The NHS can be bad for your health
Published by The i paper (27th April, 2020)
I have returned from my daily burst of exercise, walking around local streets. Many of the houses I passed have rainbow pictures drawn by children in their windows as elsewhere in the country, saluting the bravery of staff on the front line of the coronavirus fight. Sweet images say things such as “We love the NHS”, “Thank you NHS” and “NHS is the best”. Once a week my neighbourhood largely unites when residents stand outside clapping carers, some banging drums or saucepans. One household last week fired off a few fireworks.
Yet I feel a tinge of concern as I pass these signs and hear the cheers. Obviously I share the immense gratitude towards carers, doctors, nurses and all other workers performing heroics in challenging circumstances. When you hear of low-paid carers locking themselves in residential homes to protect old and disabled people, or read about medical teams struggling to save lives as they swelter in protective gear, it is impossible not to be moved by their courage and compassion. They deserve all possible plaudits.
But there is a big difference between praising the people performing heroics and sanctifying the system. Britain entered this crisis locked in weird relationship with its health service, so bedazzled by its supposed beauty that it was given a starring role in the opening ceremony of the London 2012 Olympics to the bemusement of other countries.
Politicians ceaselessly chant the mantra that it is a wonder of the world. During a decade of austerity the NHS budget rose by about £26bn, yet there were constant calls for more cash while the equally deserving care system was quietly shredded. Now it is treated like a charity, with millions lavished on heartfelt fundraising efforts, yet real charities such as our incredible hospices are left to struggle.
But behind Britain’s emotive worship of the NHS lies a more complex reality. Look at Europe, where alternative models were better at saving lives before this crisis. A landmark comparative study by four think-tanks with 18 similar nations found that we had lower-than-average life expectancy, with lagging survival rates for eight of the dozen most deadly diseases. We also had the worst “amenable mortality” levels (when people die from potentially preventable conditions).
This week Boris Johnson returns to full-time work. His gratitude to health workers, as already seen, will be profound after a frightening brush with death. This is, after all, a prime minister who won power by exploiting adoration of the NHS as a prop in his Brexit campaign; remember that dodgy slogan on the battles? Like all Tories, he knows this remains his party’s weak point for many voters and wants to retain support in the north. He will be even more determined to join the applause.
But for all the justified admiration for recent efforts by medical personnnel, we do them a disservice if we do not recognise the NHS is simply a public service with strengths and weaknesses like any other organisation. Yes, some flaws relate to funding shortfalls, which left England with just 4,100 intensive care beds when the epidemic erupted. Some failures relate to political decisions, such as the stupid abolition of bursaries that intensified shortages of nurses and immigration polices that deter carers.
But some are systemic, such as a shocking reluctance to acknowledge mistakes, silencing whistle-blowers even amid a pandemic and disturbing procurement struggles seen in recent weeks. Already union leaders are muttering about pay rises for frontline workers. Without doubt, some are deserved – such as for nurses and especially in the care sector, so corroded by profiteering private firms that pay peanuts to staff. Yet it is hard to see Tory politicians – especially a prime minister whose own life was just saved – defying any demands for higher salaries from people, however well paid, fighting this virus.
Having shaken the magic money tree to bail out Britain, ministers will struggle to resist any calls to splash cash on the health system, regardless of logic. The NHS has performed well to crank up capacity after seeing carnage in Italy and Spain. I have no problem with trying to innovate on ventilator production.
But we must examine with ruthless honesty and rationality the flaws that proved fatal on testing, protective kit and care homes. Why was the system so sclerotic that ministers had to summon the Army? Some failures are due to dire political leadership. Others seem down to stifling bureaucracy, systemic inertia, centralised procurement and confused attitudes to private firms. Differing death rates could emerge. Given the clear struggles of Public Health England, there is a case to sever protection and prevention roles that were unified seven years ago.
Lavishing praise on any institution builds resistance to change and reluctance to learn from others. But is there any hope Westminster might have the bottle to harvest this wave of emotion to change wider attitudes? Not just on the health service and social care, along with allied issues of tax and spending, but even on immigration when the public can see in stark terms the role of migrants, some giving their lives in service to our nation. Certainly ministers must ditch the crass surcharge that forces such staff, including some who treated Johnson, to pay huge and rising sums to use the NHS.
Now we rely on the race to discover a vaccine and effective treatments to find a way out of darkness that has befallen our world. Lifting lockdown is simply the first step on a long, hard road ahead. This journey will be easier if analysis of our response to the pandemic, with among the highest death rates in the developed world, is shorn of sentimentality. By all means shower praise on people performing heroics. But if you really want to honour them, do not indulge in shallow worship of a flawed system.