James Forsyth

Sleaze isn’t the biggest danger to Boris Johnson

Sleaze isn’t the biggest danger to Boris Johnson
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This week’s events have undoubtedly done the government damage. But I suspect that ultimately its fate will be determined by whether its gamble of raising taxes to put more money into the NHS results in much lower waiting lists — or just grumpy taxpayers.

Reducing the backlog will require more capacity. So, it is worrying that the Department of Health doesn’t know how many extra doctors and nurses it will need to clear the backlog. The government is currently miles off even its pre-pandemic target of 6,000 extra doctors by 2024. Optimistic numbers suggest there might be 300 more than in 2019, but others think things have gone backwards.

Given how long it takes to train a doctor, the only way the target can be met is through easing immigration restrictions, bringing some retired doctors back into the profession and improving the retention of existing staff. The government, however, is dragging its feet on making it easier for doctors from countries with high-quality medical training — such as Norway, Germany, Canada, New Zealand — to come and work here. At the same time, the amount of bureaucracy facing retired doctors who are prepared to return part-time is so onerous that few bother. Even more alarmingly, the British Medical Association reports that a quarter of GPs are expecting to go part-time in the next 12 months. If these problems can’t be sorted, clearing the backlog will become even more difficult and the pressure on A&E departments will only grow.

Sajid Javid thinks that another way to create more capacity in the NHS is through better organisation of its existing resources. The Health Secretary is struck by the fact that 40 per cent of the NHS budget is spent on treating preventable diseases but only 5 per cent goes on prevention. This kind of shift, though, won’t yield benefits for years to come. In the short term, Javid thinks that diagnostic and surgical hubs can help to clear the backlog.

Education reform is the great cross-party success story of public service reform and Javid has seen how the academies programme has allowed outstanding schools to take over ones that are underperforming. He wants to enable something similar in the NHS, allowing the best performing trusts to take on struggling hospitals. The thinking is that these hospital chains would help spread best practice.

Javid’s other aim is to get the NHS to improve its use of data and technology; remarkably, one in five NHS trusts are still largely paper-based. I understand that the Department of Health wants someone with private sector experience of data and tech for the new NHS chairman.

The Tories have already tried NHS reform once with Andrew Lansley’s effort for the coalition government. The new Health and Care Bill effectively dismantles many of the Lansley reforms. The next effort will have to be more successful, or the Tories won’t get another chance to try to reform the health service for a very long time.