The EU Leave campaign has no right to claim the NHS logo

SSONHS isn't taking a stance on whether the UK should or shouldn't remain in the EU. However we decided to circulate a comment to our email list on the unjustified use of the NHS logo on Leave publicity material including bus advertising. We thought that NHS England had not challenged this but a reply told us that apparently government lawyers did request them to stop in March but the Leave campaign refused accusing the government of 'bully-boy tactics' and no further action was taken. It says a lot about the debasement of the logo through its regular licensing to private firms that NHS England went no further than a threat and that the Leave campaign was so shameless.

Whatever side you are on in the referendum debate the NHS should not in itself be a crunch issue although broader health considerations may be. The NHS is not directly relevant to the basic arguments for or against EU membership especially as the debate becomes increasingly polarised between those who consider they have a lot to lose and those voters who feel they have very little left to lose.

The basic trope of the Leave campaign in relation to the NHS is that more money will be available for the NHS if we leave and that pressure on services will be reduced because there will be less immigration. Two Tories have commented on the finance issue: Dr Sarah Wollaston the GP who was part of the Leave campaign, has changed sides because she could not justify the claim that £350billion is paid to the EU, let alone that a significant part of this would be available for the NHS. Also speaking about the NHS last week, John Major, ex Tory PM, told Andrew Marr on the BBC that "Michael Gove wanted to privatise it, Boris wanted to charge people for using it and Iain Duncan Smith wanted a social insurance system. The NHS is about as safe with them as a pet hamster would be with a hungry python". As for immigration, yes there are pressures on the NHS just as there are pressures on the Spanish health service because of elderly Brit expatriates. These might change slightly if Brexit secured some change in migration rules but would not necessarily be hugely different especially if we remained in the single market. The threat to the many non UK nationals working in the NHS would be significantly undermining and an extension to the threats faced by non-UK NHS staff earning under £18000 under the current Tory system. We have also been told about the importance of EU membership for collaboration on medical and public health research.

The Remain campaign claim that the Brexit would lead to economic difficulties and confusion for the economy as a whole and this, as Simon Stevens (head of NHS England) has warned, could seriously affect the NHS both short and long term. The NHS is highly vulnerable right now and the head of NHS Improvement has already said that the NHS will be unable to meet its national undertaking to break even this financial year. However the dire general warnings being uttered by lead Remain campaigners and European leaders seem much too catastrophic. Faced with Brexit more bilateral or alternative agreements could and would be drawn up to cover such issues as EHIC although some of the arrangements for elective treatment in EU countries currently available for NHS patients are likely to become unavailable and this would create more demand on UK services. Nevertheless Brexit supporters who are concerned for the NHS have to weigh up whether the longish period of serious economic and political uncertainty which will follow any vote, together with the consequent high level of threat to public sector spending and an NHS which is already over-stretched, is worth the risk against whatever they think will be gained. It is quite possible that the administrative strain of leaving the EU could be at least as stressful for the NHS as Lansley's Act.

Broader health issues and the consequent effects on the NHS are also relevant. We already have austerity and further economic uncertainty will, in the short term at any rate, affect jobs and the national income. Some of the issues are listed in a BMJ article but the links are behind a pay wall. Some medical opinion is summarised by The Independent here. Most medical opinion is in the Remain camp. The EU has taken significant public health initiatives although these are constrained by the lumbering nature of the way in which decisions are taken. Would the sort of UK government or regime which might follow a Brexit vote be likely to give equal support to public health issues, environmental considerations or even human rights given that a prime argument for leaving is deregulation?

Against this it is perfectly possible to argue that taking back responsibility for decision making into UK hands would mean that credit or blame for outcomes, for instance on the NHS, could be squarely put where it belongs instead of using the EU as scapegoat or smokescreen. Some financiers fear that Brexit could give space for 'madcap left ideas' if EU restrictions on state aid to industries are withdrawn (although other EU countries seem to have found ways to provide state support where necessary/desired). One positive outcome of the referendum arguments is the present government's agreement to formally exclude the NHS from TTIP - though the real worth of this assurance is still be tested. Brexit may of course eventually exempt the UK from EU competition laws (though these might still apply, at least partially, in a single market) but what would be the likelihood of a UK government taking an even more pro-competition stance? Business leaders who favour Brexit are overwhelmingly taking a neoliberal free market line.

If this piece is read as being pro-Remain, it is largely because of the misleading claims about the NHS being made by the Leave campaign and the distrust this generates. Campaigners report doorstep opinion that the Brexit campaign is more pro NHS which, as the quotes above suggest, is absolutely untrue.

If we remain in the EU, we know what the general climate is. If we leave then we will have to fight even harder to try and retain the public services we value. For some this may in the long term be a more attractive scenario because it can be argued to favour self-organisation. For others it can only create serious alarm.