What would the NHS look like if the UK left the EU?
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3027 (Published 02 June 2016) Cite this as: BMJ 2016;353:i3027
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Will Home Office VISA Refusal Prompt West African Relatives To Vote Brexit?
Something happened just last week that has shaken the West African community in the UK. A Ghanaian friend of my son applied without success for VISA to fly over for urgent medical attention. The Ghanaian Specialist Practitioner whom the patient was coming to consult is not only a Professor in a UK Teaching Hospital but also the “Silas Dodu Distinguished Visiting Professor of Interventional Cardiology and Pudendology” in the University of Cape Coast in Ghana. The patient’s condition deteriorated rapidly and, having been refused a VISA, Professor Nicholas Ossei-Gerning, a Fellow of the Royal College of Physicians (London) had to fly to Accra with my son Dawid to treat his school mate. Please ponder Dawid’s harrowing account [1]:
http://www.dawid.com/medicine/they-always-say-its-impossible-until-its-d...
This meticulous account including the Home Office VISA Refusal Document has gone viral on the Internet and become world news on social media. Suddenly the nearly one million Ghanaians in the UK and several millions of Commonwealth West Africans resident here, paying their taxes, and possessing voting rights are beginning to view the imminent Referendum through spectacles that most British born-and-bred natives and commentators have never used. When Ann Gulland [2] wrote a week ago: “Brexit campaigners have also pointed out to the potential drain on NHS resources presented by the large numbers of European migrants who may come to the UK in coming years, from Turkey, Macedonia, Albania, Serbia, and Montenegro, all of which want to join the EU” – when Ann Gulland wrote this I wondered how many commentators spared a thought for the offspring of West Africans who fought in the Second World War in Burma who may be begging to come to the UK for private medical treatment and be blocked while Europeans can fly across The Channel without a VISA and use the NHS? Many Ghanaian residents in the UK and other Commonwealth Africans are not at all sure what message the Home Office appears to be giving the millions of them. They may well be asking: “Is the UK Home Office really asking those of us with voting rights to vote Brexit?”
BRAIN DRAIN? Or TALENT EXPORT?
Fellow Ghanaians desire to consult their kith and kin overseas, and to be prevented from doing this can be quite painful. They are well aware that Africans doing extremely well outside their country are often described as constituting a brain drain from their native land, but the truth is that we can also be described as Talent Export. Our Former Head of State His Excellency John Agyekum Kufuor more than once told gatherings of us at the Ghana High Commission in Belgrave Square London SW1 that we contributed in Billions of Pounds Sterling more than the combined Overseas Aid from the UK, USA, and other countries. That apart, exceptional talent is also rewarded by the UK, USA, and other developed countries. For Nicholas Ossei-Gerning to be not only an NHS Consultant Physician Cardiologist but to be Professor in a UK Medical Faculty is great achievement. Indeed, in the BMJ on 13 February 2014 we read: “On March 7 at the Royal Society of Medicine …Dr Ossei-Gerning MD(Lond) FRCP(Lond), Consultant Interventional and General Cardiologist, University Hospitals of Wales, Cardiff will 11.50 am – 12.30 pm give the MASTER LECTURE on ‘The Role of Interventional Cardiology in Erectile Dysfunction’”. [3] He did, and there was a standing ovation. This was the man that the Home Office refused a VISA to enable his countryman fly over to see. Fortunately, he himself flew across The Sahara to attend to him in Ghana.
Competing Interest: None declared. felix@konotey-ahulu.com
Felix ID Konotey-Ahulu MD(Lond) FRCP(Lond) DTMH(L’pool) FGCP FWACP FTWAS
Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley Street Ltd, Phoenix Hospital Group, London W1G 9AL
1 Konotey-Ahulu Dawid They always say it’s impossible until it’s done: A race against time and cold hearted bureaucracy [dawid.com ] June 9 2016]
http://www.dawid.com/medicine/they-always-say-its-impossible-until-its-d...
2 Gulland Ann What would the NHS look like if we left the EU? BMJ 2016 353:i3027 doi:http://dx.doi.org/10.1136/bmj.i3027 June 2 2016
3 Konotey-Ahulu FID. Erectile dysfunction: Test, please, for sickle cell disease. Rapid response to BMJ 2014; 348: g129 February 13 2014 www.bmj.com./content/348/bmj.g129/rapid-responses
Competing interests: No competing interests
Both sides can be criticised for pedalling hypothetical estimates as fact, in this debate. The vote leave campaign suggests that the UK will be able to invest in public services as a direct consequence of leaving the EU. Where is the evidence for this? To use such a notion to persuade the public to vote out is irresponsible. It completely disregards the unknown long-term costs which would be attached to negotiating new trade deals with European countries. If we add this to the depreciating value of the Sterling and widely forecasted economic downturn resulting from Brexit, surely it cannot be said with any certainty that leaving the EU will result in a growth in NHS spending, particularly given recent (non-EU) trends in public sector government spending.
Second, the question of NHS privatisation. The article mentions TTIP - but as the esteemed professor McKee is quoted as saying, the biggest threat to NHS privatisation comes from within the UK. The NHS Support Federation found that 70% of NHS contracts awarded between 2013 and 2014 went to the private sector. In keeping with this trend, 88% of NHS trusts were forecasting a deficit for the last financial year. The role of the private sector has steadily been increasing through private-finance initiatives (PFI) under past UK governments. Increasingly, people are finding themselves at BMI healthcare, for an NHS appointment. How does this fit in with the EU? Under the burden of PFI debt, and a lack of adequate supply of NHS services (providing a breeding ground for the likes of BUPA and BMI), many expect the British healthcare system may move further toward privatisation in future, or at least remain in it's quasi-public state. In such a scenario, few trade barriers, low business costs and the free movement of people are all aspects of EU membership, which, (through competition) may help to regulate the currently unchecked, overpriced, growing, private insurance system in the UK.
Competing interests: No competing interests
This response to the two news items from Ms Gulland and tbe responses from Mr Gregory and Dr de Belder is a selfish one. I am soley concerned with the NHS - its survival and adequacy of its medical staff ( numbers, competence and exhaustion.).
1. Money. It matters how much money is allocated to the NHS. It also matters HOW that money is spent.
If it is spent on demolishing perfectly functioning old hospitals and erecting new buildings with,
say, PFI, then the only people who gain are capitalists in the City and builders.
I do know that till a couple of generations ago, the City was a kind neighbour to Barts. Not any
more. Or, is it?
Talking of spending - not much, just a few billions - if you spend it on computer technology that
does not deliver and then you spend more on newer technology or on bug-eradication, and you
do not extract damages from the culprits, then you cannot, in all fairness claim to have spent it
on patients.
2. The European Working Time Directive. I have not heard about Germany, the Netherlands, Or France
having found any flaws in it. And if there are flaws, did the Chief Medical Officer (in office at the time it
was agreed, ) try to remedy the defects? If not, why not? And, does the current CMO has any views on
it?
3. The emotional and physical exhaustion of doctors and nurses in hospitals.
These phenomena are the result of emotional strain of continuous high pressure work in intensive
care plus perpetual demands for tick-box responses to "Continuing Professional Development" .
Go back to mixed intensity hospitals - some acute wards, some intensive care beds, and some pre-
discharge, slow tempo wards.
Doctors and nurses might then STAY , instead of going sick or emigrating.
4. Give up the bean counting activities. Your patients are Homo sapiens. Yes. They do have some
" sapiens" though you might consider all sapiential treasures to be concentrated in your Software,
Give up the habit of allocating a budget for clinical activities. You cannot forecast how many people
will become patients. Just treat them.
Do not use the general practitioner as your Rationing Officer ( or Gate-keeper - another obscene
term.) Let him(her) treat the patient according to his(her) clinical judgement. Guidelines? Strait-
jackets? Unworthy of a DOCTOR. May be all right for the first-aider.
5. The Brexiters, the Bremainers!
Well? What will be your policy?
I do not accuse your leaders of being dishonest. After all they are all " Hons". Indeed some are
" Right Hons".
Perhaps they practise "terminological inexactitudes"?
Perhaps their utterances are " economical with truth"?
6. TTIP. WIll your leaders say, unequivocally, " We will NOT accept TTIP". No ifs, no buts.
I wait to make up my mind - where to put my cross.
Competing interests: No competing interests
The £350 million per week is a gross figure, which are always quoted when talking about tax. We do not say the tax that we pay is £0 as it is all spent.
Yes we get some back but this is part of the point, Okun used the metaphor of the leaky bucket, that once taxed, money is moved around as if in a leaky bucket meaning only a small percentage gets to its intended destination. The rest is wasted in such things as administration, something the EU has plenty of. The money that we get back in EU spending would be better spent by us rather than by EU wide policies such as the Common Agricultural Policy (which is 40% of the EU budget), especially when Britain is so very different to the continent and always has been.
The main strain on the NHS is through increased demand, which would be OK if the supply could increase but it cannot as we are already massively short of doctors and nurses.
There is no non-biased evidence to suggest that there will be a post Brexit recession, only EU funded or government commissioned reports. It is far more risky to our economy to be anchored to the EU with its disastrous economics and corrupt and anti-democratic politics. It is a sinking ship on its way down.
Leaving the EU would not effect immigrants that we needed from coming in, but would actually make it easier and give equality to those from outside the EU as the article says.
That is why I am campaigning for a vote to leave the EU.
Competing interests: I am a leading campaigner for Vote Leave
Re: Will Home Office VISA Refusal Prompt West African Relatives to Vote Brexit? Full Apology Now Received from Home Office.
Will Home Office VISA Refusal Prompt West African Relatives to Vote Brexit? Full Apology Now Received from Home Office.
Following the international furore that ensued after it emerged that a seriously ill Ghanaian was refused a VISA to come to the UK for treatment, so the Specialist Professor Nicholas Ossei-Gerning of the University of Wales Teaching Hospitals had to fly to perform what needed doing in Ghana [1], the Home Office a week ago offered a full apology [2].
DR ANNE GULLAND’S “BREXIT CAMPAIGNERS” AND EFFECT ON NHS
Against the background of Dr Anne Gulland’s statement “Brexit campaigners have also pointed out to the potential drain on NHS resources presented by the large numbers of European migrants who may come to the UK in coming years, from Turkey, Macedonia, Albania, Serbia, and Montenegro, all of which want to join the EU” [3] I had I wondered how the nearly one million West African relatives in the UK of World War Two Veterans who fought in Burma and “who may be begging to come to the UK for private medical treatment and be blocked while Europeans can fly across The Channel without a VISA and use the NHS” felt? [4]
We were not at all sure what message the Home Office appeared to be giving us and we might well be asking: “Is the UK Home Office really asking those of us with voting rights to vote Brexit?” I do not for a moment think my BMJ letter [4] had anything to do with the Home Office change of heart [2]. Rather I am convinced the meticulous account of what happened, plus the more than 250 international reactions [1] including Editorial comments in a leading Ghanaian newspaper, radio stations, and my son’s interaction with the British High Commissioner in Ghana [2] made Her Majesty’s Home Office have a change of heart.
DO BMJ & OTHER UK MEDICAL JOURNALS HAVE A ROLE FIGHTING INJUSTICE?
What happened a fortnight ago that became world news [1] could have had a sympathising comment from at least the highly-esteemed-overseas BMJ. It did not. We rather have the spectacle of the Editorial Office directing adult doctors how to vote in the forthcoming EU Referendum [5] just as they have no qualm at all “advising” these same adult doctors how to handle end of life issues. Hmm!
Competing Interests: None declared felix@konotey-ahulu.com
Felix ID Konotey-Ahulu MD(Lond) FRCP(Lond) DTMH(L’pool) FGCP FWACP FTWAS
Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley Street Ltd, Phoenix Hospital Group, London W1G 9AL
1 Konotey-Ahulu Dawid They always say it’s impossible until it’s done: A race against time and cold hearted bureaucracy [dawid.com ] June 9 2016] http://bit.ly/1PKGpRf or
http://www.dawid.com/medicine/they-always-say-its-impossible-until-its-d...
2. Konotey-Ahulu Dawid. A full apology from the UK Home office – and a change of heart! http://www.dawid.com/sustainability/a-full-apology-from-the-uk-home-offi... June 14 2016
3 Gulland Anne What would the NHS look like if we left the EU? BMJ 2016 353:i3027 doi:http://dx.doi.org/10.1136/bmj.i3027 June 2 2016
4 Konotey-Ahulu FID. Will Home Office VISA Refusal Prompt West African Relatives to Vote Brexit? http://www.bmj.com/content/353/bmj.i3027/rapid-responses 10 June 2016 BMJ Rapid Response
5 Godlee Fiona, Abbasi Kamran, Gulland Anne, Coombes Rebecca. Why doctors should vote to remain in the EU on 23 June. BMJ 2016 353:doi 10.1136/bmj.i3302
Competing interests: No competing interests