By Charles Moore
Why are we clapping the NHS? It is right and just to clap NHS workers, but that is not the same thing. Virtually everyone has reason to thank good nurses, doctors and paramedics. But if we are to praise large organisations for how effectively they have dealt with the coronavirus crisis, we should be clapping vigorously for Sainsbury’s, Tesco, Waitrose and Morrisons, who have responded nimbly to sudden extra demand for one of life’s basics – food. We should give only rather tepid applause for the efforts of the NHS to look after another of life’s basics – health.
As its name suggests, the National Health Service is there to serve the health of the nation. In this crisis, the roles have reversed – it is seen as the duty of the nation to serve the NHS. “Protect the NHS. Save lives,” says the slogan, in that rather surprising order. Children are made to recite it like a prayer. How are we to do this? We must help the NHS by avoiding hospitals and surgeries, we are told. The Government’s policy of lockdown is in significant part dictated by the demands not of patients, but of the NHS, and by its lack of adaptability and readiness.
In the most immediate sense, this mantra is justified. Too many patients in surgeries and wards will spread infection. Too many Covid-19 cases will overwhelm the doctors and nurses, the ventilators and the beds. We must all do as we are told, and stay at home. But isn’t there something wrong that the problem is so extreme?
We are trained, when we notice organisational or operational failures in the NHS, to blame the Government. This is partly reasonable: the Government is ultimately answerable for its existence, and no government has ever dared grasp the nettle of reform. But it misses out something important. When dissatisfied by other organisations – the police, the BBC, utility companies, supermarkets, banks, the Church – we arraign the people who run them. With the NHS, an unwritten law forbids this. It is treated like a God, even when it fails.
Take this week’s row about testing. A significant reason for the slow development, arrival and use of the antigen tests (“Have I got it?”) and the antibody tests (“Have I had it?”) seems to be the reluctance of the health service, and of Public Health England, to look outside their own spheres for help. In a culture almost proudly hostile to the private sector and mistrustful of independent academic work, the NHS’s first instinct is to defend bureaucratic territory. The extraordinary scene on Thursday when almost no health workers came for specially provided drive-in tests at Chessington World of Adventures seems to have resulted from a bureaucratic muddle about who was in charge.
In his skilful performance at the daily virus press conference on Thursday, the recovering Health Secretary, Matt Hancock, obliquely expressed his frustration. He exclaimed how well “non-ventilator companies” had come up with inventive solutions to produce ventilators fast. He issued a “call out” to British life sciences, laboratories and universities to do likewise for antibody tests.
Behind that ventilator comparison lies a story. Three weeks ago, the NHS belatedly admitted within government that it had failed to get enough ventilators. The Cabinet Office stepped in to help procure. Thanks in part to the energy of the distinguished surgeon Professor Lord Kakkar, University College Hospital, Formula I and Mercedes Benz got together to produce the CPAP (Continuous Positive Airways Pressure) machines that are one up on normal oxygen masks but less invasive than the full, intubating ventilators. Next week, the repurposed Mercedes Benz F1 factory in Brixworth expects to produce 1,000 CPAPs a day.
An equivalently brilliant initiative is urgently needed for antibody tests. At present, we are largely at the mercy of China (many of whose kits don’t work) to produce them. This is the embarrassment which Mr Hancock was gingerly admitting. It is why he cannot promise that antibody tests will be part of his 100,000 tests per day by the end of April. Or take the amazing 4,000-bed capacity Nightingale field hospital at the ExCeL centre in east London, opened yesterday by the Prince of Wales. For two weeks after it was proposed, NHS top brass opposed it. When they finally admitted they needed it, the Army and the private contractors were the ones who made it happen in nine days.
These are not one-off problems. Every day, scores of people with useful offers of medical supply get in touch with the Government. It filters these and passes on the best to the NHS. Too often, the offers get fobbed off or not even answered. Ten days ago, government contacts found the only company in Britain with expertise in making reagent for antigen swab tests. The firm was put on to the NHS, but at the time of writing, the health service had still not had a conversation with it.
Such rebuffs happen on the small scale, too. Yesterday, I received an email from the family of a couple of working medics recently returned from New Zealand. Both answered the call to rejoin the NHS, but have so far had nothing but a holding message. They see media stories of staff shortages because of infection and self-isolation, but still await the call.
Last week, I wrote about the construction of “hot hubs” where GPs could safely triage Covid-19 sufferers and decide whether to send them to hospital. The Sussex Clinical Commissioning Group (CCG) had ordered its small rural GP groups to set up such hubs within a fortnight without means, skill or direction. When I emailed the CCG last week to get its side of the story, it replied after my deadline, and then only to refer responsibility to a higher power.
A week later, the local GP groups have finally persuaded the CCG that a hot hub must be erected next to the local hospital (only after the hospital tried, in a classic example of the destructive rivalry between primary and secondary care, to refuse because of parking problems). Even now, however, the CCG has not worked out who will actually run the hub once built. As the local GPs’ spokesman, Dr Camilla Pashley, puts it, “The system moves at an unbelievable snail’s pace, though better than usual.” Meanwhile, Dr Pashley and her colleagues have to see Covid patients in their cars in surgery car parks.
That system is the problem. Most NHS staff are dedicated people. The defects are baked into our system of national bureaucratic command. People have noticed that Germany has been more successful in managing the virus spread through testing. This is not a coincidence. Germany does not have our lumbering central diagnostic system, because it does not have, in our sense, a national health service. It has 176 testing centres, part of localised arrangements which mix private insurance, employer involvement and government funding. There are more than three times as many beds per 1,000 patients as in Britain.
It is probably also not a coincidence that Germany has a less draconian lockdown than we do: it can focus on the Covid problem more exactly.
We are locked down by the needs of the NHS in the face of Covid. If this goes on for, say, three months, we could well run out of money to answer those needs. Work matters urgently for the health and wealth of all. As soon as possible, we must get back to it.