This Will Kill More Than Covid

Aditya Chakrabortty writes:

For all the crowd noise and heavy-breathing match analysis, British democracy is a simple sport. We elect politicians to serve our interests. They direct the vital services that look after our families and communities, such as our healthcare and our schools. The entire political system rests on one basic premise: they work for us.

Believe that, as I do, and this week is one of vast democratic failure. Rather than working for us, Keir Starmer and his ministers are acting against us. They have rammed through parliament a sweeping law that will, independent experts agree, harm the public; and they have done so without even coming clean on the costs or the consequences. What’s worse, MPs and the press have failed to put this under scrutiny.

One way this has happened is through the use of eye-glazing jargon, to make everything look as dry as possible. So where I can, I shall try to avoid acronyms and technicalities.

In December, Starmer and Donald Trump struck a deal on medicine. Downing Street agreed it would spend more on branded drugs, in return for the White House not jacking up tariffs on British pharmaceutical exports to the US. As I wrote at the time, the treaty stank. One of the greatest achievements of British democracy, our NHS, set up to save lives, had been used to save face with Trump. The most rapacious president in American history now had his hands on our healthcare system.

Wes Streeting and his Department of Health and Social Care gave almost no detail about how much this would cost, or what that meant for patients. They created a black hole of information, then tried their damnedest to present defeat as victory. Look! ministers said: we get to buy these whizzy new drugs from America. Truth was, we always could, if we wanted to – except now the choice was no longer ours.

MPs never got to examine these vast changes. They had no chance to debate the great erosion of our independent system for providing medicine. No awkward backbenchers or querulous lords or scribbling hacks or public information for Starmer and Streeting. Using a statutory instrument, they smuggled the entire thing into law.

Only after the deal came into effect did the government publish even its headline facts and figures, sneaking them out just before the Easter bank holiday. Only this week did MPs finally get the chance to debate the changes, “long after the horse has bolted”, as Labour backbencher Rachael Maskell told me. And this morning we got the first detailed analysis of the cost for you, me and our NHS. The analysis has been conducted by three senior health researchers, including a former senior adviser to the National Institute for Health and Care Excellence (Nice), the body that sets how much we pay for our medicines. Published in the British Medical Journal, it suggests the public has been misled on an epic scale.

When discussing the deal with Trump, Streeting made voters three promises. First, in any negotiation, “the NHS is not on the table”. Second, “we’re not going to cut NHS services to fund the pharma deal”. And finally, over the next couple of years the agreement would cost “around £1bn” a year. All three of these pledges now look utterly false.

In the face of Trump’s bullying, the government will double how much it spends on drugs as a share of national income, going from 0.3% now to 0.6% in a decade. It also accepts that the money will come from the NHS budget. The BMJ analysis suggests that over the next couple of years the NHS will have to find almost three times the amount pledged by Streeting. By the end of the decade, the authors believe, the cost will be a total £44.7bn. For perspective, this week’s headlines have been dominated by a plan that will require the government to find an extra £15bn for defence. The NHS may have to find triple that just to pay for drugs, thanks to a deal fronted by its own health secretary.

That extra money will go from British taxpayers to shareholders in multinational drug companies. And working on the basis that it will come from the NHS budget, the study shows it will cause a massive loss of life. More money for branded pharmaceuticals means less for cancer scans or doctors and nurses, statins and diabetes drugs. Using many years of data on the links between NHS spending and patient health, the authors’ model forecasts that this will cause an extra 229,000 deaths by 2036. The academics describe this as a “conservative” estimate, but it is getting on for double the avoidable deaths Britain suffered during the Covid pandemic. You might call this a massacre made in Whitehall, at the behest of Trump’s White House, in order to buff up shareholder returns.

After the pandemic, Starmer and Streeting rightly led the charge in calling for lessons to be learned. The government was forced to launch an inquiry. Here is a trade deal that looks more lethal than Covid, yet which has been subject to almost zero democratic scrutiny. The Department of Health and Social Care told me it does not recognise these figures, but despite many requests from MPs and others, it has not published its own impact assessment. Indeed, the basics of parliamentary democracy have failed. No inquiry by the select committees working on health or trade or science. No Commons debate until this week, at which a junior minister was put up to catch the flak and was told by one MP that “everything [she] is saying is in the press release”. As for the media, there has been something close to silence. Over the past six months, according to the Guardian’s research and information department, the national newspapers published a grand total of eight stories on this deal that will change the face of our NHS; at the same time they did, however, find space for 274 stories on whether Wes Streeting would become the next Labour leader. One man’s career prospects deserve more airtime than the lives of our elderly, ill and poor people.

Soon, the UK will have a new prime minister, one who promised this week more democracy, more accountability, greater transparency. So here’s a test for Andy Burnham: is he really going to let this fatal deal, cooked up in private and shrouded in unforgivable secrecy, stand?

And Paul Knaggs writes:

Every protection racket works the same way. A man walks into your shop and admires it. Nice little business you have here, he says. Shame if anything happened to it. Then he names his price. On 1 December 2025, the British government paid the man. The UK-US pharmaceuticals deal was announced as a landmark agreement to safeguard medicines access and drive investment. Strip away the communiqué language and the transaction is simple. Washington threatened tariffs of up to 100% on British pharmaceutical exports. London agreed, in exchange for a three-year reprieve, to force the NHS to pay substantially more for branded medicines, most of them made by American multinationals, for the next decade.  This week, we learned the price. Not the price in pounds, though that is staggering enough. The price in people.

TWO HUNDRED AND TWENTY-NINE THOUSAND 

The analysis published in the British Medical Journal on 1 July, authored by Samuel Cross, Karl Claxton and Andrew Hill, is the document the government hoped would never be written. Ministers have refused to publish their own impact assessment, so three health economists did the work for them, using the government’s own methods. Their conclusion: diverting NHS funds to pay more for new drugs will cause roughly 229,000 excess deaths in England by 2036. Include the knock-on damage to adult social care and the figure rises to 291,000. 

For comparison, the Covid-19 pandemic killed 137,000 people between March 2020 and June 2022. We shut the country down for that. We stood on doorsteps and clapped for the NHS. This deal will kill more people than the virus did, and it was signed with a handshake and a press release. These are not abstract deaths. The largest impacts fall on cardiovascular, respiratory and gastrointestinal disease and cancer. They fall hardest on the poorest areas, the places with the highest baseline mortality and the deepest deprivation. The Welsh Valleys. The North East. The former pit villages and mill towns that were promised levelling up and got a levy instead.

The mechanism is not mysterious. Health economists call it opportunity cost. The NHS budget is finite. Every pound handed to a pharmaceutical shareholder is a pound taken from a cardiac nurse, a screening programme, a GP appointment. The Department of Health’s own analysis shows the NHS frontline generates a year of healthy life for roughly every £15,000 spent. Under this deal, the NHS will pay up to £35,000 for the same benefit from new branded drugs. For every year of health the deal buys, it destroys more than two elsewhere. That is not a trade deal. That is a transfusion, running in one direction, from the sick of Britain to the shareholders of New Jersey.

THE MECHANICS OF SUBMISSION 

The deal operates through three instruments, each one a ratchet. First, ministers took powers in March 2026 to instruct the National Institute for Health and Care Excellence to raise its cost-effectiveness thresholds. For over twenty years, NICE would approve a medicine if it delivered a year of quality life for £20,000 to £30,000. From April, the range is £25,000 to £35,000. The same pills, the same benefits, a higher price by decree. The Joint Committee on Statutory Instruments described this use of ministerial direction as an “unexpected and highly irregular use of the enabling power”. In plain English: the government bent the machinery of state to satisfy a foreign power, and bypassed Parliament to do it.

Second, the industry rebate scheme that claws back excess drug spending, known as VPAG, has been gutted. In 2025 the rebate rate stood at 23%. Under the new arrangement it falls to 14.5%, with anti-circumvention clauses that legally prohibit the NHS from recovering the money through any other route. Britain negotiated a treaty clause against its own health service.

Third, the government committed to doubling national spending on new medicines from 0.3% of GDP to at least 0.6% by 2036. The cumulative cost to the English NHS: £44.7bn. The annual cost by 2036: £8.8bn, or £170 million every week. Remember the bus? This is the bus in reverse, and this one is real. Science Minister Patrick Vallance has confirmed the money will come from the existing health budget. No Treasury top-up. The NHS eats the whole bill.

Ministers told the public the deal would cost around £1bn over the spending review period. The Office for Budget Responsibility puts the figure at £3.3bn by 2028-29 alone. The £44.7bn long-term cost appears in no ministerial statement. It had to be excavated by academics. And when campaigners asked to see the government’s own impact assessment, they were refused. Global Justice Now and Just Treatment have been forced into legal action to discover what their government knew when it signed. Think about what that means. The state has calculated the cost of this deal in British lives, and it is keeping the number in a drawer. 

THE EMPIRE SENDS ITS INVOICE 

Now widen the lens, because this deal did not fall from the sky. It is one payment in a larger scheme of tribute. In May 2025, President Trump signed Executive Order 14297, accusing foreign nations of “freeriding” on American pharmaceutical innovation and directing his administration to force international prices up toward American levels. The enforcement mechanism was the threat: tariffs of up to 100% on medical exports from any country that maintained serious price controls. By the end of the year, sixteen of the world’s largest drug manufacturers had capitulated, pledging tens of billions in American factories. AstraZeneca alone committed $50bn to US manufacturing. Eli Lilly, $27bn. Novo Nordisk, $10bn. The capital, the jobs and the plants flow to America. The higher prices flow to everyone else.

This is how empire works in the twenty-first century. It does not send gunboats. It sends the Commerce Department. And Britain has seen this play before, because it is precisely the structure of the NATO arrangement: the ally as client, the client as customer, security sold on subscription with the premium rising every year. We are told to find 5% of GDP for defence because Washington demands it. We are told to find 0.6% of GDP for American drug prices because Washington demands it. The threat and the protection are issued by the same address. Meanwhile, our own political class conducts an anguished debate about warfare versus welfare, as though the only question is which British service to cut to pay the American invoice. It is the wrong debate. A country whose people die 229,000 deaths early has not been defended. It has been harvested.

And here a word must be said about sovereignty, because the people of the heartlands voted for it. Whatever one thought of Brexit, its core promise was self-government: our laws, our money, our decisions. Millions of working class voters did not wrench this country out of one bloc to watch it kneel before another. NICE’s thresholds, the pricing rules of our National Health Service, the allocation of our health budget: these are now set to specifications agreed with Washington, implemented by statutory instrument, hidden from Parliament and litigated out of campaigners. If Brussels had done this, it would be a constitutional scandal. Because Washington did it, it is called a landmark deal.

THE DEFENCE, SUCH AS IT IS 

Fairness demands the government’s case be stated properly. Ministers argue the deal shields £5bn to £6.6bn of annual pharmaceutical exports from ruinous tariffs, protecting a life sciences sector that employs skilled workers across the country. They argue higher prices will attract investment, citing a £300 million AstraZeneca commitment in April. They argue patients will gain access to new medicines. And they can fairly say they negotiated under duress, facing an American administration willing to burn the global trading system for leverage. Each claim collapses on inspection.

The tariff shield defends against a threat that has largely evaporated. A US Supreme Court ruling cut the proposed tariffs from 100% to 10%, capping Britain’s realistic exposure at roughly £500 million a year. The deal’s costs will exceed the entire annual value of UK medical exports to America before 2031. We are paying £44.7bn to insure a £5bn export line against a £500 million risk. No underwriter in the City would write that policy sober. 

The investment argument is weaker still. AstraZeneca’s £300 million is less than 1% of what the NHS surrenders, and the same company has pledged 130 times as much to American manufacturing. The UK represents under 3% of the global pharmaceutical market; the economic literature is clear that domestic prices in a market that size do not move global R&D decisions. Companies invest where the science, the talent and the tax breaks are, not where the procurement contracts are fattest. 

And access? NICE already approves more than 90% of the medicines it evaluates. Its own modelling suggests the higher thresholds will admit two to five additional drugs a year. The overwhelming bulk of the new money will simply pay higher prices for medicines that were coming anyway. As the BMJ authors put it, the NHS has been reduced to “underwriting risk in global pharmaceutical markets”. 

The duress point deserves the most respect, and it indicts the government most completely. Yes, Trump held a gun to the negotiation. But a government’s duty under coercion is to minimise the tribute and protect its people. This government maximised the tribute, concealed the cost, and dismantled its own price defences with anti-circumvention clauses that no coercer could have enforced without London’s signature. There is a difference between being robbed and helping the robber carry the furniture.

THE ROAD NOT TAKEN 

There was an alternative. It was announced from a conference platform in Brighton in September 2019, and the people now in government helped bury it. Jeremy Corbyn’s medicines policy proposed a publicly owned generic drugs manufacturer to supply the NHS at cost. It proposed compulsory licensing to break the monopoly pricing of patented medicines. It proposed making public funding for research conditional on affordable prices, so that the system would, in his words, “serve public health, not private wealth”. It was denounced as extremism, Venezuela, the politics of the madhouse.

Set the two prospectuses side by side now. One offered public manufacture, lower prices and medicines security under democratic control. The other delivers £44.7bn to multinational shareholders, a health service legally barred from defending its own budget, and 229,000 graves. The first was called unelectable. The second was called landmark. The heartlands can do this arithmetic without assistance. They were told grown-up government meant abandoning fantasy economics. They are now governed by people who bought a £500 million insurance policy for £44.7bn and called it statecraft. 

SECURITY COMES FROM WITHIN 

Here is the argument this moment demands, and it is older than any of us. The security of a nation is not measured in the tonnage of its fleet or the tribute it pays to keep an ally’s temper. It is measured in whether its people are healthy, housed, paid and unafraid. Bevan understood this. The NHS was itself a security policy: the guarantee that no British family could be destroyed by illness, that the nation’s strength began in its own body.

A state that finds £170 million a week for American drug margins while its own citizens die of treatable heart disease has not misjudged a trade negotiation. It has forgotten what a state is for. Real security is a cardiology appointment that comes in time. Real sovereignty is a health service that answers to Parliament, not to the US Department of Commerce. Real defence is 229,000 people alive in 2036 who would otherwise be dead.

So the demands write themselves. Publish the impact assessment, in full, without redaction; a government that has priced its policy in lives has no right to keep the invoice secret. Put the deal before Parliament as primary legislation and let members vote with the death toll in front of them. Insulate NICE from trade negotiations by statute, so that no future minister can hand our medicine pricing to a foreign treasury. Fund any geopolitical premium from the Treasury’s trade budget, not from cancer wards. And revive, seriously and without embarrassment, the case for public pharmaceutical manufacture, because the events of the last year have proven its critics wrong on every count.

None of this requires revolution. It requires only that the British state value British lives above American dividends. That it apparently does not is the true scandal, and no tariff waiver can cover it. When the history of this deal is written, nobody will remember the communiqués. They will remember that a Labour government, custodian of the NHS, signed away more lives than the pandemic took, and hid the paperwork. They call it a trade deal. But when one side pays £44.7bn and 229,000 lives, and the other side waives a threat it invented, that is not trade. That is tribute. Britain is now a colony.

As A Solicitous Mother

Excommunicated all the way down to the pews, and with the faculties to witness marriages and to hear Confessions revoked, the Society of Saint Pius X and its adherents have become the Lefebvrian or Lefebvrist denomination. That is far smaller than it habitually claims to be, unless the True Church really were Invisible after all. At least one of its new bishops was born into it and entered its seminary when he was all of 18. Preaching yesterday, he made himself far from the first to have revived the ancient heresy of Donatism.

How should we relate ecumenically to these separated brethren? By praying for them, as we did for the Free Presbyterian Church of Ulster, or for the Old Calendarists, or for the other bodies that did not yet want to know. There are millions of Old Calendarists, as there are many millions whose position is the same as the Ulster Free Presbyterians'. There are at most half a million Lefebvrists, and quite possibly as few as 100,000. Even in their own terms, why do they need six bishops?

The real news from the real Church is the appointment of Fr Stephen Wang, the Rector of the Venerable English College in Rome, as the next Bishop of Arundel and Brighton, in succession to Archbishop Richard Moth, who was one of 35 new archbishops to receive the pallium from the Holy Father on Monday. Ad multos annos to all concerned.

War Whores

As recently as 8 December, Lord Dannatt got himself suspended from the House of Lords for four months because he had secured all past, present and future criminal charges against Palestine Action in return for payment by Teledyne, which was not even a British company.

And as for Lord West of Spearfish Security, who dismisses "things like welfare" as "unimportant" compared to "Russian Chechen stormtroopers coming down the street, raping women and killing people", Russia has spent well over four years barely holding on to a small and immediately adjacent corner of Ukraine, while West was Minister for Security in the Government of which at least the second most powerful member was Peter Mandelson, the "privileged contact" whose connections are a reminder that for rapists we would not have to await a wildly improbable Russian invasion. Indeed, we need look no further than the foreign military presence that was already here.

Non Habemus

In 1988, Marcel Lefebvre asked whether there was an Apostolic Mandate, he was given the one word and totally false answer that there was, and matters proceeded from there. But today, a fake parchment was unfurled and a windy self-justification, not even in Latin but in French, was read out. No expense had been spared on mitres, croziers, rings, and so forth. Who paid for all of that? Are they also excommunicated automatically, or does Rome need to act?

The Society of Saint Pius X now has six Bishops of Nowhere, each with an ego the size of a planet. It is no wonder all sorts of the people who stage High Masses in their front rooms while holding down day jobs as milkmen are delighted. One or more of today's consecrees will enjoy nothing more than the thrill of raising them, too, to the purple. That funny little world has been going about its funny little way for a very long time, and there is a reason why we almost never hear about it.

A Bit Rich

Donald Trump’s corruption is so flagrant that it is almost funny, but what of his wannabes? In 2017, Nigel Farage professed himself “skint”. Yet he and his partner, Laure Ferrari, now own at least five homes in Surrey, Essex and Kent, worth around four million pounds, all bought for cash since 2020, and only two of them listed in the Register of Members’ Interests. Farage has also just declared £270,000 for 12 hours’ work promoting Direct Bullion. That is £22,500 per hour. None of his households will be among the 13.5 million that from today will have to spend over 10 per cent of their incomes on fuel, an increase of more than two million since April, now that the Government has raised the energy cap yet again, this time by more than £220 per year. How is there a cap at all if they keep putting it up?

Reform UK cultivates links with the DUP, which has provided five of the eight Northern Irish politicians to have been convicted of sexual offences since 2010, all of whom have been Unionists of one sort or another, and thus Deep State operatives. In each case, the question is why his protection was withdrawn when it was. The scandal of Shabir Ahmed should be set both in that context and in the context of the events of 20 March, when the convicted paedophile Liron Woodcock-Velleman was given eight months, suspended for 15 months. His past “service” as a councillor, and the ruination of his “promising” political career, were accepted in mitigation. No wonder he and his parents were celebrating.

Like you, I have never met a paedophile. I mean, we may have done, in the way that we may have met a Muggletonian. But we are wholly unaware of having done so, you and I both. I apologise to any Muggletonian reading this. Yet this country’s cultural and political elite cannot get out of bed, if that, without tripping over one or more nonces. And every single time, our betters had had no idea. Or so we are invariably expected to believe. 

Last May, the supposedly hard-as-nails Shabana Mahmood tried to give nonces “chemical castration” instead of prison, where that proposal was received, not only by the inmates, as well as one might have expected. As an old lag, the word “nonce” is part of my culture. In that culture’s citadels, nonces are given the suspended sentences that we were not, or they are given the cushiest jobs inside, they are housed in the newest or the most recently refurbished wings, they have gym when ours has been cancelled, and so on. Why?

At committee stage of what has become the Online Safety Act, Woodcock-Velleman gave the evidence of Hope Not Hate. When Labour returned to office in 2024, then Anna Turley was both a Director and a Trustee of Hope Not Hate. As an ultimately successful parliamentary candidate in 2015, the then Ruth Smeeth described herself as “the Deputy Director of Hope Not Hate”. The American Embassy classified her as “strictly protect”. As Baroness Anderson of Stoke-on-Trent, she was recently made a Parliamentary Secretary in the Cabinet Office while remaining a Whip. Not bad for having lost her Commons seat to Jonathan Gullis. Even with the departure of Josh Simons, there are now four Parliamentary Secretaries under Darren Jones, and three Ministers of State. That amounts to a Prime Minister’s Department with, including Keir Starmer, nine Ministers, the most of any Department. They must do something. What is it?

Woodcock-Velleman’s offences were strikingly similar to those of another Labour councillor in London, Sam Gould, who offended while on the staff of Wes Streeting. Streeting would have become Leader when, as expected in 2019, the Conservative majority had been much reduced in 2024 but Boris Johnson had remained Prime Minister. Yes, that was not much more than six years ago. But in 2015, Streeting had chaired the Leadership campaign of Jess Phillips. On Tuesday 2 September last year, Phillips told the House of Commons that, “South Yorkshire police should never have been left to investigate themselves in this matter, and moving those investigations to the NCA is absolutely the right thing to do. I would be lying if I said that over the years I had not met girls who talked to me about how police were part of not just the cover-up but the perpetration.” Read again those words of the Minister who refused a statutory inquiry, an inquiry that had been, and still is, demanded by the Muslim candidate whom she had beaten by only 693 votes at Birmingham Yardley, which he intends to contest again, the wonderful investigative journalist Jody McIntyre. Then read the Epstein Files and worry about inferior cultures with no respect for women and with endemic predation on young girls.

Phillips had been supported for Leader by Hilary Armstrong and by Armstrong’s erstwhile staffer, Peter Kyle. Both Joe Docherty and Matthew Doyle were introduced to the House of Lords by Armstrong, whose Whips’ Office in the Commons had included all three of Phil Woolas, Ivor Caplin and Dan Norris. All three were made Ministers soon after the vote for the Iraq War. Norris does not turn up to Parliament, but until today, when it became pretty clear that charges were imminent, he had one of the best voting records, because despite his own suspension from the Labour whip, his proxy vote was cast every single time by the Labour Whips. Armstrong was the political patroness, both of Turley, and of Caplin’s close friend, closest ally, former lover, and constituency successor, Kyle. Armstrong remains an active Labour member of the Lords, giving it as her institutional affiliation when she endorsed a mercifully ignored book that claimed that the accused of the Cleveland child abuse scandal had been guilty all along. Every accusation is a confession.

Rapid Support Forces What?

In January, the United Arab Emirates restricted its funding of students who wanted to study in Britain, for fear that they might be radicalised by the Muslim Brotherhood. You will remember the Emiratis. The Statute Law had to be changed to stop them from buying two small circulation newspapers and a tiny circulation magazine because the writers on those moved in the same social circles as both front benches, although one of those writers has since moved to Dubai. She now files her copy from that country, where trade unions and political parties are illegal, and where she lives with the Member of Parliament for Boston and Skegness, who is the Deputy Leader of Reform UK.

Throughout, though, Britain has armed the UAE while it has armed the Rapid Support Forces, who have now been credibly accused of crimes against humanity and of ethnic cleansing, deliberating targeting children and engaging in the genocide of non-Arab tribes, during the 18-month siege of El Fasher, which ended in October with the capture of that last outpost in Darfur of the rival Sudanese Armed Forces, the proxies of Saudi Arabia. Via the British-armed RSF, the UAE has taken colonial possession of much of Sudan, in a grand old tradition of Gulf potentates in East Africa. Denial is a river in Sudan. The UAE has also declared “the State of South Arabia” in South Yemen. All in all, it is pretty radical on its own. And there’s more, with a lot more to come.

The Dangers of Devolution

Aaron Bastani writes:

The political temperaments of Keir Starmer and Andy Burnham couldn’t be more different. While the current prime minister is a sober, plodding proceduralist, whose worldview has been forged by decades of litigation, Burnham’s approach is based on instinct. Yet if media attention, perhaps understandably, has focused on how they speak, or how they dress — no suits for the constantly t-shirted Burnham — their substantive differences are clearest in how both think about devolution. That feels particularly pertinent given how loudly the incoming PM has asserted his localist credentials. Beyond announcing a “No. 10 North”, and hinting he wouldn’t even live in Downing Street, Andy Burnham has already promised the biggest “rebalancing of power our country has ever seen”.

In theory, of course, we’ve been here before, with Starmer also trying to connect English devolution with a post-Brexit politics. In 2023, while still in opposition and riding high in the polls, Burnham’s soon-to-be predecessor said his plans for devolution would transform “‘take back control”’ from a slogan into a solution. Alas, things turned out rather differently. Indeed, if a single issue encapsulates the pathologies of the Starmer regime, it is local government reorganisation (LGR) — the outgoing PM’s plan to streamline councils — as well as the introduction of more metro mayors. In the two years since 2024, when a flagship white paper was published to address both, quiet constitutional radicalism has met with ever more farcical incompetence. This is Starmerism: triple-distilled.

Because so much else has happened, it’s easy to forget just how ludicrous parts of that agenda are. From 2028, for instance, the largest city-region in Europe will be the combined “metro area” of Norfolk and Suffolk. Feted to have a single mayor overseeing a fiefdom of some 9,200 square kilometres, that mayoral authority will be around the same size as Cyprus — and six times larger than Greater London. The idea of Norwich being the administrative capital of a city-state, eclipsing Madrid or Paris in scope, sounds like something from an Alan Partridge fever dream. For Keir Starmer, it was simply part of re-forging the British state.

Almost as bad is the proposal for a single mayor to cover the whole of Hampshire and the Isle of Wight. Given the uproar when Emirates sponsored the Spinnaker Tower in Portsmouth, and planned to paint the iconic building in the same colours as Southampton football club, it’ll be interesting to see how the two places integrate. In Portsmouth, the nickname for the denizens of Southampton, some 17 miles away, is “scum”. Those who live in the home of the Royal Navy, meanwhile, enjoy the nickname “skates” (you’ll have to Google why). There is no history of collaboration between the two cities — both of which enjoy almost 1,000 years of continuous history. It’s a similar story with Cumbria, soon to be a metro area as well as a county, with the authority forecast to be over twice as large as France’s largest municipality. That’s despite the fact that Carlisle, Cumbria’s largest city, has a population of just 100,000, and the region is best known for the empty Lake District.

Would Burnham repeat such bizarre absurdities? There are grounds for cautious optimism. In February 2023, Burnham spoke to the journalist Steve Richards. There’s little reason to be cynical about his remarks at the time, not least because his chances of a national comeback seemed negligible, with Starmer riding high in the polls. And yet, for more than half an hour, the then-mayor for Greater Manchester spoke convincingly of a “place first” approach to devolution. “In a post-Brexit, post-pandemic world,” Burnham intoned, isn’t it clear “that Whitehall can’t cope with this? It’s struggling, and it’s because the wiring of the county isn’t right.”

Throughout that conversation two things stood out. The first is how, for Burnham, any localist agenda must fit the needs of communities which already exist. “Legitimacy comes from the people and the place,” as he puts it. Which makes you wonder whether plans for an East Anglia super-region, let alone a South Coast version of Neom, will truly come to pass in his premiership. The second is how devolution isn’t merely a means to rewire Britain’s economy, but to determine which issues matter in the first place. Whitehall’s inability to craft solutions partially stems from the fact it has little idea what the problems are. Policy-making, in the argot of the former Manchester mayor, is thus divorced from place.

Three years on and it’s clear that, in other ways too, Starmer has continued with the very approach Burnham was sceptical of. For all Starmer’s talk of dispersing power away from London, and the public really taking back control, his faction essentially selected the Labour candidate for the west of England mayor (the now disgraced Dan Norris), while blocking Jamie Driscoll from standing in the North East. Then there were the times the leadership’s retinue made Richard Leonard resign as the party’s Scottish leader, and steered the controversial Vaughan Gething to the role of first minister in Cardiff. Starmer, and much of the Labour Right, were comfortable with devolution, and “giving power away”, so long as those who received it agreed with them.

That hints at another divide with Burnham, who, whatever his other faults, seems to have shed any factionalist baggage. He was certainly a Blairite upon entering Parliament in 2001. Yet in his speech on Monday, he took aim at the whipping system and its tendency to foreclose political debate. Looking further ahead, of course, it’s hard to see how a “place first” approach won’t clash with the political management of the Labour establishment: including its propensity to parachute in preferred candidates for “safe seats”.

Still, it’s a start, especially when you consider that Starmer’s approach to local politics — arrogant, entitled and defined from the centre — was so inept that it actively undermined confidence in the need for reform. Starmer’s LGR was meant to be the biggest shake-up of local politics in England since the Sixties. If more mayors, furnished with greater powers, is about enhancing democracy, then LGR was about delivering a more standardised bureaucracy across England. Fair enough: my home county of Hampshire presently boasts 15 different authorities, including “two-tier” district and county councils. LGR means that number will fall to five unitary authorities, all enjoying the same range of competences.

While the changes make sense in theory, as has often been the case with Starmer the execution has been disastrous. Why? Because reforming ambition was encumbered by hubris, which in turn fed incompetence, something extending far beyond ambitions of conjoining old rivals like Southampton and Portsmouth. Starmer’s government, with its enormous majority, sought to remake key parts of national life at breakneck speed. As a result, many councils regarded the timetable as unrealistic, with authorities expected to develop new unitary structures, governance arrangements and financial models within months. It often felt like No. 10 was applying the principles of DIY SOS to the biggest overhaul of local government in over half a century.

Alongside the rush, far-reaching questions remain unanswered. For instance, will newly integrated authorities have to pool historic debts? Would a council broadly in the black (such as Portsmouth) have to absorb liabilities from another in the red (like Hampshire County Council)? And if an authority that runs surpluses integrates with another that runs crippling deficits, what help is on offer from the Treasury? These are, understandably, huge points of contention for council leaders across the country. Yet they have been met with little more than hand-waving and vague promises of things being alright in the end. Speak to almost any council leader, and you’ll likely hear shock at how blasé and reckless London has been throughout.

Which brings us to another major difference between our prime ministers, present and future. While Starmer viewed local government reorganisation, and more metro mayors, as a means of achieving growth within the existing model, Burnham regards empowering city-regions as a way of bypassing No. 11 and the most dysfunctional parts of Whitehall. That is, after all, the subtext of him opening an office in Manchester. While the primary aim is to take power out of Westminster and, as Burnham put it this week, create a political “circuit-breaker”, a secondary aspect would be to strengthen the role of the prime minister himself.

Whatever you think of it, at least that’s a vision. Compare it to the LGR, whose preference for a “unitary layer” for local government emerged from a single paper published by PWC. The ultimate argument for those vast mayoral authorities from Hampshire to East Anglia, meanwhile, can be found in a report compiled by McKinsey. Why the need for such scale? Because, in order for regional governments to compete for investment, that’s what’s required — with two million inhabitants apparently the starting point to create sufficient capacity, generate adequate brand recognition, and access the right tier of investors.

In other words, those new mayors up for election two years from now are less about empowering local people, or reviving England’s smaller cities, than ensuring creditworthiness. This is why somewhere like Cumbria is suddenly expected to become a city-region. And while this again may sound coherent in principle, you have to question whether such contrived and synthetic entities will garner sufficient democratic legitimacy in the long-term. History and tradition — Portsmouth’s star-and-crescent flag goes back to the Third Crusade — is apparently irrelevant to a Treasury that regards city-regions as little more than economic zones. In a way, it’s strangely reminiscent of arguments for greater European integration made by liberals in recent decades. Reducing transaction costs matters more than anything else. For Burnham, though, if cities are certainly a locus for policy experimentation, they are also places with heritage, history and a continuous culture. His passion for Manchester makes that clear enough.

Ultimately, the two men view devolution as a path to different things — which makes you wonder whether Burnham as prime minister will move to re-assess LGR, let alone oddities like a city-region for Norfolk and Suffolk. And, while we’re at it, why not give the Southampton and Portsmouth city-regions a mayor each? That’s what would happen in any vaguely sane polity.

Which leads us to yet another major fissure between the current prime minister and his successor, with Burnham repeatedly criticising much of the devolution agenda since 1997. He expressed as much in Monday’s speech, when he promised to offer “new opportunities to extend devolution” in the Celtic fringe by taking power “deeper down”. In words intended for the SNP and Welsh Labour, as much as the inhabitants of such places, Burnham remarked how the “people of Dundee and Bangor feel just as distant from Holyrood and the Senedd as they do from Westminster”.

Now, you might point out, Holyrood and the Senedd are consequences of Blairite reforms. Does Burnham, a former New Labour minister, think they were a mistake? The answer appears to be yes, with Burnham admitting as much while speaking on that podcast with Richards. The original sin of Scottish and Welsh devolution, according to our next prime minister, was the “same Westminster approach… where it’s all national and there isn’t that routing of power at the local level”. Rather than truly empower voters in Wales and Scotland, the Blair government created dysfunctional mini-mes in Edinburgh and Cardiff: places whose political cultures are every bit as complacent as London.

Starmer, by virtue of his connection to Morgan McSweeney and the Labour Right, could never voice such a critique. In theory, the same should be true of Burnham, given his past or present ties to Blair, David Miliband and James Purnell. Yet he’s broken ranks with his old comrades in stating that the city-based approach of the English North — whose champion is none other than George Osborne — has proven more successful.

Perhaps that’s exactly the kind of mould-breaking that’s needed. After all, the historic party of social democracy is betting the house on something which hasn’t worked for a century: pushing power to towns and cities far beyond the M25. Given Westminster’s tendency to hoard power, that’s a huge ask. Burnham’s localism agenda may ultimately end up giving him more influence — not least if he becomes ally-in-chief to existing mayors and council leaders, especially if he spikes the worst aspects of LGR — all while he undermines both the Civil Service and Parliament. As the incoming PM ominously added in Monday’s speech, the political direction he will set “will not be up for negotiation”. Still, even a President Burnham would probably be better than what we have now: spreadsheet devolution with voters a mere afterthought.