The strain on the NHS is unprecedented. Within a few weeks, hospitals across the country expect to be overwhelmed, meaning that they will be unable to deliver the standard of care to which people are entitled. The number of Covid patients in UK hospitals, 32,294, is the highest ever and climbing. Staff absences are at crisis levels, due to illness and the need to self-isolate. Morale is at breaking point (and in some cases, broken). The UK is on course to exceed 100,000 Covid-related deaths by the end of the month, or soon after.
The pandemic and the winter are the causes, at a basic level. The second wave of Covid-19 arrived with its more infectious variant at what is always the busiest time of year for the health service. But poor leadership by an inadequate, overcentralised government with an ideological bias against the public sector has made a difficult situation far worse. The number of excess deaths in the UK is among the highest in the world, with the current death rate above that in Germany, France and the European Union as a whole.
Weak and tardy decision-making around restrictions, the prime minister’s strong preference for individual freedom over social protection, and the failure of the outsourced test-and-trace system have piled pressure on to frontline workers in hospitals, schools, nurseries and supermarkets. That ministers were focused on Brexit, rather than health, over the crucial Christmas period, was a gross misjudgment. On Sunday, the health secretary, Matt Hancock, warned that restrictions may have to be further tightened, in recognition of the fact that with the R number estimated to be as high as 1.4, the virus is still spreading to a dangerous extent.
But responsibility, and blame, for the parlous situation in which the UK now finds itself extends beyond the current cabinet. Conservative governments (and their coalition with the Liberal Democrats) have been shortchanging the NHS and care system for 11 years, at the same time as widening the inequalities that are among the causes of poor health, including Covid. Jeremy Hunt, the former health secretary who now chairs the health select committee, admitted in 2019 that social care cuts went “too far”. Last year, he wrote in this newspaper that the pandemic has removed “any possible excuse” for the delay in resolving the crisis once and for all.
The immediate priority is to reduce current pressures. This means clear communication by the authorities and compliance with regulations by the public. Tasked with delivering the vaccine programme as well as care for patients, the NHS faces enormous demands. Doing what we can to support this effort (including by volunteering), and countering noxious misinformation, is essential. The chancellor, Rishi Sunak, said last year that the NHS would have “whatever it needs”. In the short term, that means renewing last year’s deal with the private sector, and funding care homes to open up spare capacity if possible.
Looking after those who are suffering, and trying to prevent further harm, is the first task. On vaccinations, thankfully, the UK has made a strong start. But attention must soon turn to a new settlement. Spending on health and social care in the UK is lower than in many comparable countries; so are the numbers of doctors, nurses and hospital beds. It is good that so many British people value the NHS; indeed, it is a cornerstone of progressive politics. But a resilient health system cannot be run on goodwill. What it needs, particularly in a country with an ageing population, is sustained and strategic investment.