Boris Johnson and health: unfulfilled promises

Much has already been written, and more will be, on Boris Johnson’s political legacy. While opinions differ on his strengths and weaknesses, few would argue that he took an unusual, perhaps unique, approach to politics, especially as foreign secretary and prime minister. As he prepares to leave Downing Street, many readers of The BMJ will be reflecting on his legacy in health and the NHS.

In 2015, when he returned to Westminster, there was much cause for optimism. He described his many successes as mayor of London—reducing knife crime, road deaths, and poverty. Once David Cameron, the former prime minister, decided to hold a referendum on the UK’s membership of the EU, Johnson set about campaigning with gusto (albeit after some initial hesitation as he decided which side to support), placing the NHS at the centre of the debate. If people voted for Brexit they would be rewarded by £350m every week for the NHS. This was a masterstroke. We now know that support for Brexit was greatest in those parts of the country where health had worsened most during the preceding period of austerity.1 There was one problem. What he was saying was untrue. Commentators have struggled to find evidence to support his claimed achievements as London mayor2 and, as was pointed out to him on several occasions by the UK’s statistics watchdog, the £350m claim was false.3

This came as no surprise to those who knew him best, given he had been fired twice before—once as a journalist and another time as a junior minister—for untruths.2 But others were willing to overlook these details given his appeal to people who would never previously have dreamt of voting Conservative.

Subsequent events seemed to justify their support for him. The Brexit process was in trouble. Theresa May, prime minister at the time, did find a way that would simultaneously impose a border with one part of the EU—France—but leave another, with Ireland, open, but the consequences, continued regulatory alignment with the EU, were unacceptable to her party. By promising to “Get Brexit done,” even if the details were unclear, Johnson made a rapid political ascent, first to prime minister, and then to an 80 seat majority. He was aided in large part by his promise to build 40 new hospitals. Just as in the referendum campaign, the promises were appealing. But once again, they were untrue.4

Then, in early 2020, disaster struck. A new type of coronavirus emerged in China and rapidly spread across the world. Almost every country introduced unprecedented restrictions to interrupt spread. Johnson rose to the challenge. For months on end he, or one of his senior ministers, would appear on television screens to describe the progress being achieved in dealing with the pandemic. These events have led many to say, notwithstanding repeated transgressions in his personal and political life, that “Boris got all the big calls right.” But did he?

Time is of the essence when a rapidly spreading infection arises. Unfortunately, as the cases were mounting, Johnson was nowhere to be seen.5 The reasons he missed a series of crisis meetings remain unclear, but it is estimated that earlier action might have saved tens of thousands of lives in the first wave of the pandemic.6

Once he did engage with the matter, Johnson did have some successes. His appointment of Kate Bingham to lead the vaccine taskforce was inspired, unlike his decision to place Dido Harding in charge of “test and trace,” a programme condemned by parliamentary committees and the National Audit Office.78

But arguably his greatest achievement was to create a narrative in which the UK, under his leadership, had performed much better than other countries. He argued that Brexit allowed the rapid approval of vaccines, that the UK had the “fastest booster campaign in Europe,” and was “first to emerge from the omicron wave.” None of these are true.9 Other countries did better and the vaccine approval was done under existing EU law. And his narrative excluded the areas where there had been spectacular failures, such as care homes10 and procurement of equipment, the latter characterised by numerous scandals involving senior politicians and their friends and families.11

It is, however, Brexit, at least in the extreme form he has pursued, that will ultimately have the greatest consequences for health. The list of problems is almost endless, from reduced economic growth contributing to ill health and reducing the funds available to the NHS, labour shortages in health and social care and in food production, exclusion of British scientists from European research programmes, and the threat to peace in Northern Ireland.1213 Sadly, none of those who seek to succeed him seem to understand this.

Historians have long argued about who was the UK’s worst prime minister.14 Anthony Eden, who presided over Suez, often features among those in the 20th century.15 The Earl of Roseberry, known as a brilliant orator who was bored with politics, in office in 1894-95, achieved almost nothing except to upset the main European powers. It is very likely, however, that Boris Johnson, who promised much but delivered little, will feature prominently in any listing for the current, and indeed any, century.