Protect the NHS. That was the centrepiece of the government’s tripartite mantra during the Covid-19 pandemic. Boris Johnson instructed the nation to reduce social contact in order to halt the transmission of the virus, and the emphasis on protecting the health service as a central part of this mission was never doubted.
Now, four and a half years since that momentous TV address, the Covid inquiry is asking a simple question: why did the NHS need protecting?
This is phase three of an inquiry that has already exposed Dominic Cummings’s expletive-ridden WhatsApp messages, made Matt Hancock squirm, and reduced Johnson to a twitching shell. Whereas previous stages looked at preparedness and core political decision-making (hence the emphasis on Downing Street WhatsApps), module three, which kicked off on Monday and continues until the end of November, is about the impact of Covid on the UK’s healthcare systems. And in her opening remarks, Jacqueline Carey KC, the barrister acting for the Inquiry, made clear that a key part of her focus was why the NHS needed to be protected in the first place.
This might not seem like an overtly political story at first glance. After a tumultuous few years (last Friday marked the two-year anniversary of Liz Truss becoming prime minister, to give you a sense of how much has happened), Westminster has largely tried to move on from Covid. This isn’t how the public are feeling – the pandemic, particularly the lockdown-breaking parties at Downing Street, came up repeatedly during the election campaign. But so many other political challenges have been vying for our attention lately: economic growth; the cost of living crisis; inflation (still not back to where policymakers hoped it would be); energy bills; broken public services; overcrowded prisons; tensions over immigration. The list goes on. With Johnson far away from the political arena for the time being and a complete change of government since those Covid decisions were being made, this phase of the Inquiry does not have the immediate potential for exploding the political scene as its predecessors.
But the questions the Inquiry are considering in this phase are deeply political, and help explain the unenvious position in which the new Labour government finds itself.
Britain went into the Covid pandemic at a disadvantage, with our health service in a far more fragile state than that of other developed countries. Hospital occupancy levels were already above 85 per cent – the rate deemed safe. The NHS had been “seriously weakened” by policies in the preceding decade, according to a report out this week by Professor Darzi, a renowned surgeon commissioned just after the election to lead an independent assessment by health secretary Wes Streeting. This weakness “magnified” the impact of the pandemic, Darzi’s report states. As a result, Covid reduced “routine healthcare activity by a far greater percentage than other health systems”.
The consequences of that reduction – necessary in order to “protect the NHS”, because the NHS was in a such poor state already – are as wide-ranging as they are tragic. Monday’s Covid inquiry hearing began with an “impact video” showing interviews with healthcare workers and patients to, as Inquiry chair Heather Hallett put it, “remind everyone why we are here”. As well as the testimonies of Covid patients, a focus came on those with other conditions, such as a woman whose partner died of a brain aneurism after he was unable to get a doctor’s appointment. There was a sharp fall in hip (46 per cent) and knee (68 per cent) replacements, far more than in other European countries.
As well as human tragedy and burnout among healthcare workers, the impact of these delays and cancellations is felt today in terms of unconscionably long NHS waiting lists: figures from June show 6.39 million people were waiting for treatment. It is felt in the sharp rise of demand for mental health treatment, particularly children and young adults. And it is felt too in the 2.8m working-age people out of the workforce – deemed “economically inactive” – because they have long-term health conditions, equivalent to seven per cent of the working-age population.
The situation we find ourselves in both economically and in terms of healthcare dates back not just to the decisions made under Johnson, but to David Cameron and George Osborne. A direct line can be drawn from the austerity-era policies that pared back the British state and piled pressure on frontline healthcare services (for all the talk of “ringfencing” the NHS from cuts) to the health system’s poor performance when Covid hit, to the challenges of a sicker, less productive population Starmer’s government is facing today.
There are parallels with the atrocious revelations of the Grenfell report last week, which (as my colleague George Eaton explained) explained in horrendous detail how a culture of short-term cost-cutting and slashing red tape in the hope of saving money led to 72 unavoidable deaths. Another crisis with its origins in the Cameron-Osborne austerity era, whose true impact only became apparent when catastrophe hit. Stripping back the resilience of the state has consequences, even if it takes years for those consequences to be felt.
Blaming the last lot isn’t always an effective political strategy, as Starmer is finding out while his government starts making unpopular decisions, such as removing of the Winter Fuel Allowance as a universal benefit which is being voted on later today. But it is worth reflecting on how many of the UK’s current political woes – stagnant growth driven by low productivity, public services that are falling apart, an exhausted population that feels more vulnerable physically and financially and is demanding things get better – are tied to healthcare in a way that both predates and exacerbated the Covid crisis.
There is a story Starmer could tell about why we are where we are that might offer more context to the “tough decisions” Rachel Reeves is warning us are coming in the October Budget. It means finding a way to link hospital capacity rates of 85 per cent pre-Covid with the present economic malaise. Whether Westminster feels it has moved on or not, what is happening at the Covid inquiry a few short miles away in a hearing room in Paddington has deep implications for today’s political agenda.
[See also: Winter fuel payments cause more trouble for Keir Starmer]
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