‘Stay at home, protect the NHS, save lives.’ It’s a simple, understandable mantra, and we have internalised it well. So well, in fact, that we haven’t noticed the sleight of hand – desperate? cynical? – that’s going on here.
How didn’t we see it? The formula says it is our duty as citizens and patients to protect our NHS – and, by the way, the government will punish us if we don’t. But that’s the wrong way round. The NHS is supposed to protect us. Protecting the NHS, and us, is the government’s job, and if it fails to do it, we should punish it at the next election. (Whether the NHS is safe with this or that party is a question rightly posed at every vote.)
As it turns out, we have done our job of not using the NHS for the purpose for which it was designed so well that A&E departments are half empty, patients are politely declining to come forward for cancer diagnosis and ministers are reduced to acting like fairground barkers to drum up trade: ‘Roll up, roll up, we’re still open for business!’
As ever, crisis has brought the best out of the NHS, which has performed heroically with the resources at its disposal. In fact, though, the conventional image of doctors, nurses, porters and auxiliaries as saints and martyrs does them a disservice, obscuring a much more interesting reality. Under pressure the NHS is quietly doing things that it, and we, would have thought impossible a couple of months ago: partnering to build and equip hospitals in a week, redeploying and retraining staff, sharing work with the private sector, improvising procedures and equipment to keep, so far successfully, one step ahead of the flow of infections… Bureaucracy, what bureaucracy?
‘It’s impossible to overstate what has happened in the last two months,’ judges one observer. Of course, it has been a desperately close-run thing, and no one would want a re-run any time soon. But the imperative to do whatever it takes (to coin a phrase) to win a real-life game of life and death is being seen as a liberation for some NHS managers, who find themselves for once with control where it should be – in their own hands. ‘We can’t go back after this,’ one is quoted as saying.
Where the news is less good is at the point where help from the citizenry’s self-isolation from health services runs out – that is, in the supply of the basic equipment that allows our saints and martyrs to perform the heroics we rightly celebrate. Or not help much, compared with the need. But that is not for want of effort. Witness the countless stories of ‘small ships’ – small businesses, individuals and groups of volunteers pitching in to sew scrubs, gowns and even craft visors, some with ‘bleeding fingers’ at the end of the day; cooking free meals for NHS staff; providing transport to and from work; and putting up and feeding them at the end of their shifts. And what about the astonishing 750,000 volunteers who came forward to help the NHS at the beginning of the crisis, a phenomenon that has left the rest of the world marvelling?
Unfortunately, the one party missing from this spontaneous outbreak of inventiveness, collaboration and sense of common purpose is the one that matters most – the government. It’s a commonplace that the pandemic has made government and the state vital again, as the only entities with comprehensive national reach. Accordingly, although the fit isn’t perfect, the gruesome league table of covid mortality also looks like a pretty fair reflection of government competence. In general the countries that come out best are those in south-east Asia, Germany and Denmark in Europe, and New Zealand that acted in character and as might have been predicted – calmly, early and firmly.
At the other end of the scale, currently the worst outcomes are likely to be in the US and UK, both notable for fractured politics and a strong belief at the top that the state is just another interest group, and in their own exceptionalism – mercilessly skewered by Fintan O’Toole in the latter case (although he failed to mention that the virus itself had already done the same thing by putting the country’s prime minister, health secretary, and chief medical officer, not to mention No 10’s chief special adviser, out of action with covid19 all at the same time – a unique full house of haplessness). The Johnson team’s slow reaction to the spread of the disease, subsequent policy zigzags and implementation failures faithfully reproduce on fast-forward the distinctive shortcomings of British government over the decades, with an added layer of arrogance thrown in.
In this context, the delegation of responsibility for protecting the NHS to citizens is no surprise – it is the culmination of the series of ‘reversifications’ under which the dehumanising pressures of financialisation and targets have gradually turned processes, functions and whole institutions into their dark opposite – think the Home Office as department of alienation and hostility, welfare as punishment for poverty instead of a helping hand. Tellingly, while ministers learned enough from the financial crisis of 2008 to enact an instant bail-out of the economy, their lack of systemic social vision is leaving a trail of destructive unintended consequences behind its initial ‘protect-our-NHS’ call: the ‘collateral damage’ of extra deaths as ill patients shun A&E and cancer departments, the unfolding tragedy of care homes become killing fields (another reversification), and now the finding that people mystified by the government’s switch from herd immunity to strict lock-down will have to be cajoled out of their houses to ‘assert their inalienable right to go to the pub’ when restrictions are lifted.
Covid19 has ruthlessly exposed the hidden faultlines and contradictions in our society, and the lazy, self-serving economics and management thinking that first engineered and then ignored them for 40 years. When we come out of it, we will indeed remember those failings. But we will also take heart from the unforced collaborations, cooperation and solidarity emerging in the lockdown that reflect a more positive view of human nature – one that will form the basis of new and more realistic versions of that dried-up, pre-Darwinian thinking. It will have been us who have protected the NHS, not governments, and it’s the least that they owe us in return.