In a post-Brexit world, we need health policy reform that respects the NHS

19 July 2023

Dr Matthew Wood - Senior Lecture, Department of Politics & IR, The University of Sheffield

Dr Ivanka Antova

Dr Mark Flear - Reader in Law and Socio-Legal Studies, Queen’s University Belfast

Professor Tamara Hervey - Jean Monnet Professor of EU Law, City, University of London

New research shows preferences for increased NHS investment in so-called left behind communities in a post-Brexit context - despite Brexit, not because of it.

Data from the recent British Social Attitudes survey shows an alarming decline in satisfaction with the National Health Service. In 2022, satisfaction fell to 29%, the lowest level since the survey was first conducted in 1983. This is on the back of two years of drastically falling satisfaction. In 2021 alone, satisfaction fell by 17 points, more than any other year-on-year decrease. Dissatisfaction levels overtook satisfaction for the first time since 2002.

What is an adequate policy response? For current Health Secretary Steve Barclay, the solution seems to be the liberalisation and speeding up of regulatory processes, and patient engagement with private sector healthcare. In a speech on 27 April to the Association of the British Pharmaceutical Industry, Barclay promised ‘a clinical research environment that is people-centred, that is digitally enabled, and all embedded within the NHS’.

Photo by Ian Taylor on Unsplash

The government’s ultimate aim, Barclay suggested, was to make the NHS a ‘better partner for industry’. He would do so, he claimed, by establishing ‘A post-Brexit regulatory environment that offers the agility to design a more bespoke and effective environment’.

Barclay’s approach is echoed in the Conservatives’ NHS Long Term Workforce Plan. The Plan states that ‘EU exit provides the potential for greater flexibility to recognise prior learning and experience towards attaining a degree’. In essence, the Plan looks for ways to cut the length of degree programmes in favour of informal experience in any clinical setting, a ‘shortened medical degree programme’ that is claimed to offer ‘a sustainable cost-effective option for supporting the medical workforce’.

What do the public want?

Alarming statistics about the failure to tackle record patient waiting times certainly suggest something deeply wrong with NHS governance as it recovers from the height of the COVID-19 pandemic. But is the government’s solution a more ‘flexible’, ‘innovative’, ‘bespoke’ NHS? Is it what the public prefer, particularly those who rely on the NHS most of all, people who live in areas with high levels of multiple deprivation and lower health outcomes?

Despite the headline problems of declining satisfaction, the BES survey also shows continued overall support for NHS principles. Strikingly, 76% of respondents agreed the NHS should ‘definitely' be free at the point of use, and only 6 percent of respondents said this principle should ‘probably’ or ‘definitely’ not apply. Survey evidence from 2022 also shows hight trust in the NHS, at 80%. The evidence suggests that any adequate response to the NHS’ crisis of satisfaction ought to pay respect to its founding principles and reputation.

Disentangling NHS Investment from Brexit

How should policy makers respond in a post-Brexit world? During the EU Referendum campaign, Leave proponents had (incorrectly, and now infamously) claimed on the side of a campaign ‘battle bus’ that “We send the EU £350 million a week. Let’s fund the NHS instead”. Despite this promise, after the referendum, hard right think tanks like the Legatum Institute advocated over-optimistic technological solutions privileging the private sector. This technological 'solutionism' is echoed in post-Brexit Conservative health policies. However, our research suggests investing in existing NHS institutions and enhancing the NHS’ founding principles coheres more with how people in areas of the UK with high levels of deprivation understand the issue. 

Our research, funded by the Economic and Social Research Council, found people in so-called ‘left behind’ areas did not easily relate their policy preferences for healthcare to Brexit. Of nearly 500 interviewees conducted in 2019, a key theme we identified was the expression of dislike and distrust of both the Leave campaign and politicians in general. Often using colourful language, they distanced themselves from the very ideas that Brexit would or could lead to the investment of £350 million into the NHS. They dismissed it as fanciful at best, and a cruel joke at worst. As one of our interviewees stated, “Nothing will change after Brexit because it doesn’t address the problem”.

They also argued for more investment in doctors and nurses because of positive experiences they previously had at GPs and hospitals, and health problems they had experienced. For example, one interviewee noted that, following the death of his brother in 1983, investment is needed in mental health and other services to tackle alcoholism. 

Looking closer

Our research enabled our interviewees to speak clearly about their policy preferences for increased investment in the NHS. They did so by distancing themselves from elite rhetoric about the link between NHS investment and Brexit, and used their personal experiences to articulate preferences that centred on investment in existing services. Our study contributes towards an understanding that people in Labour-voting constituencies faced the imposition of an elite-driven narrative about Brexit and NHS investment that they themselves do not necessarily support. 

Recent reports and research by Tamara Hervey, suggest the current government’s implementation of Brexit has likely worsened the condition of basic NHS services, and led to worsening economic and social conditions across the UK, furthering already intense inequalities. Recent research also suggests a phenomenon of so-called ‘Bregret’ – the belief that Brexit, or at least this form of Brexit, was wrong - spreading across even Leave voting constituencies. Our research further highlights the intense distrust of people in highly deprived areas that politicians, especially Conservative figures associated with the Brexit campaign like Boris Johnson, will deliver on the campaign’s promises. In light of this evidence, Steve Barclay’s suggested response – relying on the technological innovation and liberalisation beloved by the libertarian Brexiteer camp of his party – certainly does not seem to have much support.

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