Brexit won't cure the NHS, but it will deliver the tools we need

Brexit won't cure the NHS, but it will deliver the tools we need

by Jonathan Stanley
article from Friday 20, May, 2016

THE NHS remains at the forefront of concerns for those undecided about whether we should leave the EU.  Deep down many people want to leave but are worried about the short term impacts this might have on their health service. The In crowd have been spinning hard to work up such fears and it’s important they are openly and honestly addressed.

This is such a huge topic it is best handled in bite-size pieces and the recent infographic from Medigo (, a leading outsourcer of medical services to Europe from the UK, is worthy of scepticism.

It seeks to promote the EU as a source of labour for our medical workforce but completely ignores the fact that most non-UK doctors originate from outside the EU, namely India and Pakistan. Immigration has always been a choice for UK governments. It is not a celebration of diversity but the decision to trade time and money in training new doctors, against importing them ready-made by another country.

The idea the NHS would collapse without immigration is either facile or at worst colonial: third world and European countries continue to supply the UK with doctors and maintain their own health services. Finland’s nurses are 98% Finnish in origin, for Switzerland this drops to 78% and this is again based on domestic policy choices.  Finland inside the EU does not rely on migration for health service provision.

The European Health Insurance Card EHIC covers all EEA, not just EU, citizens for their first three months and is for emergency cover. Imagine my surprise when Medigo boasts it covers hip replacement surgery and coronary angioplasty. If this is indeed the case it shows EHIC needs serious work to reform it as these are not, in the main, emergency therapeutics and are confined almost solely to the elderly.

Likewise to boast that the NHS offers over £3000 to women who are pregnant to give birth here is worrying, this is a wholly anticipated and therefore elective healthcare cost and EHIC is being abused if it’s being used for this.

Finally it makes the most absurd case of all, that UK patients use EHIC far more than EU patients here. It is true older people cost far more to treat and this is a reflection of retirees to Spain, it begs the question why the NHS should fund this at all given they also pay travel insurance but this is nonetheless the state of play.

It is well recognised there is a serious problem with underclaiming by the NHS from EHIC based on its design. We don’t ID check patients, if we did we’d have to do everyone or it would be seen as racial profiling. So we just don’t claim. This is not the fault of migrants or doctors, it is the fault of politicians so in love with the EU they refuse to see the NHS and EU are wholly incompatible when it comes to reimbursements. 

Outside the EU we could levy compulsory health insurance for anyone working here but the Commission currently bans us from doing so.

We could even charge a one-off fee for entry to cover emergency costs, and once outside the EU we could exempt UK citizens from it, a welcome relief to holidaymakers and hospitals alike.

There are major issues for healthcare in the UK. Brexit won’t solve them. It may not even solve health tourism on its own. What it will do is equip policymakers with the tools and freedom to make a reciprocal agreement fit for purpose in a world where low cost airlines and academic mobility oblige a very mobile Europe. 

Jonathan Stanley works in the NHS




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