Keir Starmer has at last managed a family holiday, but by next week the Madeira sun may already feel a distant memory as he embarks on a policy blitz that could be crucial in deciding his government’s fortunes over this parliament.

A speech on Monday detailing what No 10 is billing as a “radical” approach to cut NHS waiting lists is expected to be followed by an announcement on crime, as the prime minister faces pressure to make changes that directly and rapidly benefit voters, rather than just promising they are on the way.

While in some ways it feels absurd to talk of definitive political narratives when an election could still be four-and-a-half years away, those around Starmer are keenly aware that public patience is highly finite and political loyalties increasingly slippery.

This is likely to mean a shift away from commissions and panels looking at everything from social care to prison sentences, and towards more immediately deliverable policies.

A government source said: “It’s going to be a really, really busy few months, and we just need to get on with it. We do understand the public’s expectations, and the fatigue with us setting out how big a task it is. But we’re confident that they will soon start to notice the changes.”

All this is, however, still very difficult to achieve. The NHS reforms, which Starmer will set out on Monday, including the promise of patients being able to get a scan and a follow-up consultation to discuss the results the same day, could be transformative. But at the same time, senior doctors worry that there are simply not enough staff to do it.

A similar pattern emerges in every other area that ministers are targeting, whether economic growth, crime, housebuilding or education. However good a particular policy and however determined the focus, much depends on uncontrollable external factors, while the fiscal levers are limited in scope.

To take one recent example of unexpected distractions, No 10 did not plan to spend half the week dealing with queries about grooming gangs after Elon Musk discovered the far-right agitator and serial criminal Tommy Robinson and decided he was a freedom fighter.

“Let’s just say that we’re very practised at shutting out the noise,” the government source said.

No 10 says voters will still need to be reminded how tricky a task Labour inherited, as the months tick by from the election, but there is an increasing prioritisation of policies that “move the dial” – that is to say, get noticed, and soon.

As well as announcements, ministers hope there will also be some impact from the swath of bills beginning to make their way through parliament, with the very broad children’s wellbeing and schools bill, covering everything from care provision to school attendance, getting its first full Commons airing on Wednesday.

Starmer will face his first verdict from voters in May with a series of local elections across England – although some might be delayed amid a restructuring of council powers.

This verdict might be tricky to decipher, said Robert Hayward, an elections expert who is also a Conservative peer, given not just the uncertain timetable but also the various insurgent challenges from Reform UK, the Liberal Democrats and the Green party.

Hayward has, however, noticed one apparent trend in the limited number of council byelections that have taken place since the general election: a tendency for Labour voters to stay at home.

In a trio of byelections just before Christmas, Labour support fell by up to 1,000 votes, something Hayward called “absolutely staggering” in such contests.

“A few were going to Reform, because Reform weren’t contesting the previous election,” he said. “Beyond that, it’s an abstention at the moment, rather than a massive anti-vote.”

As such, he said, a blitz of speeches and policies on day-to-day issues made sense. “You can only say so often: ‘Look, things were bad when we inherited them,’ and the fact we’re in a new calendar year adds to that barrier.

“So you do need to be able to say: these things are improving at your local GP surgery or at your local A&E. Until that happens, people are just not going to respond.”

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