Our ageing society has reached a historic turning point. After a few paroxyms of ethical anguish over closing schools, the nation has taken a profound decision: it is worth risking tomorrow’s generation to reduce the strain on today’s health service. We must assume that the country’s judgement is both overwhelming and reasonably informed: 80 per cent back the latest restrictions in the most recent polls; after two lockdowns, people have a fair idea of the likely fallout.
Hardline pro-lockdowners will see this drastic collective action as a triumph for humanity, which also confirms the moral supremacy of the the NHS. They are only half-right. Granted, the human impulse to protect the vulnerable – detectable among the earliest hunter gatherers, who shared their spoils most generously with elderly tribe members – endures even to the point of our own destruction. And as the NHS morphs from a neo-Christian institution built on compassion to a Wiccan deity demanding seasonal sacrifice, Covid has certainly bought a new rawness to its spiritual mythology. But mythology is the key word.
Torn citizens have only settled in favour of another lockdown because a vaccine is being rolled out. They assess – with a somewhat narrow optimism – that we might as well hunker down for another 12 weeks to save tens of thousands of lives from Covid. But have many also quietly concluded that this must be the last time?
After the NHS’s evident failings of 2020, not least in ensuring sufficient capacity, this year may just herald the unthinkable: momentum for reform. Lockdown heretics, bogged down in their misguided mission of questioning the severity of the crisis in ICUs, miss a trick. “Who actually knows someone who is ill with Covid?” has become the rhetorical quip. Instead they should be asking: “who actually knows someone who thinks the NHS is sacred?”
Perhaps fewer than the metropolitan commentariat assume. This is not to take away from the frontline heroism. I may not be clapping each day for the dysfunctional institution, like a good little citizen in the British Republic of North Korea, but my heart still catches at stories of overworked, poorly equipped doctors and nurses.
Are such nuanced attitudes the unspoken mainstream? More than half of the public said they think the NHS is wasteful in a recent survey; on the health service’s 70th anniversary, the fire brigade pipped it as the institution the nation is most proud of in a YouGov poll. The idea that the NHS is untouchable is a Left-wing myth, crafted in the Nineties, when both major parties moved towards market mechanisms in health. Campaigners, previously preoccupied with hospital closures, cohered into a movement to defend the NHS’s founding principles.
Clever Left-wing revisionism has cultivated the legend that the Second World War turned the public into healthcare radicals. As historian Nick Hayes has pointed out, the evidence begs to differ. Mass Observation accounts from the Forties suggest that people were more concerned with pensions (and some even took a “perverse pride” in total disinterest). By the Fifties, grumblings about waiting times and red tape were commonplace. One TB patient’s lament that at least nurses “had some genuine vocational spirit” in bygone days might be a rant heard in the privacy of any contemporary living room.
In other words, the NHS is not, and has never been, beyond popular scrutiny. While the majority think that the NHS should be protected in the eye of the storm, nobody in their right mind thinks that, in the aftermath, it should be protected from reform.
Although Nigel Farage is eyeing populist anger at China as his next campaign, he should consider the power of a pressure group to reform the NHS. After Brexit, this is the next big issue with the potential to unite the libertarian Tory shires with the economically scarred Red Wall.
Otherwise, perhaps only a Labour Party shed of Corbynite baggage would have the confidence to seize on such an electoral curved ball. New Labour showed a greater appetite for quasi-market reforms than the Tories ever have over the last decade; improvements from more patient choice, and a payment by results system, to independent foundation hospitals have all floundered under a Tory party toxified by austerity.
Tory timidity is all the more tragic given the amount of low-hanging fruit. Our nursing shortage – which has rendered the Nightingales impotent – might be addressed with more generous grants and better career progression. The Covid superspreading hospitals that already had notorious hygiene track records, make a case for finishing what Labour started with foundation hospitals, so that good ones are incentivised to expand and bad ones are allowed to fail. Also, are social health insurance models embraced by social democratic pinups in Scandinavia really paragons of evil Right-wing privatisation?
Once we are over the hump, I suspect that society will conclude – in my view erroneously – that lockdowns were the right thing to do. But the same hopeless human goodness that got us into this mess can get us out of it. Faced with the fallout, we will salve our guilt by asking what we must do to make sure lockdowns never happen again. The future belongs to the party that can answer that question.