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Opinion: ‘Vote remain to make nursing stronger’


Speaking on behalf of the Britain Stronger In Europe campaign, leading nurse academic Professor Anne Marie Rafferty makes her case to Nursing Times readers to stay in the European Union.

Health is one of the key issues in the EU referendum debate and rightly so because the EU exerts a major influence on health and employment rights within the UK. The results are likely to have a big impact on nurses across the country.

The central question is whether or not our NHS would be in a better shape in or out of the EU? A strong NHS needs a strong economy – and it’s clear our economy is stronger in the EU.

Experts ranging from the governor of the Bank of England, Mark Carney, to Christine Lagarde, head of the International Monetary Fund, to president Obama himself, argue that cutting ourselves off from our biggest market will cost Britain dear, as the cost of selling abroad rises and jobs are lost. Such economic damage would reduce the money available for the NHS, and put it under further financial strain.

The chief executive of NHS England, Simon Stevens, has warned that “when the British economy sneezes the NHS catches a cold” and that “this would be a terrible moment for that to happen at precisely the time the NHS is going to need that extra investment”.

The independent Institute for Fiscal Studies has projected that leaving the EU would create a £40bn black hole in the public finances. That’s the equivalent of NHS England losing over a third of its budget.

The NHS could face massive cuts with serious consequences for the quality of healthcare that we enjoy, and for pay and conditions for people working in the NHS. Hospitals, ambulance services, and health professionals are all at risk if we leave Europe.

Over 130,000 EU nationals work in the health and social care sector. If we left Europe, our ability to staff the NHS would be put at risk, causing waiting times to rise, the quality of care to go down, and staff to be overstretched and even more pressurised.

The support to remain from NHS workers and experts is strong. The Royal College of Midwives and the biggest trade union representing NHS workers, have both publicly supported Britain to remain in Europe.

Four former health secretaries – Alan Milburn, Patricia Hewitt, Andy Burnham and Alan Johnson – have also said remaining in will be better for the NHS. They commented that leaving would risk “frightening consequences for staffing, waiting times and levels of service care”. And the Royal College of Physicians has indicated that most of its members back remaining in the EU.


Anne Marie Rafferty

I believe staying in Europe is better for the NHS and makes nursing in the UK stronger. We benefit from common standards of education across the EU and access to research funding, second only in size to the US Military R&D budget.

Without this we would not have been able to undertake our major cross national study of nurse staffing and patient outcomes under the banner of RN4Cast. This study has been influential in the debate in safe staffing in the UK and informed the evidence base underpinning nurse to patient ratios in Wales.

But it is not just the NHS that we should look to for impact and repercussions. Leaving the EU could have a major impact on higher education for nurses and how we train and educate nurses and midwives; build capacity for exchange of expertise across Europe and most of all to protect standards of education. We are one of the last nations to mandate a Bachelor’s degree as the entry into practice in the EU in England.

Pegging practice at this level brings us into line with the EU and acts as a ballast against the ‘dumbing down’ of nursing education, which our research from RN4cast has demonstrated can be so deleterious to patient mortality and outcomes. In employment terms, the EU protects vital workers’ rights, including paid leave, parental rights, holidays and anti-discrimination laws.

These are issues that rarely make the headlines as we are often unaware of their impetus and origin. But in nursing they have impacted health and safety issues such as the management of needle stick injuries in practice.

Leaving the EU would be a leap in the dark that would rebound on our economy, health, educational and employment sectors, impacting recruitment and retention within the profession as well as mobility and movement of talent to the NHS.

The EU referendum is a once in a generation choice to secure Britain’s place in Europe and protect the NHS and Britain’s health for generations to come.

Professor Rafferty, fellow of the Royal College of Nursing and dean of the Florence Nightingale School of Nursing and Midwifery, was writing in personal capacity


Readers' comments (13)

  • Anthony Johnson

    This phrase about a stronger economy is bogus though. Question: do you have a stock portfolio? If not (and I assume almost all nurses don't) then a 'strong economy' never really affects you. That's why GDP is a useless metric for how the economy affects workers.

    What you should judge the economy is 'has your salary kept up with the cost of living' and 'is child poverty/homelessness rising'? We all know what the answers are there. This neoliberal idea that we have a stronger economy is only relevant if your a multinational corporation or have a high amount of personal wealth. Otherwise your being constantly taken advantage of.

    That's why I'm voting out. The EU, nor the British Government will protect workers rights or the NHS. When the institution was first created, it was WON by a mass movement of workers demanding a better world. In the UK, that doesn't exist. People are apathetic and politicians scapegoat and blame the EU or the opposing political party or sadly immigrants.

    If we leave, those arguments will hopefully be gone. Instead, people will have to hold their elected officials accountable. And they probably won't and we will become a more facist and reactionary country. However I would rather have the opportunity, to trust in the British people, that they will fight for themselves and will choose to stand up and be counted.

    Otherwise, a vote in means a situation like what happened with Greece with enforced, unnecessary, Austerity.

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  • Shrewdle93 - very well put. The bottom line is that the EU very clearly exists to benefit the wealthy, elites and the corporations. It does not stand for the good of the people or society, it works against us to ensure their interests are met.

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  • I am 100% Voting Out....I was a nurse in UK for 10 Years, working conditions have not improved since then, Our salaries have not kept up with inflation, Quality nursing care has worsen because of staff shortages.....maybe a change is required. Because I don't think things are going to get any better staying with the EU.

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  • I agree with you in some things. EU helps wealthy people. But I disagree with " a vote in means a situation like what happened with Greece with enforced, unnecessary, Austerity. ..":
    The UK is a completely different country to Greece. First ask yourself what kind of industry England has, in comparison to Greece.
    Don´t you think perhaps some countries, have got an industrial crisis and the EU is not guilty for that?
    You can´t compare Greece with the UK.

    Brexit means change, but this change can be too dangerous suddenly for the people who will need to be in hospital in the next 10 years.

    In my humble opinion, if Brexit happens, then the UK will need to act really quickly to compensate the disaster.

    I hope the UK can get more British nurses because it is lovely to work with them. I hope so! But it is not that easy! I always encourage students, but they want to go abroad!

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  • Anthony Johnson

    Maria, I'd say though that Greece was taken into debt by their investment in unnecessary arms spending that was sold to them by EU countries. In the UK we had this notion that we had to bail out the banks after they had made massive profits from credit default swaps etc. Now we're being told by our government, the IMF and the EU that Austerity is what we have to do... even though it's been proven to not grow the economy and is asset-stripping our public services.

    The EU is just one layer in the institutions that will stop us ending Austerity and the economic policies that are forcing our grandparents to go without the NHS they paid for. It also means me, as a soon to be qualified nurse, will be punished for something I barely had a hand in?! That's what I want to remove, the large un-reformable institutions that will stop us fighting for what we want.

    It is hard to compare the situation of Greece. However I'd argue that their people fought harder for their public services and standard of living. Whereas we don't do that in this country. So it makes me more worried. I want to leave not because I think that Brexit is a sure thing but because staying in is.

    The rest is up to us.

    If we re-align ourselves to the right the people will decide that. If we fight to turn ourselves towards progressive politics again, it will be because the people did that too.

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  • The biggest con the wealthy elite have ever played is convincing people that their plight (low wages, poor standard of living etc.) is the fault of Johnny Foreigner. There's no evidence that the EU is the cause of the rising inequality in our country (or nursing standards, for that matter), it's the decisions that have been taken by our own elected Government. And if we Brexit, then we'll be gifted with an even more right-wing Tory Government than we have now.

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  • Brexiteers aren't stupid, we know full well 'johnny foreigner' isn't the cause of all our ills. To suggest that we are racist/xenophobes, blindly blaming immigrants is getting really tired now. I presume you would agree at least that we have some appalling working conditions for nurses in acute care in this country? Whilst this is obviously not a direct cause of the EU, it's inability to get any better whilst we remain is. Why would our government try and stop the NHS haemorrhaging staff due to appalling conditions by improving things when they have a ripe supply of nurses from failing EU economies to step in and fill the gaps? It's exploitation of the poor italian, spanish etc nurses who come here because of their own failing economies under the euro, who are then exploited again by the horrible working conditions they are coming here to fill. every little guy loses. The argument about an even further right tory government is also wearing thin. What makes you so sure of yourself that this is a certainty? How do you know that there won't be a snap election if we leave - or the tory election campaign overspending investigation renders their leadership void? Also, how are you so sure that they'll actually be able to render their extreme right wing plans without outright revolt/political suicide, considering they only got 24% of the vote anyway (and I'm sure some of these supporters have dropped off since then)?. Any changes to our laws etc on leaving could take between 2-10 yrs to renegotiate, we have the next election in 2020. If they are worse (which frankly could happen, as much as it could not - none of us are fortune tellers) do you not think this is short term pain for long term gain? we may not get another referendum again, but we all know for sure we get the chance to be rid of the tories in 2020. To make such a long term decision based on such short sightenedness as having a tory government right now is just silly. Would you vote to leave the EU if we had the government of your choice in power at the moment? If so, by making a decision to stay purely because of the tories is madness. This referendum is about the EU. Not disliking european people etc (who remember half of whom are anti EU as well) and certainly not about our current UK government. Vote Out, then let's collectively ensure that the tories are ousted as soon as possible. Start with culling the wealthy elite with their feet under the table at the EU this year, then we can get to work on culling the wealthy elites in the UK conservative party by the 2020 deadline :) happy voting!!!! #Lexit xxx

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  • Ah well, seems like you've got your wish. Best of luck living with your decision.

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  • thanks! you too ;)

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  • I am actually appalled that the NT would publish anything like this. It is not your place to argue in favour of either camp re the referendum.

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