Martin McKee asks if the Irish word GUBU offers an adequate description of UK politics in 2019?

Those who are Irish, and of a certain age, will likely be familiar with the word GUBU, an acronym for grotesque, unbelievable, bizarre, and unprecedented. They were extracted from a comment by the then Taoiseach (Prime Minister) Charles Haughey, who was describing a series of events in 1982 that culminated in a murderer being apprehended at the home of the Attorney General where he was staying as a guest. In the period between the murders and his arrest he had been escorted to a hospital, along with his dying victim, by an ambulance driver who assumed him to be a doctor. Shortly afterwards, he attended a Gaelic football match with the Attorney General and with the Garda (police) Commissioner, engaging the latter in conversation about the ongoing investigation. Thirty-seven years later, the word is appearing once again in newspapers, but this time to describe the situation in the UK, rapidly descending into chaos. 

The next prime minister is likely to be Boris Johnson, who has overwhelming support among the 124,000 Conservative party members currently voting for their new leader. His support reflects his prominent role in the campaign to leave the EU. Yet his commitment to Brexit is difficult to reconcile with how he wrote two articles prior to the referendum, one arguing for Remain and the other for Leave. This is less surprising when one reflects on how, in his writing, as a journalist and author, he appears to see facts as optional, a problem that led to him twice being sacked for being economical with the truth and which has created many complications in his personal life. However, it points to a serious problem for those seeking to observe British politics. Can we believe anything he says? And what does this mean for health and the NHS?

Those who have worked with him most closely have the greatest concerns. Among the most excoriating, and the most detailed critiques was Sir Max Hastings’, who has known him from the 1980s. His view can be summarised by one quote: “Johnson would not recognise truth, whether about his private or political life, if confronted by it in an identity parade”. This may explain why the defining feature of his campaign to become Conservative leader has been the avoidance of public scrutiny. While some of the other candidates, and particularly the International Development Secretary Rory Stewart, actively sought to engage with the public, Johnson was nowhere to be seen. Instead, his supporters appeared on radio and television to interpret his views to the country, a strategy that allowed them to avoid difficult questions as they could not speak for him, even though that was exactly what they had been doing in the interview up until then. When, eventually, he agreed to participate in a televised debate, he managed to deflect almost all the questions that he was asked. Those few policies that have been announced have often been reversed a few days later. Consequently, it is extremely difficult to know what policies a Johnson government will actually pursue and there are few signs of a coherent ideology. Rather like Donald Trump, the sole unifying theme appears to be the creation of an image, with style triumphing over substance.

We do have a few clues about his ideas on health and the NHS. Many years ago he argued for NHS charges, but said little more for many years until the EU referendum campaign, where he appeared as a champion for the NHS, promising a fictitious £350 million funding boost from Brexit. During his campaign he has commented that the NHS needs reform, but with no indication of what he envisages. He has, however, said that he will do something about the pension tax rules that have created massive problems for hospitals as senior doctors find themselves losing money if they take on additional work. Given his relationship with the Trump administration and some of its supporters, much attention has focused on a possible US trade deal. There are many in the Johnson camp who favour the closest possible relationship with the US. Yet informed accounts suggest that negotiations have slowed to a crawl as the UK side is unable to decide whether it wishes to remain in line with EU rules or adopt American ones, as it cannot do both. Moreover, any US deal is likely to constrain the UK’s ability to do deals with the rest of the world too.  

It is with public health that the concerns are greatest. Johnson has hinted that he might revisit the sugar tax, despite now extensive evidence that such policies work, while commentators have noted the close links between his campaign team and the food industry.  

The one area where there is some clarity, at least in his pronouncements, is that he intends to leave the EU, “do or die”, on 31st October 2019. This has profound implications for the UK. While he has said that he hopes to leave with a deal, he has so far failed to provide any explanation of how he will achieve this. The EU has made it absolutely clear that there will be no renegotiation of the Withdrawal Agreement, which Theresa May was unable to get parliament to endorse. Its contents are a logical consequence of the British government’s “red lines”, especially restricting freedom of movement of people and exiting the customs union. The EU has made a major concession in accepting the so-called “Irish backstop”, requested by the British government to avoid a border between Great Britain and Northern Ireland, so it is very difficult to see what more could be done. 

This is not, of course, how it is seen in the fantasy world inhabited by many Brexit supporters. Drawing a false analogy with a commercial negotiation, which Brexit most certainly is not, they seem to believe that by holding out the EU will somehow cave in. Yet to do so would undermine the fundamental principles of the EU and likely require a Treaty change, something that would take years. They also seem to think that if they do have to leave with “no deal” they will somehow be able to agree a series of mini-deals to cover particular sectors. Again, this is not going to happen, and the few concessions the EU has made, for example to allow planes to continue to fly, are strictly temporary and to protect its own member states. Another fantasy is that somehow nothing will change as the UK can invoke Article XXIV of the General Agreement on Tariffs and Trade, a provision to facilitate trade between two states waiting for a new agreement to come fully into force. This claim has endured despite being refuted by almost everyone who understands it, including the Director General of the World Trade Organisation and the British Secretary of State for International Trade. Finally, we are encouraged to set aside the facts and simply believe that it will be alright, echoing the view that is seemingly widely held among those interviewed on the street by the BBC that a country that survived two world wars will be able to survive Brexit. Somehow the casualties of those wars never get mentioned. 

Theresa May might have said that “no deal is better than a bad deal” but her persistence with her doomed agreement suggests that she did not actually mean it. It now seems that the UK could well crash out of the EU at the end of October. As I described in a previous BMJ Opinion piece, this would have catastrophic consequences for health. The preparations that the UK government has made may help a bit, at least in the short term, but ultimately they are unsustainable. The UK must agree some sort of trade deal with the EU but this will be impossible without agreement on its financial obligations, citizens’ rights, and the Irish border, the three topics covered by the ill-fated Withdrawal Agreement. And even if this was agreed, it would take years, perhaps a decade, to agree any future arrangements. And the trade deals promised with the rest of the world are just not happening. Indeed, by leaving the EU, the UK is leaving deals with many of the countries, like Canada, that it plans to reach new deals with. Of course, the true believers will reject this view as “project fear” but we should recall that, so far, they have been wrong about almost everything.   

So do these events justify the word GUBU? A US President has just attacked a British ambassador, describing him as “wacky” and a “pompous fool” and causing him to resign while a former foreign secretary and potential future prime minister has refused to support him. That same person has suggested that he might suspend Parliament to ensure that his policy of “no deal” goes ahead, a move that, as his opponent in the race for the leadership has noted, led to a civil war when it was tried previously. Many elements of the government’s Brexit plans have been a farce, and in some cases, like the contract with a ferry company that had no ferries, a very expensive one. A British government is actively pursuing a policy it accepts will make the country poorer. And the mechanics of government are paralysed, with departments incapable of introducing measures to tackle growing problems such as the crisis in social care. It certainly seems an appropriate descriptor.

Jennifer Cassidy, a former diplomat now at the University of Oxford, and who is herself Irish, has said “This cannot become the new normal. We must fight this, with logic, truth, morality and diplomatic protocol and law. It will be a tough fight but we must try.” This surely seems like sound advice.

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

Competing interests: None declared.