Where will Boris get his ideas from?

Has Boris Johnson run out of ideas? It’s not an unreasonable question at the end of a week in which more than 40 per cent of his MPs said they didn’t want him leading them any more. Still less unreasonable when his big reveal policies have been getting on with something that David Cameron signed off on in 2015 but that hasn’t yet happened; and a ‘once in a generation’ transformation of the NHS which seems to amount to some middle managers going on a course.

The right to buy announcement will merely implement an old policy, while the mortgage review alongside it may help a few first time buyers. The NHS Messenger Review does cover an important issue regarding the quality of leadership in the health service, pointing to the ‘institutional inadequacy in the way that leadership and management is trained, developed and valued’. That inadequacy has clearly been a factor in some of the number of large-scale scandals in the health service over the past few years, but also in the way many whistleblowers are treated, as well as the issue of bullying in certain trusts. Messenger identified the way in which managers tend to ‘look upwards to furnish the needs of the hierarchy rather than downwards to the needs of the service user’.

Oddly, though, you will find precious little acknowledgement of one of the factors the review, led by General Sir Gordon Messenger and Dame Linda Pollard, identified which was political pressure. Either way, the review, which seems sensible enough, isn’t the radical shake up of the NHS that it was trailed as. It’s not even particularly new given there has been a series of reviews on the questions of culture and leadership in the health service in recent years.

Once again, the Conservatives seem to have been looking back to the 1980s for some kind of inspiration: it was in 1983 that the Griffiths Review recommended genuinely radical changes to the way the health service was managed. It was a necessary overhaul but not necessarily implemented in the way its author Roy Griffiths, at the time the deputy chairman and managing director of Sainsbury’s, had intended.

And of course times have changed rather since Griffiths, so there is a need to look at how the health service works. It’s just that this government isn’t prepared to do that. It is unlikely that Johnson’s Blackpool speech on housing is going to rank among one of the seminal moments of his premiership, neither are health service figures going to be talking about Messenger in 40 years’ time in the way they still refer back to Griffiths.

Why the paucity of new ideas and reliance on reheating old ones? James explains the bind Johnson finds himself in here: he doesn’t have the authority or the money to go for things that will make a real difference.

Next week, the Prime Minister will trundle to Doncaster for a conference held by the Northern Research Group of Conservative MPs. They are just one of many pressure groups in the party who have plenty of their own ideas to push the weakened Johnson into accepting. Some of those ideas are very sensible, others will annoy Tory colleagues in other parts of the country no end. But a limping and uninspired Johnson can’t dismiss them out of hand because he needs these MPs to support him. It means he will end up with a real muddle of policies in the run-up to the next election which are characterised by the ability of certain ginger groups to shout loudest, not by his own vision for Britain. And while in the short term that’s all he can hope for, in the long term it will likely make it even harder for him to persuade voters to back him again at the next election.