Why did the government U-turn on NHS surcharges for immigrant staff?

Keir Starmer's performance at Prime Minister's Questions played a part, but it isn't the whole story. 

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Did Keir Starmer win this week’s PMQs in extra time? The government will remove the NHS surcharge ⁠— the additional levy that immigrants have to pay to use the National Health Service ⁠— from people who work for the NHS, after a U-turn by Boris Johnson. 

It's a win for Starmer, who brought the issue up in the House this week. But it's also a reminder of the additional pressures on Johnson. One reason why the U-turn happened was the viral video made by a Syrian refugee and  NHS worker Hassan Akkad: a demonstration that neither the major parties nor news organisations can control what gains national prominence or drives debate in the modern world. 

But the pressure on Johnson came not only from social media but his own backbenches. One of the first to speak out, William Wragg, is a good example of the various internal challenges the PM faces. Wragg is a select committee chair and therefore his mandate depends on the whole House, incentivising him to be plain-spoken and intermittently heretical.

He's a man elected in 2015 or earlier, and many in that group fear that if they have yet to make it to the frontbench under Johnson, they never will. Those are two of the three major challenges Johnson faces on is own side. The third challenge is the China hawks, who have long been critical of the government's approach towards that country, but whose cause has been boosted by the Xi administration's lack of candour around the coronavirus. 

Part of Starmer's success so far is showing a good sense of where Johnson is vulnerable on additional flanks ⁠— he didn't cause this U-turn alone, but did use his awareness of where pressure might build. Now Starmer gets to end another week with a spring in his step.

For Johnson, it's a reminder that winning a majority of 80 doesn't mean that his parliamentary party can be counted out or ignored ⁠— and if he doesn't pick up on their concerns and deal with them quickly, then the credit for that will go to someone else. 

Stephen Bush is political editor of the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.

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