The one glaring omission from the devastating report into the NHS

The latest review of the health service is a substantial, thoroughgoing and even radical piece of work, writes Sean O’Grady. But it doesn’t mention the 2016 referendum once – despite its enormous impact

Prime minister Keir Starmer was asked about social care reform as he spoke about his plans for the NHS (PA Wire)

Nigel Lawson, a Tory chancellor with an unusual gift for perception, remarked some decades ago that the National Health Service “is the closest thing the English have to a religion”. It’s become a bit of a cliche, and one that is often misattributed, but it still contains a good deal of truth.

If the NHS is indeed a religion, then Ara Darzi – surgeon, academic and former health minister – is one of its high priests, if not a kind of pope. That is no bad thing, because his latest report on the health service is a substantial, thoroughgoing and (at times) even radical piece of work.

He challenges the view that every problem can be solved by hiring extra staff – and he is brutally honest about the fact that the service sometimes has all the wrong priorities, such as the long-term neglect of public health and preventative medicine. That is how, to quote another cliche, we have ended up with an NHS that is more akin to a “National Sickness Service” – and an uneconomic one at that.

However, there is one omission in his latest investigation for which we can fairly criticise the great man: he doesn’t mention Brexit once. This is quite strange, because it has very obviously had an enormous impact on the NHS. It has indirectly done so through its depressing effects on economic growth – and therefore on tax revenues.

Brexit has also, fairly obviously, had a dramatic direct effect on staffing, as a ready supply of certain types of professional, skilled and semi-skilled labour began to dry up soon after the referendum in 2016. Even now, almost a decade on – and even as EU staffing has been partly replaced by some “home-grown” and non-EU workers – the NHS still has around 100,000 vacancies. Those are not all unfilled, as there are temporary replacements in place for some, but the problem is acute.

Nor is that the only baleful effect Brexit has had on the NHS. It has also disrupted the supply of medicines, as the UK withdrew from the European Medicines Agency (which used to have its HQ in London). Medicine is another area in which things have been more difficult. We know this because there is ample expert evidence to this effect.

A report prepared for the IPPR, a left-leaning think tank, set it all out in 2018: “The NHS can only support the life science sector if it is properly funded and fit for purpose. Brexit poses a significant threat to innovation in health and care with changes to immigration and regulation potentially allowing us to fall behind ... What we need is an immigration policy that is integrated with the health and care systems workforce planning and training strategy.”

The author of that wise, measured but stern warning was Lord Darzi, following up what he had written for an LSE study before the 2016 EU referendum: “If we leave the EU we potentially lose out on a workforce with a common set of professional standards and agreed rules on medical education.”

Yet now, Darzi has neglected, in his latest and most important report, to mention how Brexit has added to such challenges – even as context. Brexit is another of the shocks – alongside the Covid pandemic and the energy crisis – that has brought the NHS to its present pass.

In Darzi’s defence, it might be pleaded that there is little point, as the UK is not going to rejoin the EU (or even revise its relationship substantially) for many years – if ever. Banging on about Brexit would invite the usual reaction from the still-vocal Eurosceptics and distract from the report’s important conclusions. It would be a bit like a sailor complaining about the weather.

True enough, but it still feels wrong that damage inflicted on the NHS and the life science sector should not even deserve a mention as a possible factor – even if there’s nothing that can be done about it, given the paranoid hostility of the British electorate and much of the media to immigration of any kind.

The NHS and the social care system are, sadly, not going to benefit from a transfusion of new staff from anywhere. That will impede their progress indefinitely, or least until AI and the robots can take over. It would have been useful for Darzi, as high priest, to confess to the many worshippers of the NHS that heretical truth.