Within the past few weeks it is safe to say all of our lives have changed. Most of us hope this change is temporary and we can go and visit our families and enjoy a drink or two with colleagues and friends in a few weeks or months.
Some also know that this crisis has the capability to leave us with permanent changes in our ways of life, perhaps most importantly in potentially changing the contract the public has with their government.
The National Health Service is the clear example of a public service which has seen its ability to cope with all that is demanded of it stretched. Despite its resources having actually been increased, as a percentage of real GDP, by around ten times since the 1950s, stresses on the demand side are now acutely felt.
On a positive note our friends and families are living much longer. These extra years with our loved ones are precious, and I hope we remember that when we are able to reach out and hug them after this crisis is over. This additional time is the result of both greater social progress and more technological and medical advancements which grow increasingly more expensive and intricate.
However, an even more fundamental reason for this is that demands on our NHS are now broader than ever before.
During great national crises, we often re-evaluate the fundamental principles which guide us as a nation and which hold our institutions together. When the NHS was first established in 1948, Aneurin Bevan stated it had three core principles: that it be free at the point of delivery; that it be based on clinical need, not ability to pay; and that it meet the needs of everyone.
The service is still free at the point of delivery, and this sets us apart in this turbulent time from the stresses endured by our transatlantic neighbours, whose semi-privatised model is being stretched in many other ways. However, it is the latter which has caused the healthcare system to become the single point of failure in our social safety net.
Meeting the needs of everyone from a health perspective would, you might think, be straightforward. But what was relatively simple in 1948, when there were fewer diagnosable and treatable illnesses, is now much more complex and expensive. Therefore spending on the NHS arguably does need to rise more than either the rate of population growth or the rate of increase in life expectancy.
But that point is for another debate. What is important now is to recognise that the NHS has subsumed critical roles and responsibilities once taken up by other organisations, often acting as a social worker, therapist or friend before serving as clinician. This growth in capability to treat has, paradoxically, led to a decrease in NHS capacity. As demands on its resources have increased and diversified, it has grown less able to satisfy one of its core principles.
During the past month we have seen the shedding of these additional capabilities day by day. In this crisis period the NHS has pivoted to an almost singular focus – the provision of acute, live-saving support, the number one priority for all medically trained individuals. It has become an incredibly lean and efficient organisation relative to where it was four weeks ago.
As a result, many of the additional responsibilities that the Health Service has taken on since its inception are now being taken up by a huge variety of groups of a sort that used to exist in strength. As a nation we are making a valiant effort to mobilise in all areas to mitigate this disease – in fact, we’re rediscovering the concept of community.
On top of Rishi Sunak’s support packages for business we’re seeing churches reviving their primacy as the infrastructure at the heart of many communities and local volunteer groups, which we once called neighbours, being depended on more than ever. In short the community is reclaiming what had been laid on the shoulders of the NHS.
The reason for this absorption of capability by the Health Service is the theory that centralisation drives efficiency. To some extent that is true. Centralising expertise, administration, and services can, theoretically, lead to efficiencies. However over-centralisation can dis-empower local health care providers, who may often be better placed to understand the needs of their patients.
The point here is to illustrate that the structures which are easiest for the State do not necessarily equate to the most optimal delivery of services for the people. The second point must be the standard to which governments hold themselves, not the former.
Supporting this newfound sense of community spirit must be at the forefront of our national recovery after this crisis. Not just because it has been incredibly positive for the country in general, but because it can make a real difference in relieving pressure on many of our public services, including the NHS. Much has been made of the need to reform social care, and that is vital, but the possibilities extend much further.
For example, strengthened community groups in rural communities – be they based on charities or churches – could provide a level of pastoral and social care, through established networks of local volunteers, on an ongoing basis. Not only will this take pressure of some core NHS hospitals and services, but will allow the NHS to go back to providing the excellent, and higher, level of clinical support for those in real need.
If instead we fail once the crisis is passed to remember the importance of the “little platoons” that make up our communities, we risk reverting to a health and social care system that is overstretched and fragile. The only true way to grow and become stronger is to allow our NHS to return to providing excellent care by recognising our own responsibility to each other.
The Government’s role will be to lead and manage that strengthening, to not allow our sense of collective community fall away, and to ensure that the fragile fabric woven by the people during this crisis becomes an enduring part of our social safety net.
Link to original, published on Conservative Home on 09 Apr 2020.
