Our economy is being sacrificed because the NHS was unprepared for a pandemic
Covid-19 represents a perfect storm for our health service. Why have others fared better?
In the war with Covid-19, NHS staff are on the front line. The last few weeks have been a stark and sudden reminder that their jobs are not like ours: while the rest of us huddle in our bedrooms, they are risking their own and their families’ lives and health on our collective behalf.
Yet the NHS is central to the coronavirus crisis in another way, too. The Government’s entire strategy has been driven by the need to manage hospital admissions, and in particular the burden on intensive care units (ICUS). It is when they are overwhelmed that people start dying in large numbers.
We’ve all seen the terrifying chart from researchers at Imperial College London: the vast bulge of potential cases above, with the thin red line representing ICU capacity far below. It is in order to flatten that bulge that the Government has ordered an unprecedented social and economic shutdown. The result is that the economy is effectively (and we hope temporarily) being sacrificed on the altar of NHS capacity.
All of which raises an uncomfortable question. We all now know that Britain has far fewer hospital beds, and in particular ICU beds, than other countries. We are frantically attempting to remedy that situation, for example via the crash production of ventilators. But dealing with that disparity could end up wreaking severe economic damage.
Left-wingers are lining up to argue that we have been penny-wise but pound-foolish – that the root cause of Britain’s suffering is that we did not fund the NHS enough, and that billions in bailouts being announced by Rishi Sunak are the direct consequence of that. But the reality, as ever, is more complicated than that. It is true that the NHS has, in recent years, endured an unprecedented cash squeeze. But it is also true that, to paraphrase Liam Byrne’s famous note, there was no money left.
When he entered office, David Cameron protected the NHS from the austerity that was imposed elsewhere. When Philip Hammond finally relaxed the spending squeeze, the NHS got the overwhelming proportion of the extra money. Boris Johnson followed suit, significantly increasing NHS spending both on taking office and again in his election manifesto.
In other words, recent prime ministers have repeatedly prioritised the NHS over other public services. On the current fiscal trajectory, the British state is slowly becoming a health care system with a nuclear deterrent attached. The fundamental problem is that, as the population ages, spending will always struggle to keep pace with raw demand, which was up 6 per cent last year alone.
The lesson from other countries is also that the impact of coronavirus is not just about how much you spend. America, which is struggling to contain the disease, spends far more on health care than us. South Korea and China, which seem to have it under control, significantly less.
In fact, the blue-chip Global Health Security Index found only months ago that the NHS was the second-bestprepared health system in the world when it came to epidemics although it warned that no country was fully ready for what might come.
Yet it is already clear that the crisis is hugely exacerbating the NHS’S existing problems in terms of beds, equipment and staffing. The health service has been “running hot” for years. Wards have been at close to the maximum of their bed capacity. Every winter, a surge of patients meant that the system struggled to cope. But every winter, it just about came through, not least by pushing back non-urgent procedures.
The recent increases in NHS funding were, in part, designed to address this: more nurses, more GPS, a long-term plan for the workforce. But medical staff take years to train.
Some within the health service also suggest there is a parallel here with the Challenger disaster. Nasa had got used to minor failures of the “O-rings” on its space shuttles. What should have been a giant red flag instead became seen as an acceptable risk. Likewise, for NHS staff, “flood-andretreat” slowly became the new normal. The “winter crisis” became just winter.
But this isn’t just about resources – it’s about the direction of health policy. Over the past 30 years, the number of NHS beds has halved (although the number of ICU beds has recently been rising). But over that time, we got much better at treating patients and sending them home. Procedures that used to require lengthy bed rest now saw people discharged after a few days, or even on the same day.
The focus, in other words, was on the flow through the system, not its peak capacity. Reformers concentrated on trying to get more people out of hospital, not fit more people in – either by beefing up preventative care at home, or by speeding the flow of patients into an increasingly battered social care system. There is a parallel here with Britain’s rail networks, which – despite the negative publicity they get – are actually among the most effective in Europe in terms of how many trains and passengers they push through the system. The problem is that this leaves precious little slack when things go wrong.
Yet even discussions about NHS bed numbers focused on the general groaning and creaking of a system struggling to cope with demand – rather than raising hypotheticals about the impact of a once-in-acentury plague.
This particular disease could have been precision-engineered to destroy our health system. Most viruses either kill or spread, but not both: rapidly destroying your host is a great way to ensure that you do not get passed on. Covid-19, however, offers the worst of all worlds. The young generally (though by no means always) suffer relatively mild symptoms, enabling the disease to be easily passed on, but mortality rates for the elderly are truly terrifying. On top of this, there is the early period when victims are infectious but not symptomatic: the perfect recipe for super-spreading.
At the same time, it is not true to say that “no one saw this coming”. In 2016,
Larry Summers, the former US treasury secretary, co-published a paper estimating that the economic impact of pandemics would, over the coming decades, be of the same order of magnitude as climate change. He predicted that a moderately severe pandemic, of the kind that occurs every few decades, would knock 4-5 per cent off global GDP. The “ultra scenario” of a pandemic akin to the 1918 Spanish Flu would raise that to 12 per cent. But in some developing countries, it would slash GDP in half.
“At the moment, the spending and attention given to threats such as terrorism, cyber-warfare or climate change is an order of magnitude greater than that given to pandemic prevention,” he warned, prophetically, in a subsequent article.
It was this concern which lay behind the launch, shortly afterwards, of the Coalition for Epidemic Preparedness Innovations (CEPI) – in which British researchers at the Wellcome Trust played a key part. Thanks to the efforts of CEPI and others, the time taken to develop an emergency vaccine has hopefully been cut from years to months.
In Asian countries, the memory of Sars and swine flu ensured that pandemic preparation was a priority. But within the NHS and other Western health systems, we were more complacent. Even as China was crash-building hospitals in Wuhan, we were still focused on the nowtraditional winter pressures.
As Covid-19 continues to wreak devastation, we are learning some very painful – and very expensive – lessons. It may be that, as the Global Health Security Index predicted, the NHS turns out to be better placed to weather the storm than others. But the human and economic cost is likely to be far heavier than any of us could have imagined.
On this fiscal trajectory, the British state is becoming a healthcare system with a nuclear deterrent attached
This could have been precision engineered to destroy our health system. Most viruses kill or spread, but not both