Boris Johnson must face up to multiple Covid aftershocks

If things go to form, all eyes will be on Scotland by the weekend and Britain’s political discourse will be dominated by talk of constitutional crisis and the battle for a second independence referendum. 

The future of the UK is consuming a significant amount of ministerial focus, not least because losing Scotland would probably be the end of the prime minister as well as the nation.

But increasingly Downing Street minds are turning towards another, less instantly seismic, challenge that could prove just as corrosive since it has a more direct impact on people’s lives. This is the multiple public service crises caused by the aftershocks of Covid-19.

In addition to recognised economic challenges, ministers are increasingly nervous about the daunting set of long-term Covid-generated crises in core state-run services. And while Scottish independence might finish Boris Johnson himself, a visible failure to address these issues will probably do the same for the Tories.

In the NHS, schools, the criminal justice system, social care and other state-run services, there are huge backlogs or strains. Cash alone cannot solve them but there will be extra demands on the Treasury. The danger for the Tories, and a cash-strapped Treasury, is seeing each issue in isolation and as competing priorities. That would miss the full breadth of the crisis and risk a narrative of presiding over collapsing public services. A side risk is that since control of public services is largely devolved, prioritising the issue will force Johnson’s focus more directly on to England.

NHS England is reporting a backlog of 4.7m cases, but this vast number masks the complexity of the problem. The solution for cancer patients, for whom there was an 8 per cent annual fall in urgent referrals, will be very different from that for children’s mental health. Pinch-points around diagnostics might be tackled with specialist centres, but you also need radiologists. Surgery can be lost to a shortage of anaesthetists. Efficiency reforms often require upfront investment. 

Downing Street wants to show quick wins, but the NHS is resisting traditional fixes in favour of a broader strategy for the autumn spending round. More money would come in return for reforms to boost capacity and clear targets to cut waiting times. Chris Hopson, chief executive of NHS Providers, warns: “The mistake would be to rush into an insufficiently thought-out plan which isn’t radical enough but gives the impression of immediate action. The NHS can only solve this scale of problem by transforming what it does, backed by sustained investment over several years”.

The Treasury is nervous of more demands, but when Tony Blair’s Labour government moved to slash waiting lists in the early 2000s it was amid a 7 per cent real terms spending increase. The current promise is 3.4 per cent in real terms, which must also fund existing plans and manifesto commitments.

On schools, the £1.7bn committed to tackle the consequences of the disruption has been dismissed as “nowhere near enough” by Sir Kevan Collins, the education recovery commissioner. He expects the catch-up to be the work of several years. Extended school hours and national tutoring programmes will require more money for teachers.

In the justice system, the crown courts have a backlog of 56,000 cases with some trials not scheduled till 2023. This means more prisoners on remand, a 22 per cent increase on last year. Ministers have promised extra courts and are negotiating extra sitting days with judges. Again, this costs money.

All these issues come on top of the economic challenge and commitments on housing and levelling up.

The need for revenue, especially for the NHS, strengthens those calling for a new tax or charge to fund social care, paid by those over 40. This would bring in extra funds, but does depend on the government producing its long-overdue plan for adult social care. 

There are opportunities. While opponents will argue these problems were exacerbated by Tory underfunding, coronavirus also offers cover for those failings. Ministers will also use the backlog programme to drive reforms, especially in the NHS, where a new chief executive is due by summer. Extra UK-wide branded funds may even assist the argument for the Union.

But this demands a different political approach. For the prime minister does not do bad news. Hope and optimism are his core currencies and this makes him a potent politician. But it is also a weakness when, as in the low points of the pandemic, his blue-skies-are-just-around-the-corner tone does not match the public’s experience.

Allies are urging him to be upfront about all the issues. It is going to require an experienced team to tackle this and openness from him to manage expectations about a multiyear challenge.

Voters do not blame the Tories for the pandemic and, for a time, will not blame them for the aftershocks. But their patience is not infinite. They will want evidence of progress and upbeat assurances will count for little against their own experiences of cancelled operations or other delays.

From policing to health, education to social care, Johnson has tried to reposition the Tories as a party of public services. This means restoring those core services is a key priority and voters may judge the government more harshly on this than for its handling of the crisis, if they feel he has failed in the task.

robert.shrimsley@ft.com