After all the sound and fury, we now know the result of the EU referendum and it is likely to have major repercussions for the NHS.
The referendum campaign was notable for the prominence of the NHS, including the Brexit bonus of some £5 billion to be funded by savings from our EU subscriptions.
Those savings will, however, only become available once we have left the EU in a minimum of two years’ time and may be reduced by any payments required to retain access to the single market.
In the meantime, the prospect of formal Brexit and all the attendant uncertainties are likely, at least in the short term, to have a cooling effect on the economy, depressing activity and tax receipts. The government may well therefore have to run a higher borrowing requirement, raise taxes, cut spending or a combination of the three.
The warm words for the NHS during the campaign do not, as we have already seen, represent commitments but are likely to raise issues of trust during a period when an early General Election cannot be ruled out. This should afford the NHS a degree of protection but on balance times look set to get harder.
More prosaically, the impact of Brexit on the workload of civil servants and NHS managers should not be underestimated and will divert attention from day to day business. Several initiatives may be delayed or binned in consequence eg the Accelerated Access Review.
In the wake of the Prime Minister’s resignation, the coming days and months will be politically febrile but, as ever in human affairs, there will be opportunities as well as threats arising from Brexit.