On eve of UK election, availability of healthcare and state of NHS pose late threat to Boris Johnson's Tories

Coventry: Along with millions of Britons, Jules Barcroft bought into the bold promise made by Boris Johnson in the 2016 Brexit campaign: That leaving the European Union would bring buckets of new money into the long-starved National Health Service. So she voted for ‘Leave’, staking her own health — she has multiple sclerosis and lifelong diabetes — on that pledge by Johnson, now the prime minister. Three years later, however, she feels used. “That was all a lie,” Barcroft said. “Why would they look after our medical needs? That’s not high on their agenda at all.” With Britain on the precipice of an election that could soon lead to a decisive break with the European Union, Brexit looks to many people more like a threat to their cherished health service than its salvation. The system has already deteriorated under the watch of Johnson’s Conservative Party, with beds overflowing, waiting times swelling and nurse and doctor vacancies piling up. The National Health Service became an issue in the waning days of the campaign as some hospitals started to buckle under wintertime strains. Experts predicted such troubles could shake up the race, vindicating a drumbeat of warnings from the Labour Party that Johnson was undermining Britons’ health care for Brexit. That has created a potent threat to Johnson’s campaign in the waning days of an otherwise sluggish race. It did not help matters that, shown a picture during a television interview Monday of a four-year-old boy lying on the floor of an overcrowded hospital, Johnson at first refused to look. [caption id=“attachment_7768981” align=“alignleft” width=“380”] File image of the emergency entrance of King’s College Hospital in London. By Andrew Testa © 2019 The New York Times[/caption] Instead he repeated Brexit talking points, leaving many with a lasting image of the sort of icy, oblivious lawmaker who represents what swing voters fear most about the Conservatives’ record on public services. The Conservatives have a considerable lead in most polls, and analysts believe Labour needs more missteps on Johnson’s part to close the gap. Johnson, using the tactics of the 2016 Brexit campaign, has tried to inoculate himself by rebranding the Conservatives as the protectors of the health service, though not without some controversy. He recently had to acknowledge that a pledge for 50,000 more nurses included funding for only 31,000 new recruits. Similarly, after Johnson announced plans to build 40 new hospitals around the country, it became clear that the government was giving the money to six hospitals to upgrade existing buildings. But that has not stopped Johnson from writing a stream of Twitter posts about the health service and visiting hospitals with promises of better primary care and new equipment. The efforts may have paid off: Some polls show that Johnson is now more trusted than the Labour leader, Jeremy Corbyn, to take care of the health service. But the challenges to the health service will continue after the election on Thursday — all the more so if the result leaves Britain heading toward contentious post-Brexit trade negotiations with the United States. President Donald Trump, as part of his “America First” agenda, has vowed to make foreigners pay more for American-produced pharmaceuticals. Britain, desperate for a post-Brexit trade deal with the United States, would be susceptible to requests that it drop its stranglehold on drug prices, trade experts say. At the same time, pressure on the health service has been building since the Conservatives came to power in 2010 and trimmed annual budget increases during a long period of austerity. Hospital waiting times reached record highs in October, with one in six people who visited emergency departments in England waiting longer than four hours to be seen. The number of people on hospital waiting lists has ballooned to nearly five million. And now the health service is going into winter — a particularly busy period for hospitals — while dealing with a pension crisis, bed shortages and the prospect of a major flu outbreak. Medical chiefs are concerned about how they will cope. “I would say that in the last five to six years, I haven’t seen confidence levels this low heading into winter,” said Siva Anandaciva, a chief analyst at The King’s Fund, a health care charity. Barcroft lives in the Coventry area, a pocket of working-class Labour strongholds in central England being targeted by Johnson, and she is one of many voters for whom the health service has become the dominant issue in the days leading up to the election. Some polls show that the health service is neck and neck with Brexit as the most important issue to potential voters. For Labour, success on Election Day is dependent in large part on whether it can pull the focus from Brexit and make a case that Johnson would squander precious public services. The party has pledged to outspend the Conservatives by pumping an additional £26 billion, or around $34 billion, into the health service annually by 2024. Eager to hold onto its mantle as the party of the National Health Service, Labour has also vowed to undo shifts in recent decades toward privatisation — a move that would entail a major reorganisation of the health service. A Labour supporter for most of her life, Barcroft is sympathetic to Johnson’s message that Britain needs to get Brexit done, despite her misgivings about voting for it in 2016. But since then, she has also dealt with the ravages of an overburdened health service working under the cloud of Brexit. Barcroft, a Type 1 diabetic, has had to keep a stock of out-of-date, secondhand insulin in her fridge, just in case a disorderly Brexit suddenly chokes off her usual supply. With the major insulin manufacturers all in continental Europe, diabetes patients have pushed for guarantees that they will be able to refill prescriptions if Britain leaves the EU without a deal managing future relations. Some patients say they have ordered extra insulin to protect against a no-deal Brexit. Others started buying blood monitoring equipment on Amazon or stocking up on other patients’ leftover supplies, as Barcroft has done. “I do feel a bit like I’ve got to look after myself here,” she said. Barcroft also said her regular nurses were often missing from her monthly infusion treatments for multiple sclerosis. Nearly 5,000 nurses from EU countries have left the British health service since the Brexit referendum, part of an exodus of more than 10,000 European workers who were once a mainstay of the health service staff. And some facilities have flatly refused to give Barcroft her regular medications on the grounds of cost, she said, adding that one doctor had pulled out a book of drug prices to explain why she could not be given her multiple sclerosis infusions in that area. The doctor suggested she take steroids instead. “I came out of there and I just thought, ‘Oh my God, I am such a burden on the NHS’,” Barcroft said. “He literally spelled out to me how much money I was costing the NHS. I just felt like I’m a drain on resources.” She said the experience had left her unable to support the Conservatives, but she also had deep reservations about Corbyn’s leadership. In the days before the election, she doubted that she would vote at all. Trade experts say drug prices could rise further after Brexit. Trump said this summer that the health service would be “on the table” in trade talks, before later backtracking on that claim amid efforts to protect Johnson, an ally, from criticism. But government documents recently circulated by the Labour Party (and initially posted online by an account linked to a Russian campaign) indicated that US trade negotiators saw British drug prices as a “key consideration going forward”. For a country that has not negotiated its own trade deals in decades, the risks to the health service have driven home the fact that Britain will not always get its way on the world stage, said Tom Kibasi, a left-wing policy analyst who once worked for the chief executive of the National Health Service. “It’s just dawning on the public that this idea of a trade deal is not as one way as they think it is,” Kibasi said. “People know when there is a limited NHS budget, if the US forces higher prices onto the UK as part of a trade deal, that means less money for other services. The threat is about selling out the NHS to get a deal with Trump.” Benjamin Mueller c.2019 The New York Times Company