Bishop of St Albans on the post-Brexit challenges for the NHS

St Albans 2On 12th July 2017, Lord Warner led a short debate in the House of Lords on the question:  “to ask Her Majesty’s Government what assessment have they made of the risks to NHS sustainability arising from the United Kingdom’s departure from the European Union”. The Bishop of St Albans, the Rt Revd Alan Smith, contributed to the debate.

The Lord Bishop of St Albans My Lords, I thank the noble Lord, Lord Warner, for introducing this important topic for us this evening and for his helpful and comprehensive opening remarks.

Ensuring the sustainability of the NHS is undoubtedly a significant challenge, even before the potential consequences of Brexit are considered. The uncertainty surrounding the Brexit negotiations has created significant stress for many working in already pressurised health and social care systems.

There is no doubt that urgent action must be taken to ensure the stability of the current system. That being said, I wonder whether we might be able at this time of significant pressure to begin to confront some of the deeper challenges that our health system faces. The challenges of Brexit for our health and social care services might only reveal the deeper, long-term problems of these systems as a whole. It would be unfortunate for Brexit to be only the latest in a long line of short-term crises rather than an additional opportunity for reflection.

The report of the Select Committee on the Long-term Sustainability of the NHS, published in April of this year, stressed:

“Whatever short-term measures may be implemented to muddle through today, a better tomorrow is going to require a more radical change”.

I note particularly its recommendation of,

“a new, independent standing body enshrined in statute to safeguard the long-term sustainability of the NHS and social care”.

The nature of the political cycle means that it is difficult for politicians to rise above the fray and consider the long-term sustainability of the system as a whole, and there is substantial room for a body to oversee and scrutinise independently and to report directly to Parliament. National health and social care service provision affects the lives of citizens in profound ways, quite literally from cradle to grave. It is no surprise that it is of paramount importance to both individuals and politicians, and we should consider novel ways to safeguard these systems. Bold leadership is required, but this should be an area where politicians can show courage in finding common ground to make meaningful and lasting change.

Much has been said in this Chamber about the deep feeling of division in this country in the light of the Brexit referendum. Nevertheless, the NHS, and the importance we place on caring for one another, is at the core of the “British values” discussed in the Queen’s Speech. Indeed, these values are a part of many faiths, including Christianity. Part of what it means to be British is to care for one another, even when it comes at significant cost. We must acknowledge, however, that that cost is increasing, and adjustments must be made at both an individual and societal level. We have a duty to one another and to future generations to ensure that necessary resources are in place and are safeguarded in order for care to be maintained.

It is unfortunate that the NHS is not in a better position to be able to respond to the challenge of Brexit; we are still suffering the consequences of short-term thinking and acting. The waiting list for elective treatment has risen to 3.78 million, which is 5% higher than a year ago, and the number of delayed discharges from hospital caused by waits for home care rose by 45% in 2016-17. Even within my own diocese, two wards in St Albans hospital are scheduled to be closed to cut costs despite the clear demand for beds. By taking a more long-term approach to healthcare, even in the light of Brexit, we may be able to address the issues that have weakened the system substantially and prepare for the additional challenge of our ageing population. If we can work towards preventing weakness in the system, we will be far better placed to respond to sudden challenges.

The potential loss of EU personnel in both the health and social care systems will be an enormous short-term challenge. More than 60,000 people from EU countries outside the UK work in the English NHS and around 90,000 work in adult social care. Support must be provided for these individuals, many of whom work long hours in difficult circumstances and have made significant sacrifices to make the UK their home. We need to take account of them, not just in negotiated discussions but also in any plans, after we leave the EU, to alter immigration policy.

It should never be overlooked that the NHS is heavily reliant on workers from outside the UK. Despite this, the Royal College of Physicians describes our hospitals as chronically understaffed, almost half of community mental health teams had staffing levels judged as less than adequate in 2013-14, and the Royal College of Midwives believes that in England we need 3,500 more midwives to ensure that every woman can receive one-to-one midwifery care in labour.

Not only must we have sufficient numbers of personnel, we must ensure that they have the correct skills and training that the service needs. This means that we need to invest in those currently serving in the NHS, as well as making sure that we train enough doctors and nurses here in the UK. However, in 2016 there were unfilled nursing places in UK universities, and we know that care homes would collapse without their non-UK workforce. This is in part because these roles are not sufficiently valued and hence do not attract UK applicants. Sustainability of the workforce cannot be achieved, even if all EU workers remain, unless attitudes to some health and social care roles change significantly.

As we seek to manage the staff of the NHS wisely—that staff is undoubtedly one of our greatest assets—prudent financial planning will also be required. The quality of care which we have come to expect and demand comes at a significant cost. Some 86% of the NHS’s sustainability and transformation fund of £2.1 billion has been set aside to sustain current services and meet expected deficits. As deficits increase year on year, a radical rethink of healthcare funding is required. We need a broader social dialogue about funding for health and social care, one to which the Church and other faith communities can contribute.

Along with the right to healthcare, which we are undoubtedly privileged to enjoy, as users of health and social care services we have associated responsibilities. In remembering that we both benefit from and contribute to the NHS, we must consider the impact of our own lifestyles on our ability to care for others. In treating others as we wish to be treated, we must be prepared to think creatively and make sacrifices for all to enjoy a good standard of care.