Book review: Hunt’s dreary, well-informed, well-meaning book about the NHS will make not one jot of difference

24 Jun

ZERO: Eliminating unnecessary deaths in a post-pandemic NHS by Jeremy Hunt

“He who would do good to another must do it in Minute Particulars,” William Blake wrote. “General good is the plea of the scoundrel, hypocrite and flatterer.”

Yet politicians find themselves obliged to talk about the general good. They have to make speeches and issue manifestos about what they will do to make things better for the whole country, or even the whole world.

Although they often have no real idea about how to solve or ameliorate some problem, they have to pretend that they do. How easy, in these circumstances, to degenerate into a scoundrel, hypocrite and flatterer.

Once a politician aspires to, say, the presidency or the prime ministership, speeches and manifestos are no longer enough. A book is required.

Words like “future” and “hope” often appear in the title of this volume, which is unreadable.

Jeremy Hunt is aware of these pitfalls, and has sought with immense conscientiousness to avoid them. He knows that particular cases are more interesting than general moralising.

At the start of the book, he relates a thought which occurred to him a year into his six years as Health Secretary, at Margaret Thatcher’s funeral in 2013, as he listened to the eulogy delivered by Richard Chartres, the Bishop of London:

“He read out a letter she had received from a nine-year-old boy called David, to which she had replied personally. I sat there, and thought: In my seven months as Health Secretary I haven’t read a single letter from an NHS patient. If Margaret Thatcher had found the time to do personal replies as Prime Minister, couldn’t I?”

The Department of Health received more letters than any other government department. It employed 50 officials in the correspondence unit to draft replies, and to protect ministers “from the highly personal and emotional missives received from people who had experienced problems with their care”.

Hunt asked to see one letter a day to which he would write a personal reply:

“I didn’t know it at the time, but this request sent the department into a spin. Sir Humphrey-like meetings were held behind my back to work out if they could dissuade me from such a thoroughly dangerous idea. They saw their job as shielding me from such letters, not exposing me to them.”

He at length received a letter which said: “I am just writing to thank you for the fantastic NHS care I received…”

This, of course, was not the point, and at length he started getting some proper letters of complaint, which were “eye-opening and sometimes horrifying”.

Hunt reckons the problem is that when error is admitted, a search begins for someone to blame. This means mistakes are covered up, nothing is learned from them, and often the same mistake is repeated over and over again before anyone does anything about it.

Hence the horror of the Mid Staffs hospital scandal, which continued unchecked for four years. The whole system is designed to pretend things are better than they actually are.

All this can be stated quite briefly, and is already generally accepted. Atul Gawande, mentioned by Hunt, and others have written about the need, as in the airline industry, for mistakes to be reported, not hushed up.

Once Hunt manages to get a letter a day of complaint presented to him by the department, he drafts a personal reply to it. And he uses some of these letters to introduce each of the 15 chapters in his book: his method is to recount some monstrous case of neglect, before drawing some general conclusions about the need for a culture change within the NHS.

No normal reader is likely to have the stamina to read through all these cases. One soon feels one has supped too full of horrors, and has also had enough of clunky, inconclusive passages like this one:

“I put in place an ambition to halve neonatal deaths, stillbirths, maternal deaths and severe injuries which was very ably led by leading obstetrician Matthew Jolly and chief midwife Jacqueline Dunkley-Bent, which contributed to neonatal deaths dropping by over a third and stillbirths by a quarter over the last decade. I also set up a maternity scheme modelled on what happens in Sweden, to allow instant access to a settlement in maternity cases where the NHS knows a mistake has been made. It was designed to bring faster closure for families and prevent the frustration of long court processes. To my frustration, it was not up and running before I left my role and ended up being cancelled, presumably on cost grounds.”

When I was a child in the 1960s, I knew who my NHS doctor was, and he would visit me at home when I was ill. Dr Price was a comfort both to me and to my parents.

He behaved, so far as I can tell at this distance and through a cloud of the usual childhood ailments, as he would have done before 1948, when the NHS was founded. That was the tradition in which he had been trained.

Does anyone now know the name of their doctor? Hunt works round to this question, and on page 173 states:

“we need a decisive change in the model of care offered by the NHS, so that patients always have one doctor or nurse clearly responsible for their care. In normal circumstances that should be a patient’s GP, although for frail elderly patients it might be a district nurse.”

How right he is, but can such an outcome be attained by Hunt, or some other well-intentioned Health Secretary, declaring that it ought to be attained?

In the absence of a single doctor or nurse who takes responsibility for a patient’s care, the family try to act as champions, desperately trying to see that relevant notes from the past are presented to doctors new to the case, and to provide whatever the harassed nurses are unable to provide in the way of care.

But what a supplicant one feels as one goes about this task of asking the nurses whether they could possibly provide this or that, or simply tell one, on the telephone, what sort of a night the patient has had.

The melancholy paradox must be stated that to survive a stay in hospital, one needs to be feeling more than usually fit, even though one has been taken in because one is more than usually weak.

Hunt is full of good intentions. If he appeared at one’s bedside, he would be marvellously sympathetic. It would do one good to see his furrowed brow. One would be sure he really cares. One might even think that if he was in charge, the world would be a better place.

But as Health Secretary, he too was reduced to the role of supplicant. And his dreary, well-informed, well-meaning book will make not one jot of difference to anything.

The post Book review: Hunt’s dreary, well-informed, well-meaning book about the NHS will make not one jot of difference first appeared on Conservative Home.

Peter Franklin: Five tests for the next Prime Minister

6 Jun

Peter Franklin is an Associate Editor of UnHerd.

The Jubilee was wonderful, but it’s time to start planning for the succession. No, not our next monarch, for whom arrangements are in hand, but the more pressing matter of our next Prime Minister.

We can’t assume that today’s vote of no confidence means the end of Boris Johnson,  but clearly the party must be prepared for a leadership contest. Furthermore, in the absence of an heir apparent, there’ll be no foregone conclusion to the race, let alone a coronation.

Since the implosion of Rishi Sunak, there’s been no heir apparent. So if Johnson does go before the next general election, there’s no guarantee of a speedy leadership contest, let alone a coronation.

Furthermore, it would be the third time since 2010 that the party has chosen a new Prime Minister for the country — so, if it comes to it, we’d better be sure what we’re doing. The voters are in an unforgiving mood right now — and certainly won’t forgive us if we pick a dud. So whether or not you want to bin Boris, it’s important that we give his replacement some serious thought.

But how? Right now, the field of possible candidates is wide open. With no clear front runner, there are — according to the bookies — at least ten candidates in with a significant chance. Jeremy Hunt, Liz Truss, Tom Tugendhat, Penny Mordaunt, Ben Wallace, Rishi Sunak, Nadhim Zahawi, Sajid Javid, Michael Gove, Dominic Raab: I wouldn’t bet my house against any of them.

Choosing on the basis of personality isn’t much help. Most of those mentioned above do have one, but not the stand-out charisma that Johnson brought the fight in 2019. Ideological criteria won’t be of much use either; I’d expect every candidate to toss some red meat to the right of the party while also signalling their acceptability to Red Wall voters in the North and to Liberal Democrat leaners in the South.

Instead of a test of personality or ideology, what we need is a test of seriousness. Each candidate should be asked a series of questions that require properly thought-out answers, not sound bites. After all, if it’s just bluster and balderdash that we want, we’ve already got the master-of-the-art in situ. There’s no point in swapping him for someone else unless the substitute can offer substance in place of stardust.

There are hundreds of questions that could be asked, but here are five to get the ball rolling:

How will you reform the Downing Street operation?

Though the detritus of Partygate forms the most recent layer, the mess at the heart of government has accumulated over decades — not just the tenure of the current inhabitant. Unless a new broom can put this house in order, then how can we trust him or her to make a difference in the wider world?

My advice would be to get government out of Downing Street altogether — and establish a professional operation elsewhere in Whitehall. But I’d love to know if the leadership candidates have other plans. Any or all ideas for cutting through the chaos are worth listening to.

On the other hand, a preference for the dysfunctional status quo would instantly mark out a candidate as undeserving of further consideration. But at least that would save time.

What is a woman?

Yes, I know I said no ideological tests. However, this question is about observable reality not ideology. If a candidate can’t reply with the words “adult human female”, then I want to know why.

I’m prepared to respect — if not agree with — candidates who can set-out a logically coherent alternative view on this issue. But, again, there’s time to be saved here if a would-be-leader of the Conservative Party has nothing but nonsense or evasion to offer.

Will you maintain the UK’s support for Ukraine?

The greatest irony of Brexit is that when “European values” truly came under attack, the leader who stood shoulder-to-shoulder with Volodymyr Zelensky wasn’t Emmanuel Macron or Olaf Scholz, but Boris Johnson.

If the latter is forced out, then the most urgent question for the world is whether a new PM would maintain, strengthen or weaken British support for Ukraine. Looking at the current field of possible candidates, there’s scope for all three outcomes — and that could have an impact not just on the UK’s position, but that of the West as a whole.

Foreign policy issues rarely make much impact on Tory leadership contests, but this one should be an exception. Beyond the warm words and empty platitudes which the French and Germans indulge in, each of the leadership candidates would need to tell us exactly where they stand on the most important European conflict since the Second World War.

What explains Britain’s terrible record on productivity?

I fear that any debate on economic policy would degenerate into an auction of tax cut promises. Then again, spending promises might predominate instead — especially on measures to tackle the cost of living crisis.

Either way, we need to remember that tax cuts and spending sprees ultimately have to be paid for — and, for that, we need economic growth. So in the event of a leadership contest, what I’d really want to hear from the candidates is an explanation for why UK growth has been so slow for so long.

In particular, I’d like them to explain why Britain’s productivity collapsed after the financial meltdown of 2008 — and why it’s never properly recovered. Of course, it may be that they have no thoughts on this matter at all, in which case we’ll know we have an economic illiterate on our hands.

Are your proposals for solving the housing crisis substantially different from what’s been tried so far?

Any Conservative leadership contest is about the future of the Conservative Party — but without a solution to the housing crisis we don’t have one.

You only have to look at party support by age group to see what’s heading our way if we fail to make the dream of home ownership a reality for Generation Rent. This problem has been staring us in the face for more than a decade, and yet successive Tory governments have stuck to counter-productive policies that have pushed house price inflation higher and higher.

Reform does not guarantee success, but we can either give change a chance or continue down the same road to oblivion. It would be good to know which of these options each candidate prefers.

The ConHome survey’s recent record

3 Jun

The workings of the ConservativeHome monthly survey must be explained once again.  Any Party member can join the panel that returns the online survey by sending a copy of their membership certificate to news@conservativehome.com (or else other evidence of membership).

So since this panel is self-selecting, why do other media publicise the findings?  We believe that the answer lies in the survey’s record during the 2019 Tory leadership election. We conducted four surveys during the membership stage of the contest that saw Boris Johnson pitted against Jeremy Hunt.

Our first, compiled as ballot papers were going out (a few had already been received) found Johnson 67 per cent, Hunt 29 per cent, “Other” four per cent.

Our second, a week later, had Johnson on 72 per cent and Hunt on 28 per cent.

Our third and final survey, conducted last weekend, found Johnson on 73 per cent and Hunt on 27 per cent.

The actual result saw Johnson take 66 per cent to Hunt’s 34 per cent.  So our first survey, taken at the time when many ballot papers were being returned, was within a single point of Johnson’s eventual total.

Giving panel members a don’t know-type opt-out (“other) looks like the wrong call, in retrospect, since it didn’t force a choice between the two candidates.  But getting the eventual winner’s total almost spot-on when many ballots were being returned isn’t a bad result at all for a self-selecting survey.

I know of only one poll of Party members at the time carried out by a major polling company. A YouGov poll for the Times carried out at about the same time as our second survey above had Johnson on 74 per cent and Hunt on 26 per cent.

Our three surveys were thus all in the odd position of being closer to the final result than YouGov’s poll, although the difference between its finding and our last two surveys is very marginal indeed.  But you may see now if you didn’t before why our survey is paid such attention elsewhere.

Hunt. Future leader, if Johnson falls and he returns…or future Chancellor?

18 May

A member of Boris Johnson’s team asked me, when Jeremy Hunt was elected Chair of the Health Select Committee, whether the former Health Secretary should properly hold the post.

He meant that Hunt was in the problematic position of marking his own homework, since some of the problems his committee were examining date back to his own period in office (if not earlier).

Or as a tweet once put it: “Hunt currently on Channel 4 News bemoaning the NHS staffing crisis. He’s going to be furious when he finds out who did sod-all about this between 2012 and 2018.”

The reason I know about this take on Twitter is that the former Health Secretary has put it in his new book, Zero, which ConservativeHome will review in due course.

But it’s worth anticipating whatever we write by reflecting briefly on what the book has to say about the NHS and what it tells us about Hunt.

The arrresting Zero of the title is the number of unnecessary deaths that he believes the NHS should be aiming to achieve.

Both the Stafford Hospital scandal and the Furness Hospital one took place before Hunt’s appointment as Health Secretary under the Coalition.

But babies’ deaths at Furness, which some staff attempted to cover-up, and adults at Stafford, where some patients were left in their own urine, clearly shocked him when the inquiries came.

There are some harrowing stories in the book about avoidable deaths in both places and elsewhere within the NHS.  Rather than quote some I will, for the sake of economy, cite another figure.

Hunt says that there are 150 unnecessary deaths a day, the number he wants to reduce to the lowest possible.  You may say that patient deaths is a partial and thus a flawed prism through which to view the whole system.

Hunt concedes yhat it doesn’t offer a synoptic view, but this doesn’t detract from the energy, intelligence, self-criticism and, to deploy a perhaps over-used word, compassion that he brings to the subject.

Furthermore, the drivers of avoidable deaths – a blame culture, targets (if misused), hierarchies, short-staffing, defensiveness and litigation are also the drivers of wider problems within the system.

You must read the book yourself to get the sweep of the changes that he believes are necessary, and I will pause over only one which he says he dismissed when Secretary of State as too cloudy to prioritise.

Namely, a change in the culture of the NHS itself, and some critics of the service on the right would add that problems with its culture are driven by its nature, which is why it should be replaced by an insurance system of some kind.

You hear a lot from some about the relatively poor quality of NHS outcomes, and Hunt quotes a Commonwealth Fund analysis which puts it ninth out of eleven broadly comparable countries.

You will hear less from the same quarters about other measures, which ensure that the health services comes in fourth overall.

“The NHS scores especially well for the equity of its system, its low administration costs and the speed and safety of care,” he writes.

Lord Ashcroft concluded in his own recent book on the system that it would be impracticable as well as unwise for the Conservatives to seek the tear the health service up and start all over again.

That seems to me to be a statement of the politically obvious, but the research that Hunt quotes is a reminder that health policy, like so much else, requires trade-offs.

Aneurin Bevan traded off worse outcomes than we might otherwise get for more equal access – and other reforming health secretaries, such as Ken Clarke, Alan Milburn and Andrew Lansley have not shifted this elemental dial.

Hunt was not a reformer in the sense of, as David Nicholson said of the Lansley programme, making changes so big “that you could probably see [them] from space”.

He sought to calm the waters that his predecessor had troubled, as is sometimes the case at health and elsewhere, stressing inspection and data, and thus improvement and savings.

The other side of criticism to his chairing the Health Select Committee should be praise for him wanting to do so at all – especially given the context.

Politicians who have served at the top are sticking for less long than they did, and Hunt could quite easily have pushed off at the last election, having failed to win the Tory leadership, and gone to make money elsewhere.

And former Secretaries of State don’t always develop a passion for their subject, though Lansley and Stephen Dorrell, another of Hunt’s predecessors, are among the exceptions to the rule.

He has to be given credit not for concluding that he’d had enough, and would concentrate on other matters if he stayed in the Commons, but instead for rolling his sleeves up and mucking back in.

There is rather a lot of reporting at the moment about the bad character of some MPs, and Hunt is a reminder that this isn’t so in all cases, to put it mildly.  There is a touch of the Head Boy about him (unsurprisingly, he was one).

It will be claimed that his book is an attempt to keep his name in lights as he continues to pursue the Conservative leadership.

By his own admission the latter is more or less the case, but the history of the book casts doubt on the former.  He says that he planned to published earlier, but was held up by one thing or another (such as being Foreign Secretary).

He will know that the odds of Boris Johnson being tipped out have lengthened recently, though there will never be a shortage of action at the bookmakers.

Could he be Tory leader and Prime Minister if Johnson fell?  When they fought it out in 2019, I supported Johnson and our proprietor Hunt.

I believed that the former was more likely to win a general election conclusively.  Lord Ashcroft believed that Hunt was more likely to govern well.  There is no proof of the latter, but I suspect we were both right.

At any rate, Hunt is the best-known and best qualified of the potential successors, in the sense that he’s been around at a senior level for longer.

He’s made mistakes, I hear you say.  And he says so himself in this book.  So much the better: any politician with his experience will have done so, and have the chance to learn from them.

What you see is what you would get: decent, sensible, moderate government, though there a questionmark about strategic intent.

Brexit shouldn’t be the be all and end all of judgement, but I found his shifts from Remain to a Norway-ish position to a harder one hard to compass, though in fairness he’s scarcely the only politician to have shifted view.

He plainly has little time for the Prime Minister, whose qualities he recently failed to praise, and any prospect of his future return to office is linked to Johnson leaving it.

Only one former Tory leadership candidate, Michael Howard, has made it second time round (if you discount Johnson’s own spectacular withdrawal in 2016) – and that was under circumstances unlikely to apply soon.

Hunt would be more likely in my view to be restored to office by someone else, perhaps to his last job as Foreign Secretary…or as Chancellor.

Footnote: during the last leadership campaign, he wanted “to cut corporation tax to Irish levels, 12.5 per cent, which is one of the very lowest in Europe and even in the world”.

Nazanin Zaghari-Ratcliffe. Is the cost of her freedom too high?

17 Mar

Nazanin-Zaghari-Ratcliffe, a dual British-Iranian national, has been released from custody in Iran, and is making her way home to the UK. Detained by the Iranian government over five years ago under allegations she was plotting to overthrow it, her case became even more high profile when Boris Johnson, as Foreign Secretary, misleadingly commented that she had been ‘teaching people journalism’ in the country. Since then, her husband Richard, assisted both in and out of government by Johnson’s successor Jeremy Hunt, has been zealously pursuing her release.

Speaking yesterday morning, the Liz Truss said securing Zaghari-Ratcliffe’s freedom had been ‘an absolute priority’. But that the crucial breakthrough has come at our particular moment of geopolitical tension is not wholly surprising

One of the reasons used to justify Zaghari-Ratcliffe’s detention has been a £400 million debt owed by the British government dating back to the 1970s. We had sold the Shah 1500 tanks. Before the order had been fully delivered, the Iranian revolution brought the Shah down, and replaced him with the theocracy that has continued to blight that historic and beautiful country until the present day. Unsurprisingly, Margaret Thatcher was hardly keen to hand over weaponry or cash to a regime that considers Britain the “Little Satan”. The debt has been a point of tension ever since.

Hunt has been calling for the government to pay up for Zaghari-Ratcliffe’s freedom since last year. A debt, whilst naturally undesirable, sounds better than a ransom, as Henry Hill pointed out on this site last year. When asked about the it yesterday, the Foreign Secretary commented that we were ‘looking for ways to pay it’ and that the debt was ‘legitimate’.

That the Government has decided to take this view now is likely driven not only by a desire to finally wipe out a black mark in the Prime Minister’s ledger. With energy prices surging and weaning Europe off Russian oil a priority, getting Iran’s stocks back onto the world market would be as helpful as a positive outcome to Johnson’s current visit to Saudi Arabia. Moreover, any effort to split the Iranians off from their old ally Russia would be a geopolitical boon.

Nonetheless, this move also stems from the primary objective of post-war British foreign policy: keeping in with the Americans.  Since Donald Trump removed the US from the 2015 Joint Comprehensive Plan of Action (JCPOA) – the Iran nuclear deal, as everyone calls it – and revived sanctions against the state, the foreign policy bigwigs on both sides of the Atlantic have wanted to undo his actions.

Consequently, paying up to Iran would remove one obstacle in the way of clinching for Joe Biden the same prize that the last Democratic occupant of the White House so coveted. But as Stephen Pollard pointed out for Cap X yesterday, the inconvenient truth for Western policymakers was that sanctions had been effective – in 2018 and 2019, Iran’s economy shrunk by 14.3 per cent. That was less cash to spend in its continuing efforts to de-stabilise the Middle East.

If the oil is to flow again (and a cool £400 million is to appear in the Mullahs’ bank accounts) then that economic pain won’t be for much longer. Though the Prime Minister’s conscience may be a little clearer this morning, it would be a shame if it has come at the cost of paying up to a vile and repressive regime – especially just at the time he has been doing such a good job at standing up to Russia’s. At least, for all that, today a little girl has been reunited with her mother, and a husband with his wife. But the Ayatollah and his regime have never been known for their sentimentality.

What our new Next Tory Leader survey tells us about support for the Prime Minister

1 Feb

There have been two Next Tory Leader opinion polls of Conservative Party members elsewhere since our last Next Tory Leader survey on this site.

The first, from YouGov, showed Rishi Sunak leading Liz Truss by 33 per cent to 25 per cent.  Respondents were given a choice of seven options.  (Our panel had been given 15.)

Those figures are less different from our last survey than Opinium’s – the second survey.  It had Sunak defeating Truss in a play-off by 64 per cent to 36 per cent.

At any rate, the panel is nothing if not consistent.  Last time round, Truss was on 23 per cent.  This time, she’s on 20 per cent, and top.

Sunak was on 20 per cent, and second.  Now, he’s on 19 per cent, and second.  Penny Mordaunt was on nine per cent, and third.  Now she’s on 13 per cent, and third.

This is a bit of a showing for an MP who is neither a Cabinet member not a prominent backbencher. Elsewhere, two One Nation-ish potential candidates, Jeremy Hunt and Tom Tugendhat, score less than ten per cent each.

But the real feature to note from this essentially static result is what showed up in the comments and the number of abstentions.

Out of roughly 75 suggestions in the comments, only two people made double figures: Lord Frost, who had 20 mentions…and Boris Johnson, who had 32.

Now look at those absentions – 119 of them compared to only 14 last month.  There is no other way of reading them than that the majority believe the question to be premature.

Put this result together with the panel’s view on Downing Street parties, the Prime Minister’s handling of Covid and this morning’s Cabinet League Table, and you have two polarities.

One is a significant slice of Party members who think that “partygate” isn’t overblown, and that the Prime Minister is doing badly.

A slightly larger one thinks that the party story is overblown, and it contains among it a smaller group of committed supporters of Johnson. They are part of his fightback, reasons for which I gave here.

All concerned think that he and the Government are doing well on Covid – as, hopefully, it at last begins to vanish over the horizon.

And overall there is a small positive movement in the Prime Minister’s Cabinet League Table rating, but it is still in the red.

So is the next leader question premature?  All I can say is that about 150 respondents either didn’t answer the question or wrote in for Johnson, and about 850 either did or wrote in for someone else.

Lord Ashcroft: Parties aren’t Johnson’s only problem – his voters are awaiting real, positive change

27 Jan

Lord Ashcroft KCMG PC is a businessman, philanthropist, author and pollster. For information on Lord Ashcroft’s work, visit www.lordashcroft.com

The front page of Wednesday’s Daily Mail bewailed “a nation that’s lost all sense of proportion”. The paper remains a good barometer of opinion for a large chunk of the population, and many people will have nodded with approval at the headline.

The splash cited a political class fretting over the Prime Ministerial birthday cake while Russia prepared for war, but this was not the only incongruity at hand. Readers might also have wondered whether a lengthy investigation into alleged Downing Street parties was the best possible use of the Met’s time, especially given that this news emerged on the day a woman was murdered in broad daylight on a London street by a man who by all accounts ought to have been in its custody.

Perhaps they also considered it curious that the fate of a leader who owed his position to nearly 14 million votes and an 80-seat majority in parliament seemed to depend so heavily on the judgment of a civil servant. If Boris Johnson survives it, the last few weeks might look quite bizarre in retrospect.

But that is not to dismiss the charges against the Prime Minister. Many will be understandably aghast at reports that Johnson and his entourage ignored rules they had imposed on the rest of the country – or, to look at it from the other end of the equation, imposed rules on the country which they themselves evidently considered unnecessary.

Even leaving aside the rights and wrongs, the political blunder is extraordinary: the government otherwise has a reasonably good story to tell on Covid. After one of the most successful vaccination programmes in the world, Britain is the closest of any country in the northern hemisphere to being out of the pandemic, according to Professor David Heymann of the London School of Hygiene and Tropical Medicine (and if that doesn’t sound like something the government should get the credit for, imagine who would be blamed if the opposite were true).

Yet the party saga is only one reason for the slump in public approval for the Prime Minister and his administration.

People’s relief and appreciation for the vaccines translated into double-digit Conservative poll leads that were never likely to last. During the crisis people were willing to suspend judgement and give ministers the benefit of the doubt, but the ebbing tide of the pandemic reveals what else is on the government’s agenda – or rather, what isn’t.

“Get Brexit Done, Unleash Britain’s Potential” was the crisp and effective slogan of 2019. No-one can deny that the first part was achieved in short order. We are still waiting for news on the second.

Things were inevitably derailed by Covid, but the Levelling Up White Paper – promised “later this year” in May 2021 – has yet to appear. The excellent aim of spreading opportunity and prosperity has been the driving force of the most successful Tory governments – promoting home ownership, encouraging new businesses, giving more people the chance to invest in industry, expanding university education and reforming welfare to make work pay all fall under that heading. What it means to Johnson remains an open question.

Meanwhile, we see lavish spending on unreformed public services, higher taxes, and rocketing living costs spurred by the government’s own energy policies. The air of at least comparative competence that traditionally helps keep the Conservatives in office seems to have taken a sabbatical.

All these complaints are real and justified and help explain Johnson’s predicament. But at the same time, it’s important to recognise what isn’t happening. For the Prime Minister’s many detractors, the last few weeks have seemed a vindication. “See? Told you so” has been the theme. But disgruntlement with a leader is not the same thing as wishing you had never voted for him.

Given the choice that was before them, vanishingly few will regret having helped send Johnson to Number 10. Still less will they repudiate the reasons why they did so. They really did want to get Brexit done, whether to see their own referendum vote honoured or to climb from the quagmire that politics had become. For many he represented a view of Britain that they shared, and which was a million miles from that of his opponents (he seemed to like it, for a start). Even Jeremy Hunt, whom I backed for the leadership, has said that only Johnson could have produced the amazing result.

Two years later, as the Prime Minister continues to give his many opponents the ammunition to eject him from office, they would do well to remember how and why he attained it.

Some of them might also reflect that for all their talk of probity in public office the thing they can’t forgive him for is that, by delivering Brexit, Johnson did what he was elected to do. But for his voters, that achievement was banked long ago. If they decide it’s time for him to go, it won’t just be because of warm Chardonnay in the Downing Street garden – it will be because there was so little else to remember.