To save the NHS we need to stop loving it.

AuthorArnold-Forster, Agnes

In 2018, to mark the hundredth anniversary of the Spanish Flu pandemic, Public Health England told audiences that the tragedy of a century ago was entirely a thing of the past. They confidently asserted that, together, the government, the NHS and Public Health England 'stand equipped and ready to respond with a plan in place for every stage of a future outbreak', promising that the plan would, 'ensure that minimal disruption of daily society occurs whilst we protect the health of the nation'. (1)

Fast forward to 2021, as we consider the damage already done by the Covid-19 pandemic and what its future may still hold, it is clear that the plans Public Health England touted in 2018 were seriously flawed. As of August 2021, nearly 130,000 people have died from Covid-19 in the UK, and still counting. This is a statistic that puts the country in the top 10 of worldwide Covid mortality tables.

The UK has not been alone in its general unpreparedness for pandemic, nor has it been exceptional in its inability to predict how the course of the pandemic would run. The nations of the global north are well-represented in the mortality tables, and the translation of (sometimes conflicting) scientific data into the real world, real-life application of policy has been a notable problem the world over. Like virtually all of the pandemic preparedness plans of the world's wealthier nations, the UK's was based on flu. Public Health England's Spanish Flu retrospective, oozing with what has turned out to be misplaced confidence, is not, then, a sign of a uniquely British failing, but a sign of a wider inability to even contemplate, much less rationally prepare for, the appearance of other non-flu viruses. With perhaps some minor exceptions, it is not an overstatement to say that the pandemic-whether by haplessness, by poor planning, or even by outright denial--has not been handled well by anyone.

But what is unusual about the British situation is the extent to which, at least in the public mind, the National Health Service has been given a free pass in terms of its responsibility for these failings. Public Health England has been effectively abolished on account of its role in pandemic unpreparedness, with its end date set as October 2021. The British government has taken at least some of its share of flack as well. But rather than hold the NHS as also responsible, we have instead celebrated its workers as our heroes, early on in the pandemic dutifully clapping for them every Thursday evening--as though to compensate for the repeated exposure to a deadly virus that the NHS's own poor planning had forced onto them, not least in the way of meagre supplies of personal protective equipment.

The past eighteen months have seen the strengthening of a not unfamiliar rhetoric. As Boris Johnson put it, the NHS is a 'national asset': one that will allow us to 'defeat this coronavirus'. Why? Not because of its preparedness or ability to mobilise quickly. No, it is for the far hazier reasons that the 'NHS [i]s the beating heart of this country'. 'It is unconquerable' and 'powered by love'. (2)

That is a bizarre thing to say about a health service. It is also no mere artefact of the specialness of our pandemic times. Instead, it is well-worn rhetorical territory for British politicians and their voters. Even in more regular circumstances, there is probably no other British institution that is supposed to better encapsulate the British spirit than the--or 'our' as it is personalised--NHS. It is difficult to think of any other country that has burdened its health care delivery system with as much emotional and historical import as has Britain. While doctors and nurses are nearly universally lauded professionals, the place the NHS--the entire health system-occupies in the British national imagination is unparalleled abroad, even in countries that have comparable healthcare systems that are free at the point of use, tax-funded, and generally regarded as more effective and efficient, as in Denmark, New Zealand and Canada, for example.

The current view of the NHS is not only very different from the way that health systems are perceived around the world; it is also a far cry from the way the NHS was perceived at its inception over seventy years ago. In the 1940s, after all, the NHS was far from unique. It was one example among many of the healthcare rationalisation programmes that emerged over the 1930s and 1940s, to combat economic depression and, later, the ravages of war. The emotional relationship between the British public and its health service did not, then, emerge fully formed in July 1948. So why do we tend to project back the foundation of the NHS as a singular sign of Britain as the world-leading healthcare exception? And what are the...

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