The NHS – and false claims about that £350m – helped tip the referendum. But as the threat from Brexit to the health service becomes clearer, it must now be the battleground on which the argument is finally won, argues senior doctor CHARLES HOUSE
Even those who made the promise now appear to accept the certain truth that Brexit is not going to bring £350 million fluttering down from the magic money tree, not this week, not next week, not any week, let alone the every week that many believed was being pledged from the side of a bus.
It is a sad and worrying sign of how much the terms of political debate have changed that instead of us being up in arms, and staying there until the money has been delivered, and the promise kept, so many people can heave a collective shrug, offer a wistful ‘ah well, always seemed too good to be true’ and move onto the next of life’s tribulations.
But even if we can park the anger felt at a promise broken before the votes that it won had all been counted, we should certainly be angry at what is happening in the NHS right now, and we should properly understand the very direct link with Brexit.
I am the doctor Alastair Campbell quoted in the account of his Open Britain meeting in North London on these pages last week, to the effect that the country can have Brexit, or we can have the NHS, but we can’t have both. I have worked as a hospital doctor in the NHS for 25 years. I am a consultant radiologist and also medical director. I love what the NHS stands for and I love what it does for the people who need the service we provide.
I do not enter into a debate like this without careful thought. I do so because I fear the worst for the NHS if the country continues on the path down which we are currently being led.
So before returning to what Brexit does, in fact, mean for the NHS, a few thoughts on why its current plight is a critical question for everyone who believes that Britain should remain within the EU. On why any of you, whose gut response on June 24 last year was something like the first words I wrote down, in the early Brexit dawn – ‘Hang your head in shame, Britain’ – should be focussing on this, right now.
The first 12 months after the referendum result was a period, inevitably and correctly, bound up in anger with what had happened and in ridicule at the utter absence of any sort of plan emerging from the leaders of the Leave campaign.
In the second year, our anger must now be tempered with kindness. Our friends, neighbours and colleagues who may have voted to leave the EU and are now faced with the reality of the consequences, deserve every support in reaching the brave and dignified decision to change their mind. People who voted to remain, but are tempted into thinking that maybe we should now just move along and get on with leaving, need reason to strengthen their resolve.
Our National Health Service is the biggest single reason to be brave; the steel of the resolve. For I believe that the threat of Brexit places the NHS in grave danger. The health service in which most of us were born, where we turn for unquestioning care, and in which we place our trust as a nation, will not emerge in any recognisable condition.
A source of national pride, established in a post-war era of appreciation of what actually matters most in life, the NHS is in no state to withstand the grievous blows which Brexit will deliver.
Two intertwined challenges face the NHS today. First, and most obvious, is a funding shortfall which is incompatible with adequate provision of a multitude of new and wonderful treatments. The choices for commissioners of healthcare are increasingly about making patients wait longer for some treatments, while restricting access to others altogether.
With inflation at a five-year high and the fact that we are the only EU economy with negative wage growth, Brexit spells a disastrous insult to an already desperately overstretched budget.
The tipping point for public opinion might be knowledge that the government could employ 9,000 more nurses with the money it is using to appoint civil servants to try to deal with Brexit – as research for the Open Britain campaign has revealed.
Or, pause for thought could come from a realisation that the Institute for Fiscal Studies’ prediction of additional national borrowing attributed to Brexit, in 2020 alone, is a sum which could be used to match the NHS spend for IVF cycles for over two centuries to come.
Second, less blatant but nonetheless damaging, is the difficulty in recruiting and looking after the clinical workforce – the doctors, nurses, radiographers, therapists and many other professionals – who provide care directly to patients, day in day out, up and down our country.
The impact of staffing shortage on doctor morale and productivity was highlighted recently by Professor Jane Dacre, president of the Royal College of Physicians. Calling for government to provide a guarantee to EU citizens working in the NHS that they will be able to remain in the UK following our exit from the EU, Professor Dacre identified ‘making the UK an attractive and accessible place for doctors from other countries’ as a key requirement to delivering high quality patient care. It is hard to imagine a policy more at odds with this aspiration than one of exiting the EU.
For nursing staff, the situation is arguably even worse. As noted previously in The New European, the number of nurses from the EU registering with the Nursing and Midwifery Council has fallen off its own cliff edge since the referendum, plummeting a dizzying 96% in the 12 months after the referendum.
Accompanied by a steep rise in the number of EU nurses and midwives leaving the NHS, up 67% on the previous year, this threat to the most vital aspect of patient care is real and present. As reflected by @NHSMillion on social media, ‘Whichever way you voted, no one wants an NHS that doesn’t have enough nurses’.
If training more of ‘our own’ nurses (whatever that may mean in the 21st century) was not the solution before, it is hard to see how it suddenly becomes so now; tougher than ever to understand how this is to be achieved during an economic downturn. To suggest, as the Department of Health did in December last year, that ‘Brexit will be a catalyst to get [workforce planning] right’ is to push the old saw about necessity and the mother of invention beyond the limits of credulity.
And so, in the anniversary of the month when the National Health Service Act received Royal Assent in 1946, the time has arrived for the NHS – and its leaders – to take a leading role in the fight to avert Brexit.
I was pleased therefore to see the strong, clear message coming from NHS England chief executive Simon Stevens recently about the scale of the funding crisis we face, and his direct linking to the promises made and broken about NHS spending in the EU referendum. As a public servant, he will not have taken lightly the decision to be so direct, any more than someone like me has to weigh up carefully whether to get involved in what will be seen as a political debate.
But the time for sitting on hands is over for all who care about the country, and the health service that is such an important part of it. The coming months are a critical opportunity to shift public opinion decisively: what better reason than securing our NHS could there be for waverers and doubters to summon courage, strengthen resolve and stop Brexit?
I repeat what I said at Alastair Campbell’s meeting… you can have Brexit as the Brexiteers in government want it, or you can have the NHS as the people want it, but you can’t have both.
That is the real choice facing the country, and it is one we have to fight for to make sure the right choice is made.
Charles House is medical director at University College London Hospitals