Boris Johnson has made the NHS central to his first weeks in office, alongside his other “people’s priorities” of crime and schools. In a newspaper column last month, he was effusive about “this amazing national institution” and the “care, kindness and professionalism of the NHS” he experienced when having a shard of glass removed from his foot. He has made promises galore to help the NHS, its staff and patients: an extra £1.8bn in capital funding; shorter waits to see a GP; an end to the crisis in doctors’ pensions that has led so many medics to work fewer shifts; and a solution at last – hallelujah (but, note, no details yet) – to the scandal that is social care. It all sounds great. Johnson is presenting himself as a staunch supporter of the NHS. He has even pledged to increase its budget beyond Theresa May’s extra £20bn.
But can we trust Johnson on the NHS? Anyone tempted to take the PM at face value should examine his previous pronouncements on the country’s most important public service. After all, he has previously backed the idea of making patients pay charges for health services that are currently free, such as £50 for calling out an ambulance via 999 for an ailment that turned out to be not serious, arguing that there was both a “moral [and] economic” justification for bringing in user charges and co-payments.
In last week’s Q&A with schoolchildren he said: “I promise not to privatise it”. Of course heHe wouldn’t include the NHS in any post-Brexit trade deal with the US, something Donald Trump has made clear he wants to happen. But this is the same Johnson who, in his 2001 book Friends, Voters, Countrymen, waxed lyrical about the much greater role that private sector provision plays in healthcare elsewhere, hinting that it is a model for the UK to follow. “But it is also true if you look at these other European countries, that they have a far larger private healthcare sector; and you have to ask yourself, as we prepare to spend more of our national wealth on health, how it should be done.”
Consider, too, the views of William Warr. Just six weeks ago Warr wrote in the Daily Telegraph that the NHS did not need a bigger budget – “More money is not the solution”. Greater use of genetic tests to calibrate someone’s risk of illness, widespread embrace of smartphones to help manage existing conditions, and a relentless focus on the prevention of ill-health would prove much more effective, he argued. Days later, Johnson appointed Warr his health adviser in No 10.
So is Johnson’s avowed love of the NHS just vote-winning spin for a possible general election? Or has he genuinely abandoned his politically toxic beliefs in extending the role of the private sector and introducing upfront charges?
Chancellor Sajid Javid’s spending round on Wednesday will yield some headline-grabbing extra money for health, potentially as much as £4.1bn, with £1bn more for social care. Johnson wants to be seen to be delivering on the notorious “Let’s give our NHS the £350m the EU takes every week” slogan he cynically used to rouse support for Brexit in the run-up to the 2016 referendum.
But giving money to the NHS is easy politics. Will Johnson stop the cuts to public health budgets that have reduced access to addiction, sexual health, stop smoking and other key services that are widening health inequalities? Will he embrace minimum unit pricing on alcohol and order the food industry to reformulate its products to ensure they contain much less fat, salt and sugar? Will he come up with dynamic new ideas to overcome the NHS staffing crisis, like admitting that the recent interim people plan is not fit for purpose, reinstating bursaries for nurses, midwives and allied health professionals and tearing down the barriers to overseas staff joining the NHS?
And how will he make it easier to see a GP when the number of full-time equivalent family doctors in England is still falling and a plethora of initiatives has failed to reverse that trend? Solving problems like these, not crowd-pleasing cash injections, will define whether the prime minister really is the friend of the NHS he purports to be.
• Denis Campbell is the Guardian’s health policy editor