We need Churchill’s can-do spirit to get our bureaucratic health system moving
So much for the idea that reforming the quango state was a side issue or distraction. In a crisis, the inertia of our executive agencies can become lethal. Consider Public Health England (PHE). In theory, that vast bureaucracy exists for precisely such an emergency as the present one. It has more than 200 executives on six-figure salaries, some of them earning more than the Prime Minister. For years, its busybody officials have hectored us about pizza and fizzy drinks. Yet the moment a real public health threat comes along, they prove useless.
A paper by Matthew Lesh of the Adam Smith Institute sets out to explain why the UK has conducted fewer tests for Covid-19 than comparable countries. It finds that the most successful nations, such as Germany, South Korea and the United States, were quick to push testing out to private laboratories. In Britain, by contrast, there was an early determination to concentrate the samples at PHE’s own facilities. “The UK’s Covid-19 testing has been dangerously slow, excessively bureaucratic and hostile to outsiders and innovation,” Lesh concludes. “PHE has actively discouraged use of private sector testing.”
Naturally, in politics, ministers get blamed for the shortcomings of public bodies. In an inversion of Baldwin’s quip about press barons, ministers have responsibility without power. Voters insist, for example, that they want an NHS free from political interference; yet they blame politicians, rather than the NHS, when things go wrong.
Hence the determination with which Matt Hancock, the Health Secretary, has taken control of the situation. He knows that he will be judged by the Government’s success in containing the disease. No voter wants to be told, at a time like this, that large bureaucracies are unresponsive. No voter wants to be reminded that, as late as February, PHE was fretting about inequality, while the World Health Organisation was telling us that racism was more dangerous than the coronavirus. People want action from their elected leaders.
And, by heaven, they are getting it. Hancock’s return from his seven days of self-isolation was like the teacher coming back to the classroom. After a week of lethargic daily briefings, it felt as if someone was in charge. There are to be more swab tests, more ventilators, more hospital beds, greater tracking and surveillance, and support for a British diagnostic capacity. “And I say to this man, Go, and he goeth; and to another, Come, and he cometh.”
The Prime Minister, perhaps even more than his Health Secretary, knows how Winston Churchill used to cut through bureaucracy by taking personal charge. “Action this day”, he would scrawl across memos. As Boris hauls himself from the pupa of his self-isolation, something similar is happening across Whitehall.
British commentators went weak at the knees when the Chinese managed to build a new hospital in Wuhan, but consider what has happened here: a mammoth new facility in east London completed in nine days, with regional hubs following in Glasgow, Harrogate, Manchester, Birmingham and Bristol. At the same time, clinical trials – an area where Britain can fairly be said to lead the world – are being stepped up.
True, we don’t yet have a reliable way to identify people who have previously recovered. But it is surely only a matter of time before one of the many tests currently in development is shown to have a high degree of accuracy. That will be our way out of this wretched situation. At the very least, antibody tests will allow immune people to get back to work. But they could do much more. If they suggest that infections were more widespread than was realised at the time, that there were many mild or asymptomatic cases, they might allow us to lift most of the current restrictions.
It is hard to see how else we can avoid years of poverty and unemployment. Politicians know that they are being judged solely by the number of coronavirus fatalities, which creates a perverse incentive to maintain the shutdown for longer than the hard science might suggest.
Suppose, for example, that growing evidence were to support the Swedish approach – that is, promoting social distancing and banning mass meetings, but otherwise leaving things open. Suppose (this is necessarily a conjecture, but not an unrealistic one) that we could be reasonably confident that infections had peaked by Easter. There would, I suspect, be overwhelming pressure to err on the side of caution, to keep the restrictions in place until we could be certain.
Look, after all, at the opinion polls. Fifty-four per cent back the Conservatives. Seventy-two per cent approve of the way the Government is handling the crisis. Ninety per cent support the ban on commercial activity (I refuse to call it a “lockdown”, a ghastly term borrowed from prisons). In the circumstances, all the pressure is for ministers to do things that are probably unnecessary, rather than run the slightest risk of being accused of not doing enough.
The cost of the restrictions is hard to measure, but no less painful for that. One of my university contemporaries , who has a history of mental health problems, has struggled terribly with confinement. A neighbour is facing the grimmest of hat-tricks: her business ruined, her house-move frozen and her cancer operation postponed. The village osteopath, who went from 300 patients a week to zero when the bans came in, has been forced into insolvency. Nationally, a million more people have been pushed on to benefits.
I am astonished by how many commentators duck these consequences by airily asserting that “lives matter more than the economy”. What do they imagine the economy is, if not the means by which people secure their welfare? The economy is not some numinous entity that exists outside human activity; it is the name we give to transactions among people aimed at maximising their wealth, health and happiness.
If shops and businesses (excluding only those which are judged disproportionately likely to accelerate infections, such as nightclubs) are able to open next week, we might yet escape the worst. Many firms teetering on the brink of bankruptcy could recover. But if the prohibitions remain in force into May, the fear is that businesses will topple like dominos, and a decade of depression will ensue.
Anyone can follow public opinion. The measure of leadership is to anticipate it.
All the pressure is for ministers to do things that are probably unnecessary, rather than risk being accused of not doing enough