Boris Johnson has questioned the use of what he calls “sin based taxes” to combat the national obesity crisis just days before ministers plan to extend the idea. So how will the front runner to become the next PM look after the nation’s health?

Johnson says he wants to promote walking and other exercise instead of imposing new taxes on producers to reduce the sugar, salt and fat in their food and drinks.

He is of course showing off his low tax credentials to the Tory faithful and stamping a populist beat against the interfering nanny state – mission accomplished, but what about the obesity crisis?

Britons are the fattest in Western Europe. Two thirds of us are overweight. Nearly a third are obese, and this is the second biggest cause of cancer after smoking – according to Cancer Research UK.

Young adults who become obese in their 20s can expect to lose 10 years off their life according to research.

It’s expensive too, with the NHS spending 10% of its budget on diabetes related diseases alone, the vast majority of that on the preventable type 2.

Ministers plan to extend the sugar tax to include milky drinks, after the levy successfully encouraged producers to reduce sugar content. Downing Street have been won over to the strategy and a Green paper is imminent.

Meanwhile Johnson is punting in the opposite direction, asking for a review of the evidence, much of which is already sitting in our laps.

A study by the University of Cambridge in 2015 highlighted why a sugar tax could be so beneficial. Their researchers discovered that 8,000 cases of type 2 diabetes a year were linked to sugary drinks consumption. Since its introduction UK producers have reduced sugar content.

When a similar tax was introduced in Mexico sales of sugary soft drinks fell by 6% in first year. In France a sugar tax forced companies to reduce the sugar content by 30-40%. In Berkley, California a soda tax reduced consumption of sugary drinks by more than 50 percent.

A u turn on the sugar tax by a Boris Johnson led government would come as a bitter blow to all those who have fought hard for pressure on big business, against a powerful corporate lobby with strong links to the Tory Party.

New NHS shake-up?

This is not the first hint that a Johnson led government would take a different approach on health. At a recent hustings event he suggested that the NHS needed more re-organisation, saying it was “not getting the kind of support and indeed the kind of changes and management that it needs”

Details of how this would be done were scant, instead he reassured the audience of Tories that he would get together with Simon Stevens, the CEO of NHS England – an old pal from Oxford days, who helped him get elected to the Presidency of the union, to “sort things out”. Over toasted crumpets no doubt.

Stand by for a new round of secret NHS plans

 More money for the NHS?

We learned recently that Johnson will not be prosecuted over his Brexit campaign claim that the UK sends £350 million to the EU every week, after the case – brought by campaigner Marcus Ball was thrown out by High Court judges. However, a quarter of people believed his promise that the NHS would benefit.

The controversy over the bogus pledge has stuck. Fellow Brexiteer Jacob Rees Mogg believes, “ the promise must be delivered” and Johnson has been going out of his way to plead for more funds for the NHS ever since.

As foreign secretary, he marched into a cabinet meeting to demand £100bn for the NHS. A stunt trailed in the morning press, which did much to expose his leadership ambitions.

Last month, writing for the Telegraph he hammered out another call for funding:

“we need to keep putting more money into the NHS. Of course we can make the system more productive, and of course it will become more efficient – but we must put the money in. The only argument is over how to find that cash.”

Yes – How would he find the cash? Might he ask some patients to pay for their care, or restrict treatment with a batch of new charges? Ever the hapless apprentice when it comes to detail, Johnson has not answered the key questions, including about how much he would spend.

Economists agree the NHS needs at least about 4.5% extra a year and billions and more in upfront funding to pay for extra staffing and hospital repairs that have built up through austerity.

The decision over extra funding was to take place this summer in the government spending review, but in a painful irony the Tory leadership campaign has pushed this back, delaying any prospect of extra money for the NHS.

The Health Foundation has calculated that an additional £3.2bn a year is required to reverse the impact of government cuts on public health which reduced obesity programmes, drug and alcohol services and sexual health services over the last five years.

 But what does he really think?

During the Brexit campaign traditional loyalties were cast aside. On the BBC Marr programme the ex PM John Major revealed Johnson’s view on the NHS alongside other prominent Tory Brexiteers.

Gove had wanted to privatise the NHS, Johnson wished to charge people for health services and Duncan Smith favoured a move to a social insurance system.

“The NHS is about as safe with them as a pet hamster would be with a hungry python,” Major said – ouch.

In 2003 Johnson wrote “If NHS services continue to be free in this way, they will continue to be abused like any free service,” adding, “If people have to pay for them, they will value them more.”

That’s certainly a sentiment that his leadership campaign team would bind and gag him to prevent him from uttering today.

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Open to persuasion?

Johnson has dismissed accusations that he has been taking advice from the far right commentator  Steve Bannon, calling it a “lefty delusion whose spores continue to breed in the Twittersphere”. However, a video obtained by the Observer reveals Bannon talking about helping to craft Johnson’s first speech after he resigned as foreign secretary.

How the NHS or any other domestic policy might be influenced by these far right associations is open to question, but Johnson is seeking to learn from Trump’s political success to feed his own, and runs against his supporters claims that he is  a “harmless” centrist Tory.

Full of contradictions Boris Johnson can go misty eyed about the power of the NHS to care. He described an emotional visit to an NHS unit where he met a young girl receiving treatment for her neurological condition, Johnson declared “if she had been born in virtually any other country in the world, and if she had been born in any other epoch of British history, then she would have had zero chance of receiving that care.”

There are signs too that he might clash with Matt Hancock, whose verve to see more virtual care in the NHS using apps, iphones and skype to relieve the pressure on services seems at odds with most Johnson’s recent comments.

“There is no robot that can provide that therapy. There is no app that can substitute for the patience and understanding of that young medic. You need a living human being to do that job, with a salary decent enough to allow him or her to live within reasonable distance of a hospital in London.”

When it suits, Johnson has also deployed his pen in defence of beds cuts and opposed the closing of community hospitals. But warm words, flag waving and an unhealthy appetite for popular solutions will make NHS leaders nervous.

The last thing it needs is more muddled thinking and knee jerk policy. Others already smell the opportunity to set a new policy agenda.

The right-wing Institute for Economic Affairs has wasted no time in sticking the boot into Johnson’s plan for extra spending, demanding that he end the NHS ‘socialist experiment’ and heavily reform the service. With their close links to Tory minsters public statements by the IEA will no doubt be closely followed by private lobbying.

The truth is we can’t know how Boris Johnson will look after the nation’s health, mostly because he doesn’t yet know himself. We certainly can’t be reassured that he will stick to traditional NHS values. The best defence will be a watchful and engaged public. As a populist Boris will listen to the people – at least some of the time, and the people still want a publicly driven, well-funded NHS.

Paul Evans
Author

director of the NHS Support Federation

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