A firestorm of uncertainty now menaces the NHS

British public life is now in chaos and such is the state of flux that many of these thoughts written on a Sunday afternoon could well be out of date as you read them on Monday.

Anyone expressing with certainty they know what will happen next should be treated with same level of respect as those who decided to emblazon a bus with the claim that Brexit would deliver the NHS £350m a week.

What we are left with is a firestorm of uncertainty – and, with the NHS at a crossroads in so many areas, that is a recipe for indecision, which in turn could harm the service and those it serves.

Assuming the UK does leave the EU, there may well be significant consequences for the NHS and its workforce.

But even if – by some as yet not understood turn of events – the UK does not quit Europe, damage has already been done.

One trend beginning to emerge as early as this weekend was that of existing or potential NHS staff with European backgrounds deciding the UK is no longer the place for them. The further this spreads, the more it will intensify the burgeoning NHS staffing crisis.

Meanwhile, the next nine months had been pencilled in by NHS leaders as the time to push through the tough financial and service reconfiguration decisions that are needed to deliver the Five Year Forward View, to establish new “facts on the ground” as diplomats in the Middle East would say.

The political vacuum increases the power of NHS England chief executive Simon Stevens - already unprecedented for a health service official - and he is likely to use every ounce of it over the next few months to get the service to understand why it cannot delay change.

But at a local level, delivering on this will be incredibly hard.

A general election in late 2016 or early 2017 seems a real possibility – and already the ‘save our hospital’ banners are being removed from the store rooms where they were stowed, just over a year ago, following the 2015 contest.

Even if we have no election, those leading the country are likely to be those who raised the public’s expectations, both of quicker access to services and of increased NHS funding, during the referendum campaign.

Many senior health figures have already said they will hold Boris Johnson and others “to account” for their funding claims. That is understandable, but they should be careful – raising hopes even further is dangerous when whatever sums of money are forthcoming are very unlikely to be sufficient.

The constant talk of new money also encourages the temptation to put difficult decisions on the back-burner in the hope that a bailout will allow them to be avoided or postponed.

At a national level Mr Stevens can drive forward. But, surrounded by distracted politicians and civil servants, and with the distinct possibility of a caretaker health secretary, it will often feel like the handbrake is on. He must have strong and consistent support from his peers.

The events of last week have not changed the challenges facing the NHS a bit, but they have likely made it much harder to meet them.

Those problems will be exacerbated if the economy slides into recession. For all the hopes that last year’s comprehensive spending review could be renegotiated upwards, a significant reversal in the UK’s economic fortunes could produce the opposite result; not to mention any increase in inflation adding to the service’s costs.

The Treasury, faced with a stuttering economy and an NHS struggling to control spending, might finally lose patience and take an even firmer grip on the services’ finances. If the most dismal economic predictions come true, it could even seek to end the service’s already perforated funding ring-fence.

But our final thoughts should be with those who have left homes elsewhere in Europe and are now working in the NHS, especially those working in areas that delivered high votes for Brexit. They will need the support of NHS leaders both national and local as they continue to care for British patients.