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The BMJ backs Remain in the EU referendum

Today, The BMJ has decided to come out and state that the UK should remain in the European Union.

“Some readers may wonder why The BMJ is intervening in a political debate,” say the editors. “We think this issue transcends politics and has such huge ramifications for health and society that it is important to state our case.”

Over the past five weeks, the journal has published a series of balanced articles looking at the main arguments for leaving or remaining in the EU in terms of their effects on health and the NHS.

But as the series has progressed, the editors say “it has become increasingly obvious that the arguments for remaining in the EU are overwhelming, and that now is not the time for balance.”

In fact, they say, “we realised that we could not name one prominent national medical, research, or health organisation that has sided with ‘Brexit’.”

They argue that the Leave Campaign’s arguments on the NHS are simply wrong. For example, their constant claim that the UK sends £350m to the EU every week has been blown out of the water by a host of financial and economic experts.

The Leave Campaign also claims that if the UK remains in the EU, the NHS will be swamped by immigrants, desperate to make use of our free health service. Yet a recent review of the impact of immigration on the UK found that, because EU migrants tend to be young they make less use of health services, and that some may even return home for healthcare where they can get quicker access to specialists.

So, what damage would be done to the NHS if we left the EU, they ask?

Last week, the Economist Intelligence Unit calculated that, because of the impact of Brexit on the wider economy, healthcare spending per head would be around £135 lower by 2020 than it would be if the UK stayed in the EU. “At a time when the NHS is already overstretched we cannot risk putting it under further financial strain,” they warn.

They add that leaving the EU “would jeopardise the free movement of people on which our health service relies.”

They also point out that London is home to the European Medicines Agency which would have to move if the Brexiteers win on 23 June. “While we may still get access to research funding if we quit the EU, we would no longer have influence in shaping the research agenda.”

Europe is not perfect and it needs reform, they conclude. “But both Europe, and Britain within it, are better off and safer if we vote to remain.”

In a linked article, Sarah Wollaston, MP and chair of the Parliamentary Health Select Committee, explains the health concerns that led her to change her mind on Britain leaving the EU.

“We need to continue to make the case for democratic reform, but I am convinced that the case for the NHS, public health, and research is overwhelmingly in favour of us remaining in the EU,” she writes.

She points to a “bad tempered and poorly informed” campaign and “an ugly xenophobia” that has swept in to whip up fears that EU immigration could lead to the collapse of NHS services.

Her answer to the rising tide of hostile questions on the impact of migration on the NHS is that these valued health and care workers “are far more likely to be caring for you than ahead of you in the queue.”

The simple truth is that the greatest contribution to rising demand in the NHS is not from those who come to live and work in Britain from abroad but from the challenge of managing complex long term conditions, she explains. “A collapse in the free movement of NHS and care staff would have serious consequences for those patients and the services on which they depend.”

She acknowledges that we need to spend more on health and social care, but points out that increased spending can only come from a strengthening economy.

And she points to the “near universal consensus” that Brexit would be damaging for research and international cooperation, arguing that whilst scientists would no doubt do everything possible to maintain links, “our influence would be severely diminished from the outside.”

Articles: Why doctors should vote to remain in the EU on 23 June, BMJ editors, The BMJ, doi: 10.1136/bmj.i3302, published 14 June 2016.

Brexit should come with a health warning for the NHS, public health, and research, Sarah Wollaston member of parliament for Totnes, The BMJ, doi: 10.1136/bmj.i3295, published 14 June 2016.