There is a current failure to see what the pandemic has done to the National Health Service. In disaster planning, you usually see an event of total destruction followed by a fragile, precarious rebuild. But we haven’t got there in terms of explaining the damage done by the pandemic. We’re trying to pretend it hasn’t happened. Until we find a narrative to explore the damage wrought that is not political and not partisan, we won’t get to explore what a build-back might look like.
One of the reasons why we haven’t faced the reality of our failing NHS is that in the UK we’re very good at hiding death. When other countries’ health care systems collapse, like we saw in the pandemic, the dead become very visible. But here, people didn’t get to see the pandemic toll—we didn’t see bodies in hospital corridors or in the streets. Our death care professionals are one of our strongest national services. At the earliest stages of the pandemic, in February 2020, we massively increased body storage and we worked our staff on 24-hour shifts.
This, however, gave false reassurances during the pandemic. If that falls over, I think the public will start to see what a collapse looks like.
Coming into the winter of 2023, we’ll start to have very unpleasant conversations about what complete collapse of the health system looks like.
Social care services are already precarious. If you’re vulnerable or homeless, if you need mental health support or drug addiction support, you already know there’s no safety net. Mortuary staff are also starting to see much greater anecdotal evidence that’s difficult to process in a visceral and visual way: People presenting with very developed and externally visible cancers, children dying of very treatable illnesses. By the time we get to winter this year, I think the basic reliance on the health care system for the more privileged people will also be gone. That will be the moment when our health care system failure becomes its own disaster.
Another factor preventing us from finding that narrative is the ongoing failure of the Department of Health and Social Care to fully address its litigation problem. Both safety culture and the handling of litigation need to change. NHS trusts are the most defensive and adversarial of all organizations that I ever encountered. Speaking as a patient, I once filed a complaint and got a letter back that said they found zero likelihood of that event ever occurring. That kind of response straightaway places the patient in a position at odds with the trust. The number of litigation cases are such that we’re rapidly heading toward a point where the NHS litigation will soon eclipse all of the other budgets combined. Billions are being spent on defending and paying out for health care crime and negligence. Getting rid of this aberrant defensiveness would free up significant resources to channel into the future of the NHS.
The only good thing that comes out of a disaster like the pandemic is that it creates one single opportunity to reexamine structures and institutions. I’ve become very cynical about the purpose of any public inquiry to find that narrative. What we need is something gentler, freer, and genuinely inquisitorial, a royal commission perhaps, that would allow a true airing of everything that happened, on the same scale as Bevan’s original creation of the NHS. Only going that big and broad gives us any chance of averting further suffering.
This article appears in the July/August 2023 edition of WIRED UK magazine.
This article was originally published by WIRED UK
