On the day of the world shaking referendum result, the Incisive Health team asks what the political and operational consequences are likely to be for the NHS

The people have spoken. The UK is Brexit bound. After months, years and, for some, decades of debate, we are finally crossing the Rubicon. And if the campaign has shown anything, it’s that this is most definitely a journey into the unknown.

The impact on the NHS – a political football for much of the campaign – generated plenty of heat, but not much light (does anyone actually know if the NHS is now getting more cash, or fewer doctors and nurses, or both, or neither?)

It is possible that the direct consequences of Brexit might be smaller on the NHS than on many other policy areas, given that national healthcare systems are not an area of significant EU competence. But consequences there will be, not least because of the inevitable political upheaval and the potential short-term impact on public finances. The latter of course goes some way to explaining Simon Stevens’ unambiguous support for Remain.

The civil service will apply the brakes to major policies until they can be certain that they have the backing of a prime minister likely to be in place for some years

In these tumultuous times, however, there is one thing we can be sure of: these consequences will be presided over, and shaped, by a new prime minister. As the prime minister who put himself front and centre of the Remain campaign, who asked the people to trust him (and not risk World War Three) but who ultimately presided over Britain’s decision to exit from the EU, David Cameron has suffered a political setback of historic and epic proportions. His resignation was unavoidable.  

Prepare for gridlock

So what does all this mean for health? Probably, in the short term, gridlock. Today, Conservative parliamentarians – including those in the Cabinet – will start trying to align themselves with whoever seems most likely to claim David Cameron’s crown. They will have a hard job picking a winner, because the runners and riders in this leadership contest number more than a dozen at this point in time. But with the air thick with politics, it is hard to imagine that Jeremy Hunt is thinking deeply today of the long-term future of the health service.

The civil service – including the Department of Health – will notice too the power vacuum at the heart of government, and will apply the brakes to major policies until they can be certain that they have the backing of a prime minister likely to be in place for some years. The publication of the childhood obesity strategy – which was due in September – is likely to be the first casualty of this period of unprecedented uncertainty (the Accelerated Access Review will possibly fall by the wayside, too).

But there are operational consequences for the NHS as well: how can the Treasury grip NHS finances with credibility as it was hoping to do, now that the clear winners of this contest are seeking to assume power having written a £10bn cheque for the NHS?

The politics of this situation will take months to sort themselves out. In the meantime, the machinery of government will seek to offer as much certainty as it can. Today, that means absenting itself from any speculation (which would almost certainly be unhelpful): the Department of Health is unlikely to offer its own view on Brexit. Bland statements from government – accepting the result and considering its implications – are likely to be the words from officialdom for some time to come.

Government departments will soon start trawling through the EU laws affecting their policy areas, sifting and sorting those that are unpopular, difficult, counterintuitive, and expensive

In the medium term, the Government will seek to close off as much regulatory and legal uncertainty as possible. The EU’s regulations (as opposed to directives) – of which the recent in vitro diagnostic and medical devices regulations are cases in point – have legal authority even without passing into UK law. Now that we are leaving the EU, organisations affected by them will have every reason to ask, “what next?”.

One possible solution – currently doing the rounds in Whitehall – is that the Government will seek to pass a simple law ‘freezing’ the existing body of statute. This will mean that – whatever the date on which we leave the EU – no laws will change until the UK Parliament decides that they will, which might be decades after our departure. Much to the disappointment of Brexiteers, therefore, we will continue to abide by most of the EU’s laws – including the orphan medicines directive, the medicinal products for human use directive, and the IVD and medical devices regulations, to name but a few – for some time to come.

Political battles

But what EU laws will be changed soon and will there be any changes which affect the NHS? Anticipating (not unreasonably) that the incoming prime minister will be someone who wishes to demonstrate quickly the benefits of leaving the EU, government departments will soon start trawling through the EU laws affecting their policy areas, sifting and sorting those that are unpopular, difficult, counterintuitive, and expensive. Officials will be encouraged to weigh up the complexity of repealing or replacing existing directives with UK-drafted alternatives.

Departments will be trying to assess the political battles taking place in Westminster to predict what the incoming prime minister and his or her ministers will be looking for.

Most of the symbolic or high profile examples of unpopular EU legislation do not affect the health sector. But there is one bugbear of the Department of Health that it has fought against for a decade and more: the peculiar impact of the working time directive on the NHS. If there is any EU law that the DH will gleefully throw on the bonfire, expect this to be the first.

There will of course be impact on other laws and rules and regulations, though, and at this time of great uncertainty there are enormous opportunities for those who move quickly to shape this new policy landscape. It is of course natural for all those people and organisations who care about patient care and the NHS to stop and stare at the dice the electorate has rolled and wonder what it all means.

But if that urge can be fought and they engage with policymakers and politicians quickly, they will find that they will be the ones to help craft the answers to the many questions that are being asked today.

This piece was written by the team at policy and communications consultancy Incisive Health