Healthier ever after? The NHS as a campaign issue

My long-time collaborator and friend, Martin McKee, saw it before I did.

“I’m getting a few people together on the health aspects of the EU referendum debate”, he explained, back in January (“A few people” for Martin tends to mean, say, members of the House of Lords, or the Royal College of Physicians, or in the World Health Organisation). “We could do with a lawyer who understands the EU and health – would you join us?”

One thing the EU referendum has taught me is that the claim of authority that comes from the kind of knowledge built on deep reflection and learning, valued within the academy, is much more fragile than I hoped.

And so my involvement in the EU referendum debates began. A small contribution, in the grand scheme of things. I spent an entire weekend reading, re-reading and decoding the negotiating texts of the The Transatlantic Trade and Investment Partnership. I nervously prepared to speak on Radio ٤, appear in a panel for Sheffield Law School, address a group of interested people at CoVi with Craig Bennett of Friends of the Earth and Lord Andrew Lansley, the former Health Secretary. I learned more about how social media works from Mike Galsworthy of ScientistsForEU. I reluctantly deleted a post on Facebook, because someone in another law school dubbed the post as ‘smug’ for its claim of expertise.

My daughter searched the internet for a quotation from the late MP Jo Cox, and painstakingly wrote it on our front window, as a small act of solidarity.

And, even by 22 June, there was still a part of me that simply could not believe that the NHS could be such a central part of the EU referendum debate.

Because the way health systems are organised and financed is not an EU competence. Because EU migration isn’t the main migration issue when it comes to health. Because governments have a great deal of discretion on how they implement EU law involving health (even public health). Because EU governments have negotiated health system opt outs from TTIP.

But these were all nuances that became lost in the way the discussions unfolded.

When you’ve spent your entire career, as I have, learning about and teaching EU law, and trying, in any small way possible, to use that knowledge to pursue socially progressive agendas, it does feel odd to be arguing for the EU. After all, as I have often observed to my students, the EU may be understood as a “nasty capitalist organisation”. Trade deals (like the TTIP) can have similar unpleasant – and sometimes devastating – effects on those without power.

But the UK referendum on EU membership forced us all into a yes/no debate. There’s no room for the conditional in such a choice. So, at least to begin with, I found myself explaining the potential of the EU for change for the better, with illustrations of those things that the EU has done (for women, for workers, for impoverished regions, for the environment, to constrain the global tobacco industry, and so on) as evidence of the promise of more.

But as time went on, I found myself spending a great deal of time simply correcting gross factual inaccuracies as they emerged and trying to use legal arguments to stop misleading uses of the NHS logo.  I had not appreciated the ways in which the media, in an age of ‘instant news’, simply reproduce each other’s stories, without checking their veracity. Parts of the media from which I expect more disappointed me hugely. I will never buy the Guardian again (though they did publish a later letter).

And it wasn’t enough.

For me, as perhaps for others in universities, the ways in which “experts” were depicted by the media as untrustworthy became impossible to ignore. Scientists, economists, academics were all branded as equivalent to power-driven politicians. As my former colleague Rebecca Sanders observed, it is hugely insulting to assert that the general public are not interested in the views of experts, or too stupid to understand those views.

One thing the EU referendum has taught me is that the claim of authority that comes from the kind of knowledge built on deep reflection and learning, valued within the academy, is much more fragile than I hoped.

But equally, I was reminded, over and over, of the generosity of the academic communities to which I am privileged to belong. In Twitter conversations, emails, Facebook, videos, infographics, and in face-to-face encounters – people were giving up their time and energy to inform and assist. Some were ‘big names’ – known to me only through reading their published work. We were all still doing our ‘day jobs’ – teaching students, marking their work, writing papers, going to meetings. But no one was ‘too busy’ or ‘too important’ to opt out. And in all of this, the disciplinary distinctions that sometimes beset universities were irrelevant. This was the academy at its best.

I can’t name everyone here. I lost count of the times Steve PeersPaul James Cardwell and Jo Shaw helped me out. I couldn’t have got on top of The Transatlantic Trade and Investment Partnership without Gabriel Siles-Brügge.

Simon Hix (by Twitter) and Lisa McKenzie (by email) reminded me that, while overall immigration is a net benefit to the economy and creates jobs, we mustn’t ignore its geographical dimensions. The localized effects of migration are an important part of the lived experiences of many in the UK today. Rather than demonising immigrants, we need redistributive policies that bring more local services – including health services – to those parts of the UK directly affected. Now the UK has to renegotiate its agreements with the EU and the rest of the world. The details of these agreements will affect the NHS, public health, education, and social welfare both indirectly through their effects on the economy, and in some cases directly. Where global (or European) trade is underpinned by law that supports the interests of capital, there’s a job to be done to secure a better deal for those who need it most. Law professors have a small part to play.

I shall be carrying on, until we are all ‘healthier ever after’.