As the EU referendum grows ever closer, Lord Darzi, Elias Mossialos and colleagues seek to redress a lack of evidence on the role of the union on our health system.
As clinicians and economists, we know all too well the importance of facts and evidence when it comes to making decisions that impact the lives of our patients and the public. We know too that the leaders and champions of our national health service require the highest quality evidence to make the best informed decisions possible.
That is why, as we approach the final weeks of this highly politicised and divisive debate on the UK’s future in Europe, we feel it is necessary to address the profound vacuum of robust evidence on the role of the EU in our health system. The briefing, summarised here, outlines the facts, the critical issues and the balance of risks which underpin the core arguments when it comes to our healthcare economy and the UK’s position in Europe. Download the original briefing report here.
Here are some clear and balanced answers to the important questions that have arisen during this debate:
If Britain left the EU, would there be more money for the NHS?
Unfortunately not. The widely quoted £350m per week is the gross figure. After the rebate and the money received by public sector institutions is taken into account, the cost of Britain’s membership is £164m per week. If Britain were to leave the EU but remain in the single market, we would expect to pay at least the same rate as Norway pays for single market access (approximately £106 per capita). This means the total savings would be around £27m a week or £1.4bn a year.
If 100 per cent of the savings were spent on the NHS, they wouldn’t cover this year’s deficits
Whilst any increase in funding would be welcome, even if 100 per cent of the savings were spent on the NHS, they wouldn’t cover this year’s deficits. Furthermore, exiting the EU would be a shock to the economy that might reduce the available funding for the health service.
Is the EU a threat to publicly commissioned and provided healthcare?
No. EU Article 168 clearly states that the organisation and delivery of health services is a national responsibility; it is the role of the UK government to determine the organisation of the NHS, in or out of the EU. The policies of the UK government will determine the role of the private sector in the NHS.
What about the TTIP trade deal?
National health services are not included in the trans-Atlantic trade and investment partnership trade deal. The UK government has stated that it has no intention to broaden the scope of the deal to include the NHS at any point in the future. Any threat to the NHS from opening up markets would come from decisions made in Whitehall, not those made in Brussels.
What is the impact of migration on the NHS?
Migration can put some local services under strain as the population expands. However, most migrants are of working age and therefore contribute more to the NHS through the taxes they pay than what they take out of the NHS in services. The real issue is about making sure that communities that have more migration receive more funding.
We will likely need to attract more healthcare workers to the UK, not make it harder for them to come here
Furthermore, we have shortages of all types of clincians – from nurses to doctors to allied health professionals. We will likely need to attract more healthcare workers to the UK, not make it harder for them to come here by leaving the EU. Today, there are 130,000 non-British European citizens working in the NHS, about 10 per cent of the total. If they were forced to leave, we would quickly face a workforce crisis. And with 2 million British people living in other EU countries (including about 650,000 British pensioners) we rely on the EU system to ensure they receive healthcare just as EU citizens living here do.
How would leaving the EU affect NHS research and development?
If the UK leaves the EU, we would lose our right to participate in the European Medicines Agency. To retain access to the centralised authorisation system the UK would have to make financial contributions but it would lose its influence on policy.
The National Institute for Health and Care Excellence would lose its leading edge in European health technology assessments. Furthermore, the UK is the most successful country at winning competitively awarded EU funding for research and development in the life sciences sector, accounting for around 20 per cent of the total (despite being 12.7 per cent of the population). If, on leaving the EU, we want to retain access to funding the UK will need to contribute financially but will have no voice in setting priorities in the research and development agenda.
On 23 June, when the UK takes to the polls to decide our future in Europe, we feel strongly that it is our duty to continue to champion the evidence. This is a once in a generation debate and we owe it to our patients, the public and the entire NHS to make the most informed decision that we can in order to safeguard our country’s most important social institution.
Professor Elias Mossialos is Brian Abel-Smith professor of health policy within the Department of Social Policy at the London School of Economics and Political Science, director of LSE Health and professor of health policy at Imperial College London; Dr Victoria Simpkin is research associate in health policy at the London School of Economics and political science; Dr Oliver Keown is clinical adviser and policy fellow at the Institute of Global Health Innovation, Imperial College London; and Professor Lord Ara Darzi of Denham is Paul Hamlyn chair of surgery and director of the Institute of Global Health Innovation at Imperial College London, and a surgeon at Imperial College Healthcare Trust.
This article sumarises the evidence and conclusions of a policy briefing report jointly published by the Institute of Global Health Innovation and the LSE Health. The original briefing report is available here.
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Readers' comments (16)
Patrick Newman8 June, 2016 7:15 pm
Not much "evidence" but plenty of the usual model making. EU migrants have babies you know. What may turn my vote would be a pledge by Cameron to spend the average health % of GDP in the EU on the NHS which I reckon is a £15bn increase (or less than 1% of our £1800bn economy)
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NIGEL HOLDER8 June, 2016 11:42 pm
I looked forward with interest to see an unbiased assessment of the Brexit implications for the NHS. You may be interested in my comments on the five reasons given for supporting the remain campaign.
1. If Britain left the EU, would there be more money for the NHS? Yes your correspondents are probably right - most of all the the spare cash would be eaten up elsewhere. 9/10.
2. Is the EU a threat to publicly commissioned and provided healthcare? Your correspondents are right. For those who believe in the NHS as a nationalised industry, the EU is not a threat at the present time. However, given that all the other EU nations have a much more balanced public / private provider mix, it would be panglossian to suppose that the UK could continue indefinitely with its wholly socialist model in the EU in the future. 7/10
3. What about the TTIP trade deal? Whilst the current TTIP will exclude healthcare, given that the UK has very limited power to influence future EU policy, there is no guarantee that TTIP MK2 might not include healthcare against the wishes of the UK government of the day. (c.f too many examples to quote!) 5/10
4. What is the impact of migration on the NHS? Your corespondents quote "Today, there are 130,000 non-British European citizens working in the NHS, about 10 per cent of the total. If they were forced to leave, we would quickly face a workforce crisis. " No-one has ever suggested that they would be forced to leave. Brexit is designed to enable us to import future migrants to this country from all countries subject to eligibility and skills requirements. The suggestion that we would expel any existing EU workers is a despicable and wholly unwarranted calumny. I require an apology from the HSJ for publishing an outright and unvarnished political lie. 0/10.
5. How would leaving the EU affect NHS research and development? This is finely balanced. It is true that, proportionately, we get back more in R and D funding than we contribute. But, the idea that, as the EU as a whole shrinks in its share in terms of cutting edge scientific activity as compared with the rest of the world, that our minimal influence with the sclerotic bureaucracies of the EU somehow justifies our restricting our access to non-EU institutions becomes less and less attractive as globalisation marches on. Nevertheless 6/10.
So 27/50. Just marginally in favour of the Remain cause. But I have several other reasons for supporting Brexit, each rather more important than the NHS.
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Anonymous9 June, 2016 10:26 am
Roll on the 23rd! If the campaign has done anything for me, it has flushed out a lot of views which I rather suspected were prevalent. And hopefully we can move forward with confidence following what seems certain to be a large turnout.
I will be voting to remain because I have always believed we're stronger as part of Europe. The fact that we have had peace within the EU should not be under estimated, given global instability and the highest levels of population displacement seen in recent history.
It's a much fairer world than the one I recall from the 70s and 80s. And I wouldn't want to go back to the world of Hillsborough and Savile.
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Patrick Newman9 June, 2016 11:45 am
Good appraisal, Nigel. So much of the 'debate' is little more than exercises in creative and imaginative writing!
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Anonymous9 June, 2016 12:06 pm
We've had peace within Europe for a good while because no one was trying to rule all of it and take control of it...... Perhaps we won't have wars again within Europe due to a more educated society.... But one word warning when people start to feel that they don't have a say anymore and you have unelected individuals ruling from afar. A disconnection between politicians and actual normal people that's when you start to get discontent. I'm not expecting an uprising but at the age of late forties I've never felt such apathy for my own government and all politic parties....
There is certainly an undertone with the British people of we've had enough....
Happy to live within Europe but I don't want to be ruled by them!
I want to work with Europe but not for them!
Perhaps I'm dinosaur in a changing world but can anyone honestly say they call themselves European perhaps it's time to scrap the Euros Tournament as we don't need it anymore...??
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Paul Anthony 9 June, 2016 1:59 pm
Perhaps also mention the protection of workers terms and conditions such as paid maternity/paternity leave etc. I would imagine that if Brexit happened and a right wing , pro market government stayed in for the foreseeable future then we would see a race to the bottom for terms and conditions. These were hard fought over decades and are protected to some degree by Europe. We have more in common with an angry Frenchman than you think!
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Anonymous9 June, 2016 2:21 pm
We have had wars in Europe, but outside the EU Zone.
There is a disconnection with politicians across the world. And more extremist parties seem to be gaining support. But at least these extremes are diluted within the EU, and I'm sure we're safer in than out. We are tied into agreements on the defence of Europe. But I'm sure the resolve of the EU looks stronger to Putin, for example, than if we left the EU and washed our hands of those commitments.
We can't credibly pull up the drawbridge when everything's global and interlinked.
And the people leading the out campaign don't seem to be the people who would have to pick up the pieces if we did leave.
Health and social care will need to be restructured whether we're in or out of the EU. And it will need the right level of funding to do this.
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John Middleton9 June, 2016 7:17 pm
We very much support the findings of this article: the UK Faculty of Public Health agrees that staying in the EU is the best option for maintaining and improving our health and wellbeing. Our colleagues at the Royal College of Physicians, the Royal Society of Public Health and Royal College of GPs have issued similarly supportive statements this week.
Just as our economy and society have become international, so have the threats to our health. Pandemics like ‘flu, or water and airborne diseases and pollution, do not respect border controls. Our food and economic security, as well as the impact of climate change, cannot be controlled from within the UK alone.
“The UK has a strong leadership role for public health in Europe, for example on resistance to antibiotics. We all benefit from a pan-European approach to such a vital issue. Our analysis is that is better for the UK to remain a team player within Europe, where we benefit from shared intelligence, response and action.
FPH’s report on this matter is available via http://bit.ly/EU-FPH-PR
John Middleton, incoming President, Faculty of Public Health
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john rostill9 June, 2016 7:27 pm
These views maybe perfectly legitimate but they aren't "evidence -based "
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Anonymous10 June, 2016 7:51 am
I have not heard any credible, evidence based, reasoning for staying in the EU and certainly not in this article.
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