The revenge of those who saved the NHS

We knew the sort of things – part score-settling, part confession, part acute insight and part plain bonkers – that Dominic Cummings would come out with for the Parliamentary committee in May. He confirmed much of what we guessed about Boris Johnson’s ramshackle government and how it approached the pandemic. Together with what we have learned for ourselves over the last plague year it allows us to predict with some confidence the verdict of the official enquiry into the handling of the crisis, whenever it finally comes.

Of course, the report won’t say directly that we went into the biggest crisis since WWII with an administration of opportunistic and shifty second-raters, led by the biggest chancer of the lot – although it will surely make the point indirectly with hard words about PPE procurement, the ‘unimaginable’ £37bn spent on track and trace, the hopeless messaging surrounding the lockdowns and social distancing, and the ‘ring of steel’ supposedly thrown around care homes, among other things. It will also acknowledge that what happened last year was unprecedented, at least since the Spanish flu pandemic of 1918, and that if no government has got all its crisis measures right it is no surprise – one of the most sobering lessons of the Covid episode is that evolution in the shape of a tiny blind virus without a brain is a lot cleverer than we are.

Yet any report should also point out that Covid wouldn’t have been able to make itself so comfortably at home in our richest societies without inherited weaknesses that even a more competent and less feckless team would have struggled with.The most glaring is the neglected and run-down organs of state which both individually and jointly have comprehensively failed the challenge thrown at them. For this blame successive governments that having enthusiastically accepted the neo-liberal axiom that the market is the answer to everything if only the government would get out of the way, have over the last two decades casually outsourced capabilities, responsibilities and increasingly decision-making to the private sector and even more worryingly private sector IT.

As Cummings confirmed, what was left to face the crisis was a collection of inturned agency silos that were riven with rivalries, distrust and turf-wars, had no shared goals and were chronically unwilling to share information. Take your pick of hapless UK institutions to supply the aptest symbol of the UK government in 2021 – the risibly renamed Great British Railways, currently the worst run, highest cost, and least passenger friendly in Europe; the once-revered Post Office, which put more faith in its terrible computer system than in its staff and after a decade of defending its scandalous treatment of innocent postmasters is now having to pay reparations worth billions; or, nearer to home, the mother of Parliaments and home of British democracy which has been left untended and unmaintained for so long that billions are having to be spent to prevent it subsiding into the Thames. I could go on.

Then add to the state’s self-mutilation a decade of austerity that Covid has revealed as one of the most monstrous false economies of all time. Not so much thrifty housekeeping, more criminal failure to invest in the state’s decaying institutional infrastructure. The report might list an NHS subject to constant reorganisations that that can barely cope at the best of times; a threadbare unjoined-up care sector that is an insult to civilised society; contemptuously slashed essential local-authority services; unfit-for-purpose regulation (Grenfell Tower stands as another symbol of the UK’s complacent and negligent government); and the consistent blind eye turned to burgeoning economic, health and housing inequalities. 

As we have been learning, over the last year the cost of these policy choices has come flapping home for payment. It has been paid in the horrific tally of lives lost to Covid. The first job of any government is to protect its citizens. Instead, fearing above all the collapse of the perennially tottering health service, and without any other thought-out policy to hand, the government persuaded us to protect the NHS, and it, by, in effect, sacrificing the most deprived of society – the poor, the unhealthy, the inadequately housed and above all the elderly in care homes, all of whom suffer disproportionately from it – to the disease. And as a stopgap solution, grotesque as it seems to say so, it has worked. 

But there’s a kicker. ‘Saving the NHS’ in last year’s terms is not only not a long-term solution; it is a Pyrrhic victory that we can’t affort to repeat. Reparations for the decades of neglect and austerity are urgently due. And there can be no question of non-payment. In an increasingly interconnected world, the occurrence of more non-linear, extreme events in the future is almost guaranteed. If the gaping holes in the social infrastructure and state competencies are left unfilled, society will remain as vulnerable to these future unexpected unknowns as it was to Covid in December 2020. In the meantime, the pockets of deprivation in our midst will remain breeding grounds for new variants of the coronavirus, just as will happen in poorer countries until they are vaccinated too. The report might but probably won’t call it the revenge of those who saved the NHS.