Intended for healthcare professionals

Observations Health Policy

What a Johnson or Corbyn government might mean for the NHS

BMJ 2019; 367 doi: (Published 20 November 2019) Cite this as: BMJ 2019;367:l6557
  1. Andy Cowper, editor, Health Policy Insight, London, UK
  1. andycowper{at}

Andy Cowper looks at the personalities and politics of the two men who could be the next prime minister

The 2019 general election will be the UK’s third in four years, making rather a mockery of the notion that our “first past the post” Westminster voting system is a prerequisite to creating the conditions for strong and stable government. One key aspect of this system is that (with all due respect to the Liberal Democrat leader, Jo Swinson) the two people who can conceivably become the next prime Minister are the Conservative leader Boris Johnson and Labour leader Jeremy Corbyn.

The economic context of the 2019 general election is that austerity, a central influence on the political weather in the UK since the global financial crisis in 2008, is spectacularly and suddenly over. The political climate in the UK now features lavish public spending promises, with the actual funding sources strikingly ill defined and uncertain.

Within this climate there continues the Brexit culture war between leavers and remainers. Some describe the effect of this as the “Ulsterisation” of UK politics: consensus, compromise, and attempts to seek the centre ground are no longer the way to go. Those who share your party’s views are good; those who oppose them are bad. All this makes the personalities of potential PMs hugely important.

The Conservatives’ problem is that Boris Johnson is a serial liar who can be relied on to be unreliable and to betray or lie to those around him. He was sacked from his first job in journalism for making up a quote and from his job in Michael Howard’s shadow cabinet for lying about one of his affairs.

Gaffes and inflexibility

Johnson is also turning out to be quite a poor campaigner, and the Conservative Party’s campaign so far is notably gaffe prone, including as it does Jacob Rees-Mogg’s comments that Grenfell Tower victims should have shown common sense and fled the building, despite firefighters advising them to stay put, and the resignation of Welsh secretary Alun Cairns.

Another part of the Johnson problem is that his colleagues simply do not know which of them he is going to betray or let down next. If Johnson’s tendency to lie a lot cuts through to the voting public, they may start to question whether his pledges of extra NHS funding are credible.

Labour’s problem is almost the opposite: inflexibility. Corbyn made up his mind about how the world and politics work in the early 1970s, and his views have not changed since.

Many moderate Labour MPs are quitting Westminster, either unable to advocate for Corbyn becoming prime minister or unwilling to continue biting their tongues. The real view of Corbyn’s aptitude among most Labour MPs was demonstrated on 28 June 2016 by the 172-40 vote of no confidence against him by the parliamentary Labour Party.

Yet his massive majority in the subsequent leadership contest showed MPs that the Labour membership remained behind Corbyn. This, combined with his relatively solid performance in the 2017 general election, despite losing it, forced MPs into complicit cooperation.

All this has important implications for the funding of the health service and social care. And one of the consequences will be seeing whether the political adage that the major party with the best leader always wins still stands. Johnson’s Ipsos MORI poll rating of −46 would be enough to give his party palpitations, were it not for the same polling data finding that Mr Corbyn’s net approval ratings are −60.1

Now Labour has come out with a promise of an average 4.3% increase to the NHS budget over the next parliament: £6bn more than the Conservative Party’s £20.5bn pledge.2 Labour also plans to offer free, tax funded personal social care for all adults, but it has not given details on how any of these pledges are to be funded.

The latest financial and operational performance figures for the NHS show further deterioration, to a record low in the case of waiting times targets in emergency departments.345 This is unlikely to help the Conservative Party’s interesting effort to rebrand itself as the party of the NHS.

If the party with the best leader still wins UK general elections, the choice between these two likely lads is profoundly unappetising. This raises the likelihood that voters look at other big issues, and the NHS has been number two in the long running Ipsos MORI issues index for some time.67 The same polling found that a lack of public trust in politics had reached a new high.


  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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