Boris Johnson’s former chief advisor, Dominic Cummings (Image: REUTERS)

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A Labour Prime Minister would 'probably' be needed to improve the NHS, Boris Johnson's former top aide has said.

Answering questions from readers of his online newsletter, Dominic Cummings said: "NHS won't significantly improve until someone is serious about all the incentives that drive such terrible behaviour.

“I don't see Tories doing it, will prob need a Labour PM but of course they'd be under huge pressure to preserve status quo."

He added: "What we really need is for young NHS staff to organise and push for changes [against the British Medical Association] – they would have moral authority unlike MPs."

But he criticised Keir Starmer, saying he was "just another not great lawyer who thinks politics is about watching the media all day."

He added: "He's very much in tune with modern Commons. Content to fail in all the usual ways rather than shake anything up."

And the former chief strategist said for Labour to win it needed to ignore 'culture war' issues and the media, and focus on violent crime.

He said: "An immediate test of is Labour serious [about] winning: forget the hysteria and childish nonsense around 'trans' and focus on violent crime.

“But [Labour] MPs seem more interested in media/social media than the people they should focus on."

Mr Cummings was answering questions from readers of his Substack newsletter
(Image: REUTERS)

Mr Cummings again took aim at his former boss, describing Mr Johnson’s behaviour at the height of the pandemic as like “a trolley smashing side to side.”

Asked what Mr Johnson’s greatest strengths are, he said that for around 1% of the time “when incentivised by fear of imminent career death he is much more self-aware than almost anybody else in politics.”

But he said Mr Johnson was a “pundit who stumbled into politics and acts like that 99% of the time” – and was “obviously unfit for PM”.

Mr Cummings called his once long-standing ally Mr Johnson a "gaffe machine" last week, just days after releasing text messages from the early stages of the pandemic in which the Prime Minister was critical of Health Secretary Matt Hancock.

Mr Cummings, who left Downing Street in November following a behind-the-scenes power struggle, recently launched a profile on Substack, a platform that allows people to charge for newsletters.

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In response to a question on his experience of being "close to power and the opportunities it provided", Mr Cummings said: "Fascinating but very troubling.

"The world is so dangerous, there are so many very smart and able people – when you watch the apex of power you feel like 'If this were broadcast, everyone would sell everything and head for the bunker in the hills'."

Asked what he thought Labour could do to change its lagging poll numbers, he said: "First thing is kick Tories up and down the street on violent crime.

"But Starmer is fixated on media/bubble, he won't re-orient to public."

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He went on to accuse the Labour leader of being unfocused, saying he "seems like he's so all over the shop he can't keep focus on anything for 2 days.”

Asked whether he considered himself a Conservative, he said no. “Nor right/left. My political views are 'incoherent' in [Westminster] terms”

In answer to another question – on the use of psychedelic drugs for psychotherapy – he said: "I actually organised a meeting on psychadelics (sic) in No10 with some professors.

"It does seem there is serious progress in that field that could help people but I know absolutely nothing about it. It should be explored but probably won't be for a while for obvious reasons."