What are the implications for health communications of the forthcoming EU referendum campaign?
Grab your pen and circle the date. 23 June 2016 is now almost certain to be the day of reckoning when we decide once and for all (well, until the next time) whether we stay in Europe or break away.
For those working in health policy, the temptation may be to shrug our shoulders in anticipation of a battle already lost – not the result, I hasten to add, but the possibility of anything of significance in domestic policy breaking through the media obsession with Europe. Just look at last week’s headlines. But a cooler analysis is needed to understand the dynamics of the next few months and what it means for those working in and around health.
First up, the politics. David Cameron and his allies are desperate not to be the team who led Britain out of Europe. Despite conceding that Cabinet members can openly campaign to leave Europe, the Prime Minister will be doing everything in his power to keep high profile figures inside the in tent (or not in vocal opposition).
That gives power to the waverers. Ahead of the vote, keep an eye out for warm noises on pet projects in the constituencies of the undecideds. If a stronger hand is needed, boosts from Number 10 to major employers – including in the life sciences industries so long identified as an engine of growth – may encourage business leaders to speak out (and in private to local MPs) in favour of a no-to-Brexit result.
Number 10 is understandably keen to have as calm a domestic landscape as possible ahead of the vote. The EU vote must not become a referendum on an unpopular government so ministers have been told to drop or delay controversial new policies until after June. See for example the shelving of reforms to Freedom of Information (FoI) laws to limit scrutiny of Government departments but potentially broaden the scope to cover voluntary and independent sector providers. Under public pressure, opening up a debate on the future of FoI was not worth the fight.
For Jeremy Hunt (a loyalist who is likely to back the In Campaign) there could be a harder task. The fallout from proposed changes to junior doctor contracts and training bursaries for nurses is rumbling on. The increasing strain on social care funding is creating a ticking bomb that could blow into a ‘scandal’ at any moment. NHS leaders are under significant pressure to bring down the provider deficit before the end of the financial year by any means possible.
Health is also being pulled into the referendum debate by both sides. Some senior figures from the pharmaceutical industry have raised concerns over a UK split from Europe, including the impact on medicines licencing and access to research funding. Meanwhile Vote Leave’s campaign launch video focused heavily on the NHS, reminding viewers how much could be spent on hospitals, medicines and health research if the UK wasn’t paying to be part of the EU. Given the Leave campaign’s Twitter biog (“Take control. Invest in NHS & science. The safer choice.”), you would almost think that health wasn’t a power reserved for Westminster and the devolved nations.
So how do we respond? First, by recognising that controversial new policies are unlikely to be announced between now and the referendum. The proverbial long grass will be utilised for kicking difficult decisions; discussions will be ‘ongoing’. How this will impact on issues of significant political and public interest – such as the announcement on the future of the Cancer Drugs Fund in March – will be interesting to watch.
More broadly, delays don’t mean that all work on new ideas will stop or that controversial decisions will be dropped for good. Stakeholders need to keep talking to officials and politicians, maintaining the pressure and getting ducks in a row for later in the year. Just don’t expect a resolution before June.
Second, any challenging policies that cannot be delayed or dropped need to be resolved – and quickly. Hunt will be under considerable pressure to sort the junior doctor dispute – a Downing Street team wanting to clear the decks may not tolerate the noise required to win this fight. Similarly, if a late winter cold snap arrives and hospital and A&E waiting lists start to soar, expect Trusts to face significant pressure from the centre to clear patient backlogs and prevent damaging headlines.
For health campaigners (and the Labour Party), this could also be a good time to whip up a storm. Campaigns that can catch the public mood might have a greater chance of success in (at least) securing a positive response from ministers eager to be on the right side of the public. Is now the right time to ratchet up calls for a sugar tax to tackle the obesity crisis? Maybe.
Third, use the Euro bandwagon to create debate. Pity the poor journalists covering the Brexit debate from every which way between now and June (and probably beyond). Europe can be a hook – comparisons between the UK and Europe on survival, service performance or integration – will fit with the broader narrative. Stories don’t need to come down on one side of the In or Out fence, but a European angle for research or communications may well be worth considering.
Finally, be prepared for a busy July!