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Navigating Brexit: Chair of Council's speech

Good morning,

I am Chaand Nagpaul, Chair of the British Medical Association which represents over 150,000 doctors across the UK. I’d like to warmly welcome all of you to BMA House and to today’s event on an issue which represents the most serious challenge to face our health service to date this century. 

We have delegates who work in the NHS, other trade unions and leading thinktanks, as well as an array of expert speakers. 

As doctors, we have an ingrained duty of care and we adhere to the maxim of “do no harm”. This means we have a professional responsibility to raise concerns when we believe there will be detriment to patient care. For this reason, we must as doctors speak out when necessary and this is why the BMA and BMJ are today holding this event on behalf of the medical profession.

Because we believe that Brexit will be harmful to patients, to NHS staff and to the NHS as a whole. 

We’re not being alarmist nor are we seeking to comment on wider political arguments about leaving the EU – rather, we are speaking as doctors deeply fearful that Brexit will further prevent us from providing the care our patients need and deserve.


The NHS as it stands

Our starting position is already precarious. We are underfunded – the UK spends £20 to 30 billion less per year on its health service than leading EU nations such as France and Sweden. We are under-bedded – a third of what they have in France, a quarter of Germany. And we are under-doctored by tens of thousands– with one doctor for every 360 people, compared to an EU average of one per 288.

A recent major BMA survey of nearly 8,000 doctors found that 97 per cent said that the quality and safety of patient care is undermined by this lack of funding, and that 95 per cent are fearful of making mistakes largely because of a lack of staff and capacity.

Trolley waits have gone up seven-fold in seven years with 200,000 more patients waiting more than 4 hours than in 2011. And these waits were worse last summer than in five of the previous eight winters. Demonstrating that the NHS is now facing a year-round crisis.


Brexit affect on the health workforce

And the evidence shows that each of these pressures will be worse after Brexit. Only this week, an analysis by the Nuffield Trust has shown that Brexit could add £2.3 billion in increased costs to the NHS – further draining our health service of the basic resources required to provide safe care, and wiping out the proposed increased investment announced in the Prime Minister’s Long Term Plan.

On workforce, we know that doctors and nurses will leave the UK in order to work elsewhere, in an environment in which staff shortages have already pushed the NHS to the brink. If the potential for Brexit to exacerbate the challenges facing our NHS wasn’t already apparent, then hot off the press are the results of the BMA’s latest survey of EU doctors working in the UK, who make up almost 10 per cent of the NHS’s medical workforce.

This survey, which we have published today, leaves little room for doubt and serves as a further wake up call:

  • Over a third of EU doctors working in the UK told us that they are considering leaving the UK
  • Over a quarter of those individuals said they had gone so far so as to make plans to relocate

When asked what had prompted this decision, they cited not just Britain’s decision to leave the EU but a sense of uncertainty regarding the future and negative attitudes towards EU workers.

It’s clear that the government should be doing everything in their power to retain this crucial component of the NHS workforce. And yet, 78 per cent of the EU doctors polled told us that they are not reassured by the prime minister’s commitment that, in the event of a no deal Brexit, the rights of EU citizens in the UK will be protected.


Letter to the Prime Minister

That’s why I’ve today written to the prime minister on behalf of the medical profession to urge the government to publish a specific statement setting out – in no uncertain terms and without delay – the rights that these doctors will be entitled to in the event of a no-deal Brexit. And not only should these doctors continue to have the legal right to live their lives in the UK – they should be recognised as hard-working and valued members of their communities and be made to feel welcome in our country.

These individuals are vital to our hospitals, GP surgeries and medical institutions – providing first class care to patients on a daily basis or doing research and which saves lives. Many of them have dedicated years of service to the NHS and frankly deserve better.


Brexit and the NHS

Over the course of the morning, you’ll hear from experts from across the medical and research sector about what Brexit could mean for our nation, and what they’re doing to navigate the myriad of issues it presents. The exodus of doctors, nurses and midwives and plummeting recruitment. Less money for research, and less scope to collaborate internationally. A risk to critical supply chains of medicines.

It’s completely unacceptable that we find ourselves in a situation in which the Secretary of State for Health and Social Care is reported to have told Cabinet earlier this week that he cannot guarantee that patients won’t die as a result of medicine shortages in the event that Britain leaves the EU without having secured a deal.

I’d like to conclude by once again seeking to view this issue through the eyes of a doctor – a perspective from which it would be entirely unethical to operate on a patient without proper prior informed consent of the outcome, risks and benefits of treatment.

As a doctor, I would never prescribe treatment on the basis of false and misleading promises, and I don’t think I’m asking too much of our politicians in asking them to apply the same approach.


The EU referendum

The public were asked to vote to leave the EU without knowing the facts of what this would mean for them, and with the false belief that our NHS, which is already under severe strain, would benefit from an extra £350 million per week. There can be no doubt that this influenced many at the ballot box.

Being misled with false promises equates neither to democracy nor consent. We now have a better picture. And we should be able – at last - to give that consent or withhold it. A first opportunity to make an informed choice, not a second. A first, properly democratic, People’s Vote. That is why the BMA is supporting the proposed amendment to the Withdrawal agreement by a cross-party group of MPs to enable this choice to be provided to the British people. 


Final word

I’d like to thank one of those MPs – Paul Williams, an MP, GP and health select committee member – for joining us and giving the keynote speech today. Paul is the former CEO of the Hartlepool and Stockton Health GP Federation, and, since his election to parliament last year, he has rapidly emerged as a leading campaigner on the dangers that Brexit could pose to the NHS.

It’s up to us, as the people who know the NHS  best, to lead the conversation as to how it could best weather the storms ahead.
At today’s event we have the opportunity to speak with one voice to the government, to parliament and to the European Union.

To implore them, with clarity and conviction, to hold to that tried and tested counsel, “First do no harm”.

Thank you for being here.