• " On 21 March 2016, the Telegraph published the views of UKIP’s health affairs spokesperson, Louise Bours MEP, under the headline ‘Britain’s NHS can’t survive staying in the EU’. Her argument is that the EU referendum gives us a choice between the NHS or the EU, ‘because we can’t have both’. At a cross-party conference in February 2016, on ‘The Good Life after Brexit’, UKIP member and cancer specialist Professor Angus Dalgleish suggested that the NHS is currently in danger of complete collapse, because of the volume of patients coming from the EU to the UK for medical treatment.

      These and other similar comments have sparked a lively debate about the interplay between Brexit and the future of the NHS, but as we examine the various aspects of the debate we see a great deal of uncertainty surrounding the possible impact of Brexit on healthcare in the UK.

      First, let’s examine Dalgleish’s main point, also mentioned by Bours: the issue of health tourism. Under EU law, some people from EU countries are legally entitled to be cared for by the NHS, but the majority of these patients already live and work in the UK. This means that they pay the same taxes as UK citizens – taxes which pay for the NHS. If the UK leaves the EU, their position in the UK would depend on the negotiations between the UK and the other countries in the EU. Some of those people might then choose to leave because of the uncertainty of their employment position, and so would cease to be a burden on the NHS. But they would also cease to contribute to the UK economy, and to the NHS. And, in fact, since they use the NHS significantly less than UK citizens (as shown by a Nuffield Trust study), the net effect would be that the NHS would be worse off.

      It’s impossible to get accurate figures on movement of patients around the EU. ‘Medical tourists’ have always come to the UK for specialist health care – our doctors are among the best in the world. Many are seeking fertility treatment, cosmetic and bariatric (or weight-loss) surgery. EU rules mean that some people from the EU have a right to access NHS treatment – and have it paid for by their home country. But as parts of the NHS now increasingly subsidise public functions by also serving private patients (under the Health and Social Care Act 2012), are these European patients putting the NHS in jeopardy?

      Research from the London School of Hygiene and Tropical Medicine and York University found that, on the contrary, the UK is a net exporter of patients. What’s more, figures from 18 hospitals showed that 25% of their private income came from medical tourists, but they were only 7% of patients. In other words, the NHS is making a disproportionate profit from medical tourism.

      And while they are here, let’s remember that medical tourists spend as ordinary tourists: on accommodation, food, taxis and so on. This brings in about £219 million additional tourism spending a year, according to the LSHTM/York research. Would this stop if we left the EU? Probably not. Most of it is paid for privately. Even when it is covered by national health insurance systems, our hospitals would probably be able to contract with national insurance funds in other EU countries under WTO rules. But the EU rules smooth the way. "

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