Monday, 13 June 2016

PoliticalSpeak: Brexit and the NHS

As a person with MS, where do you stand on Brexit? #PoliticalSpeak #MSBlog #Brexit

"I keep getting asked by my European colleagues what would happen if 'we', the 'British public', vote to leave the EU. To be honest with you I don't know and have no idea how things will play out if we do. However, what I do know is that a Brexit vote on 23 June will have a major impact on NHS and on pwMS. The BMJ have been running a series of articles on the EU Referendum and what it means for the medical profession and the NHS. If you are interested I would suggest reading them; to access them simply put 'BMJ' and 'Brexit' into Google search engine and all the articles will come-up. They are very well written and make interesting, if not essential, reading."



"What I can say is that a large amount of collaborative MS research we are involved in is funded by the EU including research fellowships and studentships. A Brexit would almost certainly impact on MS-related research in the UK. The UK is a member of ECTRIMS, the European Charcot Foundation (ECF) and the European Academy of Neurology (EAN). Would we lose our membership of ECTRIMS, ECF and the EAN in the event of a Brexit? It would be sad if we did; the European MS community is very collegiate and we would be poorer for not being part of these organisations."

"I chaired a CME meeting in London this weekend with about 100 delegates attending. I would estimate that about 20% of the Healthcare Professionals at this meeting were born outside the UK. How would we staff the NHS and our research laboratories post-Brexit? I assume the Brexiteers have  a well thought-out plan to manage a manpower crisis a Brexit vote would trigger. The most pressing concern for me are carers for pwMS. As you know carers tend to be relatively low-paid, semi-skilled, workers and almost all the carers that come to clinic with disabled pwMS in London are from Europe, in particular eastern Europe. If we exit the EU where are we going to get semi-skilled, and skilled, carers from to look after our disabled MSers? I can go on, and on, with examples like this, but I am not the most qualified person to discuss the pros and cons of a Brexit."

"I can conclude by saying that what has made Britain, and its ex-colonies, great have been their ability to look outward, beyond the horizon, and to have a world-view that is based on optimism, hope and a can-do attitude. The current Brexit debate is so lowbrow; it feeds on pessimism, fear and xenophobia. If you have MS, or you are and MS researcher, or you are involved with the care of people with MS there is little space in our lexicon for pessimism, fear and xenophobia. In my opinion a Brexit would be bad for the NHS and bad for pwMS. What do you think?"


Anne Gulland. What would the NHS look like if the UK left the EU? BMJ 2016;353:i3027.

Excerpts


.... Would there be more money in the NHS budget as a direct result of Brexit? ....

.... The Conservative MP Boris Johnson has been touring the United Kingdom with his fellow Vote Leavers in a battle bus emblazoned with the words, “We send the EU £350m a week. Let’s fund our NHS instead.” Technically, that figure is correct, says the Institute for Fiscal Studies, but it does not take into account the rebate the UK receives from the European Union or money that doesn’t go through government departments, such as EU grants to universities. The UK’s net contribution to the EU will average £8bn a year over the next five years, the institute has calculated....

.... Brexit campaigners have also pointed 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....

..... But NHS England’s chief executive, Simon Stevens, has sounded the alarm over the potential of a post-Brexit recession and its effects on the NHS. He spoke to the BBC’s Andrew Marr Show just two days after figures showed that the NHS in England ran up a deficit of £2.45bn. He said, “It has been true for the 68 years of the NHS’s history that when the British economy sneezes the NHS catches a cold. This would be a terrible time for that to happen, at just the time that the NHS is going to need that investment.”....

Would it be harder for the NHS to employ EU doctors?

...... The latest figures from the General Medical Council show that there are currently just over 30 000 doctors working in the UK whose primary medical qualification is from another EU or European Economic Area country—11% of the total number of doctors....

Would increased privatisation of the NHS be more or less likely?

...... But Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, says that the risk to the NHS comes from within the UK. “As is apparent since the passage of the 2012 Health and Social Care Act … the risk is one arising from domestic politics rather than any agreements being made in Brussels.”....

22 comments:

  1. Re: " As you know carers tend to be relatively low-paid, semi-skilled, workers and almost all the carers that come to clinic with disabled pwMS in London are from Europe, in particular eastern Europe. "

    This may be the case in London but it is not always the case in cities outside of London. The carers I know are UK born.

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    1. According to a source (Migration Watch report) London has the largest proportion of EU migrants in the UK, next is the south east (EU citizens in the UK 2014).

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    2. And London is firmly in the remain camp. Interesting isn't it?

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    3. The ORB poll finds that seven per cent of all voters are still undecided and less than a quarter (22 per cent) are likely to change their minds before the referendum.

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  2. Your position doesn’t surprise me. You’d think the UK never achieved anything before we joined the Common Market (surprising given that we had a big part to play in the agricultural revolution, industrial revolution and a large amount of the major inventions of the last 200 years). As you see from the horrific events in Florida on Sunday (and similar events in France and Belgium), your ideal of a mix everyone up approach has some drawbacks. When my children apply for jobs in London they are not only competing against other British graduates, but any other graduate in the EU. Does that seem fair? What are the chances of my children getting on a graduate scheme in Albania, Spain or Romania? Most of the other EU economies in the EU, particularly in Southern Europe are broke. Understandably, their workers want to come to the UK. However, at what point would you assess the numbers to be too many? One million, ten million? If I am an Albanian bricklayer and I come to the UK with my wife and 3 children, where do I live? I can put my children into a British school, sign up with the GP and head off to the local British hospital when I fall off the scaffolding and break my leg – and that’s before I have paid any taxes. Is that fair? If you came home tonight to your nice Clapham home and four EU migrants were sitting in your kitchen and drinking your expensive red wine, what would you say? “I paid for all this out of my hard work, but please help yourself and stay as long as you like”? A key reason why the NHS is creaking because of the uncontrolled influx of immigrants from the EU (it’s certainly not because of the birth rate of the indigenous population). We then have to draw in doctors and nurses from abroad. Does anyone think about the impact on the healthcare of citizens in other EU countries, or in India, Pakistan….? What about all the professionals (IT, Finance) coming to the UK from other EU countries. Will the economies of these countries ever recover if they lose their best young people? You need to get out of your nice suburban idyll to other parts of the UK. Try a working class town in the North. I imagine your children went to private school so you didn’t encounter the mounting problems of getting your children into the local state schools. No doubt the Brexit supporters will be rubbished as xenophobic and racist. Most of us just want to have some control over our country. We can see on the ground over the last 10-15 years the pressures that have been building on school places, GP lists, hospital appointments. The Ivory Tower types will blame the government for not building millions of new houses and hundreds of new hospitals and schools. The south east already looks like a concrete jungle / car park and total gridlock on our roads is not far away. Is the solution really to continue with an open door to everyone in Europe and a relentless building programme that kills off what was lovely about this country (green spaces)? I suppose as long as researchers keep getting grants from the EU they will not bite the hand that feeds them.

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    1. I am lucky enough to have been born in London long before Britain joined the Common Market. I went to school with the children of West Indian immigrants. There were 46 children in my class, I have the evidence on my old school reports. Most of my peers did very well whatever nation their parents arrived from. I remember going on holiday abroad and being forbidden to take more than £25 out of the country. I remember only being allowed a tiny pay rise inflicted by the government even though I worked in the private sector. When I heard John Major speak in Northern Ireland I knew what he said was true, because I've lived through it. I waited for appointments at London hospitals although I had undiagnosed MS. I walked past the broken glass from an IRA bomb and the fear of being caught in a blast meant evacuating my place of work at least twice a day. The problems with housing are exacerbated by property developers selling housing to the Chinese and Russians that are inflating property prices in London. A Russian MP has congratulated Russian football hooligans for their behaviour at the weekend. India have taken more of our IT jobs with the UK outsourcing much of the work and children still sleep on the streets. What I do know is that successive governments in this country have sold off social housing, failed to replace them and made it more difficult for social mobility. The EU social chapter was there to protect people like me. So don't blame the EU it was worse before we joined and without the EU workers in the NHS we'll all be waiting a whole lot longer for our healthcare.

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  3. Apart from all the consequences of a possible brexit, what makes me more sad is the possibility of the European union failing. I'm of the thought that if it happens it would trigger a Dominoes effect.

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  4. Future Paper:

    December 12th 2019, The United Kingdom in a strange twist of history has applied for United States Statehood. A distant relative of General Lafayette was interviewed and stated that he saw this coming in a dream back in July of 2016.

    "I was like stunned when I woke up from a sound sleep in July of 2016 when I awoke from a dream where President Trump and his wife Hillary Rodham Clinton Trump announced in my dream that the United Kingdom applied for statehood. I could not get back to sleep. So I made coffee and pop tarts. The pop tarts caught fire in my toaster which never happened before.", Lafayette said.

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  5. On a more serious tone...

    What is with the new global thought tendency towards what appears to be isolationism? Is that not contrary to globalization? Or could it be the precursor to the what some deem "looming disaster" to try minimize it?

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    1. It's a response to the economic stress that the middle and lower classes have been under for some time now. All of this has happened before, all of it will happen again. Factionalism, increased fascist thought in our politics, racism... At least isolationism, while woolly headed thinking, does get at something causing the suffering, which is the multinational 1% sucking the lifeblood from people while skipping out on taxes. But rather like inflammation, isolationism is the body politic trying anything to purge a bad actor it doesn't fully recognize.

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  6. Having a German partner, I have voted already (by post) with all my heart to stay in the EU. I have many other more cerebral, less idealistic reasons too, including the requirement for close international cooperation to develop effective environmental legislsation. And the UK leaving the EU would almost certainly lead to the break up of the UK. Scotland is reportedly relatively pro-EU and the SNP would use this situation to call up another referendum on independence. I do not like nationalism, politics which separate people, create yet more "us" and "them". But I'm tired of the debate by now, tired of the ranting - from the disingenuous, deceptive and actually often quite distastefully xenophobic leave campaigners in particular. No, the EU isn't perfect, but that just means people have to try harder to make it work, and learn the lessons from history finally.

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  7. This brexit fantasy will end in tears if it goes through - little Britain will be an extremely desolate place. The glorious colonial era is over, and anyone who thinks inherent British exceptionalism will carry the day is frankly kidding themselves.

    It is concerning to see this level of delusional thinking. inequality is the real challenge but you don't notice it if you're only looking sideways rather than upwards

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  8. Would an immigrant write anything other than support of staying in the EU?

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    1. Lithuanian with MS living in LondonMonday, June 13, 2016 1:05:00 pm

      Yes, particularly as I am on natalizumab, which was not available to be back home in Lithuania.

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    2. Given Prof G does not originate from inside the EU, what's your point ?

      Where I was born was not a matter of choice for me - I happen to have been born in the UK as have my ancestors for at least the last six hundred years. I will be voting to remain in the EU next Friday.

      I took the opportunity of free movement of people to go and work in other European countries and would like my children to have that opportunity. I learned valuable skills by living and working outside the UK that improved my career back in the UK, before I was diagnosed with MS.

      If the Brexiters want an idea of how successful a developed country can be without immigrants just look at Japan. It's had over twenty years of economic stagnation and because of an ageing and shrinking population has fewer taxpayers to pay off the public debt.

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    3. Sure I am immigrant; but that is life. My mother is a second generation English immigrant to South Africa; my maternal grandmother was a Carrington from Greenwich London and my maternal grandfather a Williams from Cornwall. My father was second generation Italian, my paternal grandfather was from Luca, in Tuscany, and my paternal grandmother from a village in Southern Italy close to Naples. I am now British does that disqualify me from having an opinion about what I think is best for my patients and for the NHS?

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    4. Us versus them. We deserve more. They are taking everything. I wonder what would happen if before voting everyone took a DNA test to see where we really came from. Suddenly there would be no us and them. Just us. We are all migrants after all.

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    5. England, much of Europe past was responsible for spreading civilization as we know it across the globe in the days of colonialism.

      The EU (IMHO) was one of the boats that certainly has a place upon the sea of the world. But just as is the case with globalization the rush to make it so never took the time or foresight to recognize and plan for the blows.

      When driving factors towards unity place at the top of the list matters of money, matters of policy, matters of perceived visionary direction they have placed people at the end of the laundry list albeit selling it to the public.

      "When the ties that bind are not strong and fast the hopes of a future are a dream relapsed" (c) Me :)

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  9. From an article in today's Guardian.
    "We are 10 days away from making a terrible mistake for deplorably stupid reasons. As the comedian Billy Crystal said at Muhammad Ali’s funeral on Friday: “Life is best when you build bridges between people, not walls.” True enough. But in this referendum those who disagree, or have chosen to disagree in pursuit of power, are making the most noise. With a symphony of dog whistles as our soundtrack, we are trudging dangerously close to the idiot option."
    Article here for those who wish to peruse.
    http://www.theguardian.com/commentisfree/2016/jun/13/10-days-from-terrible-mistake-europe-immigration-leave-campaign

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    1. A Peace Loving EuropeanMonday, June 13, 2016 1:41:00 pm

      Mending Wall
      Robert Frost, 1874 - 1963

      Something there is that doesn’t love a wall,
      That sends the frozen-ground-swell under it,
      And spills the upper boulders in the sun;
      And makes gaps even two can pass abreast.
      The work of hunters is another thing:
      I have come after them and made repair
      Where they have left not one stone on a stone,
      But they would have the rabbit out of hiding,
      To please the yelping dogs. The gaps I mean,
      No one has seen them made or heard them made,
      But at spring mending-time we find them there.
      I let my neighbor know beyond the hill;
      And on a day we meet to walk the line
      And set the wall between us once again.
      We keep the wall between us as we go.
      To each the boulders that have fallen to each.
      And some are loaves and some so nearly balls
      We have to use a spell to make them balance:
      ‘Stay where you are until our backs are turned!'
      We wear our fingers rough with handling them.
      Oh, just another kind of outdoor game,
      One on a side. It comes to little more:
      There where it is we do not need the wall:
      He is all pine and I am apple orchard.
      My apple trees will never get across
      And eat the cones under his pines, I tell him.
      He only says, ‘Good fences make good neighbors.'
      Spring is the mischief in me, and I wonder
      If I could put a notion in his head:
      'Why do they make good neighbors? Isn’t it
      Where there are cows? But here there are no cows.
      Before I built a wall I’d ask to know
      What I was walling in or walling out,
      And to whom I was like to give offense.
      Something there is that doesn’t love a wall,
      That wants it down.' I could say ‘Elves’ to him,
      But it’s not elves exactly, and I’d rather
      He said it for himself. I see him there
      Bringing a stone grasped firmly by the top
      In each hand, like an old-stone savage armed.
      He moves in darkness as it seems to me,
      Not of woods only and the shade of trees.
      He will not go behind his father’s saying,
      And he likes having thought of it so well
      He says again, ‘Good fences make good neighbors.'

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  10. Being a part of a larger organization is hard, you give up some freedoms. I think that we could make the EU fairer, but the UK is just too small a market to thrive in today's emerging trading blocks.

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