The Institute for the Study of European Laws hosted a book launch for Hervey, Antova, Flear and Wood’s Not What the Bus Promised: Health Governance after Brexit, on 21 February 2024. People joined in person and online, from several countries, and including representatives from the third sector and private sector. The launch was chaired by Adrienne Yong, and speakers were co-authors Tamara Hervey and Mark Flear, with Charlotte Godziewski and Francesca Strumia as discussants.
The book is an output from several overlapping projects, especially an ESRC Governance after Brexit grant, led by Tamara Hervey, who is now Jean Monnet Professor of EU Law at City, University of London. Mark Flear and Matthew Wood were co-investigators on the project; Ivanka Antova was the project’s post-doctoral research fellow. Charlotte Godzieski commented favourably on the scope, scale and amount of data reported on in the book, the levels and layers of the book, and the interdisciplinary approach. Despite all this complexity, she found the book very approachable, and remarkably easy to follow, even for non-experts.
The book’s core research questions include the following: The Leave Campaign’s implicit promise included that Brexit would involve improvements to the NHS. To what extent is this the case? To the extent that this is not the case, who should be held accountable, and how? What would make for a legitimate post-Brexit health governance?
The heart of the book reports on legal and policy analysis conducted during the period between the EU referendum (June 2016) and winter 2022. Looking at all the components of a health system, and considering likely (and sometimes actual) effects of leaving the EU, the detailed analysis shows that all kinds of Brexit are, overall, bad for the NHS, but some are worse than others. The discussion includes ‘big picture’ analysis, such as for example the effects of changing legal entitlements and opportunities consequent upon Brexit on NHS staffing, medicines supply, or biomedical research. But it also includes smaller-scale, focused analysis, such as the effects of Brexit on receipt of cross-border healthcare by kidney dialysis patients, for example while on holiday; or the effects of Brexit on emergency acute health care situations in the north of the island of Ireland. These individual stories are an important feature of the book’s methodology.
On the question of accountability for post-Brexit health governance, the book draws on data from a series of street conversations, held in Northern Ireland and the north of England, during specific dates important to the Brexit process; and on ‘vox pop’ data from a film made about the project by the social enterprise ShoutOutUK. The street conversations involved photo elicitation: an ethnographically-inspired method that seeks to access understandings and interpretations of the world that would not be easily determined by more standard social science methods like survey data. The researchers showed people a copy of the infamous ‘Brexit bus’ photograph (also featured on the cover of the book), and asked ‘what comes to mind’. From there, they allowed people to tell whichever stories they wanted to tell, with gentle prompting towards questions of accountability, where appropriate. The book interprets the stories people told, and the metaphorical language they used. The suggestion is that people expect some kind of accountability for perceived broken Brexit promises concerning the NHS: while at the same time many people also understood that the ‘promise’ being made was ‘bullshit’ – a kind of lie where both the person saying it and the person listening know that the statement is not true. Accountability is conceived politically (for example, the ballot box, Parliamentary scrutiny, enquiries), but it is also conceived legally (litigation, civil and criminal liability). Here there is an evident gap between people’s expectations and the formal legal position.
But Not What the Bus Promised is more than a piece of legal, political and social history, about Brexit and health. It is also a significant contribution to (socio-legal) research, its methodologies and epistemologies. As Francesca Strumia put it at the launch, the book is really two books in one, and can be read as two readers: a researcher and a reader of stories. The book’s legacy includes that it investigates the intersection between the “noise”, of the time-bound and frenetic pace of Brexit (and its effects on the NHS and health) and the “silence” and timelessness of law.
The book takes very seriously the roles of its authors as positioned researchers, rather than ‘objective’ observers. Both discussants found this transparency and reflexivity an impressive feature of the book. The book draws on, and narrates, the stories that the authors heard from ‘experts’ and people in the street, as they conducted their work on Brexit and the NHS. At the same time, and threaded throughout the text, the book also narrates the stories of the experiences of the authors, before and during the research. Reflecting on these different lived realities, and drawing on those in their analysis, the authors were able to draw out much broader implications on the roles of legal, political science, and more general social science research, both for national policy, and for collective learning. The book’s core call is to a greater humility, and better listening, from those in the academy and policy domains. This is not the kind of false humility that fetishizes the experience and views of ‘the people’; it recognises the role of various types of expertise (especially legal) in healthy public life. Yet neither does it claim that expertise leads to the only kinds of understandings that are important. It is only by listening to those whose views we may find hard to hear that we can hope to move towards accountability for post-Brexit NHS governance.
Leave a Reply