Intended for healthcare professionals

Rapid response to:

Feature EU Referendum and Health

What would the NHS look like if the UK left the EU?

BMJ 2016; 353 doi: (Published 02 June 2016) Cite this as: BMJ 2016;353:i3027

Rapid Response:

Re: What would the NHS look like if the UK left the EU? What about the EWTDirective?

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

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

04 June 2016
JK Anand
Retired doctor
Free spirit
3 Wayford Close, Peterborough