As the EU referendum grows ever closer, Professor Lord Ara Darzi 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 politicized 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 enclosed 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. 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 £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.
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.
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% of the total (despite being 12.7 per cent of the population). If we want to retain access to funding on leaving the EU 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.
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 Hospital trust.
This editorial summarises 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.