Is the UK health establishment prepared for a populist government?

This opinion piece was first published in the British Medical Journal (BMJ) on Monday June 8. The original version with references is available here.

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The results of Britain’s 2026 local elections, held in May, confirm the collapse of the old political order. The Reformists, a radical right-wing populist party led by Nigel Farage, emerged as clear winners, alongside the populist left-wing Greens. Even if these results do not translate directly into success in the next general election, it would be unwise to rule out the possibility that a populist party could gain access to government. In the case of right-wing populism, characterized above all by hostility to expertise and evidence, this would have serious consequences for public health. The World Economic Forum’s Global Risks Report 2026 identifies societal polarization as one of the top ten global threats. Failure to prepare for a political environment in which expertise itself is contested would amount to gross negligence. The issue is not only political orientation, but also the status of expertise itself in public life.

Government in the United Kingdom has traditionally relied on what Peter Hennessy calls the “good guy” theory, which assumes that well-intentioned actors govern in the public interest. This assumption proved fragile when former British Prime Minister Boris Johnson illegally prorogued Parliament and pandemic-related public procurement scandals showed that private interests trumped public interests. Supporters of reform propose dismantling there remain safeguards, many of which exist to protect the independence of scientific and professional expertise. The main risk lies not only in specific policies, but also in hostility towards expertise itself, combined with policy inconsistency, creating space for irresponsible and harmful actions.

We don’t need to speculate about what this might mean. The second Trump administration issues a warning. In the United States, institutions charged with protecting health have been politicized, scientific agencies have been weakened, and expert opinions have been sidelined or replaced by ideological mandates. The result has been measurable harm, including a resurgence of vaccine-preventable diseases and a reduction in support for those most at risk.

Although the British context differs from that of the United States, reformist leaders have expressed his admiration for the American approach. Meanwhile, many UK public bodies in science, health and the environment vulnerable to a political attack. The UK also does not have a written constitution that would allow citizens to directly hold the government to account. Appeals to the European Court of Human Rights (ECHR) will likely cease if the Reform Party leaves the ECHR, as it has repeatedly said. intends TO DO; protections under the Equality Rights Act could also fall if it were repealed, as the Reform Party has done. propose. Ministers often exercise considerable control over the public bodies that provide their expertise, determining who runs them, how they are funded and what they can say. We have proposed measures to reduce these risks, including putting institutions on a statutory basis, making them directly accountable to parliament rather than through ministers, and ensuring more stable funding. Given what may lie ahead, these reforms are urgently needed.

In such a situation, healthcare institutions will play the role of primary protector and advocate of population health and evidence-based policies. When expertise is delegitimized, policy decisions may be driven by ideology, favoritism, or opportunism rather than evidence. How then should the healthcare establishment prepare? Royal colleges and learned societies are themselves vulnerable. Their charitable status brings them financial benefits, many receive government funding, and all rely on their connections to politicians. They may soon be faced with difficult choices: whether or not to engage in “anticipated obedience”, align with the agenda of a new administration, even if it is detrimental to public health; or resist.

As charities, they operate under constraints. The scope of advocacy permitted by charity law is contested and unevenly applied, creating uncertainty about rights under a hostile administration. Although they may advocate for specific policies, as the Royal College of Physicians has done on smoking, deference is still expected once government policies are adopted.

This deference is based on the assumption that governments respect expertise through evidence-based decision-making, scientific integrity, and the independence of advisors. It also depends on shared democratic norms. What happens when these assumptions no longer hold?

Healthcare organizations in the UK need to figure out how they can defend the integrity and authority of the expertise itself. They should start with a thorough examination of their own situation, the views of their members (if any) and learn from others, from history and currently internationally, to answer the following questions:

• What protections do they have in law?

• To what extent is their income dependent on government funding?

• What are the views, opportunities and risks of and for their members?

• Do they have public support for their work?

• What will they do if their agents are the subject of politically motivated prosecutions or investigations?

• How do they distinguish issues that involve differences in values, such as the role of the state and the individual, from those that involve attacks on their role in providing the evidence that underpins democratic debate?

• Have they learned from their Hungarian, Turkish, Serbian and American counterparts, and built alliances capable of offering support if necessary?

• The risks are all too real and there is no excuse for not preparing for a political environment in which expertise itself is constantly under attack.