Leave campaign big wig Nigel Lawson once famously called the NHS the closest thing Britain has to a national religion. Since then, it’s been received wisdom that posing as champion of the beloved health service is generally a decent electoral strategy.
No wonder then, that in recent days the Leave campaign has made a great deal of noise about the fact that £350m a week could be spent on it, if only we were to leave the European Union.
The claim is made in giant lettering on the side of their battle bus. It is in the leaflets, and it also features in an emotive new campaign video that compares (dramatised) footage of an elderly woman suffering a long wait at A&E, with (equally dramatised) footage of the same lady being seen very speedily in a post-Brexit hospital, presumably built in a week with all that wonderful money we’re going to rake back from Brussels.
The other reason the post-Brexit hospital is coping so well, we are to assume, is that it hasn’t had to cope with the influx of five million EU migrants (many, impressively, from states not in the EU) that will, Michael Gove has predicted, make the NHS “unsustainable by 2030”.
Unfortunately for Vote Leave, these claims to the mantle of NHS champion were somewhat undermined this week when the most prominent health expert backing Brexit – the former GP and chair of the House of Commons Health Select Committee, Dr Sarah Wollaston – said she would be refusing to hand out their “deliberately misleading” NHS leaflet.
What’s misleading about it?
What is misleading is that (as has been stated by the UK Statistics Authority more than once) we would not get back £350m a week by leaving the EU. It bears repeating (because Vote Leave keep using it) that the figure does not take into account the UK’s rebate or the funding we receive from the EU. The real figure is between £110m and £135m a week.
Let’s leave aside for the moment the fact that members of Vote Leave’s campaign committee have in the past argued for the break-up of the NHS; that MEP Daniel Hannan said in 2009 that the health service was a 60-year-old “mistake” that had “made people iller”.
It would also be churlish to mention that we never heard a peep about the NHS from Michael Gove, Iain Duncan Smith and other Cabinet colleagues backing Brexit in the past six years, despite it undergoing the most sustained funding squeeze in its history as a result of their Government’s policy. Waiting times have increased, nine in 10 hospitals have overspent their budgets, and morale among staff is flat-lining, so one would have thought that those who care deeply about the NHS and had a powerful platform in government to say something about it might have done so, but there we are. Bygones are bygones.
Setting aside the potential economic cost of Brexit and the impact that would have on public spending (something NHS England chief executive Simon Stevens warned over this weekend) to spend even £110m more a week on the NHS, a post-Brexit government would have to make the very bold political decision to spend all of the UK’s former EU spending on the NHS – ignoring the competing claims of social care, education, defence, welfare, transport and every other area of public spending.
Then there is the question of migration. Vote Leave’s estimate that the possible influx of five million migrants could increase A&E attendances by 12.8m a year by 2030 by is based on an assumption that they will attend A&E the same amount, if not more than, the average person. However, studies have shown that migrants – who tend be young and fit – use health services less than the average person.
No-one denies that increased migration increases demand on a health service – that’s just common sense.
But speak to any health think tank, NHS manager, or leading medic and they will say that by far the main reason the NHS has come under such huge pressure in recent years is not an influx of immigrants – it’s an ageing population, more likely to suffer long-term health conditions like heart disease, diabetes, cancer, and dementia.
If anything, we are likely to need more not fewer young migrant workers to come to the UK to pay taxes and potentially work in the NHS or social care, to support the growing numbers of older people in care.
Simon Stevens has made the important point that the NHS has benefitted “enormously” from the migration of workers. Nearly 8,000 nurses from European Economic Area countries – the vast majority EU members – registered in the UK in 2014/15. With staffing shortages already a serious problem because of underfunding, it’s worth asking how much worse things might have been without them.
The NHS’s ever-sanguine chief executive has also made clear the key nuance in this debate which the Leave campaign appears to have missed.
An increased population is in itself not inherently bad for a publicly funded health service – because for every new patient, there is a new taxpayer. What is bad for the NHS, is when a government chooses not to pass on enough of the proceeds of that tax to the health service.
In a referendum debate so far low on hard facts, and high on rhetoric, it would be good for the patients and the staff of the NHS if that message, at least, finally sinks in.
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