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This year, to save me from tiers… 

Boris Johnson took a leaf out of his old foe David Cameron’s book and headed north to don a hard hat.  

His predecessor pioneered an era of austerity that hit the poor pockets of the region the hardest, but clearly relished the chance to promote his “northern powerhouse” or “midlands engine” from the factory floor.   

By contrast, the prime minister of 2020 clearly felt powerless and somewhat out of steam in Bolton on Friday, as the looming inevitability of a third national lockdown heaved into view.  

Barely a month after Downing Street had briefed that Johnson was resetting his premiership after Dominic Cummings’ exit, his government is grappling with a nail-biting Brexit deadlock and a resurgent Covid pandemic.  

With Christmas just around the corner, Johnson was determined to strike an upbeat tone. But Northern Ireland has already committed to a six-week lockdown from Boxing Day and there was no masking a bleak midwinter of tighter restrictions is on the cards.

“We’re hoping very much that we will be able to avoid anything like that,” said the PM, careful to ensure his libertarian backbenchers don’t hear him utter the words “third national lockdown”. 

“But the reality is that the rates of infection have increased very much in the last few weeks.” 

In the last week alone, lab-confirmed cases crept up by an astonishing 41%, with London and large chunks of the south east joining huge swathes of the north in tier 3. 

So it was with a gloomy inevitability that the R rate jumped above the crucial number 1 on Friday (now 1.1-1.2, having been 0.9-1 the previous week). 

After health secretary Matt Hancock revealed the virus had been doubling in seven days in some areas, despite the November lockdown, scientists are increasingly applying pressure.  

Professor Neil Ferguson, whose Imperial College London infection survey persuaded the government, finally, to lockdown in March, told the BBC “there may be a need for additional controls beyond even what were in place” last month.  

Johnson has so far refused to back down on the five-day relaxation of rules at Christmas and amid business fury at his chopping and changing hopes to stick to his regional tiered approach.  

Former minister Jake Berry, once a staunch Johnson ally, has little faith that piecemeal further restrictions will work.  

“I think for many people across the north of England it’s a bit like the Brexit debate under Theresa May, when the public had stopped listening,” he said, in a comment Johnson will find unflattering given May’s sharp demise.  

With many desperate to see loved ones next week, there are some who sympathise with the PM relaxing rules at Christmas.  

Chief medical officer Chris Whitty is not one of them. At a press conference last week, standing beside the PM, he said this was “not a moment to relax at all, quite the reverse”. 

The top adviser, whose own actions will be heavily scrutinised in any future public inquiry, put his finger on a deeper problem for Johnson, in CMO’s annual report which was published on Friday.  

It heavily criticised the growing overall gap in life expectancy between the most and least deprived areas in England.  

Life expectancy was the lowest for people living in north Cumbria, County Durham, and in areas of Lancashire and Yorkshire, all of which contain “red wall” seats Johnson won from Labour in 2019 with a promise to level up.  

“There is wide variation in ill health across the country, and much of this is avoidable,” Whitty said.  

Cameron’s austerity agenda exacerbated health inequalities in much of the north where areas were already deprived, and many face poor elderly health and chronic conditions.  

All of which means the NHS can come under pressure quickly in areas like Bolton, which is one of the 20% most deprived council areas in England.  

Something which, incidentally, can land an already struggling area, and its local economy, in tier 3 and place them at a disadvantage to wealthier areas.  

In clearly identifying the need to “level up” Johnson pinpointed the problem. The question is: has he internalised how endemic, disfiguring and urgent that problem really is?  

Or as Whitty put it in his report: “Ill health and disease concentrating in areas of deprivation is long-standing and needs to be tackled. 

“Describing and deploring it is not enough, we need to have actionable plans to improve it.”