From The NHS To Brexit: What Can We Expect From Johnson's Government?

Boris Johnson made a raft of promises and comments indicating future policy during the election campaign. Our specialist reporters take a look at what we can now expect from the government on key policy areas.

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Health

Johnson said the NHS would be his government’s top priority. He has made an array of pledges – on funding, staffing and new facilities – aimed at reviving a visibly ailing service that hospital bosses say is “on its knees”. Johnson’s voluble support for an institution “that represents the very best of our country” means he will be closely scrutinised over the delivery of his promises, several of which may prove very challenging.

Johnson has promised to increase the budget of the NHS in England by £20.5bn in real terms (after inflation) by 2023-24. That is less than the equivalent £26bn extra that Labour offered. While that will be the biggest uplift in cash terms the NHS has ever received, the annual 3.4% rises are smaller than the NHS’s historical average and less than health thinktanks believe it needs, given demand for care is going up very rapidly.

The Conservatives have committed to building 40 new hospitals in England by 2030. Only six of these – which will receive £2.7bn and should be ready by 2025 – have been identified so far. Twenty-one other NHS trusts will share £100m seed money to help them draw up plans for the 34 other projects. Experts say the 40 will cost up to £24bn, although the government’s estimate is £13bn. It is unclear whether the money will come from the NHS’s capital budget or be over and above the sums Johnson and the health secretary, Matt Hancock, have pledged.

Lack of staff remains the NHS’s number one problem. Johnson was scorned for pledging to recruit 50,000 extra nurses and then admitting that 18,500 of them would come from stopping existing staff quitting early. Restoring maintenance grants of up to £8,000 a year for student nurses should improve recruitment, but nursing leaders doubt the 50,000 pledge will be met. There is similar scepticism about the aim of recruiting 6,000 more GPs, given numbers have actually fallen since a 2015 pledge to grow the family doctor workforce by 5,000. Without more GPs the promise of 50m extra appointments a year will prove illusory, even with more physiotherapists, pharmacists and other health professionals working in surgeries to take some of the pressure off family doctors.

Waiting times for A&E care, planned operations and cancer treatment have worsened so sharply in recent years that the Health Foundation thinktank is warning that “the safety net [of the NHS] … is at risk of breaking down”. Delays are the worst since records began. The millions of people affected by longer and longer waits are likely to become Johnson’s biggest NHS problem. He has no obvious plan to resolve this beyond more money, more staff and backing for the NHS long-term plan, which aims to keep people healthier. Denis Campbell

Brexit

Michael Gove has said a new Brexit deal will be concluded by the end of next year. High-level political negotiations will start in February, and the detail of getting Britain ready for Brexit is where the devil lies.

Much work has been done on the new systems that must be in place for the worst possible outcome of talks in relation to the Dover-Calais crossing and other UK-EU trade issues. No work has been done on the Great Britain to Northern Ireland routes that must now be treated as a UK-EU border under the Johnson deal. HMRC has previously said it would take five years to get what was known as a maximum facilitation customs IT arrangement in place.

If tariffs on goods exported from the UK into the EU apply after 2020, a new tariff rebate system has to be bolted on to cover goods that go from Great Britain to Northern Ireland only. This would apply, for instance, to all goods going from Tesco warehouses in the UK to supermarket shelves in Belfast, Derry or Armagh.

Border inspection posts will have to be built from scratch for sanitary and phytosanitary checks on all animals and fresh food going from Great Britain to Northern Ireland. The EU has already said it would prefer them to be in ports such as Stranraer and Liverpool to prevent potential disease in animals, plants or timber pallets making its way on to the island of Ireland.

The Northern Ireland office has had several meetings with business leaders on what checks will be necessary but these cannot be determined in detail until after Brexit on 31 January.

Under the withdrawal agreement, specialist committees to determine this detail cannot be appointed until the withdrawal agreement is ratified. This means they could be up and running by February, leaving 11 months for preparation. But as HMRC has warned previously, IT systems take years, not months, to build. Lisa O’Carroll

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