Richard Horton, respected editor of the medical journal ‘the Lancet’, aptly summed up the current pandemic in the following words: “Coronavirus is the greatest global science policy failure in a generation. Austerity blunted the ambition and commitment of government to protect its people. The objective was to diminish the size and role of the state. The result was to leave the country fatally weakened”. China implemented a lockdown in Hubei province on 23rd January in response to a new and severe respiratory infection. One week later the World Health Organisation declared a global emergency in recognition of what had become a worldwide pandemic. It then took nearly two months for the UK government to grasp the seriousness of the problem and to implement social distancing and isolation. This delay has led to many unnecessary deaths.
Despite there being core public health principles of “test, isolate and contact trace” in response to an epidemic, this process has not been implemented in the UK. There was talk of ‘herd immunity’ as an alternative strategy, but scientists then pointed out this could mean hundreds of thousands of deaths before the infection was under control. A panicked government decided to abandon its irrational belief in ‘British exceptionalism’ and on 23rd March instituted a lock down of sorts, with people encouraged to stay at home, and most businesses closed down. News footage still showed London underground packed with people and construction workers as key workers were expected to turn up for work as usual.
Unrecognised dangers included the risk to the elderly living in care homes together with their carers, the risk to bus drivers and other key workers with public-facing roles in the community. The fact that many workers on zero hours contracts and those outsourced from the NHS and not entitled to sick pay would be forced to continue to go to work even if ill. Sick and elderly patients were discharged to care homes only to spread infection without having been tested for the virus, and outrageously, ‘do not attempt cardio-pulmonary resuscitation’ orders proliferated for pensioners and those with learning difficulties or disabilities often without discussion. The official death toll has gone up to above 20,000 – but these are confirmed deaths in hospital and there may be at least as many again in the community without a definitive diagnosis.
In the meantime, countries like Singapore, South Korea, New Zealand and Germany, which rapidly instituted widespread testing and contact tracing were demonstrating a much lower number of cases and deaths. While the UK government kept promising more testing, numbers grew painfully slowly. Centres specially created to test key staff were set up by the accountancy firm Deloitte, given the contract without it going out to tender under obscure legislation passed in 2015. As usual, reports of problems with lost samples and mis-communication of results followed, just as the privatisation of NHS logistics caused problems with distribution of personal protective equipment (PPE). Despite repeated reassurance from government ministers that stocks of PPE were available, this turned out not to be the case as week after week front line staff complained of being sent to war without the necessary armour. Around 132 NHS and care staff have now died from the disease and will be remembered along with many others on International Workers’ Memorial Day.
Worse still for government credibility were details of the unpublished Cygnus report from a 2016 pandemic planning exercise, and more from the 2019 National Security Risk Assessment, both showing that the government knew full well of the major risk posed by the likelihood of a new pandemic, and the need to stockpile PPE and equipment such as ventilators for intensive care, yet did nothing. As one commentator remarked: “We have been paying for a third-party fire and theft policy for a pandemic, not a comprehensive one. We have been caught out”.
Things which have assisted the pandemic response include the fact that we still have a ‘national’ health service and brilliant staff with a public service ethos. Things that have hindered the response include government reforms over recent years promoting marketisation, fragmentation, privatisation and outsourcing. NHS England has rightly taken over commissioning functions from Clinical Commissioning Groups, and government has wiped away the £14 billion hospital overspend to let Trusts focus attention on doing what was necessary to fight the infection. The small private sector capacity was harnessed to assist the NHS. However, the huge PFI debt millstones remain in place, and private hospitals are only too happy to be subsidised to the tune of £2.3 million/day through block contracts- one of the businesses that will not now go under in the coming recession.
The hostile environment aimed at those migrants with uncertain immigration status not only meant the end to universal health care under the NHS, but now fear of being reported to the home office or financially charged will undermines planned contact tracing. This charging needs to be abolished now, as does the yearly surcharge of £625 for members of NHS staff coming from abroad, and each of their family members.
Government policies left the NHS in a weak starting position, with over 100,000 staff vacancies, cuts in bed numbers of 17,000 since 2010, and near the bottom of the European league table in relation to intensive care beds (half as many as Italy and around one fifth of those in Germany). The government will be constructing a narrative portraying themselves as victims of a natural disaster, doing their best in impossible circumstances and leading us all to victory in the war against Covid-19; in this they will be aided by large sections of the media.
Trade unionists must make sure that ministerial incompetence, arrogance and callous disregard for human life are not forgotten and there is a holding to account. When the pandemic is over, we cannot go back to how things were before. We need to take the public with us in demanding a return to NHS founding principles, a publicly funded, managed and delivered health service with democratic control, linked to a national social care service. Renationalisation of the NHS; proper funding; an end to PFI, the Health and Social Care Act and the Long-Term Plan for the NHS; and an end to outsourcing and privatisation. We are witnessing a tragedy unfold and a government scandal of momentous incompetence. The right lessons must be learned.
Dr John Puntis is co-chair of the campaign group Keep Our NHS Public.