It’s the NHS that now runs the country

The PM has effectively conceded that lockdown will return if the health service deems it necessary

Who governs Britain? In his announcement of the Covid winter plan this week, Boris Johnson gave a clear answer: the NHS. Flanked once again by Professor Chris Whitty and Sir Patrick Vallance at a Downing Street press conference on Tuesday, the Prime Minister reserved the right to introduce anti-covid measures, including vaccine passports and mask mandates. He even refused to rule out the possibility of another lockdown if, as the winter plan document puts it, we have to take “whatever action is necessary to protect the NHS from being overwhelmed”.

For the avoidance of doubt, Sajid Javid, the Health Secretary, said: “We don’t want to get into a position ever again where there’s unsustainable pressure on the NHS so it’s not able to see people in the usual way.”

The logic is simple: if this winter the NHS declares that it can’t cope, the Government has committed itself to bringing the country to a standstill until it can. Somehow, after three national lockdowns and the rollout of vaccines to more than 80 per cent of the adult population, we are still in the position where the people of Britain are being asked to “protect the NHS”, rather than the other way around.

This worrying reversal of priorities was born during the pandemic and it would be a dangerous step if it were to linger after it. In NHS crises of the past, as tragic as it undoubtedly was to see ambulances backed up outside hospitals, there was no question of normal life being suspended until the crisis had passed. Or, indeed, of allowing the NHS itself to dictate terms to the rest of us. The answer was to try to improve the NHS.

Boris Johnson, as other prime ministers have done before him, has sought to do so with a massive cash boost, in his case an unprecedented commitment of an extra £36billion. But where is the incentive now for the NHS to use that money well?

The first mistake was in writing a blank cheque with few, if any, conditions attached. Where, for example, is the stipulation that the extra money be spent not on extra managers but in training frontline staff ? Or the demand for innovative ways to keep wards open, including devising a proper plan to make the most of Nightingale hospitals and seeking new ways, anathema to many in the health service bureaucracy, of integrating elements of the private sector? Why are frontline NHS staff, unlike those in care homes, still for the moment getting away with not having the vaccine?

Offering the reserve option of a lockdown if the health service’s leaders fail to improve capacity sufficiently and hospitals are overwhelmed only further weakens the incentive to improve. Worse, it is easy to see how the threat of a costly new lockdown could be leveraged to demand even greater injections of health funding.

To be fair to Amanda Pritchard, NHS England’s recently appointed chief executive, capacity cannot be built overnight. In a creaking, monolithic structure that has proved stubbornly resistant to change, it is not easy to implement emergency measures capable of tackling a winter with the threat of Covid coupled with other seasonal illnesses such as flu. But what we have seen so far is precious little appetite to right these wrongs and few incentives from Government for things to change.

Sir Patrick made clear that he was keen to see the Government do everything necessary to repress the virus because the NHS was, in his view, already “under extreme pressure”. For all too many in this country, struggling to get a face-to-face appointment with their GP, or unable to get cancer treatment, the NHS is still not seeing them “in the usual way”. But rather than an all-hands-to-the-pump effort to make hospitals fit for the challenge, we have more threats of lockdown and ministers and advisers once again resorting to doom-laden projections.

Be in no doubt: if this winter the NHS declares that it can’t cope, the public, not the health service, will get the blame.

Perhaps the most dismaying conclusion from this week’s announcements is that this Government will never say no to the NHS, whatever the cost to the country. We must remain in thrall to an unreformed, inefficient service which we must continue to revere, despite its many failings.