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The NHS is already in crisis – Brexit could finish it off

Campaigners promised leaving the EU would deliver £350m a week to our most treasured national institution. The reality is quite the opposite. 

It is becoming sadly clear that the crisis engulfing the NHS will be the worst we’ve seen for many years. GP surgeries are full and hospitals are at breaking point. The shortage of social and community care means that a small problem for an older person quickly escalates into a hospital admission, and many who no longer need to be in hospital cannot be discharged. This week we learned that non-urgent operations in hospitals in England will be postponed until after January.

Huge credit must go to the staff who have worked over the holiday period to manage this crisis. Doctors, nurses, paramedics, community teams, social workers and even managers are giving their all to patients. We all owe them a debt of gratitude, but what they really want is to be able to do their job with adequate resources.

Having worked in the NHS for 17 years as a GP, I know that the causes of this crisis are complex and multi-faceted. People are living longer; there are major staff and skills shortages; social care provision is inadequate and too disconnected from the health service; budgets are under severe strain; and the extra money provided by the government for this winter was far too little, and far too late.

But what is increasingly clear is that the biggest – and perhaps even an existential – threat to the NHS is Brexit. Clean, hard, soft, deal or no deal – whatever the government comes back with from Brussels later this year, Brexit is already damaging the NHS and will be a stress multiplier for all the challenges facing the health service for decades to come.

Leave campaigners promised that by voting to leave the EU, the public would be delivering a £350m a week cash injection to our most treasured national institution. The reality is quite the opposite. To date Brexit has in fact cost around £350m a week in lower growth. And that’s before the £40bn divorce bill and the many years of anaemic economic growth that lie ahead.

The weakening of our currency, falling investment and business uncertainty are suffocating our economy, taking us from being the fastest growing economy in the G7 before the referendum to the slowest today. While the NHS is crying out for more money, we are systematically downgrading our economy.

And the “sunlit uplands” promised by ministers show no sign of materialising. A Canada-style free trade agreement, which is the only option available to the government now it has ruled out remaining in the single market, would be devastating for the public finances. Philip Hammond himself said during the referendum that the Canada deal “does not even remotely replicate the access we have as an EU member,” and the Treasury has predicted it would hit GDP by 6.2 per cent by 2030.

Be in no doubt that the impact of this will be lower tax receipts, more austerity and ever-tighter budgets for the NHS and other public services.

As the funding crisis deepens, Brexit is also exacerbating staff shortages. The uncertainty felt by EU nationals, coupled with the fall in the value of the pound, has led many to reconsider whether this is the country for them. Almost 10,000 EU NHS workers have already quit since the Brexit vote. Almost one in five of the NHS’s European doctors have made plans to leave the UK, according to a survey by the British Medical Association. And there has been a 96 per cent drop in EU nurses registering to work in Britain since the Brexit vote.

It cannot be overstated how vital nurses and doctors from the EU are to keeping the health service running. Much more must be done to train more doctors and nurses in Britain, but this will take many years. The NHS simply will not survive an exodus of European staff.

Meanwhile, a weaker currency also means a greater share of the health service’s budget is being swallowed up on importing medicines and equipment. At least half of the products used in the NHS originate from outside of the UK, and with the pound around 15 per cent down against the Euro since the referendum, those imports cost significantly more today than they used to. While data on this is yet to emerge, a study in July 2016 predicted that this could create a £900m a year shortfall, meaning less money for patient care.

Under these stresses and strains, demands from the Tory Right will grow for the NHS to be privatised. Indeed, this is what many of those who campaigned for Brexit have always wanted. Former Prime Minister John Major, who knows as well as anybody about the real agenda of the Brexiteers, warned last year of the risk of NHS privatisation under Leave campaigners like Boris Johnson, Iain Duncan Smith and Michael Gove. “The NHS is about as safe with them as a pet hamster would be with a hungry python,” he said. We should all take heed.

With new facts about Brexit and its impact on the NHS coming to light all the time, everyone has the right to keep an open mind about whether this is the right future for our country and our health service.

5 July will mark 70 years since the NHS was founded. Those who remember a time when it didn’t exist know just how precious a creation it really is. As this winter crisis deepens, it is clear that hard and destructive Brexit is not a panacea for the NHS, but the greatest threat it has ever faced.

Dr Paul Williams is Member of Parliament for Stockton South and a member of the Health Select Committee. He is a leading supporter of Open Britain

The University Challenge final. Photo: BBC iPlayer
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Why University Challenge is deliberately asking more questions about women

Question setters and contestants on how the show finally began to gender-balance its questions – and whether it’s now harder as a result.

University Challenge has long had a gender problem. When the show first started airing in 1962, some Oxbridge colleges were still refusing to admit women as undergraduates; in the decades since, women have been consistently outnumbered by men, with all-male teams still a regular occurrence. Those women that did appear were all too regularly criticised and objectified in equal measure by audiences: notable contestants like Hannah Rose Woods, Emma Johnson, Samantha Buzzard and Sophie Rudd have experienced intense media scrutiny and criticised the sexism of the show and audiences. In recent years, sexism rows have dogged the show.

How satisfying, then, to see two women carrying their teams in last night’s final: Rosie McKeown for winners St John’s, Cambridge, and Leonie Woodland for runners-up Merton, Oxford. Both secured the majority of points for their teams – McKeown with visible delight, Woodland looking unsure even as she delivered correct answer after correct answer.

But there is another site of sexism on University Challenge, one that earns less column inches: the questions. Drawing on all areas of history, science, language, economics and culture, the questions often concern notable thinkers, artists, scientists, and sportspeople. Of course, our society’s patriarchal hierarchies of achievement have meant that the subjects of these questions are mostly men. General knowledge is, after all, a boys’ club.

Over the course of this 2017-8 series, though, I noticed a shift. More women than ever seemed to be making their way into the questions, at times with deliberate reference to the inherent sexism of their lack of cultural prominence. On 5 February, there was a picture round devoted to female composers, with contestents asked to identify Clara Schumann, Ethel Smyth, Rachel Portman and Bjork from photographs, who, Paxman explained, are all “women that are now listed in the EdExcel A Level music syllabus after the student Jessy McCabe petitioned the exam board in 2015.” Episodes have included bonus rounds on “prominent women” (the writer Lydia Davis, the pilot Lydia Litvyak, and the golfer Lydia Ko), “women born in the 1870s and 80s” (Rosa Luxemburg, Elizabeth Arden and Vanessa Bell), and the female philosophers Mary Midgely, Philippa Foot and Iris Murdoch.

Elsewhere, questions raise a knowing eyebrow at the patriarchal assumptions behind so much of intellectual endeavour. A music round on famous rock bands quoted the music critic Kelefa Sanneh’s definition “rockism”: “the belief that white macho guitar music is superior to all other forms of popular music”. Another, on opera, quoted Catherine Clement’s Opera, Or The Undoing of Women, which explores how traditional opera plots frequently feature “the infinitely repetitive spectacle of a woman who dies”. “Your music bonuses are three such operas,” Paxman said dryly, to audience laughter.

University Challenge’s questions editor Thomas Benson confirms that there has been a deliberate attempt to redress a gender imbalance in the quiz. “About three years ago, a viewer wrote in to point out that a recent edition of the programme had contained very few questions on women,” he explains. “We agreed and decided to do something about it.”

Last night’s final included a picture round on artists with works concerning motherhood (Mary Casatt, Lousie Bourgeois, Leanora Carrington and Frida Kahlo) and a music round on Marin Alsop, the first woman to ever conduct the Last Night of the Proms, as well as sets of bonuses on the American writer Willa Kather and Byzantine historian and princess Anna Komnene.

Former winner Hannah Rose Woods is delighted by the increase in such questions. “I think it’s fantastic!” she tells me. “These things are really important in changing people’s perceptions about women in the past, and the way women’s contributions to science and the arts have often been written out of history. We need to keep challenging the idea of the White Male Canon.”

Last night’s winner Rosie McKeown says that while she didn’t necessarily notice a deliberate attempt to gender balance the questions, she was “very pleased with the quality of those questions that did come up”.

“Although it wasn’t in one of our matches,” she tells me, “I thought the picture round on female composers was especially good for highlighting women’s achievements.”

For all the enthusiasm for these questions, in the studio they’re often met with blank stares. While University Challenge questions are broad and imaginatively posed, there are some reliable revision topics and techniques: from Nobel laureates and the years of their wins to identifying famous paintings and classical music excerpts. McKeown says she has been a religious viewer of the show since she was 11 years old, and admits to watching reruns of the show to prepare. Shift the kinds of answers you might be looking for, and teams may struggle.

“Do we know any female British composers?” Leonie Woodland said weakly, looking at a picture of Ethel Smyth. Trying to come up with a female Muslim Nobel laureate, one contestant desperately suggested Aung San Suu Kyi. Asked to provide a first name linking an American concert pianist with the sister of Lazarus one male contestant still buzzed in with “Daniel”.

“Even if we didn’t always get them right,” McKeown tells me, citing that round on female philosophers, which saw them pass on every question, as an example, “it was great to see so many important female figures represented.”

“I don't think the questions about women necessarily affected our performance, but it’s certainly a very good thing that they were there and I hope that they’ll arouse people’s interest in the women featured and in their achievements.”

Benson believes that it hasn’t had a significant effect on performance. “The great majority of the questions that feature women are no different to any others, in that they sit firmly within the realm of standard academic general knowledge.”

He notes that they often refer to historical and background details, citing sets of bonuses on Canadian novelist Ruth Ozeki and British physicist Hertha Ayrton, which both teams answered correctly in full. “Though Ozeki and Ayrton may not be household names, the questions are definitely answerable and deal with central themes in their work and achievements.”

It’s easy to brush off the significance of a fairly geeky Monday night BBC quiz show, but University Challenge still regularly pulls in three million viewers. In any case, a show like University Challenge has a cultural significance that outweighs its viewing figures. It helps to shape our understanding of which subjects are intellectual or important, which are history’s most notable achievements, and who is worth learning about. To ignore questions of identity is to risk intellectual laziness, relying on tired ideas of canonical figures – or worse, supremacist propaganda, privileging the achievements of white men over all others.

Quite aside from making for less predictable and more enjoyable television, by including questions on the likes of Stevie Smith, Nella Larsen, Gertrude Stein, Myra Hess, Margaret Mead, and Beryl Bainbridge, University Challenge can diversify the mental encyclopaedias of its viewers, be it a tweed-wearing 60-year-old in Leamington Spa or an 11-year-old like Rosie McKeown with her own dreams of one day competing. It has a responsibility to do so.

Anna Leszkiewicz is the New Statesman's deputy culture editor.