As Britain officially records the highest death rate in Europe from Covid-19, urgent lessons must be learned from the tragedy being played out before us.
Free-market ideology has divided and weakened the NHS. Social care has been decimated. The hostile environment has ended universal access to healthcare. Universal Credit has exposed those who need support to cruelty. The failed policies of the last decade have fatally undermined the ability of the NHS to respond to the pandemic, endangering our population.
The government and Public Health England had two months to prepare the UK response. Classic public health measures – testing, rigorous contact tracing, quarantining – initially effective, were abandoned in March when resources, weakened by austerity, were outstripped by the spread of coronavirus. Government policy was written to cover up this reality.
Only recently have plans materialised to attempt to reinstate these essential measures. Yet the government has clung on to discredited outsourcing policies and the measures are incompetently operationalised through Deloitte, Serco and other outsourced contracts, with centralised yet chaotic results bypassing local authorities and primary care.
The ignorance of those in power about the reality of people’s lives has played a role in exacerbating this crisis. The dangers for people living and working in care homes, vulnerable to the spread of infection without adequate protection; workers on zero-hour contracts, one pay cheque away from starvation or losing their home, forced to go to work when unwell or when they should be self-isolating; transport workers driving crowded buses and trains; children in poverty, losing the lifeline of free school meals and breakfasts if schools are closed down; teachers in schools still open, or reopened, without serious public health measures and, where needed, personal protective equipment.
Official deaths of over 33,000 underestimates the awful toll in care homes and people’s own homes – the Financial Times estimates the true toll is over 53,000 now. Hospital deaths alone are four times the deaths per population in Germany.
The tragedy of the deaths of key workers worsens daily. As early May, 195 health and social care staff have died. At least 28 transport workers in London alone have died – supermarket staff, transport workers, delivery drivers, teachers and emergency service workers all face serious risk. There’s been a failure to test for coronavirus, a failure to protect key workers with PPE, a failure to even identify who are key workers beyond the NHS.
Daily government briefings pronounce a ‘ramping up’ of testing and PPE, yet the government continue to fail the very workers that they are clapping weekly. Arrogance and ignorance have exposed NHS and frontline staff to dangers at work and lives have been lost.
These serious errors of judgment and incompetence have been fatal. And compound the impact of the damage done to public services. The weakest links in the NHS, public health and social care exactly mirror the most ignorant, vindictive and ideological of recent policies. The NHS has lost 17,000 beds since 2010. The UK started with one sixth of Germany’s ventilators, one third of their hospital beds, two-thirds of their doctors. We had to erect emergency Nightingale hospitals around Britain; Germany did not.
England has 100,000 NHS staff gaps and 122,000 care staff vacancies. 750,000 volunteers have not been utilised properly by a government without a plan, when thousands would have the skills to help in this crisis given adequate training.
The parasitic nature of the marketised system has weakened England’s NHS. Private competition has undermined unity, strength and morale. The Health and Social Care Act 2012 allowed NHS trusts to earn half their income from private practice. Private hospitals have been sustained by £1.3 billion funding for NHS waiting list work. Thousands of NHS staff work part time in private hospitals. All these have damaged the public NHS as a unified national service.
Austerity has dealt severe cuts to the very public health services this country now relies on. Public health teams in local authorities and nationally have been stripped back. So too have staff groups that could have helped launch the public health mobilisation – school nurses, health visitors, community nurses, local authority staff in their tens of thousands. Primary care, GPs and other staff have been neglected and undermined.
The 2016 findings of pandemic planning were ignored by former health secretary Jeremy Hunt. The findings of Exercise Cygnus – a pandemic modelling exercise – warned of dwindling PPE stocks; that face guard masks were vital for frontline staff in a pandemic; that there was a lack of hospital beds and ventilators. The report was suppressed. The government ruled that the recommendations were unaffordable.
At the very time when all those with possible Covid-19 should be seeking urgent advice without hesitation, the hostile environment had ended universal access to the NHS. Fear of being reported to the Home Office or being given unpayable invoices has driven migrants and undocumented people – including 120,000 children – away from NHS care. So, even though coronavirus is a notifiable disease and its treatment is free, the damage has been done. Many have endangered themselves and the community, and there have been fatal consequences.
The UK needed to source equipment, and for national procurement policies and mechanisms to respond quickly. Although NHS England still runs the company NHS Supply Chain, it has outsourced procurement heavily. This is one reason why the national response on questions like personal protective equipment (PPE) has been such a failure.
The need is clear to restore a publicly provided national procurement process and indeed a production capacity for NHS staples. National decisions have been needed to direct our health services in local areas to respond in a coordinated way – that goes against the power of local CCGs over commissioning decisions and how NHS services are used given them by the Health and Social Care Act. Emergency powers gave back to NHS England the power to award national contracts directly, to get round the legislation.
The government also decided to set aside the Long-Term Plan – including plans to divide the NHS into 44 areas – for the rest of this year. The artificial burden of running NHS trusts in deficit, something we now known was unnecessary, has meant the NHS has been subject to bullying by government, accused of being £13.4 billion in debt.
Suddenly, the government has decided to write that off and trusts told to set aside cost savings programmes. Quite rightly, they need to spend what is needed in this crisis. But that’s how hospital and community services should always have been funded. It exposes how wrong previous policies have been.
There is still no systematic reliable testing, contact tracing or quarantining that a safe public health response requires. Lockdown cannot be ended safely without these prerequisites in place. Keep Our NHS Public has a 6-demand petition jointly with the Socialist Health Association which has been signed by over 250,000 people. It calls for testing and PPE, support for those on social care, a living wage for NHS staff, bringing private healthcare resources into public hands, making government medical advice available to the public and an end to the hostile environment in healthcare.
Now is the time to demand a return to a wholly public NHS. The tragedy we face must be the imperative for a safer healthcare and social care system in the future. There has never been a higher profile for these causes, and rightly so – now they need to be given the support they deserve. A useful first step would be scrapping the Health and Social Care Act.
We also need to abandon permanently the damaging intent within the Long-Term Plan to break up England into 44 commissioning areas, and to continue a commercialised NHS based on commissioning, contracting and privatisation of clinical services.
Staff in cleaning, catering and portering are at last recognised as key workers. Outsourcing has exposed them and the patients in our care to huge risks. It must be ended. Agency staff are sent from hospital to hospital, from care home to care home. During this pandemic, never has that been shown more clearly to be wrong.
The NHS must be properly funded. This has to mean the end of the debt burden hanging like a sword of Damocles over our health services. We must end the damage done to NHS hospitals and community services to constantly held in debt and end the burden of PFI debts.
We must call now for personal social care for all those who need it. It is the time to ask the public to support the creation of a wholly public National Care Service that can ensure the situation in our care homes – before and during this crisis – is never repeated.
Coronavirus is a tragedy. The response is a political scandal. Now we need to seize the opportunity to learn from these mistakes.