As Boris Johnson recovers from his brush with mortality, he has had plenty of time for contemplation.

Even with his self-confidence, he must be questioning some of his decisions in politics. He was right to praise the NHS staff that saved his life, but he must be wondering whether he was right to have voted three times to block their their pay rises.

He may also be regretting that he did not slap down harder those in his government who harboured thoughts of giving American businesses access to the NHS as a price worth paying to buy a trade deal.

Above all he must be wondering how the government he fought so hard to lead is going to get out of the looming economic disaster it faces.

A few months ago, he believed Brexit would define how history judged a potential two or even three term as Prime Minister. Now, he must know he will be judged for how he handled the coronavirus crisis and whether delaying a lock-down will be defined as failure.

Like the disease, however, that will pass. What he will ultimately be judged on is how effective he and his government are in rebuilding an economy facing a slump on a scale that will not have been seen for generations.

There is no quick fix for what lies ahead. Life will not return to normal when the lock-down is eased and eventually lifted. People will have redefined what is important in life – and they will remain reluctant to travel.

Airlines, travel agents and cruise companies face a bleak future. There may well be a demand for holidays closer to home and with that will come new opportunities for farm businesses seeking diversification ideas.

A lack of normality will slow the recovery of a UK economy focussed on the services sector and retailing, at the expense of manufacturing, food and agriculture. Many retail businesses, large and small, that have closed for the lock-down will never open again. Meanwhile, the financial services sector is facing a bleak future, dealing globally with a crisis that will take away much of the demand that drove those businesses.

The nightmares that keep Johnson awake revolve around questions of affordability. His government is going to face some historically tough choices on the allocation of increasingly limited tax revenues from income tax and VAT, as incomes fall and drag down spending.

There will be endless calls on the government for 'special cases' funding and big confidence-building gestures. A prime minister who loves being popular will have to become adept at saying 'no'.

He will find it even harder now to cut public spending to the big areas of demand, including the NHS, public authorities, education and welfare payments. People now deem those even more vital services than they did just a few short months ago when Johnson was riding high on his election victory.

The question he must be asking, but which no other minister dare raise publicly, is the affordability of Brexit on top of all this. Johnson came to power to 'get Brexit done' but the benefits he saw in it are less clear now.

There is little, or no enthusiasm in Brussels to discuss a trade deal with the UK. Its focus has moved on to how to meet its obligation to put a €1trillion into a rescue package for economies devastated by coronavirus.

The UK could yet be the European country hardest hit in terms of deaths and illness as well as economic fallout. As an EU member state it would have joined those seeking aid and for once would probably have been a net beneficiary of EU funds.

Brexit is about trade, but the battleground for that has changed. There will be a renationalisation of demand across the world, with Romania this week banning grain exports because of concerns about food security. This is a trend that will develop across the globe.

The EU will view a trade deal with the UK as less important than at the start of the year. The problem for Johnson is that the US, Canada and every other country on his trade deal target list will say the same.

That is a tough outcome for a government ebullient about post-Brexit trade successes just a few months ago. However, it is the new global economic reality.

How Johnson handles that demanding and long lasting challenge will be the real measure of his ability, and how history will judge his term as Prime Minister.

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