What happens when the Prime Minister is incapacitated?


Boris Johnson’s admission to hospital has led to speculation about who is ‘in charge’, if he is not able to fulfil his duties. Former Unit Director Robert Hazell outlines the constitutional position when the serving Prime Minister is incapacitated, arguing that our parliamentary system allows for greater flexiblity than a system in which a president is directly elected.

Since Boris Johnson was admitted to an Intensive Care Unit, the airwaves have been full of speculation about how government will be conducted in his absence, and what would happen if his condition worsens; or worse still, if he fails to recover.

When he formed his government, Boris Johnson appointed Dominic Raab as First Secretary of State as well as Foreign Secretary, and when he went into intensive care Johnson asked Raab to lead the government in his absence. So Dominic Raab will chair meetings of the Cabinet and the main Cabinet committees, and at the end of the discussion he will sum up and pronounce their collective decision. He will represent the government at its regular COVID-19 press briefings, unless he invites another minister to do so: as Johnson himself did in asking Health Secretary Matt Hancock to talk about health issues. And Raab will lead on all the government’s day-to-day business, and in responding to any other emergencies: for example, convening meetings of the National Security Council if there is a flare-up in the Middle East. In all this he will be supported by Sir Mark Sedwill, now a very experienced Cabinet Secretary, and the staff of the Cabinet Office, as well as the civil servants and political staff in Number 10.

What will happen if Johnson is ill for longer than expected? The Cabinet would then have to discuss whether to continue with these temporary arrangements, or start to consider a longer term solution if it seemed unlikely that Johnson could return to office. That leads on to the further question, what would happen if Johnson failed to recover. In those circumstances the Cabinet would then discuss who should be appointed as his successor, and would advise the Queen accordingly. Back in 1963, when Harold Macmillan reluctantly resigned from his hospital bed, it was the party elders (led by the Lord Chancellor, Lord Dilhorne) who took soundings of the Cabinet, leading to the Queen being advised to appoint Lord Home as his successor. But party leaders are now elected by the party membership rather than emerging through secret soundings, which can lead to a much longer process, typically lasting three months if the leadership election is contested. However, these would be difficult circumstances in which to hold a leadership contest, and it is notable that since the change in their rules the Conservatives have twice managed to choose a new party leader without reference to the wider membership – Michael Howard being elected unopposed in 2003, and Theresa May in 2016, when two of her rival candidates were eliminated in the initial votes by MPs, and two other candidates withdrew.

In the event of a contested election the Cabinet would probably advise the Queen to appoint an interim Prime Minister, pending the election of the new party leader. And they might choose as interim Prime Minister someone who was not standing as one of the candidates in the leadership election, lest it give that person an unfair advantage. That is what happened in Australia in 1967 when the Prime Minister Harold Holt disappeared while swimming in the sea and was presumed dead: he was replaced on a caretaker basis by John McEwen, and then by John Gorton following a Liberal party leadership election. But the interim Prime Minister would not lead a caretaker government, in the strict sense of the caretaker convention restricting what a government can do: the government would continue to enjoy a large parliamentary majority, and would be able to govern with the full authority conferred by that majority.

One final comment. A contrast is often drawn between the UK’s unwritten constitution, which has the advantage of flexibility but the disadvantage that we rely heavily on conventions, and written constitutions which – it is assumed – prescribe solutions to these unexpected situations. In fact many written constitutions, including that in Australia, make no such provision and rely just as much on conventions. The real contrast is with presidential systems, where an alternative must be constitutionally provided for if the President is suddenly incapacitated, because the President was directly elected rather than being chosen by the legislature. In parliamentary systems there is no such necessity, because the legislature can choose a successor. The government is chosen by the parliament, and must retain the confidence of parliament; so it is up to the government to choose a leader – and if necessary an alternative leader – who explicitly or implicitly commands the confidence of parliament. This is just one of several respects in which parliamentary systems are more flexible, and more nimble, than presidential systems. 

This is an edited version of a blog that originally appeared on The Conversation

This is the latest in a continuing series of blogs in response to the constitutional challenges posed by the coronavirus. To see past blogs in the series, click here. To be notified of future blogs as they go live, sign up for updates in the left sidebar.

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About the author

Professor Robert Hazell was the first Director of the Constitution Unit, and closely involved with helping the Cabinet Office draft the Cabinet Manual. He is the co-editor of The Role of Monarchy in Modern Democracy, which will be published in July.