7. What assessment has the First Minister made of the impact that any changes to immigration controls following Brexit will have on the NHS in Wales? (OAQ51229)

Yes, it’s bad.

Well, I thank the First Minister for his observation, but the latest figures show that immigrant workers from the EU amount to just 1.55 per cent of employees in NHS Wales, and, given that the Welsh population of immigrants from the EU amounts to 3.3 per cent, it would seem that controls on immigration may well have a positive effect on our health service.

But, I have previously brought to the attention of this Chamber the fact that each year, 80,000 applicants to work in the UK NHS are turned down due to a lack of training places. Surely, First Minister, it is time that we in Wales expanded training facilities, reconsidered the practice of sending every nurse to university, and explored the possibility of reintroducing the distinction between SEN and SRN nurses and on-the-ward training, particularly for SEN staff. Incidentally, Mark Drakeford said in 2015 that,

‘Discussions about the long-term future of the Welsh NHS should sit outside the knockabout of day-to-day party politics.’

Perhaps, First Minister, we should once again examine that excellent suggestion.

Could I say to the Member that I could not care less where doctors come from when they work in the Welsh NHS, as long as they deliver an excellent service to our patients? There are many doctors who come from the EU, and beyond—India, of course; we know that many doctors have come from India. Frankly, they are great additions to our NHS. The market for doctors and for nurses is worldwide. It’s worldwide. People will go—it’s a portable qualification—to where they think they will get the best deal for them as an individual and for their families.

We know, for example, it’s true to say that EU nurses make up a fairly small percentage of the NHS workforce in Wales, but can we really afford to lose 360 nurses? Is that what he’s saying? Because what he seems to be saying is that that’s fine, as long as we train people to a lower standard in the future, and that will be fine as far as the future is concerned. Is he really saying, for example, that we don’t want doctors from the EU? Well, I have to say that I want to make sure that doctors and nurses come to work in Wales, regardless of their nationality, because they will add a lot more to the NHS than they take out. The myth that is peddled by his party is that, somehow, immigration puts a strain on the NHS. Most of the people who come to Wales are young. They pay taxes, and they pay far more in than they take out via the NHS. And we know that we pay tribute to those doctors from the EU and beyond who come to work in the Welsh NHS, who contribute to treating our people, who save lives. For me, that’s far more important than checking their passports.

The external affairs committee recently reported on the implication of Brexit for Welsh ports, of course, and there is criticism there that the economy Secretary hadn’t at that stage had direct conversations with his counterpart in Ireland, but I think that that may have happened now. Do you know whether there were any discussions about whether existing technology could be rolled out to help maintain the invisible border between Northern Ireland and the Republic, but also to reduce the delays in the transit of people between Wales and the Republic of Ireland itself?

Well, firstly, the reason why the committee mentioned it is that I mentioned it to the committee. I was the one who first raised it, this issue of the ports. I discussed it months ago with Leo Varadkar, when he became Taoiseach, and made it clear that we could not support a scenario where there was a more seamless border between Northern Ireland and the Republic than between Wales and the Republic while 70 per cent of trade between GB and Ireland goes through Welsh ports. If there is any incentive to go through the Scottish ports instead, through Northern Ireland, obviously it’s bad and the committee identified that—it’s bad for Wales. So, there have been discussions with the Irish Government on this.

Frankly—I know the Member’s views on Brexit, and I appreciate them—I have now seen many documents from the UK Government that say that the issue of border control will be taken forward by way of innovative technology. It doesn’t exist. This technology doesn’t exist. If it existed we’d have sight of it by now. It talks about having innovative solutions, exploring solutions. That is code for, ‘We have no idea how to deal with this.’

It’s one thing, of course, to have passport-free travel between Wales and Ireland. Customs-free travel is a different thing. There were always random checks in those ports in years gone by, but not every vehicle was checked. There’s a greater problem in Dover, because the UK doesn’t have the capacity at the moment to put in place border controls in Dover without enormous delays, and the same, I suspect, applies on the French side as well, if I’m honest, in Calais.

I do not believe that there is a technological solution to this. If there was one, then by now we’d know from the UK Government what that solution is. One of the solutions that was put to me was that there would be cameras on the border between north and south in Ireland. You put cameras in Northern Ireland and we could open a book as to how long they’d stay there, because they would not. They just wouldn’t stay there. It’s a physical manifestation of the border. People would see them as a breach of the peace agreement.

So it’s an intractable problem. It can be resolved. The resolution is that the UK stays in the customs union. Then there’s no problem. There’s no problem. The UK leaves the customs union and you have to have the same kind of border as exists, for example, between Gibraltar and Spain, because Gibraltar is outside the customs union. That is an extremely hard border. You cannot have a scenario where goods go to two different markets in two different customs unions without any kind of physical checks on crossing a land border. This has always been the problem, to my mind. In the Brexit referendum, nobody thought about Ireland and nobody thought about that border, and it’s still an intractable problem. The solution? Stay in the customs union.

Of course, one of the greatest threats to staffing long term in the Welsh NHS would be for us to have a one-size-fits-all UK immigration policy after separation with the European Union. The University of Edinburgh have published a paper by Professor Christina Boswell, ‘Scottish Immigration Policy After Brexit: Evaluating Options for a Differentiated Approach’. It looks at a number of regional and national approaches to migration post Brexit, knowing the intentions of the UK Government in terms of their aspirations. The options include looking at human capital, a points-based system, post-study work schemes, employer-led schemes, occupational shortage lists, which I would suggest are of particular importance here in Wales, and in this paper they are proposing imaginative ways in order to have minimal administration costs and burdens. Would the First Minister agree that this is now worth exploring and taking forward seriously, and that we need Wales to have its say on a regional or national post-Brexit migration policy for the UK? Because at the moment, this is the only constituent part of the UK that has said very little about that prospect. Otherwise, we face having the UK net migration target being the big policy objective of the UK, which, as we know, will be detrimental to Welsh public services and the Welsh economy.

Let me just remind him what I have said publicly to set his fears at rest. First of all, I don’t agree with an artificial cap. I don’t see what sense that has. Surely an economy needs to recruit according to its needs, not have an artificial cap. If there were to be an artificial cap, then there are serious issues that arise as to whether there’d be sectoral caps. I have no doubt that the thinking in the UK Government will be to do as much as possible for the City of London—and the financial services sector’s important to us, but it’s hugely important to the City of London—and we will end up with a higher sectoral cap proportionally for the City than we do for the NHS. Clearly, that would not be in Wales’s interests.

He didn’t say it specifically, but I know he is intimating the idea of regional quotas, and that’s an interesting idea. It is done in Canada, it is done in Australia. All right, they’re far bigger, but it’s not impossible to do this. Personally, I prefer there not to be a cap, but if there is to be a cap, I think then there is a case for looking carefully at whether regional quotas would work, and particularly at whether they’d work for Wales.