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Matt Hancock pressed on in pursuit of lockdowns regardless of the number of Conservative MPs seeking to pull him back. He was thus either a bad politician or a brave one, according to your point of view. Either way, Sajid Javid is determined not to follow in his footsteps.
The Health Secretary knows that the outcome of the next general election may turn on him: if voters become convinced that too many are waiting for treatment, and the issue takes centre-stage, the prospect of a clear Tory victory will recede.
Javid must grapple simultaneously with a promised Mental Health Act, the present Health and Care Bill and the healthcare restructuring it proposes, the unfinished business of social care, hospital queues…and now GP ones too.
That face-to-face surgery appointments haven’t returned to pre-Covid levels is driving lots of patients nuts: unsurprisingly, since the percentage of such appointments has fallen from 80 per cent to 58 per cent.
Those patients kick their MPs who in turn kick the cat. Or rather the Health Secretary, who has no intention whatsoever of taking the rap, any more than he did over lockdowns about which, unlike Hancock, he sung a song that Conservative backbenchers wanted to hear.
Nor will Javid, whose leadership ambitions may not be dead, want to get on the wrong side of the Daily Mail, which has been speaking up for its readers and demanding that Something Must Be Done.
So it is that the Health Secretary has unwrapped a package of carrots and sticks, in the Mail naturally. On the carrot side, there will be extra £250 million, found from goodness knows where, to help get the system back to roughly where it was pre-pandemic.
To further improve access to GPs, millions of patients with minor complaints will be directed to local pharmacies by the online service NHS 111.
More sick notes will be done by other staff to free up doctors’ time, phone systems will be upgraded to make it easier to book appointments, NHS 111 will seek to divert patients with minor complaints to local pharmacies.
On the stick side, there will be league tables, naming and shaming, special measures-type hit squads of NHS inspectors, and the full panoply of Gove-type education-style change.
The same objections to these will be raised as have been everywhere else – with much the same result, we hope. Which isn’t to say that the facts of the case all point in the same direction.
As Andrew Haldenby wrote recently on this site, there were a lot more face-to-face surgery appointments during lockdown than some suggest; online ones can cut down form-filling and speed up treatment…and many patients prefer these anyway, at least some of time.
Furthermore, doctors have a point when they ask what progress there is towards the Conservative pledge at the last general election of “6,000 more doctors in general practice”. History suggests that it won’t be met.
And then there is the truth that dare not speak its name: that some people who want appointments nonetheless don’t need them, which is why NHS 111 is to point them in the direction of the nearest pharmacy, or try to, as it does already.
The upside of free-at-the-point of use is that one doesn’t have to pay upfront (or at all if not a taxpayer); the downside is that one has what inevitably follows: rationing by queue rather than price.
People in neighbouring countries wonder at the strange British habit of free doctors’ appointments. In Ireland, for example – so topical given the Northern Ireland Protocol row – patients pay a small sum. Our neighbours’ roof doesn’t seem to have fallen in.
But such thinking would be, if done aloud by centre-right politicians, further evidence that the effing Tories want to smash the NHS, into which the Johnson Government is actually, needless to say, pouring record amounts of cash.
The sum of the matter is that lots of people want – and indeed need – to see their GPs face-to-face and can’t. A lesson of lockdown more broadly is that conversation at a distance isn’t quite the same thing as conversation in person.
Body language, a view of the whole person, direct physical proximity: these things matter in healthcare, often very much. And in any event, what voters want voters must have, at least unless or until the money runs out.
So if more face-to-face appointments is what they want than more face-to-face appointments they will get, assuming Javid’s measures and Rishi Sunak’s – sorry, your – money delivers.
Or, as Boris Johnson might put it in his demotic lingo: don’t let the argy-bargy get to you, Saji – Vox populi, vox Dei, old bean. Forward to victory!