The NHS takes control: consequences for health policy in England.
| Author | Iliffe, Steve |
| Position | LESSONS FROM THE CORONAVIRUS CRISIS |
The new coronavirus that arrived in the UK in January 2020 has triggered changes in the NHS which will be difficult to reverse, at least in the short to medium term. (1)
In the beginning, the place and funding of public health as a discipline became a hot topic in the coronavirus debate as experts gave differing views of how to manage the pandemic. The 'herd immunity' view (building up a protective sub-population of the immune) was favoured initially, on the grounds that testing as many as possible of the whole population was impractical. The 'herd immunity' view gave way to the World Health Organisation's strategy of selective testing in mid-March, but there were political as well as scientific reasons for this change.
Public Health, taken into the NHS from local government in 1974, was restored to local government control in the Lansley Reforms of 2012. Like the rest of local government, it has experienced substantial cuts in its budget over the last decade. Public Health has been under-resourced, and the adoption of the 'herd immunity' strategy reflected the inability to mobilise the resources needed for mass testing and contact tracing. National government therefore opted for the second-best option of mitigating (but not controlling) the effects of COVID-19, in a country in which successive governments have deliberately underfunded Public Health services.
Changing strategy
Although it still has its advocates, the herd immunity strategy failed. The government then turned to selective testing combined with containment measures (social distancing and the closure of public spaces) as the optimal method for containing the pandemic. The change in strategy did not alter the problem of limited resources. Accident and Emergency departments were struggling with high levels of demand before the pandemic's arrival; there were (by one estimate) 100,000 job vacancies across the health service; and historically the NHS had spent relatively little on intensive care facilities or staff.
An attempt to mitigate the impact of the virus by promoting voluntary action by individuals reflected not only the Conservatives' ideological hostility to 'big government' but also a belief that most people could be nudged (but not coerced) into following public health advice. This optimism ignored the evidence that people in affluent and individualistic societies easily adopt an 'eat, drink and be merry' culture, breaching social distancing (and other health-preserving)...
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