Brexit should come with a health warning for the NHS, public health, and researchBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3295 (Published 14 June 2016) Cite this as: BMJ 2016;353:i3295
- Sarah Wollaston, member of parliament for Totnes
The European Union is not perfect, and the renegotiations missed an important opportunity for reforms that could have benefited all its citizens. There are genuine concerns about democratic accountability, particularly of the Commission, and a serious disconnect between the public and the EU institutions that have such an extensive role in shaping our lives. Having started the campaign as a sceptic, however, I am now convinced that the benefits of our membership far outweigh the problems. We should not sweep the concerns, including the Transatlantic Trade and Investment Partnership (TTIP), under the carpet, but rather than walk away I believe Britain should stay and influence from within.
The debate covers a complex range of issues, many of which cannot be reduced to simplistic yes or no answers. But the referendum choice is binary—remain or leave—and the outcome will have profound consequences that will last for generations. We need to continue to make the case for democratic reform, but I am convinced that the case for the NHS, public health, and research is overwhelmingly in favour of us remaining in the EU.
NHS has been hijacked
The campaign has been bad tempered and poorly informed. The public deserved far better than the cynical manipulation of data, especially on the NHS. The hijacking of its trusted branding by the Leave campaign has been a disgrace, especially planted alongside a knowingly deceitful figure implying a £350m (€440m; $500m) weekly Brexit bonanza could boost NHS funding. Worse still, an ugly xenophobia has swept in to whip up fears that EU immigration could lead to the collapse of NHS services. The saddest emails and conversations I have held during the campaign have been with people born overseas who have been left feeling alienated and unwelcome by the tone of the debate. Colleagues from our EU partner nations make up an essential 10% of the UK health and care workforce but only 5% of the population. My answer to the rising tide of hostile questions on the effect of migration on the NHS is that these valued health and care workers are far more likely to be caring for you than ahead of you in the queue. The simple truth is that the greatest contribution to rising demand in the NHS is not from those who come to live and work in Britain from abroad but from the challenge of managing complex long term conditions. A collapse in the free movement of NHS and care staff would have serious consequences for those patients and the services on which they depend.
We do need to spend more on health and social care, including in my view a greater proportion of our gross domestic product, but increased spending can only come from a strengthening economy. The financial turmoil of Brexit would more than consume any gains from our net EU contribution, which averages less than £10bn a year.
There is near universal consensus that Brexit would be damaging for research and international cooperation, including our ability to respond to the infectious diseases that are no respecters of international borders. Britain is also significant net beneficiary of EU health research funding and plays a key leadership role. While scientists would no doubt do everything possible to maintain links, our influence would be severely diminished from the outside. The EU could go further to support public health, especially in addressing the imbalance with big commercial interests such as the alcohol industry, but that will also take a greater engagement with our MEPs and direct campaigning from the grassroots if Britain votes to stay.
Considering all aspects of the debate, including those beyond health and research, I know that I would feel a profound sense of loss if I woke on 24 June to the news that Britain had voted for the isolation of Brexit. If that prospect fills you will horror too, it's time to get out and make the case for us to remain. The polls could not be tighter.
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare
Provenance and peer review: Commissioned; not externally peer reviewed.