Leaving the EU: NHS Funding

Delegated Legislation – in the House of Commons at 5:20 pm on 15th November 2016.

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Motion made, and Question proposed, That this House do now adjourn.—(Graham Stuart.)

Photo of Chuka Umunna Chuka Umunna Labour, Streatham 5:25 pm, 15th November 2016

On 23 June, our country voted to leave the European Union. The result was not a landslide: 48% voted to remain; 52% voted to leave. London, Scotland and Northern Ireland voted to remain; the majority of England and Wales voted to leave. The young overwhelmingly voted to stay; older voters opted to go. Socioeconomic classes and ethnic groups also voted in different ways.

I was immensely proud to play a leading role in the “Labour In for Britain” and “Britain Stronger in Europe” campaigns during the EU referendum. To my core, I still believe that by the strength of our common endeavour we achieve more together than we do alone, not only as individuals but as a nation state, as we seek to amplify Britain’s role in the world and achieve as much for our community of nations around the world as possible. However, I accept the result. Before the vote, remain campaigners accepted the rules under which the referendum was fought. I do not think that, having had a referendum conducted under those rules, which we debated in the House, we can now reject them because we do not like the outcome. Either you are a democrat or you are not, Mr Speaker, and I am a democrat.

Various promises were made by each side in that referendum campaign. Now it is over, it is important that we hold to account the winning side for the policies and claims that were made and upon which people voted. I say “hold to account” deliberately. We on the remain side would not want all of Vote Leave’s promises to be delivered, but it is right and proper, for the sake of our shared values of democracy, accountability and transparency—the foundations upon which this House is built—that Vote Leave campaigners who are Members of the House should be tested on whether they deliver what they pledged to the people. If they do not, they should explain why not to their constituents and the nation in this House. Thousands of people agree—they have joined the Vote Leave Watch campaign because they care about this, too. I chair that campaign, and I draw the attention of the House to my entry in the Register of Members’ Financial Interests.

One promise that the overwhelming majority of people—both the 16 million who voted remain and the 17 million who voted leave—want to see kept is the Vote Leave campaign’s pledge to put £350 million extra per week into the NHS. That was the key pledge of the Vote Leave campaign. Prominent members of the current Cabinet—the Foreign, Environment, International Development, International Trade, and Transport Secretaries—went around the country in a big red bus that said, “We send the EU £350 million a week. Let’s fund our NHS instead”. They gave speeches in front of a sign saying, “Let’s give our NHS the £350 million the EU takes every week”. None of them disowned that pledge during the campaign—not a single one. The clear message they sought to give to the people was that if we leave the EU, £350 million a week extra will be put into our national health service. No qualification was given to that pledge.

Photo of Stella Creasy Stella Creasy Labour/Co-operative, Walthamstow

My hon. Friend is making a powerful case. This is such an important point for our economy, as we know in my part of London, where the Barts trust has the largest predicted overspend in NHS history. Does he agree that it is vital that those who campaigned on the pledge that this money would be provided are held to account, because communities such as mine are suffering without investment in the NHS?

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

I agree absolutely with my hon. Friend. When I had the pleasure of visiting her constituency the other week, I saw for myself the situation that she describes.

Photo of Wes Streeting Wes Streeting Labour, Ilford North

My hon. Friend is absolutely right that the claim of £350 million a week for the NHS was at the centre of Vote Leave’s campaign. Leave campaigners were given a number of opportunities to review, qualify or disown the claim, including following strident criticism from all members—remainers and leavers—of the Treasury Committee. The fact they chose not to distance themselves from the claim surely demonstrates that this is a promise that ought to be delivered. If it is not delivered, they will have some explaining to do.

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

I completely agree with my hon. Friend. As he said, it was significant that the Treasury Committee came to its conclusion, since it is a cross-party Committee whose members include leavers and remainers.

As my hon. Friend Stella Creasy said, we know that the NHS needs extra cash. The Minister also knows this. As members of the Health Committee pointed out last month, the deficit in NHS trusts and foundation trusts in 2015-16 was more than £3.5 billion.

Photo of Lilian Greenwood Lilian Greenwood Labour, Nottingham South

My hon. Friend makes a powerful argument for extra NHS funding, but does he share my concern that our NHS could actually be worse off as a result of the decision to leave the EU, given that the reduction in our exchange rate will make it more expensive to purchase products from abroad? Does he also share my concern that, when I asked the Secretary of State for Health how much and what proportion of the total NHS budget was spent on imports, the Department was unaware and therefore unable to give me that information?

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

It is outrageous that Ministers were unable to give my hon. Friend those figures. Ministers themselves exacerbated the knock-on impact on the economy of the depreciation of the pound. It depreciated in value by 6% before October, and then by a further 15% because of uncertainty around our trading arrangements that was triggered by comments made by the International Trade Secretary that differed from those of the Chancellor to the Treasury Committee and in other forums. The knock-on effect is not, however, just on household budgets. As the cost of things increases, of course the NHS will take a big hit. Public services in general will be affected if growth reduces and Exchequer receipts fall.

Ministers’ claimed increases in NHS funding, which the Under-Secretary of State for Health, David Mowat, might mention, are actually being funded by reductions in other areas of health spending that fall outside NHS England’s budget. Reductions in spending on social care are having a serious impact on the NHS, and that is translating into increased accident and emergency attendances, emergency admissions and delays to people leaving hospital. I have talked about what Select Committees, Ministers and Members of Parliament are saying, but we have also heard from third parties. The King’s Fund, the Nuffield Trust and the Health Foundation are clear that current Government spending plans through to 2019-20 will not be enough to maintain standards of care, to meet rising demand from patients and to deliver the transformation in services outlined in the NHS five year forward view.

I and more than 40 Members from different parties, including all my hon. Friends in the Chamber for the debate, have written to the Chancellor asking that when he presents his first autumn statement on 23 November, he sets out how he will put the Government on a path to increasing national NHS spending by that promised £350 million extra a week once we have left the EU. To be clear, that additional funding must be over and above the amount currently planned to be spent on the NHS. The British Medical Association has made the same demand.

Photo of Anna Soubry Anna Soubry Conservative, Broxtowe

Is the hon. Gentleman saying that the Government have to honour a promise made by others to the tune of £350 million a week extra for the NHS? My hon. Friend Mr Rees-Mogg and other notable leavers have now conceded that the actual figure was £120 million. Would it not be unfair to say that the Government have to deliver that pledge, given that they never made any such promise to the British people?

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

I am grateful for the right hon. Lady’s intervention; I shall come on to those precise points shortly. I note, however, the public statements she herself made when she was a member of the Government. She criticised the way in which her fellow Ministers were going around making these big promises, perhaps on her behalf.

Photo of Anna Soubry Anna Soubry Conservative, Broxtowe

We must be very clear about this. During the referendum, we campaigned individually, not as Ministers on behalf of the Government. The hon. Gentleman is right that some Ministers campaigned for leave and made this promise—and indeed many other promises that I do not think they will be able to deliver—but there is a distinction to be made between the promises of the Government and those of people who now happen to be in government. It is really the leave campaign that must be held to account, not the Government.

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

The right hon. Lady pre-empts what I am about to say; I shall come on to that precise point.

To be clear, I want the Minister, on behalf of his Department, to give the same commitment that we are asking the Treasury to make, and to outline how his Department will make good on this pledge. I shall explain why this is a pledge that the Government should deliver. The Minister might give a number of reasons, perhaps echoing Anna Soubry, to explain why the promise given by his ministerial colleagues during the referendum should not be treated as such. I will deal with each of the main possible reasons in turn.

First, there are those who claim that this was not a pledge at all. Nigel Farage, the interim leader of the UK Independence party, said that it was one of the mistakes that he thought the leave campaign made. The current Transport Secretary, who was also a member of the Government at the time of the referendum, has said that Vote Leave’s specific proposal was, in fact, to spend £100 million a week of the £350 million for the NHS that was originally hoped for, commenting that that would be an “aspiration” to be met. Let me tell the Transport Secretary that the poster that the Vote Leave supporters all stood next to did not say that this was an “aspiration”; it was a pledge—pure and simple. There was no qualification on the poster or on the big red bus. This statement was made, and the people who made it should be held to account for it.

Secondly, many leave campaigners deny ever using the £350 million figure. One of them said:

“I always referred to Britain’s net contribution of nearly £10 billion—some £200 million a week…rather than £350 million.”—[Official Report, 5 September 2016; Vol. 614, c. 20WH.]

It is true—my hon. Friend Wes Streeting touched on this—that the Office for National Statistics said that the £350 million figure was misleading, but the head of the Vote Leave campaign said:

“the £350 million figure is correct and we stand by it.”

Vote Leave, whose banner Government Ministers campaigned under, carried on citing the figure, as my hon. Friend said, and those Ministers must now be held to account.

Photo of Stella Creasy Stella Creasy Labour/Co-operative, Walthamstow

I take my lead from Boris Johnson, who sadly does not appear to be in his Chamber. He was one of the most prominent members of the Vote Leave campaign and said that Brexit must give the NHS a boost. In my part of town, a boost to the NHS is the vital funding that we need to get our NHS back on track. Does my hon. Friend agree that we should listen to the right hon. Member for Uxbridge and South Ruislip about that point?

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

I shall come on to him shortly.

A further thing that is said—again, I think this has been touched on—is that not all the people who made these pledges were members of the then Conservative Government. Perhaps that could be said of Boris Johnson. Well, of the five current members of the Cabinet whom I mentioned, three were members of the then Government and one—the right hon. Member for Uxbridge and South Ruislip—attended the political Cabinet at the time. Yes, the Secretary of State for International Trade was sitting on the Back Benches, but countless other Ministers from outside the Cabinet at the time who are now serving more than make up for that—for instance, the hon. Members for Portsmouth North (Penny Mordaunt), for Camborne and Redruth (George Eustice) and for Stockton South (James Wharton). I could go on. Those are just a few of the people who posed by those posters and next to that big red bus, and they must be held to account.

Finally, it is said—this is the crux of the argument advanced by the right hon. Member for Broxtowe—that the commitment was given by one side in a referendum campaign, not by a Government. I am sorry but that simply will not wash. Many of those people were put up to appear in the media and to campaign on Vote Leave’s behalf precisely because they carried the authority that attaches to Government Ministers. That was why they were used. That was why they were asked to stand by that red bus, and to stand by those posters.

All those key Vote Leave campaigners, whether they were Ministers or not, were Members of this House. If our democracy is to mean anything, it must mean that Members are answerable to the electorate for their policies, and held to account in the House for the things that they say. People cannot go around the country casually promising the world and betraying people by failing to deliver, but then expect to get away with it. We will not forget; we will not let up. It was in the name of parliamentary sovereignty that those Ministers campaigned, and it is time that the House, on behalf of the people whom we are elected to represent, took back control, if we want to use that phrase, and made those Ministers answer.

Photo of Lilian Greenwood Lilian Greenwood Labour, Nottingham South

I thank my hon. Friend for giving way again. He is being very generous with his time.

Is this not dangerous and damaging not only to parliamentary democracy, but to the morale of workers in our national health service? I was told by the chair and chief executive of my local NHS trust, Nottingham University Hospitals NHS Trust, that they are frequently stopped by members of staff who ask, “When are we going to get the extra money?” Those people will surely be not just incredibly disappointed but doubly disappointed, given the difficulties that they are facing because the trust has a huge deficit and is struggling to provide the services that they know that patients require.

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

My hon. Friend is absolutely right. I am very grateful for all the interventions that Members have made today.

Either those Ministers made this pledge to the people in the expectation of delivering on it, in which case they must now show us the money, or they made it in the sure knowledge that their promise would never be fulfilled, in which case they will never be forgiven for their betrayal of those who, in good faith, relied on them. Perhaps the Minister can tell us which it will be.

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health 5:42 pm, 15th November 2016

I congratulate Mr Umunna on securing the debate, and on the points that he made. Like him, I voted and campaigned for the remain side, and, like him, I accept the result. I am now part of a Government who are responsible for delivering what was democratically decided by the British people. I should say at the outset, however, that I am speaking today for the Government and not for the leave campaign. If the hon. Gentleman feels that he is taking part in the wrong debate, I apologise for that in advance.

I will, however, address some of the points that have been made about the impact of Brexit on the NHS, because valid points were made about staff morale, the level of funding and the exchange rate. All those are variables, and I think it is good for us to spend a bit of time talking about them this evening. I will also talk about what stage I think we have reached on the pledge and the amount of money that we will no longer be giving to the European Union when we leave—although, as the hon. Gentleman knows, that depends on how we leave, and on the nature of the agreement that we eventually reach.

Let us begin by agreeing on one point. The single most important thing that the NHS needs to be properly funded is a strong economy. To the extent that Brexit may have positives and negatives, that fact is relevant, but the NHS is properly funded at the moment. We have heard some stuff about budgets and all the rest of it, but let me tell the hon. Gentleman that the OECD’s analysis of health and social care spending in every OECD country shows that we are now above average, although that has not always been the case. We are possibly 1% lower than the best of class, including France and Germany. That figure was for 2014, and the gap is likely to have been filled because this year we gave an increase to NHS spending of three times the rate of inflation and we have pledged that the NHS budget will increase in real terms by £10 billion between now and 2021. I do not believe Brexit will make any difference to that; indeed it is a commitment and priority of this Government that it will not.

We do know, however, that there are issues in how that money is allocated within the NHS. We are broadly at the average point of the OECD, and we do and could spend that money more efficiently and effectively. We could spend more on primary care, cancer and mental health than we do, and those are Government priorities, and we hope the sustainability and transformation plan process will help to deliver that because at the moment we spend too much on acute care.

Of course we can find efficiencies, too. Agency staffing is too high and we need to address that. There is a lot we can do on procurement—Carter and new care models and all that go with that.

Photo of Stella Creasy Stella Creasy Labour/Co-operative, Walthamstow

The Minister could also work to renegotiate the private finance initiative loans that are crippling our NHS, and not use PF2 to do that. In order to do that, we need money in the NHS to be able to renegotiate. Surely the £350 million would help get us to that place; it would help us to renegotiate our debt, get our constituents back into work and get our NHS fit for purpose in the 21st century?

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

Nobody in this House would be more pleased than I if we did not have the PFI millstone around our neck. The hon. Lady talks of renegotiation; this is real money, and these are real contracts that were signed more or less entirely by the last Labour Government. There is no magic wand that enables us to just to set those PFI contracts aside, although I wish there was; that is not how the commercial world works.

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

I am sure the Minister will be aware that the £10 billion figure for increased funding he has just cited is rejected by the cross-party Select Committee on Health. It is also very well him referring to what he alleges are increases in NHS funding, but the other cuts his Government have made over the last five to six years, in particular to local authority budgets, have put huge pressure on social care, which has led to a knock-on impact on the NHS and its funding.

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

The hon. Gentleman mentions social care, and that is fair. It is funded separately to the NHS, and the budgets are separate. During the course of this Parliament the social care budget will increase in real terms. I do accept that the social care system is under pressure, but there is a massive disparity in performance in social care between councils. The top 10% of councils are about 20 to 25 times better in terms of outcomes for delayed transfers of care and so forth than the bottom 10%. There are many facets to this, therefore, but I accept the basic point. I think that, all other things being equal, Members on both sides of the House would like the NHS to have more money; let us agree on that and see how we make progress on it.

Brexit introduced a number of variables that may not have been there before. What will be the impact of Brexit on our economy? Our GDP in three or four years could be higher, but also could be lower, because of Brexit. The truth is neither the hon. Gentleman nor I knows the answer to that. There are different views on that in this House, too, although some with other views may not be here today. This is important and relevant because if the economy were to have a significant difficulty, that could impact on spending commitments.

The second variable is a very substantive one and was mentioned earlier: the exchange rate. Our exchange rate went down about 15%, principally, it would seem reasonable to say, as a consequence of Brexit. That is a good and a bad thing for the economy. Many countries in the world are trying to get their exchange rate down. I represent a constituency in the north of our country where we have a more manufacturing-based economy. Frankly, a lower exchange rate will help the economy there. That may not be the case in other parts of the country and in the City.

The exchange rate has an impact on the NHS. In fact, it has two impacts. As Lilian Greenwood mentioned, it will be more expensive to import products such as scanners and, potentially, to import drugs. She asked what the figure was, but I cannot give her an exact figure. My understanding is that it is considerably less than 5% of the total NHS expenditure of about £100 billion. Nevertheless, this is a relevant factor and it makes a difference.

The other impact of the exchange rate, which the hon. Lady did not mention, is that it will affect the attractiveness to overseas workers of the UK economy in general and the NHS in particular. If someone comes in from the EU to work in our economy and the value of the pound is 15% lower than it was a year ago, they will be earning 15% less in their home currency. That will have an impact on the margin in relation to staffing, and that is an issue that we need to manage.

The third variable is the one that we have spent so much time talking about—namely, the payment that we make to the EU. I am not going to get bogged down in the numbers, but I believe that we pay the EU about £20 billion a year, of which we get roughly £10 billion back. Leaving the EU would therefore create a bonus. The hon. Member for Streatham mentioned a letter. Even if that bonus were to materialise, as I expect it to, it will not happen until after we have left the EU, so his writing a letter to the Chancellor now strikes me as somewhat symbolic.

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

To be absolutely clear to the Minister, the ask was that the Chancellor should set out the path for achieving this payment after we have left. I want to ask the Minister two questions. First, given his view that the pledge to make a payment to the NHS was made not by the Government but by the campaign, would he say that it was wrong for people to go around giving the impression that the Government would dish out that money? Secondly, for the record, is he saying that this Government will not meet that pledge?

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

Just for the record, I am not saying that this Government will not meet it. All I can say is that this Government have yet to decide how they will spend any bonus that comes from any rebate we get. This will all depend on the precise negotiations that take place and the precise type of exit that we make from the EU. Nobody in this Chamber knows the answers to those questions. For example, we could get a Norwegian-type deal that could entail paying money to the EU. I am not a member of the Department for Exiting the European Union and I do not know where the current thinking is on that, but this is of course a variable.

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

Given what the Minister is saying, does he believe that it was wrong to go around giving people the impression that all they needed to do was vote to leave the European Union in order for £350 million a week to be dished out to the NHS?

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

Had I been writing something on the side of the bus, and had I been campaigning on that cause in the referendum, I might have been more circumspect. I might have said that £350 million could become available and could be spent on whatever the Government’s priorities were, one of which was very likely to be the NHS. I hope that that satisfies the hon. Gentleman.

Photo of Stewart Jackson Stewart Jackson Conservative, Peterborough

I regret that I seem to have stumbled into a sort of elongated primal scream therapy session involving refighting last June’s referendum. Mr Umunna would have a more persuasive and cogent argument if he saw the other side of the equation. Yes, EU workers have a massive impact on and are committed to the NHS, but unrestricted EU migration over a number of years has put massive strains on the delivery of our health services. He has never conceded that point.

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

That is not what I am talking about.

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

I want to make some progress in the debate, although I understand that I have until 7.30.

We have mentioned the payments to the EU, and there is also the point about staff. Another point that has not been mentioned—I shall mention it for completeness—is that there will be an impact on EU institutions. For example, the European Medicines Agency is located in London, which is of benefit to our pharmaceuticals industry. Where it ends up should be an issue for the people negotiating this deal, because of the potential impact involved. From my point of view, we talk too often about the conditions in relation to the EU for the City of London and passporting and all that goes with it, but not enough about other world-class industries, one of which is pharmaceuticals. I hope that those responsible will listen to that.

We have talked about the economy, which is a big variable. To be frank, neither I nor the hon. Member for Streatham knows whether the economy will be better or worse as consequence of leaving the EU, but it is true that the 15% fall in the value of the pound is helping manufacturing firms in the north and will have an effect on GDP, but it will also have some effect on imports of, for example, scanners, accelerators and drugs.

The NHS is hugely reliant on staff from the EU. Some 58,000 people from EU countries work in the NHS, and another 90,000 work in social care. I want to take this opportunity to reiterate the Government’s position that we understand that massive contribution and know that it is important to our NHS that it continues. The Secretary of State said exactly that to the Health Committee and the Prime Minister has said that she hopes and expects citizens from the EU to stay in our vital services. I would like—perhaps the hon. Gentleman and the group he is speaking for today can help with this—some of our EU colleagues and friends to make a similar commitment about people from this country who are working in EU countries, because that has not yet happened.

Photo of Chuka Umunna Chuka Umunna Labour, Streatham

I speak for my constituents above all others whenever I speak on such issues in this House. On that specific point, will the Minister explain why the Government do not simply guarantee the right to stay of EU citizens working in our health service? I understand the demand for the reciprocal right to be given to UK citizens living in other EU countries, but they should not be used as a bargaining chip. When the Immigration Minister appeared before the Home Affairs Committee, he admitted that we do not know where most of the EU citizens are in this country or who they are, so if we were not to deliver on the promise to guarantee them the right to stay we would have no way of removing them.

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

It is not for me to make that specific guarantee. The Prime Minister clearly said that she hopes and expects them to remain. It is disappointing that a similarly strong statement has not been made by any Head of State in any other European country.

It is also right that we do more to train more of our own nurses and doctors—not because we need to replace people from the EU, but because it is the right thing to do. We should try to become self-sufficient in these matters, and that will happen.

We have knocked around this point quite a lot during the debate and have talked about variables such as the exchange rate, GDP and the EU bonus or payment that we will get, but there is one thing that is not a variable and it is probably the single most important constant: the extent to which this Government give priority to the health service in their spending commitments. That constant is absolutely clear. The previous Prime Minister treated the NHS as his No. 1 commitment, as does the current Prime Minister. Many of the points we have discussed this evening are things that should properly form part of the negotiation that we are going to have after we trigger article 50, as we hope to do by the end of March, and I am certain that that will be the case. What is not negotiable is that our commitments to NHS funding and social care funding are unmoved by any of these things; this is the No. 1 priority for this Government.

Photo of Stewart Jackson Stewart Jackson Conservative, Peterborough

Is it not the case that in the future dispensation after Brexit we might have a fairer system of recruitment and retention of NHS staff? In all our constituencies, we have staff from outside the EU—my constituency has Nigerian, Ghanaian and, in particular, Filipino nursing staff—who have hitherto been discriminated against inadvertently vis-à-vis those from the European Union, and we will have a much fairer system in reaching out and getting the brightest and best to work in our NHS in the future.

Photo of David Mowat David Mowat The Parliamentary Under-Secretary of State for Health

My hon. Friend uses the word “fairer”, and of course we do have staff from other parts of the world. I will be honest and say that part of me has difficulty with this country taking large numbers of doctors and nurses from places such as Nigeria and others parts of Africa that need them more than we do. So it is right that we try to train more of the people that we need in these vital public services, but it is also right that we make it absolutely clear how important the people who currently work in our NHS and in social care are—those from the EU and from outside it, as my hon. Friend reminded us. That is important.

I make the point again, because I will not go on until 7.30 pm, that the NHS is this Government’s No.1 spending priority and it will continue to be so.

Question put and agreed to.

House adjourned.