we have to resource it effectively to do its job; it cannot do it on thin air.

* Caron Lindsay is Editor of Liberal Democrat Voice and blogs at Caron's Musings

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14 Comments

  • Sal Brinton raises the issue of older people reverting to mother tongue or another learnt language. It sounds like a pretty obscure issue. In fact it is a significant factor now in dementia care. One of the proudest things we ever achieved in Southwark Lib Dems was twenty years ago when we exposed the appalling neglect of an elderly Polish man in “care” who had been left without first language communication for years. We were jeered by Labour councillors when we joined with Conservatives to raise the case in Full Council.

    Caron, how lovely that you are semi-back. So relieved for you when you said a while back on twitter that your husband was recovering sufficiently to sit up and eat a little.

  • Katharine Pindar 30th Nov '16 - 11:16am

    Caron, it is good to know that you are back with us, and of course that your husband is now recovering at home, having had most excellent treatment. But it is indeed frightening that the illness came on him so quickly and unexpectedly, a real terror for you at the time. Thank you for going on to explore the health services and social care crisis, and giving us Sal Brinton’s comprehensive speech in the Lords, among so many pertinent comments drawing attention to the absolute need to ensure health care professionals from the EEA can remain here and keep on coming. It is important also that one of the main demands of our party in response to the Autumn Statement was for an extra £4 billion for health and social care.
    Of course we have to keep on requiring a proper Government response. Here in West Cumbria, one of our new Liberal Democrat councillors has been fighting with very detailed and effective research to keep services open at one of our two main hospitals. And I hope Norman Lamb’s Beveridge Commission is progressing well. I was sorry not to hear him called to speak in a discussion on child mental health services (completely inadequate apparently) on yesterday’s Radio 4 World at One. On adult mental health, our local MIND is trying to cover the shortfall in local provision. There is so very much to fight about for health and social care, and we must keep at it.

  • Jayne Mansfield 30th Nov '16 - 11:45am

    @ Caron,
    The tasks that care workers carry out do not need special skills. I know that when my late sister needed additional care to that we could provide . it was a fifteen minute visit from someone who helped with showering and then the preparation of a sandwich which was left in the fridge to be eaten later.

    Those who are in favour of Brexit will always be able to respond to the need for such a large foreign workforce with the question as to why this is necessary when they see unemployed working age people on their estate.

    The NHS and particularly some areas are in crisis now and were so even before the Brexit vote which is why the lie on the side of the bus had traction. The fact is there was a large gap between the list of statistics David Cameron was spouting at PMQs and the reality of peoples’ experience .

  • Richard Easter 30th Nov '16 - 12:12pm

    It is politicians of all hues from Thatcher onwards who have harmed Health and Social Care be it via PFI, privatisation or the NHS Health and Social Care 2012 Act.

    This BBC interview with a Cardiologist in Leeds suggests that the EU might even wish to push market liberalisation and privatisation in EU Health Services – see 04.57 in…

  • Richard Easter 30th Nov '16 - 2:45pm

    P.S. is there a way of putting links to videos in here without spamming the whole comment section with previews of them – so just the link can be shown for those who wish to view it.

  • Caron, amy I add my ‘welcome back’….

    I have mentioned before on here two friends/neighbours who are surgeon/anesthetist in our NHS…They are both ME immigrants and are leaving the UK as soon as their contact finishes. (Their home is for sale so they are serious)…

    Brexit has had a demoralising affect on many such people and these are among those we can least afford to lose….

  • Andrew McCaig 30th Nov '16 - 8:53pm

    Caron,
    Very glad to

  • Andrew McCaig 30th Nov '16 - 8:56pm

    Sorry! Phone playing up!
    Glad to see you back and hope everything continues to improve!
    Expats: what you say exposes the folly of our most illiberal Prime Minister!

  • Lorenzo Cherin 1st Dec '16 - 3:49am

    Caron

    Very glad your husband is home and you are both doing well in those areas mentioned.The site here seems to need more hands on deck so you all can cope as it is all done so well by volunteers. Has the time come for some party funding for self employed fees paid to admin staff ? What a terrific team you have !

    I would like it if my own , and my wife’s, experiences, having experienced so much that is wrong with the NHS in many years and going some considerable way back, could have had your experience of quality . Also , having witnessed friends and loved ones get very let down in extremely serious circumstances. Having said that , my late father , over many years needing treatment at the Royal Brompton in London , received terrific levels of service.

    My view is so much needs to change . I have very many years analysing , this, from direct experience and political involvement and have come to many conclusions.

    I believe so much needs to improve . We are ,in the subject you raise, barely scratching the surface . The structure of it in Britain is uniquely poor , literally as well as not !

    I have spoken at meetings on this going back to my Blair supporting days in the latter nineties! Sympathetic ears there then , to change. Some things happened . Much right and wrong. Our party needs to get busy on this .

    Unless we recognise that we need massive injections of money into the front line and real reform, massive changes to the admin side too, nothing can come of a few doctors extra, essential though it is that they stay, from the EU . We must continue that fight.

    As for social care , it is as shameful ,we are not , with staff ,in weeks , training British people , as with doctors or nurses , which takes years.The Blair years barely made a dent , nor the coalition, with regard to impact .

    No convincing argument can emerge for the EU when we were in it for forty years and not once were prepared to say most of them have better models of health care , with better outcomes.

    Could you give details of the new Health and social care association and the Norman Lamb commission? It is amazing how few party groups bother with open facebook or web site giving access to actual info for our own party !

  • David Garlick 1st Dec '16 - 9:53am

    Great to have you back.
    This is a great story, a horror story which is not well known despite it occasionally being in the media and on TV. Sadly it will take the deaths of older people in distressing circumstances of neglect which will make this a real public outcry. I hope it never happens but expect that it will be soon.
    The NHS never funded social care properly even before it was separated from health. Indeed I believe that the separation was entirely to give social care a fair crack of the whip. Why would an NHS manager fund care at home when an A & E department geared to saving life in an emergency needed the funds too? Given that most of the managers in a merged NHS/Care at Home system will come from the NHS … God help Care at Home and its clients.
    Immigration is not the only issue important though it is. NHS and Social Care must work together in a tight collaboration but merging them is not the answer. Doing so at a time of funding shortfall will be catastrophic!

  • Lorenzo
    As usual common sense and spot on.
    I would also add the training of nursing staff needs a complete rethink.
    “Nursing degrees” have had a number of negative consequences not least of which is that the values and qualities of many entering nursing is very different from years past.
    Many seem to think certain aspects of “nursing’ to be beneath them.
    So called Modern Matrons spend less time on the wards and considerable amounts of time in offices managing.
    The “cliff’ of senior nurses retiring in a short period of time and/or leaving the profession has created a vacuum in experience and knowledge.
    Training of the inexperienced used to be done on the wards by the experienced.
    Matrons were respected, ran the wards and ‘trained’ the junior doctors too as they rotated through their disciplines, to a large extend.

    Young people used to enter nursing because they had certain personality traits and values as well as abilitynot because they were simply because they were able to “jump to a certain academic height”

    Like so many areas of the workplace, “apprenticeships” (which effectively were what nursing schools were) where quality ‘on the job training’ is done by experienced staff leads to confidence and competence in those coming up through the ranks.
    In my view we need to get back to training on the wards.

    This of course is linked to the need for huge targeted investment – tax rises for this purpose would get my full support.

  • Matt (Bristol) 1st Dec '16 - 1:25pm

    As someone who works on and off in social care, I find it hard to coment on this issue as I am so angry and depressed about what is happening to the sector.

    I have to admit, that our own party’s plans never felt to me like a sustainable approach, and the 2014 Care Act, well meaning as it was, had an air of ‘tiptoeing through the minefield’ all around it.

    There is still a tendency to talk about social care in vague terms, and a refusal to admit that assaults on local government independence and funding have been a major issue.

    Most non-specialist people I talk to think the money to provide care workers for elderly people comes from the NHS budget. They are always surprised when I explain it is at least part-funded through Council Tax.

    Also, we are at the time of year when everyone talks about ‘bed-blocking’ in NHS hospitals. Very few people discuss the cuts to the number of hospital beds in the UK over the past 20 years, when all governments of all parties knew (if they bothered to check) that the number of elderly people was rising, local authority investment in care homes was falling, and the eligibility threshold for provision of residential and nursing care was becoming consistently stiffer.

    Result: more elderly ill people who cannot be easily discharged home, filling up less beds. Oh, what a shock.

    There is a very British underlying problem – longterm failure to invest, interspersed by short-term randomised panic based around thowing money at symbolic totems.

  • Lorenzo Cherin 1st Dec '16 - 1:29pm

    Thank you Mike.

    You are so correct on nursing and it goes beyond in its impact.

    I can say from my experience and professional involvement and love of and personal interest , in the performing arts , the same applies.Once , before my time there was repertory theatre and , indeed , studio film contracts. An actor , writer , director, could sign a year or two in theatre, sometimes five or seven in film ! Small parts , work as a gag writer , odd jobs , whatever , it was an apprenticeship.

    Now the only one to be had in the media especially , gets you on natonal or international tv or becoming president !

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