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It's official – there's a £200m hole in the Brexit bus NHS promise

The UK contribution to the EU budget was £156m a week in 2016-17. 

The strategists at the heart of the campaign to leave the European Union were in no doubt about what won it for them. “Would we have won without £350m [for] NHS?” said Vote Leave campaign director Dominic Cummings. “All our research and the close result strongly suggests no.” Insiders knew that, without that big red bus promising £350m more a week for health services, the British voters would not have given them their narrow victory.

That is why it is so maddening that this pledge has turned out to be a simple lie. Yesterday, the official Treasury figures for UK contributions to the EU budget came out. In 2016/17, it showed, the UK contribution to the budget was just £156m a week – less than half of what Vote Leave promised. The entire Vote Leave campaign was built on 200 million little lies.

This, of course, was perfectly apparent during the referendum campaign. Andrew Dilnot, the head of the impeccably impartial UK Statistics Authority, called the £350m figure “potentially misleading”. The figure was savaged by the then chair of the House of Commons Treasury Select Committee, Andrew Tyrie. A Conservative MP himself, he called it a “false prospectus” that amounted to “nonsense politics” and “a form of electoral bribery.” But seeing the lie busted in black and white on a balance sheet proves conclusively how utterly misleading it was.

The tragic truth is that Brexit, and especially the hard Brexit course this Government is charting, will mean less money for our NHS rather than more. The government’s own forecasters, the Office for Budget Responsibility, have forecast that Brexit will be directly responsible for a £58bn black hole in the public finances. This can only be filled by raising taxes or cutting spending – for example, on the NHS. I think we all know what choice this Tory government would make in that scenario. The independent Institute for Fiscal Studies has likewise concluded that the government’s decision to leave the single market alone will weaken the public finances by £8bn in 2019-20. To minimise the damage of Brexit to our NHS, the government should be negotiating to keep Britain in the single market, as the Open Britain group is campaigning for.

Brexit is having another dire impact on our NHS – staff shortages. Our health and social care system is dependent on workers from the EU, with more than 60,000 of them working in our NHS alone. Since the referendum, there has been a shocking 96 per cent fall in the number of EU nurses applying to work in the National Health Service – and this is before we even leave the EU and the government institutes a more draconian immigration system. The Tories’ target of cutting annual net migration to the "tens of thousands" will clearly damage our NHS; even their leader in Scotland, Ruth Davidson, is now calling on them to scrap it.

The cynical right-wingers who ran Vote Leave won partly by misleading the British people on the consequences of Brexit for our NHS. They are already being found out. Given that those who voted for Brexit did so in part to boost health funding, ministers have an absolute responsibility to ensure that Brexit does not damage our NHS. They should start by welcoming rather than repelling EU nationals seeking to work here, and by negotiating to retain our place in the single market.

Chuka Umunna is a leading supporter of Open Britain

Chuka Umunna is Labour MP for Streatham.

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David had taken the same tablets for years. Why the sudden side effects?

Long-term medication keeps changing its appearance – round white tablets one month, red ovals the next, with different packaging to boot.

David had been getting bouts of faintness and dizziness for the past week. He said it was exactly like the turns he used to get before he’d had his pacemaker inserted. A malfunctioning pacemaker didn’t sound too good, so I told him I’d pop in at lunchtime.

Everything was in good order. He was recovering from a nasty cough, though, so I wondered aloud if, at the age of 82, he might just be feeling weak from having fought that off. I suggested he let me know if things didn’t settle.

I imagined he would give it a week or two, but the following day there was another visit request. Apparently he’d had a further turn that morning. The carer hadn’t liked the look of him so she’d rung the surgery.

Once again, he was back to normal by the time I got there. I quizzed him further. The symptoms came on when he got up from the sofa, or if bending down for something, suggesting his blood pressure might be falling with the change in posture. I checked the medication listed in his notes: eight different drugs, at least two of which could cause that problem. But David had been taking the same tablets for years; why would he suddenly develop side effects now?

I thought I’d better establish if his blood pressure was dropping. I got him to stand, and measured it repeatedly over a period of several minutes. Not a hint of a fall. And nor did he now feel in the slightest bit unwell. I was stumped. David’s wife had been watching proceedings from her armchair. “Mind you,” she said, “it only happens mid-morning.”

The specific timing made me pause. I asked to see his tablets. David passed me a carrier bag of boxes. I went through them methodically, cross-referencing each one to his notes.

“Well, there’s your trouble,” I said, holding out a couple of the packets. One was emblazoned with the name “Diffundox”, the other “Prosurin”. “They’re actually the same thing.”

Every medication has two names, a brand name and a generic one – both Diffundox and Prosurin are brand names of a medication known generically as tamsulosin, which improves weak urinary flow in men with enlarged prostates. Doctors are encouraged to prescribe generically in almost all circumstances – if I put “tamsulosin” on a prescription, the pharmacist can supply the best value generic available at that time, but if I specify a brand name they’re obliged to dispense that particular one irrespective of cost.

Generic prescribing is good for the NHS drug budget, but it can be horribly confusing for patients. Long-term medication keeps changing its appearance – round white tablets one month, red ovals the next, with different packaging to boot. And while the box always has the generic name on it somewhere, it’s much less prominent than the brand name. With so many patients on multiple medications, all of which are subject to chopping and changing between generics, it’s no wonder mix-ups occur. Couple that with doctors forever stopping and starting drugs and adjusting doses, and you start to get some inkling of quite how much potential there is for error.

I said to David that, at some point the previous week, two different brands of tamsulosin must have found their way into his bag. They looked for all the world like different medications to him, with the result that he was inadvertently taking a double dose every morning. The postural drops in his blood pressure were making him distinctly unwell, but were wearing off after a few hours.

Even though I tried to explain things clearly, David looked baffled that I, an apparently sane and rational being, seemed to be suggesting that two self-evidently different tablets were somehow the same. The arcane world of drug pricing and generic substitution was clearly not something he had much interest in exploring. So, I pocketed one of the aberrant packets of pills, returned the rest, and told him he would feel much better the next day. I’m glad to say he did. 

This article first appeared in the 13 March 2018 issue of the New Statesman, Putin’s spy game