Tag Archive: NHS

EU Enlargement: Lies, Damn Lies and Brexit

The European Union (EU) referendum to decide whether Britain will remain in the EU is less than a month away and the “Brexiteers” (those in favour of leaving or “British Exit”), complain that their opponents, the “Remain” campaign, are making every effort to scare the electorate (“Project Fear”) so as to get a vote to stay in the EU. The Brexiteers cannot complain, as far a I can tell, because they are busily bending the truth while also cranking-up the pressure (“Project Fear”) on the poor average British voter.

To illustrate this let us consider the way the future enlargement of the EU is being handled.

The Balkan Horde Cometh

Ms Theresa May, the Home Secretary, was the first to bring-up the issue of EU enlargement even though she is superficially in the Remain camp: “The states now negotiating to join the EU include Albania, Serbia and Turkey – countries with poor populations and serious problems with organised crime, corruption, and sometimes even terrorism.  We have to ask ourselves, is it really right that the EU should just continue to expand, conferring upon all new member states all the rights of membership?” (emphasis added)

Iain Duncan Smith formerly the Secretary of State for Work and Pensions and one of the leading Brexiteers, immediately jumped on the enlargement bashing bandwagon: “The Home Secretary is right to warn of the dangers of countries like Albania and Turkey being allowed to join the EU. If these countries are let into the EU’s open border system it will only increase the pressure on our NHS, schools and housing. It will also vastly increase the risk of crime and terrorism on British streets.” (emphasis added)

Boris Johnson, the former Mayor of London and the most prominent of the Brexiteers, was his usual self. He said whatever came to his mind that sounded vague humorous while paying scant regard for facts. He can be relied upon to say the exact opposite at a later point in time if it suits him and can help to position him to become the next Prime Minister.

The supposedly most intellectual of the leading Brexiteers, Mr Michael Gove, the Secretary of State for Justice, then capped it all in his widely reported article about possible future enlargement: “Albania is on course to join the European Union — alongside four other countries, Macedonia, Montenegro, Serbia and Turkey. The already unwieldy group of 28 is due to become a throng of 33” … When (they) join the EU, another 88 million people will soon be eligible for NHS care and school places for their children. And what will even more immigration from the EU mean for access to housing across the UK? … What will it mean for jobs and wages?” … “And allowing millions more people to come here from the Balkans and Turkey is too much.” (emphasis added)

Unusually for the Brexiteers, they went on to be very specific about the implications of a future EU enlargement connected with the five countries:

  • Turkey, Albania, Serbia, Montenegro and Macedonia could join the EU in 2020;
  • They forecast 3,1 to 5,2 million extra immigrants coming to the UK from the 5 countries;
  • Britain would face an influx the size of population of Scotland by 2030.

The Sun, Telegraph, Mail, Express and the other pro-Brexit newspapers widely reported the enlargement claims and forecasts. The image conjured up was one of 5,2 million extra immigrants (the population of Scotland) beating a path straight to the UK, bringing crime and terrorism to our streets, along with making all our public services unsustainable. Since the Brexiteers keep constantly suggesting that British public services are already at “breaking point” due to EU immigration, it is not hard to imagine what life would become like for the long-suffering Britons, once the Balkan hordes have descend upon the green and beautiful land in 15 years´ time. Thanks so much for the timely warning!

So I though you might be interested to read the perspective of someone who has worked in all the Central and South East European countries that are now part of the EU (e.g. Poland, Slovakia, Romania, Bulgaria and Croatia), as well as the five current EU accession countries.

I know that the mere fact that I have worked in all those countries, including the European Commission as a client, will mean for some that I am disqualified from commenting on the issue of EU Enlargement. They will automatically dismiss me as someone who is “benefitting from EU funding” with the implication that I must be totally biased and am somehow being paid to write something in favour of the EU. I notice this particular argument frequently emanating from the Brexit camp whenever someone has the temerity to call the case for Brexit into question. I can only say that if first hand experience of EU accession is not relevant to a debate about EU accession, then that is a bit of a Catch22, right? Perhaps it is those that know absolutely nothing about the countries or the process of enlargement that are best placed to comment (like some ministers I could mention)?

A little respect goes along way

The first point is that those countries are far from perfect. There are criminals, there is corruption, there is fraud, there is terrorism and there is much else besides such as imperfect democracies and questionable treatment of human rights in the EU accession countries. All true but if that were not the case, they would probably already be part of the EU. It could be argued that a similar litany of woes applies to Britain, Greece, Poland, Hungary… indeed all 28 EU countries; it is merely a matter of degree.

The whole point of trying to join the EU is to develop rules, regulations, policies, standards, norms, etc. through adoption of the EU´s body of rules (called the acquis communautaire) that will enable those countries to become more democratic, transparent, productive, competitive and wealthy and thus developer a higher quality of life. Yes, this does indeed happen by preparing to join and then being part of the EU: it happened in Ireland, it happened in Greece (their implosion was due to joining the EU, which is why the Greeks have absolutely no desire to leave the EU) and it happened in Britain for those that remember the country prior to joining in 1973. For the citizens of the EU accession countries, the EU remains a bright beacon of hope. As a consequence they are willingly going through a painful and drawn-out process of reform and change across all elements of laws, institutions and practices, so as to approximate the EU framework.

To then be singled out for misused in a British debate which tars them with the brush of all current British public fears, is an affront for people and countries that also have their national pride. Shame on you Brexiteers, for your smug, holier than thou attitude, as well as your lack of respect towards the people of those nations. 

Not only is it offensive to project a future EU enlargement far into the future and couple it with “crime, corruption and terrorism on British streets”, it is also a wilful and malign mischaracterisation of the nature of the people concerned. I have worked with and enjoyed the company and hospitality of Turks, Serbs, Macedonians, Albanians and Montenegrins (as well as Kosovars, Bosnians and others who aspire to join the EU). I feel privileged to consider many of them to be my colleagues and friends. My experiences have never been anything short of positive in those countries. (As an aside, it so happens that I am writing this post in Tirana; the UK Ministers in question will no doubt be relieved to find out that I have yet to be kidnapped, robbed or terrorised.) In contrast to the calculating Brexiteer portrayal of these people, I am reminded time and again of their warmth, friendliness and positivity in the face of their everyday challenges as they make the slow, painful transition towards alignment to the norms of the EU.

They are as European as the rest of the EU. They have the right to aspire to become part of the EU, as long they fulfil the extremely rigorous conditions connected with EU accession. That applies equally to Turkey, a small part of which is undeniably a geographical part of the Balkans and thus Europe. The EU is not forcing any country to join: those countries wish to be part of the EU and it would be wrong to deny them the opportunity, just as Charles de Gaulle was wrong in vetoing the UK´s efforts to join the EU, twice. The Balkans is undeniably the next, obvious phase of EU enlargement, even if the Turkey question remains highly politically charged.

Every European should be aware of the fractured history of the Balkans. It is totally indefensible for one Brexiteer after the other to chuck them all into one big basked and then proceed to attach to them the most negative stereotypes imaginable. As if the EU does not suffer from some of the same problems. There has always been more than enough crime, fraud and terrorism in the original EEC/EU6 and there still is in the enlarged EU28, as far a I can tell.

I doubt that the Brexiteers have been to the countries that they so disdainfully dismiss. For Europe to turn its back its Balkan neighbours (including Turkey) would be a mistake of epic proportions (let us not forget Europe twiddling its thumbs during the collapse of the ex-Yugoslav Republic and its aftermath) that would reverberate through decades to come. The EU understands this intrinsically, hence the process of Balkan enlargement. Ms May, Mr Gove, Mr Duncan Smith and Mr Johnson: your cheap political points are calculated to instil a dreaded fear of those countries, those people and the process of EU enlargement. In my eyes, all of you have forfeited your status of being serious, thoughtful and responsible politicians.

Playing a different tune, again

It is important to stress that Britain is now playing a very different tune in terms of its position on EU accession. For decades the UK was one of staunchest advocates of EU enlargement. In 2004, it allowed all new EU countries (Poland, Slovakia, etc.) to have access to the UK´s labour market a full seven years before it was required by EU transition provisions to do so. This is because the British economy was booming at the time. Many EU citizens responded to the UK´s invitation and came to the UK, thus maintaining the growth of the British economy. However, when the global economy faltered badly during 2007/8, the very same people which Britain had encouraged to come, who had paid their taxes and who had contributed to our wealth generation, were suddenly persona non grata.

First there was Labour´s “British Jobs for British Workers”, then UKIP´s swift rise shuffled the cards of British politics, leading directly to the decision to hold the EU referendum. The longer this debate has gone on, the more it has become divisive, resulting in a no holds barred onslaught on EU immigrants, emboldened by the Brexiteers insistence on overcoming the deadening hand of political correctness and determination to call a spade a spade. But the simple fact is that the persistent characterisation of EU immigrants coming to the UK for benefit tourism, for social housing, for health tourism and all the rest of the claims about public services such as shortages of school places (all distorted – follow the links) amounts to scapegoating people who are hard-working, contributing to the wealth creation of the country and perfectly within their rights as EU citizens. Blaming all of Britain´s long standing public service woes upon the EU and EU citizens, apart from being untrue, lacks class, is unfair and does not reflect the values that Britain and Britons have historically stood for.

British public services have been run down by decades´ worth of neglect, underfunding and lack of political will, which is the reason why housing, education, health, transport, etc. are in the state that they are. It has something to do with the recent levels net immigration, granted, but it is primarily to do with consistent and systemic public policy failures and insufficient funding, over a period of several decades. It is politicians such as Mr Gove, Mr Duncan Smith and others in Government who were responsible for those public services. The current situation reflects long-term political neglect combined with an unprecedented degree of austerity which is squeezing British citizens beyond the point where the pips squeak. The losers in this process are first and foremost the non-working population, followed by those on low incomes, followed by the middle-income population. All are feeling the pinch, but it is the EU and the EU citizens are feeling the fall-out.

It is hypocritical to invite EU immigrants with open arms (certainly during early to mid-2000) when all boats were rising, and then promptly turn our back on the same people, once the recession came along and life becomes harder for most. This is not for the first time. Think back to when the Afro-Caribbean population was similarly invited to keep the British economy ticking over and then made to feel somewhat less welcome in the 1970s and 1980s, when the economic tide turned (as it invariably does). History is repeating itself, though it is no longer a racial matter. Indeed, because they are being squeezed hard by the economic situation combined with the effects of austerity, some of the harshest critics are some of the non-EU immigrants: irony of ironies. But the fact is that by being part of the EU, the EU immigrants who are being derided by the Brexiteers have full and equal rights to be in this country. The very same rights as the very large number of Britons living throughout the other 27 EU countries have. The issue is how to deal with the public policy issues, none of which are new, not to scapegoat some people while blithely continuing to sit on our hands, rather than responding to changing patterns of demand and supply in public services, including housing.

Get your facts right

Coming back to the main point, Ms May, Mr Duncan Smith and Mr Gove and others have also got their facts wrong about EU accession.

The five candidate countries comprise an overall population of 88 million, of which Turkey makes up 75 million. Four out of the five are a mere drop in the ocean in the scale of things. If they were to join the EU, they would add 12 million or 2.3% to the population of the EU (currently 508 million). How adding four countries would turn 28 into a “throng” is up to Mr Gove to explain. The greatest concern would undoubtedly be the possibility of adding Turkey, set to become the most populous country in Europe (but see below), potentially adding 7% to the overall population of the EU at some point in the future.  But the issue of Turkey has little to do with population and a lot to do with religion. It is not by accident that Turkey has been has been an Associate Member of the EEC/EU since 1963 – it has been waiting in the EU´s antechamber for 53 years! How the Brexiteers can suggest that Turkey will suddenly become a full member of the EU by 2020 stretches credulity. But the Brexiteers´position undoubtedly has little to do with “Project Fear” or hounding Britons into voting for Brexit by suggesting that the Balkan horde cometh. 

The EU has learned from the accession process in 2004 and especially 2007, when Bulgaria and Romania joined. The progress (or lack of it) being made by all five existing Candidate Countries is regularly assessed and widely available for all to see in the EC website. A reading of the annual progress reports makes it clear that negotiations have only started with Montenegro, Serbia and Turkey, but not with Albania and Macedonia. It is clear that none of them is making particularly rapid progress and accession will take years, possibly decades, for them to be assessed as having made sufficient progress for the European Commission to recommend that they be accepted as new members of the EU.

The suggestion that they will all join the EU any time soon, such as 2020, is far-fetched, with the possible exception of Montenegro, a country of 600,000 inhabitants. Turkey´s ongoing struggles with the basics (democracy, human rights, media freedom, etc.) mean that it has an extremely long path ahead before it reaches the point of accession readiness: 2020 is completely out of the question at the current rate of progress. The suggestion that all of them, including two that have not even stated officially negotiating accession, could join the EU by 2020 is simply pie in the Brexit sky.

28 accession vetoes

The Brexiteers are ruthlessly stoking-up and exploiting people´s fears by projecting an unrealistic scenario 15 years from now. This calculated fearmongering is as manipulative as it is irresponsible for several reasons:

  1. None of the countries is making sufficient progress to be ready for accession by 2020;
  2. The European Commission has learned from previous rounds of accession and is monitoring progress much more careful than in previous rounds of EU accession;
  3. Two of the countries have not even started official negotiations;
  4. Each of the 28 EU member countries has a veto on EU enlargement (despite what Brexiteers, such as Ms Penny Mordaunt may wrongly claim);
  5. There has been a sea-change in public mood towards further enlargement, especially after Bulgaria and Romania, though Croatia´s accession is barely mentioned;
  6. Some EU counties have pledged to hold a referendum on enlargement connected with Turkey, thus adding a huge degree of further uncertainty about its future accession.

The Brexiteers´arguments are plain wrong and they are fully aware of this. The same goes for their diagnosis of the role of EU immigration in relation to the breakdown of British public services. The same applies to the claim that the EU costs Britain GBP 350 million per week. And yet the Brexiteers keep pushing the misleading buttons. They have run out of valid economic arguments and the only Joker left in the pack is the current and future EU immigration card.

7 year transition provision

The Brexiteers are wrong in their estimated scenarios of possible future immigration from the five EU accession countries. Because in addition to the arduous process of accession connected with the acquis communautaire, there is the small matter of getting 28 unanimous “yes” votes to accession, followed by the referendums that any of the 28 nations may choose to hold. These multiple barriers undermine the scaremongering.

Even if the EU accession countries, especially Turkey, get through all those hurdles, there is also the EU´s 7 year transition provision, which means that each new country that joins the EU, must wait up to 7 years before its population acquires the right to live and work in the rest of the EU countries.

Even in the extremely unlikely scenario that all five countries join the EU by 2020, it would be 2028 before any of them would have the right move, live and work in the UK, unless Britain chooses unilaterally to suspend the 7 year rule, as it did in 2004 but not in 2007. For 5,2 million additional EU immigrants to move wholesale from these five countries to the Britain is yet another stretch of the Brexiteers´ febrile imagination as the 23 of June 2016 approaches.

When it comes to EU enlargement, there are lies, damn lies and Brexit.

© Ricardo Pinto, 2016, AngloDeutsch™ Blog, www.AngloDeutsch.EU


EU health tourism and the breakdown of the National Health Service (NHS)

In addition to other issues connected with the EU referendum (e.g. EU immigration, EU benefits tourism and housing crisis and the EU), Britain is currently hotly debating the crisis in the health system or the National Health Service (NHS). It is not unusual for segments of the British media to lead with headlines such as “Migrants are pushing NHS to breaking point,” claiming that the NHS has been left “on its knees” by “uncontrolled migration” from the EU which has merged with the theme of “health tourism” or the practice of travelling abroad in order to receive medical treatment.

Prominent members of the Leave EU campaign, such as Michael Howard and others in the Vote Leave campaign have said: “We will be talking a lot about the NHS in this campaign because we believe that a leave vote is vital if we are to protect the NHS for future generations.” Priti Patel, the Employment Minister, claims that the health service is under threat because of EU membership: “Current levels of migration are causing unsustainable pressures on our public services and we can see that the NHS is creaking under the strain.”

The implication is that EU migration / benefit tourism is at the root of the problems of the NHS. So this post addresses the nature of the UK health crisis and the extent to which it is attributable to the EU migration and health tourism.

Challenges every which way you look

The National Health Service (NHS) is the largest and oldest single-payer healthcare system in the world. It is primarily funded through the general taxation system that is overseen by the Department of Health. The NHS is built upon the principle of comprehensive health service provision based on clinical need, not ability to pay. The NHS provides healthcare to every legal resident of the UK, with most services free at the point of use.

When created after WW-II, the NHS was the pride and joy of the pioneering British welfare state and served as a model for many other countries. But the fact is that the NHS has been in crisis for decades going back to at least the 1980s. As Britons are well aware, wave upon wave of health reforms have sought to cure its ills yet the NHS remains as sick as ever. The starting point in the health debate is to acknowledge that the problems with the health system predate the influx of EU migrants to the UK which started in earnest in earnest 2004 and continues to this day. The NHS’ problems did not begin with EU immigrant and will not end if migration were suddenly to end, regardless of whether migrants originate from the EU (less than half of UK immigration) or elsewhere (Britons returning home, Commonwealth, students, etc. – more than half of the immigration).

The second point is to recognise that the challenges facing the NHS are many and varied, not least connected with an ageing population and the impact of modern diseases such as diabetes, obesity, cancer, etc., combined with escalating costs of procedures, medication and so on.

The health professionals are in the best position to assess the issues and whether those issues are connected with migration or not. In a recent publication “Challenges facing the NHS in England: a guide for MPs and Peers”, the NHS Confederation (representing over 500 NHS organisations that commission and provide health services, including hospitals, community and mental health providers, ambulance trusts and independent sector organisations providing NHS care) set out the main health challenges facing the health system. These are illustrated in the diagram below.

Chart 1 NHS Challenges

Neither immigration in general nor EU immigration specifically figures as a health challenge. There is no reference to NHS creaking / breaking / lack of sustainability due to migratory pressures. This is hardly surprising since all the evidence is that EU immigrants tending to be younger, better educated and in better health than the average Briton in the labour force. We tend to consume disproportionate amounts of health services as babies/children and as pensioners, especially after the age of 75. Young adults – the typical EU migrants – put relatively few pressures on the health system.

Rather, the Call for Action focuses on areas about which there is little controversy among the 500 health professionals in the NHS Confederation. They stress the need for stability if the NHS is to tackle its challenges (endless reforms); the need to increase staff (too few); the necessity for social care funding for people with long-term illnesses; the need to make mental health services available and accessible, etc. The most critical issue by far is the finance challenge; this is the underlying reason for the continuing problems faced by the NHS. The point to note is that the UK is exclusively responsible for the resources that it devotes (or not) to the NHS. No amount of finger-pointing in the general direction of the EU will alter this particular fact.

Furthermore, the NHS funding challenge is nothing new: it predates and supersedes other factors such as EU migration. This is the fundamental reason why the NHS has been gradually overtaken by other countries, as illustrated in comparative research among OECD countries highlighted in the Table below.

Chart 2 OECD health indicators 2015

Health Care Resources in OECD Countries (OECD, 2015)

The UK’s performance compared with OECD countries highlights the NHS’ fall from grace. The UK ranks:

  • 19th in terms of health expenditure per capita;
  • 24th in terms of doctors per capita;
  • 19th in terms of nurses per capita;
  • 26th in terms of hospital beds per capita;
  • 29th in terms of Magnetic Resonance Imaging (MRI) units per capita;
  • 30th in terms of Computer Tomography (CT) scanners per capita.

Some countries, such as Germany, have even higher levels of EU immigration than the UK yet it comfortably outperform the UK in terms of the selected health indicators. Money, or rather the lack of it, is clearly an important reason for why the NHS is in the state that it is.

The UK’s austerity measures, which have been in place since 2009, included severe budget constraints with zero growth in health spending per person in real terms. On a per capita basis and as a share of GDP, health spending in the UK is slightly below the OECD average. Lack of financial capacity is clearly not the issue. Rather the UK government chooses to prioritize other public expenditure, such as defence, over the heath system. Furthermore, the situation is set to deteriorate: the NHS Confederation estimates that the gap between increasing demand for care and the funding available will be at least £30 billion by 2020. The key point is that other economies choose to put more resources into their health systems than Britain. The state of the NHS, by and large, reflects this particular policy prioritisation. Transferring the entire net budget that Britain spent in 2015 on the EU into the NHS, namely £8.5 billion (2014) would not make that much of a difference in the projected NHS deficit of £30 billion in 2020 for England alone. The Vote Leave campaign misleads in suggesting that cancelling one (EU contribution) will solve the problem of the other (NHS crisis).

EU health tourism: where’s the beef?

Health provision is clearly a national issue – the EU has no direct powers in this area except to support the common market. The Government’s audit of EU powers (the so-called balance of competence review) also covered health area and its official report concluded that: “…the UK Government believes that the current balance of competence is broadly appropriate.” It also noted that: “Industry were generally very supportive of the current position regarding competence.” It concluded that: “Evidence suggested that free movement of persons brings benefits for the UK health sector and for patients, but not without risk.”

There are “risks” perceived in some quarters, such as the EU’s Working Time Directive (WTD), which limits work to a maximum 48-hour week and lays down minimum requirements for rest periods and annual leave. But can critics really sustain the argument that the health profession should work longer hours than other professions? Most people would not agree. When it comes to a critical matter of life and death, most people would want a doctor / nurse / surgeon who is neither exhausted nor overworked (we all recall UK health workers, especially junior doctors, having to work absurd and dangerous numbers of hours in the past) when attending to their health needs. The WTD applies to all 28 countries and all professions; I see no reason for making an exception for the UK or for the NHS, though this does not preclude the possibility of fine-tuning the WTD.

There is also freedom of movement of doctors and nurses from across the EU working in the health system in the UK. This is actually a very good thing for the NHS, as acknowledged by the government’s official report: “In terms of health professionals, there has been a very positive impact for the NHS as 10% of NHS staff are from European Economic Area (EEA) countries, without whom there could be staff shortages.” For example, the Royal College of Midwives, has stressed that Britain would be hard-pressed to find enough midwives and nurses trained in the UK to replace the 33,000 from other EU countries who currently work in the NHS.

It is not only an issue of the damage that staff shortages might cause in such a sensitive area as the heath sector. The issue which those interested in improving the health system should be focusing on is exactly why Britain continues to be completely incapable of training a sufficient number of its own health professionals. I recall nurses and midwives being sourced from Ireland before the EU and the rest of the world became the NHS’s recruitment pool for health workers. No open-minded individual can fail to see Britain’s gain in this form of EU migration. If anything, other nations might well criticise the NHS’s beggar-thy-neighbour recruitment strategy (i.e. a policy by which one country attempts to remedy its economic problems by means that tend to worsen the economic problems of other countries) which basically mops-up experienced doctors, nurses, midwives, surgeons, etc. which other countries have paid to educate and train.

There is also the Cross Border Healthcare Directive which allows individuals to purchase health care and treatment from a provider in another Member State. This is supported by the health industry in the UK since it offers them the prospect of widening the sources of income by attracting EU patients and using excess capacity in the health system, for example in specialist areas such as diagnosis and treatment of rare diseases. Furthermore, under the current NHS arrangements, patients in one location of the UK are not free to seek treatment in another part where waiting times/lists may be shorter. However, the Cross Border Healthcare Directive enables them to seek treatment in other EU countries if they wish. This is a good thing: it allows patients to control their own health needs. Something that puts power in people’s hands over vast bureaucracies, for that is exactly what the NHS is, must be a good thing.

EU-related health costs: Britain only recovers 23% of what it could claim back

There is limited reliable data on the use of health services by immigrants and visitors, making robust estimates difficult. That said, the available evidence suggests that use of health services by immigrants and visitors appears to be lower than that of native Britons, as previously discussed, not least because immigrants and visitors are, on average, younger.

In 2014 an official report (Quantitative Assessment of Visitor and Migrant Use of the NHS in England), showed that EU (27 countries) and EEA (3 other countries) visitors and non-permanent residents cost the NHS an estimated £305 million, of which £220m is recoverable by England under the European Health Insurance Card (EHIC) scheme. Every EEA country issues EHIC cards to their citizens, thus enabling them to receive healthcare whilst on a temporary visit to another EEA country on the same basis that is provided to its own residents. People go on holiday in the EU/EEA knowing that if they fall ill or have an accident they will be able to access health care without the need for separate insurance. This saves time, effort and money for all and is widely considered a good thing.

Department of Health data for 2012-13 show that only about £50m was recovered from the EEA countries compared with the £173m that the England pays for British visitors to EEA countries. This means that the NHS / Department of Health are not claiming as much of the money that they are eligible to receive from the EEA countries as they could.

Some forget that this is not a one way street; it is not only EU nationals that come to the UK and use health service here. Britons also make a good deal of use of the health services in other EEA countries and the costs more or less balance out: £220m worth of health services received by EEA people in England, compared with £173m worth of services received by people from England in EEA countries.

The low percentage of recovery (22.7%) is due to one reason and oner reason only: NHS inefficiency, which is an issue for the UK to rectify. Why should Britain need over a decade to set-up a working reciprocal health cost management system when the other 27 nations have long ago managed to do so? It has been argued that there is a lack of knowledge among NHS healthcare professionals as to who is eligible for free treatment. Can this really be so fiendishly complicated as to systematically defeat the British health care system with its new generation of sharp suited, MBA educated management? Surely it is not like expecting the NHS to crack the health equivalent of the Enigma Code.

Rather than voting to Leave the EU for a problem that can only be pinned on Britain itself, it might be more effective to set-up a system to check if an individual is from the EEA and train healthcare professionals to recoup the costs of EU patients, as Britain is fully entitled (but fails systematically) to do.

EU-related health costs: instead of 0.18% of the NHS budget in England, it costs 0.26%

Interestingly but not surprisingly the actual health costs of EEA migrants are very low, despite all the emotive talk of “EU migrants / freedom of movement pushing NHS to breaking point” and “NHS is creaking under the strain of immigrants” emanating from the Vote Leave EU group such as Priti Patel and others. The annual NHS budget in England was worth £116 billion in 2015/6, so EEA migrants used-up 0.26% of the annual NHS budget (£305 million). When the costs that could have been recovered from EEA countries are taken into consideration (on the assumption that the NHS ever gets its act together), the percentage would drop to 0.18% (£220 million). There would appear to be vastly bigger fish to fry when it comes to saving costs in the British health system.

When this analysis is extended from England to the UK, the same health competences report noted that in 2012/13 the UK paid a net £805 million to EEA countries to cover the healthcare costs of Britons, especially pensioners, living in other countries. This sum illustrates just how many UK citizens benefit from the EU health provisions.

The health competences report also stressed that: “… many more UK pensioners choose to live in other EEA countries than pensioners from those EEA countries who live here. Using Spain as an example, approximately 400,000 British pensioners reside there at any one time. For a great majority of these, the fact that the UK covers their healthcare is of great benefit. It should also be noted that, had those citizens remained in this country, the UK would be meeting the costs of their NHS care in the usual way and in some Member States the average cost of healthcare can be lower.”

In other words not only do more British pensioners benefit from the system than EU pensioners gain from using the NHS but it would cost the NHS more to provide health care to those 400,000 Britons currently living in Spain (and potentially many others, since there were about 1.4 million Britons living in the EU) if they came back. The Vote Leave EU campaign would find it hard to swallow the point that EU health provisions may actually be saving British taxpayers money (and/or that the savings are being recycled for the benefit of the health of the people in Britain).

It should be noted that the NHS (Charges to Overseas Visitors) Regulations Act of 2015 requires hospitals to charge overseas visitors (not ordinarily resident) for the NHS services that they provide in a hospital or provided outside by staff employed by a hospital. GP services and services provided outside hospitals are not chargeable. So it would appear that Britain is well on the way to meeting the public concerns about the costs of health for visitors, whether from the EU or elsewhere.

EU health tourism: much ado about very little

The UK’s competences review concluded that, on balance, the EU’s engagement in the health sphere is appropriate and noted the major advantages of EU health directives, including the IHIC card, the number of EU educated nurses and doctors working in the UK and the capacity to access European level health services. There are real benefits for health institutions and citizens across EU countries.

In terms of the major health challenges facing the UK in the future, the 500 NHS Consortium health institutions did not identify immigrants as an issue: money or rather the lack of it is the key issue in Britain. The evidence is that EU/EEA citizens use the NHS intensively less than native Britons. In any case, Britons make extensive of health services in EEA countries, especially those that retire in Spain, France and elsewhere.

The EU introduced health transfer arrangements to ensure that each EEA nation pays according to the health services absorbed by their nationals. This is fair but it is up to each country to introduce the necessary systems and procedures. After a decade, the NHS is still unable of charge its share, which means that instead of EU nationals costing the NHS 0.18% of its annual budget, it actually costs 0.26% in England.

Boris Johnson, Michael Gove and other Vote Leave campaigners may insist that the “billions spent on the UK’s EU budget contribution to be spent on the NHS.” That is fair enough but let us not pretend that this will solve the problems in the health system at a stroke. Even if the GBP 8.5 billion net EU contribution were poured in its entirety into the NHS tomorrow, nothing would change fundamentally because the financial need is much greater than this contribution. Can it realistically be argued that EU migration / health tourism is pushing the NHS to breaking point, especially when large numbers of Britons and British pensioners living in the EU are actually reducing the costs to the NHS since the costs of health provision in Spain and elsewhere are lower than they would have been in the UK?

I don’t think this is such a bad health deal for Britain and is not a sufficient reason for voting to leave the EU in the forthcoming referendum.

  • Is the EU responsible for the state of British health system: the EU ensures that all EU citizens have access to health services in all countries at no extra cost or hassle.
  • Is the British government responsible for the state of British heath system: the UK is 100% responsible for national health provision and the health budget. The UK chooses to invest a smaller amount on health than other countries and this is the root cause of the health problems. Pumping Britain’s entire EU annual contribution in the NHS will not change the fundamentals of the health system, though it would certainly be helpful.
  • Should I vote to leave the EU because of EU health tourism: EU nationals make less use of the NHS than do native Britons. Also, there are more retired Britons living in EU countries and making use of other EU health systems than there are EU nationals living in the UK. Both save the NHS money and/or allow resources to be focused on health services in Britain.

© Ricardo Pinto, 2016, AngloDeutsch™ Blog, www.AngloDeutsch.EU