Crisis? What NHS Crisis?

At last the government have acknowledged something bad is happening in the NHS. With Accident and Emergency departments completely breaking down, the UK Health Security Agency has finally issued advice: if people are ill and need to go out, wear a mask. Health Secretary Steve Barclay said there is a £500m fund available so patients with nowhere to go can be discharged into the community. And now Number 10, please note not Rishi Sunak, have conceded that A&E waiting times are making for a difficult Winter but there is no crisis. "We are confident we are providing the NHS with the funding it needs, as we did throughout the pandemic, to deal with these issues" the Downing Street spox said. Tell that to striking nurses and ambulance workers. Or patients worrying whether they'll be among the estimated 500 excess deaths this week.

This is the culmination of the Tories' laissez-faire approach to public health. Since the removal of all Covid precautions, they have acted as if Covid did not exist. According to the ONS, the result in 2022 has been between 300 and 350 deaths a month with Covid on the certificate. Excess deaths are about a fifth above the five year average (excluding 2020). On hospitalisations, admissions have remained above average since the pandemic broke in March/April 2020. The Tories have left the NHS to run hot, not allowing staff breathers and recovery time between waves. The crisis has become the new normal.

Covid matters for several reasons. There are still risks of serious illness, especially for the elderly and the clinically vulnerable. This means hospitalisations and greater incidences of long Covid. The second problem is the long-term consequences of Covid. The disease is now well known, and it can - whether someone contracting it is ill or has a symptomless infection - erode the immune system, the body's ability to eliminate potentially harmful cell mutations, and increase the risks of strokes and cardiac arrest. Multiple reinfection leaves us prey to experiencing other illnesses more acutely. Such as the flu wave that is also putting thousands in hospital. What the long-term consequences this will have on the developing bodies of children is unknown. Instead, what messaging there has been is little better than vibes, suggesting infection gives us residual immunity and protection, as if Covid is a flu strain or a bout of measles. Instead of pretending everything is okay, the public health message should be clear about the risks of infection. It should recommend masks in crowded public places, especially enclosed spaces, for everyone - not just those who are ill. N95 masks should have been publicly procured and made freely available. The government could have rolled out its last vaccination booster programme to the under 50s. It could have undertaken a programme of air filtration fittings and UV light disinfection in public buildings. Instead, they did nothing.

The Covid crisis came on top of another crisis in the NHS. Since the Tories took office 13 years ago, hospital beds have fallen, and adult social care cut to the bone just as the ageing population were making greater demands of it. Successive governments deliberately let health spending lag behind demand, ensuring there was no slack in the system and making it look like the NHS was fundamentally broken. This was exacerbated by their further marketisation of the NHS, and an apparent enthusiasm to "take on" the medical professions. Nurses and ambulance workers are in the firing line now, but before them it was junior doctors and the British Medical Association.

What is the Tories game, then? Evidently, the Prime Minister and his lackeys don't care about patients and burned out NHS staff otherwise they'd have done something about it. There are two intertwined strategies at play. The first, which goes back to the Coalition years, is the effort at effectively depoliticising politics. This takes the shape of defunding multiple public institutions as well as the NHS, run it down to a level of decrepitude, and thereby reduce the state's capacity to do anything. This lowers people's expectations so they become cynical and sceptical about whether things can get any better, and the Tories - presenting this as inevitable and natural - escape (they hope) responsibility, or at least allows them to frame politics in terms of reduced expectations.

The second is the residualisation of the NHS. When people talk about the privatisation of the NHS, what is often meant is the introduction of charges and the removal of the free-at-the-point-of-use principle. The Tories would only ever do this around the edges, because they know how politically toxic treatment-by-payment would be for them. Especially for a party overly dependent on a shrinking, elderly voter base. But they are also keen on getting more private capital into the NHS. We saw how Covid procurement was a free-for-all for Tory donors (as well as, directly, some Tories). They would like nothing better than a guaranteed market, underwritten by state money. An arrangement that the pharmaceutical giants have enjoyed since the NHS's foundation. However, they want to run the NHS down to the point where those with means opt out and go for private medicine, strengthening markets there as well as generating new opportunities for medical insurance. Which they and their donors can also do well from. And it appears Labour's shadow health secretary is not that ill-disposed to some aspects of this.

The crisis in the NHS has been engineered through over a decade of neglect, and exacerbated by a pandemic the Tories took political advantage of. The government will have to be forced to intervene, be it by a bigger turnout for the next round of strikes, mass demonstrations, Tory MP post bags brimming over with complaints, and jittery backbenchers applying pressure on the (still weak) Sunak administration. The Prime Minister and the Health Secretary aren't going to do anything simply because something "must" be done. As far as they're concerned, the misery and suffering is their programme running according to plan.

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