Image: Poll Card EU referendum from Abi Begum's Flickr PhotoStream

As we move towards the referendum on membership of the EU, British citizens face a bewildering array of claims and counterclaims.  The conventional wisdom is that the voting public will favour the ‘status quo bias‘.  Unfortunately, we seem to be living in times when established wisdom no longer holds.  While the campaign to ‘remain’ part of the EU has enjoyed narrow poll leads, it may now be the case that ‘leave’ is closing the gap and even overtaking ‘remain’. We may well be heading for a possible Brexit.

If the assertions made by either side are even partially correct, then the stakes are very high.  Thus, many voters may feel they are duty bound to vote even if they don’t quite know which box to tick.  Some have characterised this as the most irrational referendum yet where “voters will be swung even more than usual by feelings and biases that have nothing to do with the issues at stake“.  So can we make any sense of the issues we face as voters and in particular what the impact of a vote to ‘leave’ may have on healthcare and the NHS?

The debate has often marshalled an army of ‘straw people’ and, at best, been puerile.  Whether it be: Boris Johnson proving Godwin’s Law; criticisms by LEAVE (despite being supported by the majority of the tabloid press) of media bias; or claims by Nigel Farage that women may be subjected to mass sex attacks if Britain stays in the EU.  Some think that the whole debate is little more than a blue on blue civil war and that progressive politicians should not even be sharing a platform with pro-EU Conservatives.  The idea of a Tory civil war certainly seems credible after John Major’s extended and brutal assault on people in his own party on the BBC’s Andrew Marr Show.  Perhaps his most telling and harsh comments were in response to claims that leaving the EU would allow us to spend more on the NHS:

The concept that people running the BREXIT campaign would care for the National Health Service is rather an odd one.  I seem to remember Michael Gove wanted to privatise it, Boris wanted to charge people for using it, and Iain Duncan Smith wanted a social insurance system.  The NHS is about as safe with them as a pet hamster would be with a hungry python.

The issue of the safety of the NHS, and the ‘leave’ campaigners’ claims that money sent to Brussels could be spent on healthcare were further undermined when it emerged that the co-founder of the Leave.EU group, Arron Banks, did not support a state-funded NHS.  As he said, “If it were up to me, I’d privatise the NHS”.

Exeter UK 11 May 2016 Brexit Battle Bus arrives in Exeter. NHS logo abuse © Anthony Collins/Alamy Live News

Image: Anthony Collins / Alamy Stock Photo

Despite these inconsistencies, the NHS and spending on healthcare are a prominent feature of the ‘Vote Leave’ campaign’s briefing notes and are consistently echoed by those working for Brexit.  Central to these claims is that “the EU now costs the UK over £350 million each week” and “Our EU contributions are enough to build a new, fully-staffed NHS hospital every week”.  An assertion repeated on the side of the ‘Vote Leave’ group’s campaign bus (together with an unauthorised NHS logo) and in their leaflets distributed to households.  An extra £350 million a week would surely go a long way towards ending the current funding crisis in the NHS.

The trouble that this figure is bunkum.  And we are not even in the general area of an honest difference of statistical interpretation of the data.  Both the UK Statistics Authority and the Treasury Select Committee have disputed the amount.  The BBC ‘Reality Check’ said of the claim: ‘We’ve said it before, and we’ll say it again – the UK does not send £350m a week to Brussels.’   Once rebates, regional aid and research income are taken into account, the figure is closer to £161 million a week.  So the £350 million figure is an invention or just a lie.

But the £161 million is still a significant amount the UK could use on healthcare if we leave the EU.  Except it couldn’t.  Non-member countries in Europe who want to trade with the EU’s single market, Like Switzerland and Norway, still have to make significant contributions to the EU.  So the only way to get the extra £161 million would be for the UK to leave the single market and head into isolation.  Perhaps the leave campaign has the idea of turning ourselves into some type of rightwing North Korea led by a Boris Kim Jong-son.

Of course, the trump card that Brexiteers hope to play to their advantage in the closing weeks of the referendum campaign is immigration.  According to the Brexit argument, public services and especially the NHS is being ‘overrun’ by demand from immigrants.  Fewer immigrants will mean more resources to treat UK nationals and shorter waiting lists.  Recent statistics suggest that immigrants to the UK are younger than UK-born workers, and most EU migrants came here for work related reasons (84%) with 60% of these having a specific pre-existing job to go to.  This suggests that these are fit and healthy people and thus unlikely to be a significant burden on NHS services; and that they are doing jobs that UK workers do not want to take.

It is also the case that the NHS has a significant dependence on overseas workers for all levels of staff.  Around 11% of those who work for the NHS and in community health services are from outside the UK.  Of this around 10 % of doctors and 4.5% of NHS staff overall come from EU countries.  While many NHS trusts are struggling to recruit experienced staff, and there is a severe shortage of GPs, do we really want to be further restricting the supply of people able to offer specialist skills in healthcare?

The negative effects of leaving the EU, for the NHS, were further highlighted in a recent survey of NHS Trust chief executives.  Around 80% of respondents thought departure from the EU would have a negative impact on staff recruitment.  Other findings of the study emphasised concerns about an adverse impact on both direct funding and access to the financing for research and innovation (including access to knowledge from clinical trials).

The majority of economic organisations and economists warn that exiting the EU would have a negative impact on the UK economy, with some saying the impact could be severe.  In this context debates about the UK’s net contribution to the EU could be irrelevant. As the Institute for Fiscal Studies says:

These impacts [EU budget net contribution] of EU membership on the public finances are easiest to calculate, but not the most important: if leaving the EU significantly increased or reduced national income, the impact on the public finances would dwarf the UK’s current overall net contribution.

So perhaps the most compelling reason to be wary of effects of Brexit and the NHS are the overall economic arguments.  Brexiteers tend to shy away from the economic case for leaving and have not actually offered any convincing models about how we, or the NHS, may prosper outside the EU.  Leaving the EU would not allow us to spend more money on the NHS. In reality, the likely effect of leaving would mean that there would be significantly less to spend on public services.  But maybe that’s been the veiled agenda of the leave campaign all along.