EU referendum: Will Brexit save taxpayers money and mean more money for the NHS?

The big EU questions: The EU debate so far has been characterised by bias, distortion and exaggeration. So until the end of the referendum, we are running a series of question-and-answer features that will try to explain the most important issues in a detailed, dispassionate way

The NHS needs to curb its spending on specialised treatment, the NAO warned (Getty)

Why is the cost of our EU membership an issue in the referendum?

One of the main slogans of the Vote Leave campaign is that being part of the EU club means “giving £20bn a year or £350m a week to Brussels” .The Remain camp insists the figure is highly misleading because our gross contribution is not handed to Brussels, since the rebate won by Margaret Thatcher in 1984 is deducted first.

Our membership fee does vary from year to year; Vote Leave says it is rising and will increase further if we stay. Treasury figures put the gross payment at £18.2bn in the 2014-15 financial year, and the rebate worth £4.8bn.

In addition, the EU spent about £4.6bn in the UK, mainly in payments to farmers and regional aid for poor areas. Private sector receipts such as EU research grants were worth another £1.4bn. When all that is taken into account, the net cost of membership was £7.3bn a year or £140m a week, well under half the amount claimed by the Leave camp.

So who’s right?

Sir Andrew Dilnot, who chairs the UK Statistics Authority, said the £350m-a-year figure is “potentially misleading”.

The National Audit Office, using a different formula and measured over the EU's financial year, put the UK's net contribution for 2014 at £5.7bn. So did the independent Institute for Fiscal Studies. Vote Leave has ignored calls from Remain to stop using the £350m-a-week figure. It insists that it is valid because the money Britain gets back from Brussels comes with “strings attached” and the Government does not control how it is spent.

Would leaving the EU allow the UK to spend more money on the NHS?

A bit. Vote Leave argues that NHS underfunding could be eased by ending our “£350m-a-week” EU budget contribution – enough, it claims, to build a new hospital every week. It said: “We will be able to spend our money on our priorities like the NHS.“ Gisela Stuart, the Labour MP and group’s vice chair, said: ”I'd rather that we control how to spend that money, and if I had that control I would spend it on the NHS.” Boris Johnson, the former Mayor of London, has said that Brexit would reduce waiting times at accident and emergency units.

What do supporters of EU membership say?

That the Out campaign is misleading the public since spending our gross EU budget contribution on health would mean, for example, ending aid to poor regions, payments to farmers and research grants, which no government is likely to do. Our net payment to the EU would fund the NHS for 19 days a year, according to NHS England.

The In camp accuses its opponents of hypocrisy, pointing to previous statements by prominent Outers, including Johnson and Nigel Farage, that questioned their commitment to the NHS. Even some supporters of Brexit think Vote Leave’s claims about extra money for health are over the top. Sarah Wollaston, Tory chairman of the Commons Health Select Committee, said: “The current preoccupation with exploiting the NHS, and its protected branding, to support the Leave campaign’s argument on the EU is a cynical distortion which undermines the credibility of its other arguments.”

What does the NHS say about Brexit?

Simon Stevens, the chief executive of NHS England, has warned that the NHS could be hit by the effect of Brexit on the economy. “It would be very dangerous if at precisely the moment the NHS is going to need extra funding actually the economy goes into a tailspin and that funding is not there,” he said.

What about the pressures that EU migration puts on the NHS?

For Vote Leave, Priti Patel, the Employment Minister, claimed: “It is becoming clear that our membership of the EU is putting the NHS under threat….What we get back from the EU is a city the size of Newcastle (population 288,000) of new immigrants to the UK every year. Current levels of migration are causing unsustainable pressures on our public services and we can see that the NHS is creaking under the strain.”

Michael Gove, the Justice Secretary, claimed that up to 5.2m EU migrants could enter the UK by 2030 if Turkey, Serbia, Albania, Macedonia and Montenegro all join the EU, warning that A & E attendances would double to 12.8m a year and that the NHS would need another £9.4bn.

What does the In camp say about that?

It points out that the NHS and care sector employs 135,000 EU migrants, including 10,000 doctors and 20,000 nurses, some of whom might choose to leave the UK after Brexit.

Does EU membership encourage “health tourism” in the UK?

Vote Leave says that the UK has paid £6.2bn since 2007-08 to other EU countries for giving health treatment to British citizens, but recouped only £405m from EU members for treating their citizens in the UK. But the In camp points out that this is due to British tourists and the 190,000 UK pensioners living on the continent being big users of EU health services. It is doubtful whether the bill would fall after Brexit. Some 40m visits to EU countries are made by British people every year and 27m have a European Health Insurance Card, a benefit that might not be guaranteed after Brexit.

Would a proposed EU-US trade deal threaten the NHS?

Trade unions, Jeremy Corbyn and some Leave campaigners have warned that the Transatlantic Trade and Investment Partnership (TTIP) could lead to the privatisation of the NHS. They are worried that investor protection rules could allow American health corporations to sue if they lost NHS contracts.

But the European Commission and the UK Government insist that this would not happen and reject claims that TTIP would force governments to put public services out to tender. An unlikely alliance of Tory Eurosceptics and the Labour Opposition forced the Government to make a tactical retreat to avoid an embarrassing defeat on the Queen’s Speech. Ministers accepted an amendment regretting the absence of a Bill to protect the NHS from TTIP. But they insist there is no threat from it.