Sunday, April 03, 2016

The EU and the NHS

Anyone who has read this blog much in the last few weeks will know that I am deeply disappointed in both the "Leave" and "Remain" campaigns.

There is a positive case to be made for British membership of the EU and although the alleged risks of leaving have been endlessly cited - many of the points concerned being entirely reasonable - the positive case has barely ben put.

There is also a positive case to be made for leaving. Again the alleged risks of staying have been endlessly cited, some of the points concerned being reasonable.

Again, a clear and coherent positive case for leaving has not been made, though I'd argue this for a slightly different reason. Plenty of "leave" campaigners have cited a plethora of alleged positive reasons for leaving, many of which could potentially be achieved but the problem with the different benefits put forward if we leave is that too many of them are mutually exclusive.

I'll go into this in more detail in a post in the next few days but I am far from being the only person who is fed up with both sides - as Matthew Norman wrote in "i" recently, "A sane, reasonable EU debate ... is the opposite of what we're getting." (The article had a different title in the Independent and on the web but the sense is the same.)

But from some of those on both sides, the most egregious oversimplifications, scaremongering, and sometimes downright nonsense has been what they have written about the NHS.

Again, I am not the only person who is irritated or depressed by what has been written about the NHS during the EU referendum. Iain Dale wrote on Friday on Conservative Home that certain people on both sides had made idiots of themselves over the EU membership debate and cited comments mae by both sides about the National Health Service.

Here are two example of tweets about the NHS, one from each side - both can reasonably be described as scaremongering and neither does credit to the campaigns which published them.

One of these is a classic example of something which both sides have done at every opportunity and then criticised whenever the other side does it - quoting the views of a distinguished expert with no other explanation or justification. Trouble is, both sides have managed to find at least one highly regarded or experienced person in almost every field who backs them, so this doesn't actually get us very far.

I have already explained in some detail here why the above allegation from Leave.EU (that if we vote "Remain" then EU trade deals might force the privatisation of the NHS) is black propaganda of the worst and most dishonest kind.

Different people might take it another way: Fraser Nelson of The Spectator joked that the above "Leave.EU" tweet was the best argument he's seen to vote IN, although that may be a niche view.

I had an exchange on Twitter earlier this weekend with various "Leave" supporters, one or two of  them quite prominent in the pro-Brexit campaign, in which I lamented the over-simplistic discussion of the NHS by both campaigns.

Because the position of the NHS in relations to the debate about migration really is a classic example of one with no simple answer - our health service is both absolutely dependent on movement of people and put under pressure by the same thing.

I would be prepared to bet that a vanishingly small proportion of people reading this who are regular users of the NHS will not have been cared for in the past five years by a doctor, nurse, or dentist from somewhere other than Britain - perhaps from another EU country, perhaps from the rest of the world.

I and every member of my family have had health care from people from all over the world in the last few of years, from Poland to India to the Philippines, from dentists to the surgery on my eye a couple of days ago. The NHS hospital where my wife works is one of many which would collapse tomorrow if all non-British workers were sent home.

Equally, uncontrolled migration and "health tourism" is capable of putting great pressure on the NHS.

One valuable lesson which the lecturers and professors at both the Universities from which I hold degrees in Economics imparted was that whenever you consider an economic impact there are usually two sides of the story, and this has never been more true than when considering the impact of migration on the NHS.

So it makes me want to put my fist through the computer screen when I read things like "open borders = pressure on NHS" from a very prominent member of one of the Leave campaign groups who really should have known better than to produce that sort of oversimplification as if it solved the problem or answered the question. It is addressing the demand for NHS services while completely ignoring the position of the NHS as an employer which needs skilled and unskilled workers to function, and currently needs them from abroad, as I pointed out.

(You can, of course, ask some very pertinent questions about why successive governments of all political colours have not done more to train increased numbers of doctors, dentists and nurses from within our own country so we do not have to plunder the health services of many much poorer nations of some of their best people to staff our own, but that problem will take decades to solve and cannot be resolved within the timeframe of the period left to the referendum.)

Of course, the mainstream of neither side in the EU debate is advocating either completely closed borders or completely open borders.

There may well be Corbynista Labour supporters who want no immigration controls and there are some UKIP supporters who want a total ban on immigration, but neither of those extreme positions represent the views either of "Britain Stronger in Europe" or any of the leave campaigns.

One argument which was put to me is that we currently have freedom of movement for the 500 million holders of an EU passport. Yes we do, but let's be precise about the issue - the EU principle is free movement of WORKERS which is exactly what has saved the NHS's bacon thanks to all the foreign doctors, dentists and nurses who have come here. What puts pressure on the NHS is free movement of PATIENTS which is why the British government has been trying to reach agreement with other EU nations on measures to reduce health tourism, not entirely without success.

As Jeremy Hunt said, we have a National Health Service not an International Health Service.

Now that really IS an issue, which is why people need to take a dispassionate look at the facts rather than quote simplistic slogans about it. There is an excellent report by the Kings' fund into the effect of health tourism and immigration on the NHS here and the debate would be far more fruitful if people on both sides read up on the evidence from sources like this before sounding forth.

Neither side in this debate or any other has a monopoly of wisdom and I don't claim one either. The people who work in our NHS have enough problems without using them as a football in the EU debate.


Jim said...

Correction - thanks to the ECJ, the EU princilple is the Free Movement of PEOPLE.

The EEA principle does remain the free movement of WORKERS, but only where the ECJ has no jurisdiction.

Jim said...

Before you think I am going all Anti migration on you, im not, but its true the ECJ extended (or rather interpreted it to mean) the free movement of PEOPLE within the EU for us.

Now I for one dont really care about the free movement definition thing. Ok you can make a point that you get a bit of health tourism, but I dont think its overly major from within the EU. The point I dont like is that the ECJ can interpret the rules and there is sod all we can do about that.

I however do quite like the free Movemovent of people, I am pretty damned sure there would be no way I would have an NHS dentist were it not for the free movement of workers.

But when you make a case about the EU retaining the "Free movement of WORKERS, and i know that the ECJ interpreted that to mean the free Movement of PEOPLE for us, then I have to challenge it on this blog. Well lets face it, its not like someone from UKIP or Labour is going to is it?

Jim said...

P.s. - for further clarification, no its not an error or a typo i quite like the free movement of PEOPLE. The reason being that I think more WORKERS like my dentist I refer to or your doctors are more likely to want to settle in the UK if they can bring their family. The part I dont like is the fact the ECJ make that decision not us, and the ECJ do it on a blanket rather than a case by case basis.

Jim said...

For even further clarification, what i am saying is that though though the free movement of any WORKER is permitted under EEA rules, there could be a case by case agreement for a highly skilled worker to bring in their own family (even if they have no job to come to). I would still be happy for that. It would also allow us (in a way) to stop health tourism ( unless of course a highly skilled worker is applying for a job, brings in the family for an operation, then goes off again) but at least we get the worker, working, for while to off set it.

Think long and hard on these points, its not any of the 4 freedom's per say that are a problem to be honest, its the fact the ECJ interpret them for us.

if we were EEA/EFTA that would not be the case, and we would also be able to deploy an "emergency brake, (articles 112 and 113 of the EEA Agreement) if we really needed to.

P.P.P s - Are you wishing UKIP and Labour were more competent yet? :-)

Chris Whiteside said...

Some very important points there, Jim, and unlike almost everything I have read from the partisans of either side when they discuss the NHS, you are digging into the meat of the real issues.

The challenge for both sides is to develop a serious strategy which will enable the NHS to get the workers it needs without encouraging health tourism or overloading it with an unsustainable level of migration. I don't think either side has met that yet and neither will while they are content to chuck slogans around.