Like an overstressed junior doctor running around the wards dishing out medicaments, Boris Johnson has spent a good deal of his first fortnight in office attending to the poor old National Health Service.
His tour of the wards and ambulance stations has a frenetic, almost panicky aspect to it, as if, just say, he was also concerned about patching up his party’s record on the NHS in the event of an early general election. His latest pledge is some £250m for artificial intelligence.
Leaving aside the obvious wisecracks that any Johnsonian involvement with intelligence, artificial or human, usually prompts, it is something that should help diagnosis, inform clinical decision-making, and free staff from administrative tasks in favour of “frontline” patient care.
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His other initiatives are equally welcome. The AI move follows the announcement of £1.8bn for 20 upgrades at hospitals in “left-behind” towns, largely in the north (and often, oddly enough, in Leave-voting marginal constituencies). Mr Johnson, his health secretary, Matt Hancock, and the chancellor, Sajid Javid, have also moved swiftly to remove the pensions anomaly that has artificially depressed senior doctors and clinicians’ overtime earnings. Mr Johnson has also promised to reduce waiting times for a GP appointment and for treatment in accident and emergency departments.
During his leadership campaign, Mr Johnson even promised an unspecified pay rise for public sector workers, still to be actioned. Even more ambitiously he has told the Commons that, in the absence of any a cross-party consensus, he will “fix” the care crisis himself.
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Mr Johnson knows that he will never be able to convince the electorate that the Conservatives are the best party to protect the NHS, but he does seem keen to bury the old austerity vibe, and to make some show on delivering the infamous £350m a week in extra funding promised on the side of his Vote Leave bus in 2016.
Yet still the embarrassing statistics are being wheeled in to the political emergency care bay. NHS England confirm that the four-hour A&E waiting-time target has now not been met since July 2015 – some 86.5 per cent of patients were seen within four hours last month, against the target of 95 per cent. In addition, the government has failed to meet six out of its eight cancer targets, the ambulance waiting-time target, the six-week diagnostic target and the 18-week wait for treatment.
The greatest irony is that Mr Johnson’s Brexit project will make success almost impossible for any efforts he makes to improve the NHS. Even without the nightmarish no-deal scenario, we know that the NHS will find it much harder to recruit and retain staff from the EU, skilled and unskilled.
The hit to the economy and the public finances will also make it much more difficult for the government to fund the improvements without recourse to an even more substantial increase in the budget deficit and the national debt than is being planned. A savage devaluation of sterling will make it more expensive to import drugs and equipment and, most likely, push even more EU workers home.
As the Conservatives used to say before Mr Johnson arrived, there is no magic money tree, and certainly not of the kind to provide for “current” spending such as wages and recruitment, as opposed to investment. The prime minister’s approach seems to be to promise the impossible, spend now and ask questions after the election. A familiar theme from the Vote Leave campaign.
Brexit, in other words, will render the £350m-a-week NHS pledge even more ridiculous and unrealistic. Mr Johnson is engineering an old fashioned pre-election boom – tax cuts included. The bills will roll in well after polling day.
No-deal Brexit would pile catastrophe upon disaster on to the NHS. During the spring, when the Brexit deadline was set at 29 March, the Department of Health was busily trying to stockpile medicines and even body bags. Those preparations are no doubt being pursued once again, but there is no way that the NHS will be able to escape the chaos of a no-deal Brexit any more than the rest of the economy. There are limits to how much material, including radioactive isotopes, can be stored in any case.
No wonder, then, that the Johnson team inside No 10 seem to be looking at an election immediately after their forced Brexit, in early November. They hope that it will be too soon for the full horrors of Brexit to play out, including in the NHS – but still with the delivery of Brexit on 31 October an established legal fact. Maybe their subterfuge will work – this gang have a track record in playing fast and loose with facts and political convention.
A cynical, fanciful pledge of an extra £350m a week for the NHS will no doubt find its way into the Conservative manifesto, which is no doubt being written even now. No one should be taken in again by that. In the months after, however, there will come a terrible financial and clinical reckoning for the NHS. The question is: will Mr Johnson, Dominic Cummings and Michael Gove will be allowed to get away with it again?