Not surprisingly, Rishi Sunak has dropped plans to fine NHS patients £10 for missed appointments. It was one of the campaign pledges the new Prime Minister made in his first leadership contest of this year, arguing that it would deter people from wasting ‘valuable NHS time by booking appointments and failing to attend’. Today, No. 10 said:

We have listened to GPs and health leaders, and have acknowledged that now is not the right time to take this policy forward.

It’s not uncommon for a campaign pledge to be abandoned when it makes contact with reality. This one only made sense to people who thought in simple campaigning terms rather than how policies work.

The amount of admin involved for a GP’s surgery to track down the missing patients, find out if they had a valid reason, adjudicate on that reason and then fine the small proportion of people who had just casually not attended an appointment would have cost far more both in time and money than the missed appointment itself. It is well-documented that the people most likely to miss appointments in the NHS will have mental health problems, and studies have previously shown that the highest rate of non-attendances came from new mothers missing perinatal psychiatric appointments. It’s not difficult to fathom why they might not have turned up, or indeed that a £10 fine probably wouldn’t help deter them or indeed improve their state of mind.

Sunak often brought out the pledge when he was talking about the need to make the health service more efficient, something that has become even more urgent for the new PM since he started trying to work out how to plug the black hole in the public finances. That has reduced from over £70 billion to around £35 billion, but a hole that size is still not a cause for celebration. I look at the dynamics around cutting money for the NHS in my latest i column (spoiler alert: it’s a little more complicated than campaign pledges might suggest).

The way the Treasury has been rolling the pitch in the newspapers this morning shows that the forthcoming autumn statement is going to be a difficult time for the Conservatives. Although, they have hyped up expectations of how difficult in order to make the actual announcements seem rather less scary. That might work on a short-term basis, but the political woe from making difficult decisions doesn’t tend to come in the 48 hours after a fiscal event. Instead, it is a slow burn of MPs in the governing party waking up to the impact of certain policies on their constituencies, and realising that the simple proposition made in parliament works rather differently on the ground.