Martin McKee: Creating chaos and confusion from strength and stability—the general election 2017

The chaos that has resulted from the result of the general election has important implications for health, says Martin McKee

mcKee_martinOne word summarises much of the past few days. Regret. Theresa May must surely regret calling a general election. It was not just that she transformed a small working majority into a minority. She also exposed herself to unprecedented public scrutiny, something she had avoided for many years, as we now know with good reason. She must also regret focusing the campaign on her “strong and stable” leadership, suffering reversals almost before she got started. But Jeremy Corbyn must also have regrets. It now seems that the Labour Party’s own polling failed to capture what was happening, leading him to ignore a few key seats within easy reach, in which victory could have propelled him to Downing Street. With a few notable exceptions, the major polling companies may also be feeling some regret, publishing results suggesting that reading tea leaves may be a viable alternative. And on a personal note, I’m feeling considerable regret at ever agreeing to write this article for The BMJ, wondering what to write amidst this state of utter confusion, although the knowledge that other commentators on health policy share this problem brings some small reassurance.

To quote the prime minister, “let me be perfectly clear,” nothing is clear. Even before the final result was in, giving an entirely unexpected victory to Labour in Kensington, one of the wealthiest parts of the UK, Theresa May had been to the Palace to advise the Queen that she was in a position to form a government. This seemed a little premature, given that David Cameron delayed five days in 2010, first ensuring that he really did have an agreement with the Liberal Democrats. In contrast, Theresa May assumed that she had a deal with the Northern Irish Democratic Unionist Party (DUP), a view that they rapidly contradicted, forcing Downing Street to issue a correction, stating that their initial press briefing had been “an error.”

Rumours now abound about how any relationship might work. It is said that the DUP may demand that Nigel Farage, after appointing him to the House of Lords, would be part of the Brexit negotiating team. The resurgent Conservative Party in Scotland, led by Ruth Davidson, who has described herself as a gay Protestant unionist about to be married to an Irish Catholic, has made it abundantly clear that she finds the homophobic views of the DUP repugnant. So too have a growing number of English Conservative MPs, such as Sarah Wollaston, whose response to the idea of teaching creationism in schools, advanced by some DUP politicians was “Hell, no.”

The cabinet reshuffle has created further confusion, with the prime minister appointing as first secretary of state (in effect deputy prime minister) Damian Green, who has previously explained how Brexit threatens national security and is arguably the most pro-European minister in the cabinet. She has also promoted David Lidington to justice secretary, even though he previously pointed out that Brexit was “confusing, contradictory nonsense.” Yet she has also retained the three Brexit related ministers: David Davis, Boris Johnson, and Liam Fox.

Given the inability of almost everyone to predict the situation we now find ourselves in, it would be rash to speculate about what will happen tomorrow, let alone by the end of next week. Yet in health, and other areas of domestic policy, it seems likely that little will change. Jeremy Hunt remains secretary of state for health, having served longer with the same portfolio than any other cabinet minister. Of course, this raises the question of whether anyone else wants it. Yet his scope to introduce new legislation is severely constrained by the new parliamentary arithmetic and the many other pressing concerns facing the cabinet. His difficulties are compounded by his poor relationship with NHS staff, exemplified by the 20% share of the vote won by the National Health Action Party in his constituency.

For health, as for all aspects of government, the crucial question now is whether Theresa May will remain as prime minister for long, given calls from within her own party for her to go. Yet it would be unwise to underestimate her persistence. As home secretary, she relentlessly pursued several futile legal actions, on issues such as asylum seekers’ benefits, citizenship, and deportation of suspected terrorists, incurring vast expense before ultimately losing. Learning nothing from this experience, she did exactly the same in opposing the argument that parliament should have a say on triggering article 50, giving notice to withdraw from the European Union. Thus, even when faced with ultimate defeat, she is unlikely to give up easily. That said, the loss of her two key advisers, on whom she depended for support in all important meetings, will have seriously weakened her, above and beyond her loss of credibility within the party and in the country. However, there is another reason for her to stay. Negotiations with the European Union on Brexit begin in a few days. The clock is already ticking, and valuable time has been wasted with the election.

Many informed commentators expect the talks to break down within weeks, given the lack of understanding of the issues and of any meaningful preparation on the British side. Yet while this will undoubtedly create a short term political crisis, it may bring a much needed dose of reality to the debate in the United Kingdom. This applies as much to the Labour Party as to the Conservatives. While at least Labour realises that crashing out with no deal would be catastrophic, its manifesto aspiration to have all the benefits of the single market and customs union without actually being in them, while arguably politically expedient in constituencies where there is still support for Brexit, is just another example of the fantasy that one can have one’s cake and eat it. However, Labour is not alone. The DUP seem to believe that it will be possible to leave the single market but remain integrated economically with the Republic of Ireland, avoiding a hard border, without even attempting to explain how this might be possible. None show any evidence of having engaged at all with the complex challenges that Brexit poses for the NHS and public health.

While most attention has, understandably, focused on the seemingly intractable political problems of forming an effective government, including that of reconciling the conflicting policies of the Conservatives and the DUP in areas such as welfare, it is easy to overlook the need for someone to govern the country and, specifically, to negotiate Brexit in a limited timescale, a task whose scale and complexity has been compared with fighting the Second World War. This risks totally overwhelming parliament and the civil service; one German politician has reputedly suggested that the UK is on the way to becoming a first world failed state.

This has important implications for health. The NHS is in crisis, after years of austerity. There is the ever present threat to health from major terrorist attacks, epidemics, or natural disasters such as flooding. Unless the government can sort itself out soon, real dangers lie ahead. Solutions must exist, but so far they seem to have been elusive.

Martin McKee is professor of European public health at the London School of Hygiene and Tropical Medicine.