Reality Check: Will EU migration put too much pressure on NHS?

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Michael Gove saying: The idea of asking the NHS to look after a new group of patients equivalent in size to four Birminghams is clearly unsustainable.

The claim: Migration from the European Union will increase the UK's population by between 2.58 million and 5.23 million by 2030. This would create a 28% to 57% increase in demand for A&E services.

Reality Check verdict: Some migration from the EU is expected but the assumptions behind these population forecasts are very unlikely to be realised. An increasing population would put additional demand on A&E but the extent of that increase has not been demonstrated.

Justice Secretary Michael Gove has unveiled Vote Leave's research on the effect free movement will have on the National Health Service.

The document, external makes broad predictions, but even so, some of the assumptions it makes are questionable.

The lower end of the forecast, that EU migration will rise by 2.58 million by 2030, is based on taking the most recent ONS net migration figure and multiplying it by 15.

But the ONS actually produces a forecast, external for total net migration by 2029 (so not just from the EU), which it expects to have added 3 million to the population by then.

Now there are uncertainties surrounding all forecasts, but it makes the bottom end of Vote Leave's forecast look somewhat high by comparison.

To get to the higher ends of the forecast, the research assumes that all five current candidate countries wanting to join the EU (Turkey, Albania, Montenegro, Serbia and FYR Macedonia) do so in 2020. This is very unlikely to happen. You can read more about why Turkey in particular is not going to join the EU by 2020 here. They also assume no transitional controls to limit migration from the new members. Existing states are allowed to impose seven years of restrictions to freedom of movement from new members, as the UK did with Romania, Bulgaria and Croatia.

Add to that the impact of the new National Living Wage and you get to Vote Leave's "high" forecast of 5.23 million. The quote from Michael Gove above is supposed to illustrate the "medium" forecast, which excludes the effect of the National Living Wage to get to a figure of 4.25 million. The population of Birmingham, external is about 1.1 million.

It is hard to completely discount any forecast. Even so, the line about four Birminghams is hard to justify based on these such assumptions.

Demand for A&E

From the figures on the growing population, the research gets to a figure on the extra demand from A&E departments, concluding that it would lead to an increase in demand of between 28% and 57%.

It has reached these figures by looking at increases in A&E attendance since 2002 and noting a strong correlation with cumulative net migration over that time. In other words, attendances to A&E went up quickly at a time when there was continuous net migration to the UK.

This relationship is then used to predict how future migration would affect demand for A&E.

The problem is that while demand for A&E has gone up at the same time as there has been migration, the research has not demonstrated that one has caused the other.

While it is clearly true that higher numbers of migrants would mean more A&E visits, it could be that A&E attendances have gone up for other reasons as well, so the relationship is not reliable.

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