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Archive - Year: 2016

August 12, 2016

Private Eye Medicine Balls 1423
Filed under: Private Eye — Dr. Phil @ 8:32 am

Humanising Healthcare

“Dying gives you a freedom to speak your mind.” So said inspirational geriatrician Dr Kate Granger, who died of cancer on July 23 at the age of 34. Granger was diagnosed with a very rare sarcoma (desmoplastic small-round-cell tumour) in 2011, when her median life expectancy was just 14 months and yet she lived for nearly 5 years. Even more extraordinary was her desire while dying to improve the NHS.

Granger’s first job on qualifying as a doctor was in Dewsbury hospital, working for a wise diabetologist called Dr Kemp who told her: “Being a physician is about painting a picture. It’s not about ticking a box or following a protocol. And during the admission, you’re painting extra bits of the picture every day until you’ve got the full painting.” When she became a patient, she observed that while many of the staff took time to introduce themselves and get to know her, some of them didn’t. This was less out of callousness, more because some doctors struggle to know what to say to patients with terminal cancer, especially if they are also doctors.

As Granger put it; ‘I’ve been referred to, within earshot, as ‘bed seven’ and by several consultants as that girl with DSRCT. Within one sentence, I’m just reduced to somebody with a rare cancer, and nothing else. I’m much more than just a rare cancer, I’m a wife, a daughter, a doctor and an auntie. I like to play the flute, I’m an avid baker, and there are lots and lots of things about me that are more important.’ She launched a hugely influential ‘Hello My Name Is…’ campaign to emphasise the importance of the little things in humane healthcare – introductions, listening and just being there. Over 400,000 NHS staff put their name to her campaign, and even those who didn’t like being told to introduce themselves made sure they remembered to do so.

Politicians predictably boarded her bandwagon. On page 36 of the government’s response to the Francis inquiry, there’s a “#hello my name is” box. Jeremy Hunt mentioned it in a speech about continuity of care and treating patients as people, without asking Granger’s permission. On July 19, she received a letter from Downing Street which began, “Dear Kate, My name is Theresa and I took over from David Cameron as PM last week.” She died just four days later.

Granger raised £250,000 for Yorkshire cancer centre before she died, but she was no political soft touch, campaigning for her junior doctor colleagues and asserting herself as a patient. She would get particularly annoyed if her drugs were changed without her involvement and consent. In an email to MD, she gave this advice for patients: ‘Ask for a copy of all your letters. Do not let anything be written about you that you have not seen yourself. Make sure you understand what is happening to you. Be involved in decision-making and don’t let things just happen to you passively. Take an active role in your care and be part of the team looking after you. Keep a diary of major events in your illness. It allows you to give a rapid history to anyone that sees you with all the info they will need. Keep a list of your medicines with you. The power balance is very much in favour of the NHS and its staff, but patients and carers can redress this by thinking critically and demanding information.’

Granger’s advice about death was equally clear. ‘The most important first decision is “where?” Preferred place of death is rarely achieved in the UK and I think that’s because we don’t plan properly. It takes a lot of effort and preparation to die at home successfully. I personally think if it is someone’s wish to die at home and they have been diagnosed with an incurable condition, the planning for that event needs to start then. Patients and families need early conversations with health and social care professionals about what support and resources are available so that expectations are not dashed. Anticipatory medicines need to be in the house long before the final crisis.’

Granger chose to die in St Gemma’s hospice in Leeds. Her greatest legacy would be if Theresa and Jeremy would fight as hard as she did to properly fund an NHS that is humane and safe for patients and staff, and provides great palliative care and gentle deaths for all, not just the lucky minority.

There are further tributes to Kate Granger in both of MD’s Edinburgh Fringe shows





August 11, 2016

Reviews of both Edinburgh Fringe Shows
Filed under: Edinburgh Fringe 2016 — Dr. Phil @ 6:59 pm

I’m doing two shows at the 2016 Edinburgh Fringe, August 5-27

3.05 PM Life and Death (But Mainly Death) – on at 19.05 on Aug 21 only
10.05 PM Dr Phil’s NHS Revolution with Dr Margaret McCartney

Tickets  here   in advance, or walk up to @theSpace Venue 43 box office:
Symposium Hall, Hill Square (Off Nicolson Street), Edinburgh EH8 9DW
0131 5102385

Come and say hello after

Some very nice reviews below…


Dr Phil’s NHS Revolution ★★★★

Fest Magazine

By Si Hawkins

Published 09 August 2016

One wonders if Jeremy Hunt might send an incognito aide to see this show. If so, the awkward stooge should be easy to spot. This being an onstage revolution, there’s an awful lot of chanting – a hefty chunk of it directed at the health secretary. Although the rhyming couplets are more creative than you might expect.

If you weren’t particularly worried about the future of our healthcare system before this show, you definitely will be by the end of it. Practising doctor and popular comedian, journalist, radio presenter and medical sitcom-writer Dr Phil Hammond has been a high-profile campaigner since his junior doctor days in the early 1990s. But the NHS now faces its biggest crisis since then, hence this, his first return to Edinburgh in five years, and a passionate call for action.

In truth, most of his audience are on board already. Lots of health workers are in, and the constant chuntering of approval give this the feel of a rally as much as a show. Hammond is a fine rabble rouser—aided by guest Dr Margaret McCartney, who reveals some troubling stats about NHS wastage—and, unlike most politicians, he remains impressively positive throughout, despite the weighty issues.

To keep things light Hammond utilises slogan T-shirts, children’s toys, handy acronyms, those chants and singalongs; there’s even a nice shout-out to lefty children’s TV genius Oliver Postgate, whose ’60s show The Clangers surreptitiously suggested a more caring model for a modern utopia. The perfect health secretary if that ideal world ever happens? Dr Phil Hammond.


Dr Phil’s NHS Revolution Review

BRITISH MEDICAL JOURNAL Feature: The Big Picture

Stand up for the NHS: Margaret McCartney joins Phil Hammond on stage in Edinburgh

By Bryan Christie

Published 09 August 2016

Margaret McCartney, the Glasgow GP and columnist for The BMJ, made her Edinburgh Fringe Festival debut last week. She joined the doctor and comedian Phil Hammond in an hour long show urging the audience to form a popular movement to save the NHS from market mayhem.

Dr Phil’s NHS Revolution is a verbal Punch and Judy act. The villains are dishonest politicians, profiteering corporations, and market solutions. The heroes are striking junior doctors, Britain’s army of carers, and evidence based decision making.

McCartney heads the revolution’s Anti Bollocksology Unit, providing facts that people need to know about today’s NHS.

Hunt and homeopathy

It is not an hour that England’s health secretary, Jeremy Hunt, would much enjoy. His support in 2007 for a motion in parliament defending NHS homeopathic hospitals is highlighted as an example of his unfitness for the job. His use of questionable mortality statistics to justify his drive for a seven day NHS is another. Hammond combined these two in one of the best jokes of the night: “The statistics that come out of Jeremy Hunt’s mouth don’t have any trace of the original statistic in them.”

The Labour Party may have created the NHS, but it does not escape Hammond and McCartney’s anger. It was the same Labour Party that also introduced PFI—the private finance initiative or “pay for it indefinitely,” as they suggest it should be renamed. PFI will result in taxpayers being charged a total of £100bn in ongoing payments for the construction of £10bn worth of hospitals, they said.

Rants with references

McCartney treated the audience to some “rants with references.” One was, “We are treating more and more people at lower and lower risk for conditions they may never get in life.” This trend has led to the idea of pre-diabetes and pre-hypertension. What next, asked McCartney, pre-death?

“There isn’t enough rational debate about the NHS in the mainstream media,” McCartney told The BMJ when asked about her motivation to take to the stage this summer. “I’m worried that the reasons for the perilous state of the NHS aren’t getting fair hearings—it’s underfunded and, worse, we are wasting fortunes on non-evidence based, thought-up-in-the-bath, short term party political policy.

“What do we want? Evidence based policy making! When do we want it? After systematic review and independent cost effectiveness analysis!”

Although the subject matter could not have been more serious, the show’s bitter pill was coated with comedic sugar, contrasting the values of the NHS with the absurdity of much that goes on in its name.

“We have to pay for the NHS. We have to look after ourselves. We have to protest. If we don’t fight for the NHS now, we’re stuffed,” said Hammond in his final plea. The audience cheered, eager conscripts to the revolution.

“What do we want? Evidence based policy making! When do we want it? After systematic review and independent cost effectiveness analysis!”

Footnotes


Life and Death (But Mainly Death) ★★★★

Broadway Baby

by Timothy Leonine Tsang

Published 9th August 2016

In spite of the morbid title, Dr Phil Hammond’s stand-up show makes mischief of the macabre. I was already taken in when he tells the audience that those who have seen a play with ‘death’ in the title are statistically more likely to die (no correlation of course).

Laughter is thinned out tactfully to address a range of issues that include Jeremy Hunt and the state of mental health

Dr Phil’s act comes with a powerpoint. This set-up is not unfamiliar to the audience, who may have seen him before on Have I Got News For You and various media productions on the BBC. Though the majority of the viewers are more mature and elderly, there is no shortage of young viewers who, I’m sure, immensely enjoyed this show.

The entire routine is a narrative effort, as Dr Phil starts with his little known family history, tracing the past to explain his lifelong desire to work for the NHS and Private Eye. There are memorable wisecracks along the way about family dynamics, and about deaths to loved ones that are commemorated with a humour seldom flippant, but which shone with a hindsight that is particularly heartwarming.

It is rather rare for a comic to sustain momentum throughout, yet Dr Phil manages so by segueing into more worldly terrain later on, as he muses upon our society at large. Laughter is thinned out tactfully to address a range of issues that include Jeremy Hunt and the state of mental health in this country. Comedy makes way for tribute to a compassionate society.

Dr Phil delivers a hugely enjoyable hour of well-crafted stand-up, a welcome reprieve from other performers these days who dabble with too much at once. This veteran of the comic circuit revels in the poignant, and provides just the tonic for the aged.


Life and Death But Mainly Death

FringeReview

By Kate Saffin

Published August 12

Low Down

Dr Phil considers the deaths of two dads and his mum still gate vaulting in her eighties. And considers his own death asking is it possible not to kill yourself before your time, yet die gently when your time comes? Laugh, think about sanity and plan your exit.

Review
Phil Hammond was an NHS GP for twenty years, has worked in sexual health and now works in a specialist NHS team for young people with chronic fatigue. He first appeared at the Fringe in 1990 as half of the junior doctor double-act Struck Off and Die, has been a Private Eye journalist, is an outspoken supporter of the junior doctors in their current dispute, appeared on numerous radio programmes and written several books. So an hour in his company promises to be interesting.

He starts by cheerily announcing that people who come to see his show are more likely to die. But then again 99% of people involved in car accidents are wearing shoes which doesn’t prove that wearing shoes causes car accidents…

He wants us to think about what we want, to be talking about death – not only because it makes life easier for those you leave behind but because it brings people closer together. That in his experience as a doctor people reaching the end of their life don’t regret what they haven’t done but the time they haven’t spent with their family and friends.

He then goes on to do just that, to talk about his life and family;  sharing highs and lows in a thoroughly disarming way. He may have spent much of his childhood in Australia but he has nailed our trademark self-deprecating British humour.

Experience of death came young for him with the death of his father when he was only seven. Amidst the humour he gives us an insight into grieving as a child; how children won’t always react in the way we think they should as though they are merely mini adults.

Back in England as a teenager he followed in his father’s footsteps in his interest in science and settled on a career in medicine – where he found discussing  death and the sharing of difficult diagnoses and news with patients was all too often absent. He touches on the very serious as well, using the example of the Bristol paediatric cardiac survey scandal to highlight the importance of openness and honesty when things do go wrong.

This is a thoroughly life affirming show, mostly about death, and one everyone should see. You will leave smiling… and thoughtful. And if that hasn’t convinced you; as a child he asked his father about the meaning of life… go just to hear the answer.

 

Note:

Life and Death (But Mainly Death) is also part of the festival within the festival Death on the Fringe featuring drama, comedy, spoken word, music and other events. It is part of the ongoing charity-led campaign, Good Life, Good Death, Good Grief, which works to promote more openness about death, dying and bereavement.

 





July 28, 2016

Private Eye Medicine Balls 1422
Filed under: Private Eye — Dr. Phil @ 8:10 pm

The Sins of the Hunt

The reappointment of Jeremy Hunt to Health Secretary seems odd given that so many of the staff distrust him and Jim Mackey – Head of NHS ‘Improvement’ – declared on the same day that the NHS was ‘in a mess’, would miss all its finance and performance targets and there had been “five years of decline on all of the things that people would worry about”. Theresa May kept Hunt waiting, testing if any sane woman wanted the job first, before ordering Hunt to fix his – and Andrew Lansley’s mess.

The odds aren’t good. Hunt struggles with critical thought, such as signing an early day motion to support homeopathy. After tweeting about meetings with pharmaceutical companies making new drugs for dementia, Hunt decided that GPs weren’t diagnosing dementia enough, so he offered them £55 per new diagnosis via screening them. The trouble is, ‘positive’ screening tests are wrong 80% of the time. Take 100 people over 65, and 6 will have dementia. If you screen them all, 23 will have a false positive. Only when the press found people were selling up and moving into care homes when they thought they had dementia, only to find they had mild cognitive impairment, did Hunt and NHS England ditch the bribe.

Hunt’s involvement in the Tory manifesto pledge to deliver ‘a truly 7 day NHS’ is unclear, but he decided to ambush the junior doctor negotiations to try to get staff working at weekends. When it was pointed out that staff were already working at weekends to provide emergency cover, and that taking more staff away from weekdays – when the wards are busiest – to work at weekends might not be a good idea, Hunt started firing off statistics. He repeatedly claimed that 11,000 more people die at the weekend because of lower staffing levels, even though the BMJ paper concerned said to assume the two were related would be ‘rash and misleading’, as did the National Statistics Authority, but he carried on telling the same untruth in the hope that it might one day become true.

On a roll now, Hunt said that you are 20% more likely to die at the weekend due to stroke. In fact, his data was 20 years old, and most recent data shows no day of admission difference. Tragically, patients swallowed the message that hospitals were less safe at weekends and delayed seeking help for life threatening illnesses. Hunt then decided to piss off consultants by claiming only 10% of hospitals had consultants seeing patients within 14 hours. David Speigelhalter, a professor of statistics, said this conclusion was flawed and Dr David Craven, a Fellow of the Royal Society said it was ‘simply impossible’ to know on the set of data used. But Hunt, like Gove, is long since sick of experts.

Unsurprisingly, the normally placid but numerate junior doctors don’t trust Hunt. His offer of a 13% and then 11% pay increase when the ‘overall cost envelop remains neutral’ sounded very fishy. His claim he could introduce a truly 7 day NHS without extra staffing or funding was just laughed at. His claim that he had the power to impose a new contract on them if they refused to accept it was when relations got really frosty. To be fair to Hunt, the BMA should spend its money on professional negotiators rather than using knackered junior doctors, but Hunt’s ‘go to war with the staff’ stance undoubtedly triggered unprecedented strikes. Junior doctors and medical students overwhelmingly rejected their final contract offer in an advisory ballot – despite the recommendation of the BMA and Hunt to accept it. Junior doctor leader Johann Malawana immediately resigned but Hunt has had the brass neck to remain when the vast majority of NHS staff would like him to leave. If he tries to impose the junior doctor contract again, he will doubtless be heading for a High Court challenge

May is not stupid. Hunt is a convenient smokescreen for the creeping privatization of the NHS. NHS England director of strategy Michael Macdonnell says the latest NHS reforms ‘offer private sector organisations an enormous amount of opportunity’. Virgin Care is busy hoovering up as many NHS services as it can. So many GPs are planning on reducing hours or retirement that practices are easily bought up. Private takeovers of hospital chains are on the cards, the bureaucracy of administering a market takes £4.5 billion away from the frontline and a Lords NHS Inquiry lead by the “Under Secretary of State for NHS Productivity” (sic), Lord David Prior is considering patient charges and insurance. Hunt is just the happy whipping boy, diverting attention from the real agenda.

MD’s NHS Revolution is at the Edinburgh Fringe August 5-27





July 1, 2016

Filed under: Edinburgh Fringe 2016 — Dr. Phil @ 12:00 pm

TICKETS ON SALE HERE

Your two urgent appointments with the Doctor: 3:05 pm - Life and Death (But Mainly Death) Dr Phil reflects on life, the death of two dads and his mum still gate- vaulting at eighty. And he considers his own death. Is it possible not to kill yourself before your time, yet die gently when your time comes? Can we live and die with pleasure, purpose, compassion and modest medical interference? Laugh and plan your exit. 10:05 pm - Dr Phil’s NHS Revolution Laugh, love, shout and reclaim our NHS. Ditch the market, cherish the carers, fund the frontline, avoid the harm, kill the fear, tell the truth, use the evidence, inspire, collaborate, recover, die gently. Are you in? With guest appearances from Dr Margaret McCartney, inspirational Glasgow GP, writer and broadcaster. Phil Hammond is an NHS doctor working in chronic fatigue, an investigative journalist for Private Eye, a BBC Radio Bristol presenter, comic and author of ‘Staying Alive, How to Get the Best from the NHS’ and ‘Sex, Sleep or Scrabble?’ Phil has appeared on Have I Got News for You, Jack Dee’s Helpdesk, The News Quiz, The Now Show, Question Time, Trust Me, I’m a Doctor, Long Live Britain, The One Show and Countdown.





June 22, 2016

Private Eye Medicine Balls 1420
Filed under: Private Eye — Dr. Phil @ 11:27 am

Why are so many doctors and scientists in favour of Remain?

No-one takes much notice of doctors, least of all politicians, but all the doctors MD has spoken to are in favour of the UK staying in the EU. Indeed, MD cannot trace one prominent national medical, research, or health organisation that has sided with Brexit. This is partly because of the un-evidence based fantasy bollocks of the Brexit camp and partly because, on balance, doctors and scientists overwhelmingly believe the UK is better off, healthier and safer in Europe.

The best guess of the net saving of withdrawing from Europe if there was no pursuant economic crash is £27 million a week. Even if every penny was spent on the NHS it wouldn’t even wipe out the current deficit. If there was an economic crash, it would wipe out any saving and make the NHS funding crisis even worse. The EU is not a prominent threat to the NHS as Article 168 clearly states that the organisation and delivery of health services is a national responsibility. A far greater threat to the NHS is the current UK government’s creeping privatisation and outsourcing of vital services, and a lurch to the right from Brexit is likely to accelerate this.

National health services are not included in the trans-Atlantic trade and investment partnership trade deal. (TTIP). The UK government has stated that it has no intention to broaden the scope of the deal to include the NHS at any point in the future, but a change of leadership and personnel in the Tory party post Brexit could well signal a change of intention and a new trade partnership with the US, with a ‘Privatise the World’ agenda that further opens up a £130 billion NHS market to American buyers.

Migration is more complex, and clearly puts strain on public services. However, EU migrants tend to be of working age, use the NHS less and pay taxes to fund it. The failures in NHS provision come from poor capacity and workforce planning, not because EU migrants aren’t paying taxes. Some even return home for healthcare because they can get quicker access to specialists than in the UK. There are 135,000 non-British European citizens working in the NHS and social care, about 10 per cent of the total, at all levels of the service from consultants to carers. There are also widespread staff vacancies at every level, and a current shortage of 50,000 staff in the NHS alone. How many would be able to stay or take up jobs post Brexit is unclear, as is how many of the 2 million British people living in other EU countries – including about 650,000 British pensioners – who would return home particularly for health reasons, as they lose eligibility for EU citizen health services.

As for the impact on research, Brexit would sacrifice our right to participate in the European Medicines Agency. We would have to pay to keep access to the centralised authorisation system, but have no influence on policy. The National Institute for Health and Care Excellence (NICE) would lose its vital European health technology assessments. To date, the UK has been the most successful country at winning competitively awarded EU funding for research and development in life sciences. After Brexit, the UK would have to pay to keep access to funding but have no influence in setting priorities in research and development.

As for the wider implications, a sense of belonging and connection is fundamental to mental health. Many NHS staff want to feel part of a Europe where compassionate collaboration triumphs over profiteering and virulent nationalism. Some people will do very nicely out of Brexit, and their health may even improve because of it, but it won’t be the people who depend most on the health and social care system, or those who work in it.

To believe that the UK can be a gated community, immune to consequences of millions of displaced citizens and a resurgence in right wing nationalism in Poland, Hungary, Austria, and beyond is fantasy. The refugee crisis has created a public health disaster, as has civil unrest and war in Ukraine, with a resurgence in multidrug resistant tuberculosis. Clearly the EU can be a wasteful, bureaucratic nightmare and needs continuous improvement. But denial and refusal to engage in Europe-wide solutions to such urgent and dangerous problems will not keep the UK secure or healthy for long.

References:

Policy briefing report jointly published by the Institute of Global Health Innovation and the LSE Health. The original briefing report is available here.

Why doctors should vote to remain in the EU on 23 June: BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i3302 (Published 14 June 2016) Cite this as: BMJ 2016;353:i3302

The Brexit debate. www.bmj.com/brexit

80k workers in social care (Source: Skills for Care, September 2015: https://www.nmds-sc-online.org.uk/reportengine/GuestDashboard.aspx?type=Nationality

55k workers in NHS (Source: Health and Social Care Information Centre, September 2015: http://www.hscic.gov.uk/media/20194/All-staff-by-staff-group-nationality-and-HEE-region—full-time-equivalents-and-headcount—Sep-2015/xls/Staff_groups_by_nationality_and_HEE_region_FTE_and_HC_-_Sep_2015_-_Final.xlsx)

“Academics across Europe join ‘Brexit’ debate” Nature 530, 15, 2016 http://www.nature.com/news/academics-across-europe-join-brexit-debate-1.19282

“The EU: what’s best for UK cancer research and patients?” Lancet Oncology Volume 17, No. 5, p556–557 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30063-8/abstract

“If Mark Carney is right, then that is a severe concern for the National Health Service, because it would be very dangerous if at precisely the moment the NHS is going to need extra funding, actually the economy goes into a tailspin and that funding is not there.” Simon Stevens, CEO of NHS England http://www.bbc.co.uk/news/uk-politics-eu-referendum-36353145

“HM Treasury analysis: the immediate economic impact of leaving the EU” https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/524967/hm_treasury_analysis_the_immediate_economic_impact_of_leaving_the_eu_web.pdf

Governor of the Bank gave evident to the Treasury Select Committee that leaving the EU carried the risk of a “technical recession” http://www.independent.co.uk/pugpig/7026821

Letter from 200 health professionals to The Times April 4, 2016 http://www.thetimes.co.uk/article/the-benefits-to-the-nhs-of-staying-in-the-eu-dnjnp8b82

“Paediatric research and the Brexit debate” Letter from six doctors at Great Ormond Street to The Times June 11, 2016 http://www.thetimes.co.uk/past-six-days/2016-06-11/comment/paediatric-research-and-the-brexit-debate-njtgztr6k

“EU boost to science” Letter from 150 members of the Royal Society to The Times, March 9, 2016 http://www.thetimes.co.uk/tto/opinion/letters/article4709281.ece

Torjesen I. EU exit would have a detrimental effect on the NHS, academics warn. BMJ2016;353:i2953.http://www.bmj.com/content/353/bmj.i2953?trendmd-shared=0doi:10.1136/bmj.i2953 pmid:27220718.

EU members. UK cannot be an island in science. Guardian 2016 Feb 27. http://www.theguardian.com/politics/2016/feb/27/eu-membership-uk-cannot-be-an-island-in-science

Wessely S. Why health of NHS will be at risk if UK leaves EU. Yorkshire Post 2016 Apr 8. http://www.yorkshirepost.co.uk/news/opinion/professor-simon-wessely-why-health-of-nhs-will-be-at-risk-if-britain-leaves-eu-1-7840583

Wollaston S. Brexit should come with a health warning for the NHS, public health, and research. BMJ2016;353:i3295.

A response to the RCP’s ‘call for views’ on the EU referendum, 2 Jun 2016. https://www.rcplondon.ac.uk/news/response-rcps-call-views-eu-referendum

Why should we Vote Leave on 23 June? http://d3n8a8pro7vhmx.cloudfront.net/themes/55fd82d8ebad646cec000001/attachments/original/1463496002/Why_Vote_Leave.pdf?1463496002

Dilnot A. Letter to Dominic Cummings, 27 May 2016. https://www.statisticsauthority.gov.uk/wp-content/uploads/2016/05/Letter-from-Sir-Andrew-Dilnot-to-Dominic-Cummings.pdf

Institute for Fiscal Studies. Brexit and the UK’s public finances. 2016. www.ifs.org.uk/publications/8296.

House of Commons Treasury Select Committee. The economic and financial costs and benefits of the UK’s EU membership. 2016. http://www.publications.parliament.uk/pa/cm201617/cmselect/cmtreasy/122/122.pdf

Centre for Economic Performance. Brexit and the impact of immigration and the UK. 2016. http://cep.lse.ac.uk/pubs/download/brexit05.pdf

National Institute for Economic and Social Research. Impact of migration on the consumption of education and children’s services and the consumption of health services, social care and social services. 2011. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/257236/impact-of-migration.pdf

Mason R. John Major: NHS at risk from Brexit pythons Johnson and Gove. Guardian 2016 Jun 5. http://www.theguardian.com/politics/2016/jun/05/john-major-nhs-risk-brexit-pythons-johnson-and-gove

Economist Intelligence Unit. Healthcare markets in Europe: what would be the impact of Brexit? 2016. http://www.eiu.com/public/topical_report.aspx?campaignid=BrexitHealth

Dearden L. “A dark day for Europe”: EU reaches agreement to send refugees back to Turkey despite legal concerns. Independent 2016 Mar 18. http://www.independent.co.uk/news/world/europe/eu-turkey-refugee-deal-what-is-it-erdogan-a6939156.html.





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