The NHS has emerged as one of the lead issues in the debate over Britain’s membership of the European Union, ahead of the upcoming referendum on the 23rd of June. For most people, it sits well behind economics and immigration, but its prominence has been nevertheless striking.
In part this has been a case of the two sides trying to benefit from being seen as the true defenders of an institution that is well known to be close to the heart of British voters. The arguments on either side are by now familiar. As in the rest of the campaign, economics and migration have been at the centre of the debate. Remain has warned that the economic repercussions of lost trade following Brexit would be devastating for the NHS; Leave argues that the money that Britain saved if it no longer contributed as a member nation could help rescue the NHS from current financial crisis, and it highlights the dangers posed by the TTIP free-trade deal currently being negotiated between the European Union and the United States, which could see American health care providers competing to take over NHS services. On immigration, Leave argues that open borders place severe strain on NHS services; Remain questions whether immigration levels would fall and draws attention to the value of free movement of labour when it comes to staffing the service.
Most of us by now will have clear views on which side of the argument we find more convincing. In general, the representatives of the NHS and British medicine have come out firmly on the Remain side. But there’s also something that both sides have in common. The emphasis for both is on protecting the NHS as a great national institution. The idea that the NHS is evolving in some respects into part of a broader European health strategy and system of cooperation, and that there could be significant advantages in this, has had no real place in the debate. As elsewhere in the campaign, we have heard little about the positive case for being part of Europe.
However, a generation has now grown up knowing that through membership of the EU they can access health care, not just in the UK, but across much of Europe. Britons travelling to Europe or going there to work and live have been the beneficiaries of what might be described as a kind of European Health System. A symbol of belonging to this ‘EHS’ is the EHIC (the European Health Insurance Card). In fact, it’s perhaps the closest thing the British have to some kind of European identity card.
It was fascinating to hear a British expat in Spain recently talking of the benefits of receiving high quality care from the ‘Spanish NHS’. What was meant by such a term? Does it reflect a feeling that Spain, like Britain, provides an NHS (and that what we are so proud about is not so unique)? Or does it reflect a feeling that when Britons receive healthcare for free in the European Union they are doing so as some kind of extension of the right to free care provided by the NHS? Both possibilities would have significant implications for the meaning of the NHS and its relationship to the nation some forty years after joining the European Community.
For the historian of the experience and meaning of the NHS, one thing is clear: this history now needs a European dimension. The story of how people from other parts of the EU have experienced and contributed to the NHS has been a very significant aspect of the history of the NHS over recent decades (as has the way that Britons have benefited from and responded to this). Britons, too, now have far more experience of European healthcare systems, and this will have had implications for how they think about and experience the NHS. These histories are very far from being understood. We recognise the importance of such a European dimension for our People’s History, but we need your help. If you have any experiences, ideas or reflections, please use the Comment box below.