Cowper’s Cut is a new weekly column from HSJ’s comment editor Andy Cowper. It will be published every Monday and seeks to serve as an informative and entertaining stimulant for HSJ’s subscribers at the start of the working week.

Life comes fast at Prime Minister Theresa May: in a matter of months, she’s gone from holding hands with one orange man in the White House to a forced marriage with 10 Orangemen (and women) to hold on to her job. One hesitates to think how things might escalate if Mrs May visited the Cote d’Azur, where almost everyone is orange.

Visiting the Cote d’Azur (and everywhere else in Europe) is set to be considerably harder once the UK’s departure from the European Union takes place on 31 March 2019.

Why does this matter to NHS leaders and staff and users?

Because Brexit will impact on the UK’s economy, which provides the tax revenues that fund the NHS. The UK exports 50 per cent of all we sell overseas to the rest of the EU. Our economy has for decades outperformed the rest of the EU’s major economies bar Germany on the basis of the UK being a highly open, globalised country which due in part to EU freedom of movement can, with minimal bureaucracy, attract migrant workers as and when industries need them.

The biggest share of migrant workers, for reasons of opportunity and proximity, come from EU countries.

Mrs May called this year’s general election so she could have a strong mandate to deliver Brexit. The British people duly refused to give her one.

The two main results of this? 1. Brexit isn’t what it used to be. 2. The internal discipline of the Conservative Party has broken down.

Risks of Brexit

Chancellor Philip Hammond has warned against “hard” Brexit’s economic risks as has the independent Bank of England’s governor Mark Carney, based on downbeat economic data.

Cabinet ministers, including health secretary Jeremy Hunt, are openly lobbying for more public spending.

And one of Mrs May’s former special advisors briefed a friendly newspaper that Mrs May will stage a walkout of Brexit negotiations over the exit payment at some point, to curry favour with the UK domestic audience. Her EU negotiating counterparts will see this as yet another example of the UK’s fundamental unseriousness.

Talk about Brexit to any serious NHS leader and you find horror both at the misleading Vote Leave campaign pledge to redirect to the NHS the UK’s £350 million a week payments to the EU (much of which comes back to the UK instantly in EU grants), and also at the outcome of the advisory referendum on EU membership.

Vote Leave’s director Dominic Cummings wrote, “would we have won without £350m/NHS? All our research and the close result strongly suggests no … some people now claim this was cynical and we never intended to spend more on the NHS. Wrong. Boris and Gove were agreed and determined to do exactly this … I said to Boris – on day one of being PM you should immediately announce the extra £100 million per week for the NHS [the specific pledge we’d made] is starting today and more will be coming – you should start off by being unusual, a political who actually delivers what they promise. ‘Absolutely. ABSOLUTELY. We MUST do this, no question, we’ll park our tanks EVERYWHERE’ he said. Gove strongly agreed.

“If they had not blown up, this would have happened. The opposite impression was created because many Tories who did not like us talking about the NHS reverted to type within seconds of victory and immediately distanced themselves from it and the winning campaign”. 

We cannot know whether Cummings is describing matters accurately here. Boris Johnson still publicly maintains his support for the pledge, but he has well known form for lying

The NHS has for decades relied on migrant labour, from the Windrush generation to those from within and beyond the EU today. The gracelessness and political rectumitude of the government’s failure to offer existing EU nationals a unilateral deal on remaining appals almost every serious NHS figure.

The cabinet ministers Mrs May tasked with delivering Brexit – David Davies, Boris Johnson and former shadow health secretary Liam Fox – would all be content with a hard Brexit, or even a “no deal” move to World Trade Organisation standards, which experts in business, law and trade believe could be highly damaging

Already workforce experts have warned of the impact on the NHS from Brexitcorroborated by HSJ’s own workforce terrier Shaun Lintern.

Just as UK economic uncertainty is growing, there appears to be a shift in public attitudes to supporting higher public spending, as shown in the latest NatCen British Social Attitudes survey.

The hard Brexit tribe of Conservatives dream of less regulation and of British Empire 2.0. Meanwhile, the party’s pragmatists can see an economic hazard with the potential to be deeply damaging looming on the horizon, but have no ideas how to stop it. Nor does the Labour opposition, whose leader has a lifelong antipathy to the EU.

Amid all this sits the NHS: “clowns to the left of me, jokers to r=the right, here I am, stuck in the middle with EU”.

It’s interesting to imagine how swing Brexit voters will feel if Brexit hurts the UK economy as many predict. If people find out that they’ve been taken for a ride in a bus with a massive lie painted down the side of it, they might get angry. That anger could have awful consequences.

Andy Cowper is comment editor of HSJ