Dr Mike Galsworthy
The two top issues of the General Election – Brexit and the NHS – are entwined. The fact that Brexit is dire news for the NHS is slowly starting to drip into public awareness. But a slow drip is not enough.
There’s a General Election on. We need to turn the fire-hose full-blast. Vote Leave won the referendum debate in no small part by pairing its Brexit vision with something that impacts on the lives and hearts of Brits: the NHS.
It was devastatingly effective. But it was cynical and false. The experts knew Brexit was bad for the NHS, but struggled to be heard as they issued the warnings that we are now seeing materialise. Brexit not only drastically exacerbates the NHS’s current problems, it also presents an existential threat in the form of a US-UK trade deal. Those who love the NHS and see where this is headed must arm themselves with the arguments and drive the message with a ruthlessness to match the Vote Leave campaign.
Experts versus politicians in the referendum campaign
In April 2016, while 75% of NHS hospital leaders thought that Brexit would be bad for the NHS, the UK public thought Brexit would be good for the NHS in a 32% to 14% ratio. Any national cognitive dissonance on the issue could be solved by jettisoning the importance of experts. Additionally, the colourful trash propaganda pouring out from the breadth of the Leave campaigns reached demographics of the country where experts cannot reach.
It was not just the ‘£350m a week’ red bus. Remember also the 75m Turks who would soon be walking into this country to use our NHS? Remember the ‘Save Our NHS’ flyers that Vote Leave put out? Their fake NHS logos in the top corner to make them look like official literature? Add to this the tabloids with years of ‘immigrants strain our NHS’ rhetoric now hitting crescendo on the front pages.
Finally, Vote Leave wheeled out Lord (David) Owen to warn of the dangers to the NHS of the Transatlantic Trade and Investment Partnership (TTIP) between the EU and the US, parading him as a Labour ex-Minister for kudos. Incidentally, Lord Owen had not been Labour since he abandoned the party at the beginning of the Thatcher era. As to his argument, many EU countries had already insulated their health services from TTIP by the time of Lord Owen’s intervention – rendering his claims obsolete. Lord Owen (where is he now?) was an odd addition alongside a raft of prominent Leave campaigners, like Douglas Carswell, Aaron Banks, Matthew Elliott, Daniel Hannan and Paul Nuttall, who had overtly proposed the privatisation of the NHS. These wolves put on sheep’s clothing to infiltrate their chosen flock.
On the other side, The Lancet, British Medical Journal, Royal College of Physicians and Royal College of Midwives warned about Brexit impact on UK healthcare. As did Genetic Alliance UK, which represents more than 180 patient groups. The chief executive of NHS England also warned about Brexit on broad economic grounds, saying “when the economy sneezes, the NHS catches a cold”. So did 71 former leaders of the UK’s Medical Royal Colleges and British Medical Association, saying: “It is Brexit that is the threat to the NHS.” A further 200 leading health professionals wrote a letter to the Times saying “Brexit should carry a health warning”. The reasons behind these warnings are now proving themselves true. They are set out here…
In the April-May 2016 survey by NHS Providers, 75% of 45 hospital leaders predicted a Brexit would be detrimental to the NHS, with 80% predicting it would damage staff hiring. This is what we’re now seeing, with a reported drop of 92% in EU citizens registering as nurses in England from July to December 2016. Another poll by the General Medical Council (GMC) found that 60% of EU doctors in the UK are considering leaving, with 91% of those saying Brexit is a factor in that decision. Alongside the likely loss of rights and protections for EU citizens, there is the salary drop associated with a falling pound, a feeling of being less welcome, pervasive, widespread philosophical objection to the choice to leave the EU – and also the general mismanagement and austerity of the NHS deteriorating the working conditions. This means it is also harder to attract new staff from the EU. A leaked government report in March 2017 predicted a staff shortage of 26,000-42,000 by 2025, with Brexit cited as a major factor. The NHS is already hugely understaffed and training new doctors takes more than seven years. Therefore, making the UK unattractive to foreign doctors, nurses, other NHS staff and social care workers hurts right now. Next winter could be very grim.
The NHS is colossally underfunded by tens of billions of pounds and entering crisis. Compared to France, Germany, Sweden, and others, which fund their healthcare to 11% GDP, the UK is on 8.5%. Most NHS Trusts used to be in surplus, but now two out of three are in debt. The NHS is now in continual financial crisis, with impacts from cyber attacks to severe winter emergencies and GPs being forced to charge patients for preferential treatment in places. If Boris Johnson had been serious about his pledge of support for the NHS, he could have made it a condition of his appointment as Foreign Secretary. He didn’t. Neither did he or other lead Brexiteers push it into either the budgetary agenda or Article 50 conditions. The Autumn Statement offered no help for our NHS. Not even a mention. But for Brexit, the Chancellor could find money – borrowing £58.7 billion more for the ill-advised adventure.
Just the falling pound will push up NHS supply costs by hundreds of millions of pounds each year as about half of NHS supplies come from outside the UK. The infamous £350m a week figure on the bus was not only a lie, but moot. Our net contribution to EU is a tiny sliver of taxpayer expenditure. Even if we did stop paying contributions after two and half years, firstly that’s too late for the NHS’s current Brexit crisis, and secondly the negative bureaucratic and economic impacts will have already swallowed the “free” £100m a week many times over. Just the Brexit borrowing bill is £245m a week over the next five years.
Care in other EU countries
Brexit – and particularly a Brexit without a deal – is set to impact UK citizens living in the EU and UK citizens travelling in the EU. There are around 190,000 people in receipt of British pensions currently living in other EU countries such as Spain, Ireland, France and Cyprus, who depend on reciprocal arrangements for their healthcare. The UK pays out about £650m per year for care provided to British people in other countries of which about £500m is on pensioners. Given that the average cost of treating pensioners elsewhere in the EU works out to about half the cost of similar treatment within the UK, then we’re looking at an annual saving of £500m on the pensioners alone. Imagine not just the extra cost, but also extra burden, should some stay in or return to rainy Britain. Yet already we have surveys showing that because of Brexit, pensioners are now less likely to move out to those healthier climes. A falling sterling from a Hard Brexit would make life more costly for our expats already out there on UK pensions too.
For Brits wanting to travel, the European Health Insurance Card arrangement is invaluable. Guaranteed health insurance across the continent, with our governments covering the costs, makes for an equitable system. Without it, UK citizens with chronic conditions may find themselves forced to purchase expensive insurance every time they travel. The UK Government may crow that ‘no deal is better than a bad deal’, but this is emphatically not the view of people who depend on reciprocal healthcare arrangements at the moment.
Medical innovation and research
The UK has benefited enormously from hosting the European Medicines Agency (EMA), which hosts 890 staff, draws thousands of experts for visits and conferences and is flanked by attendant medical innovation industry which likes to stay close. The EMA is now leaving London, with a feeding frenzy from other European cities keen to host the medical regulations powerhouse.
It’s not just the financial considerations in hosting a hub of medical expert activity – it’s also the self-imposed restrictions of the UK giving up the driving seat of pan-European healthcare innovation policy. Worse, it could mean leaving the European system of medicines licensing, leading to the exclusion from the EU’s single process for authorising medicines. In Switzerland and Canada, which have separate approval systems, medicines typically reach the market six months later than in the EU.
With research, some 17% of university science contracts come from the EU. These are not replaceable by UK funds, because the majority of them are related to the EU’s big multinational schemes on which UK entities often lead. Although the UK can pay to play from outside the EU, without MEPs or Council representation we would have no policy voice. Further, unless we accept Freedom of Movement, we’d be in the same place as Switzerland was when it did not accept Freedom of Movement – namely, not allowed into certain research schemes and not allowed to lead the multinational consortia. That would be a hammer blow to our world leading health and medical research.
In case you had not noticed, US healthcare is currently in an appalling state with private interests locked into control of the national politics on health. The result is a hugely inefficient system with deep corruption, millions of families with no coverage and bankruptcies over medical bills being a daily event. This US profiteering system wants to get a piece of the UK and its £116bn per annum NHS. During the TTIP negotiations, Nigel Farage was keen to warn that staying in EU could lead to ‘privatisation by the back door’ for the NHS because of these companies. While the other EU countries protected their healthcare systems, our own government were keen to push through TTIP with no amendments. Now that the UK has peeled away from the protective herd and is desperate for a US-UK free trade agreement, our neoliberal-leaning government would likely happily yield to the slick promises of US pharma and healthcare companies that have saturated their own market and are looking to the UK as a gateway to Europe. They are certainly preparing as we speak. All that is needed is a broken NHS for privatisation to ‘save’. Political and business smooth talk will soon infect the media with a ‘debate’ on whether the free market can ‘help’ our predicament, even though our own UK experts overwhelmingly have concluded that the NHS is the cheapest and fairest model available.
So what to do?
With the latest cyber-attacks attributed to NHS underfunding, the health service has overtaken Brexit again as the lead issue in this General Election. We need to spread the message far and wide that our NHS is now breaking from Brexit and is under mortal threat from the aggressive neoliberal agenda. Tell your family and friends, read up on it, write to your local papers and national papers. Get out on the streets with the activists, knock on doors, make your own flyers, tweet it and Facebook it. The direction of travel is clear… and acquiescence is not an option.
Dr Mike Galsworthy is programme director of Scientists for EU and co-founder of the Healthier in the EU campaign (healthierin.eu)