Health Governance after Brexit: Law, Language and Legitimacy

Language such as 'a red, white and blue Brexit' or 'Brexit means Brexit' allows for an array of ideas about Brexit to be projected onto the process of the UK leaving the EU and what it means. The EU is not just a political organisation, it is also a legal organisation. Leaving the EU means agreeing a new legally expressed relationship for now and for the future. It also means new UK laws, such as a Trade Act and Immigration Act.

We are investigating the (legal) language of Brexit, and comparing how elites and ordinary people understand it. We are doing that in the context of a topic that matters a great deal to the general public: health and the NHS. We want to analyse what the new laws will mean for patients, for NHS staff, for drugs, medical devices and equipment, blood and organ donation, and for laws that affect our health, like food safety and tobacco regulation. It may not be immediately obvious what the effects of general laws (like the Trade Act) or agreements (like a UK-US trade agreement) will be on health and the NHS. We will analyse the texts to find out.

To make that legal analysis useful, we will work with some specific groups, all of whom have expertise in key areas impacted by Brexit, to help us understand what scenarios the people they work with or represent are facing. These groups will include Kidney Care UK; the Faculty of Public Health; and the Colleges of Midwives in the UK and the Republic of Ireland.

Once we have done that, we will find out how the general public understand what is happening to health and the NHS post-Brexit. Are people happy with the changes? Who do they think is responsible and should be responsible? Do they think the new law is legitimate? We will work in two places that represent different issues in a post-Brexit world: the north of England, and Northern Ireland. The north of England is a 'left-behind' region economically, and this is one explanation given for its pattern of Leave voting. Northern Ireland faces special challenges post-Brexit, because it shares a land border with the rest of the EU. Health services have been shared in the north of the island of Ireland for a long time, and EU law has helped to support that.

We will carry out street interviews, to understand how ordinary people think about abstract ideas like Brexit and accountability. We will use the information from our legal analysis to ask people what they think about what the new laws mean - for patients, for NHS staff, and so on.

Finally, we will compare the language that the law uses, and that experts use, with the everyday language used by the general public. When we talk about abstract things, we often use metaphors, like 'red, white and blue Brexit'. Examining metaphors will help us to understand how people feel, and whether the general public feel the same as experts. Metaphors will help us find out if there are gaps between how people feel about the new post-Brexit laws on health and the NHS, and what those laws achieve. This will help us understand whether post-Brexit law enjoys social legitimacy - and if not, why not. That could - and should - inform policies about what to do about it.

The project builds upon the applicants' work. Our professional and policy networks (within and beyond academia, law and public health) will help cement its impacts. We will ensure the insights developed become widely read, and central to academic, policy and public debates on post-Brexit governance. We will also ensure the project findings are impactful within debates on the public understanding of constitutional arrangements and their social legitimation.
The desk-based and street interview research comprising the core of this project will inform debates within academia, regulatory and policy stakeholders, and wider publics, on elite and public understandings of post-Brexit health governance and its legitimacy. This will in turn make it possible to further reflect on improving legitimacy should a gap between elite and public understandings be revealed. The research is likely to be of specific relevance to (1) policy/legislative communities; (2) health professionals; (3) third sector organisations; (4) wider publics; and (5) scholars (see Table 4 in separate document and Pathways to Impact).

We have in place a strategy to ensure the integration of perspectives from elite stakeholders from the very start of the project, throughout and long after. Co-producing scenarios at the initial stages with selected co-producer stakeholders ensures direct policy and practical relevance for those stakeholders, and others in similar positions. We therefore expect the legal analysis we undertake to have at least an indirect and possibly a direct impact on policy and practice of those stakeholders. Our dissemination plans ensure that our analyses reach other elite stakeholders with an interest in the work in a timely manner.

Wider publics feed into the project through street interviews, and an important aspect of the project's findings will be communicated through the documentary film, which will be launched in a public event in Belfast. Wood has already worked with ShoutOut UK and will continue to do so after the project ends to ensure sustained legacy for the project's findings. This will ensure the alignment of the project with their needs.
The project Steering Group (see Case for Support) lends significant expertise and support for facilitating project impact. The Steering Group includes law and governance scholars (Donnelly, Hunt; Schillemans); sociologists and social research methods scholars (Benson; Fierlbeck; Richardson); and public health and science specialists (McKee; Galsworthy) (see further Table 7).

Our plan to integrate the responsiveness of the research process and impact-generation within the design of the research entails the involvement of elite stakeholders in co-constructing scenarios affected by Brexit. This follows from Wood's current ESRC project focused on co-production of research questions and data collection with regulatory bodies (ES/L010925/1). Co-production will ensure the research is embedded in key user communities. Wider public dissemination of findings will also occur through media pieces, tweets with a dedicated #, and project website. Tweets will facilitate public participation through project team responses. Contacts made during the project will be developed and maintained, and informed of events and outputs, so as to continually secure and gauge impact.

The co-production process will be innovative in extending beyond project design, incorporating data collection and project outputs. The street interviews will involve members of the public with the documentary film to integrate elements of the data collection with public-facing engagement outputs. The project will not only co-produce key questions and themes informing the research, but data collection and engagement/outputs will be integrated at the end of the project in a reflexive way. This will ensure significant legacy engagement and a broad potential impact from the project.