We need to give the NHS more than just applause

It was, of all people, the former Conservative chancellor Nigel Lawson who noted in his memoirs that the ‘National Health Service is the closest thing the English have to a religion’.

The observation was intended as a complaint, more than anything else, about the difficulties any politician seeking to reform the NHS would face, especially from the ‘priesthood’ of those working for it.

But whatever its original intent, the sentiment it expressed about the importance of the NHS in the UK’s national psyche rings true more now than ever, nearly three decades after the words were written.

Posters in windows thank the NHS and the 1.5 million people who work for it. Ministers praise its staff in daily briefings. Companies are falling over themselves to offer NHS workers discounts and freebies.

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And every week, millions of us stand outside our homes and applaud the work done by them, and those who have paid a price no-one should be asked to while doing their jobs – giving up their lives as they try to save those of others.

Scores of NHS staff have already died during the outbreak, and the toll increases every day.

More is being asked of our NHS workers than would ever be asked during usual times, and they deserve every bit of recognition they get.

But we should also remember that saving lives – or improving lives – is hardly out of character for the NHS: that’s what it exists to do every day, crisis or no crisis.

It will still be there when coronavirus ends. It will, we surely hope, still be there to face whatever pandemic eventually succeeds it, hopefully many decades into the future.

How can we make sure our current surge of gratitude extends into helping the NHS with its day-to-day role – and into making sure it is better prepared for the next time disaster strikes?

We must start by being blunt. Clapping won’t save a single doctor, nurse or patient. It won’t fix shortages of protective equipment, failures of oxygen supply systems, or critically low staffing levels exacerbated by a late and chaotic testing regime.

What started as a genuine and largely spontaneous outburst of affection and respect for the NHS cannot be allowed to turn into a ritual, a cargo cult form of help for a service in need of real support – as risks happening today.

Perhaps even more difficult to accept is that we won’t help anything by taking cheap shots or pretending that battling pandemics is simple. Such ‘knee-jerk’ criticism can be tempting and is sometimes easy to confuse with an attempt to achieve real accountability – which does matter for preventing repeats of this situation – but it accomplishes little.

This kind of cheap shot approach includes, for instance, point-scoring over the fact the UK sent a largely symbolic shipment of a few hundred thousand items of PPE to China early in its own outbreak. The total amount of PPE items used and shipped in the UK since the beginning of the crisis here is well over a billion, and this early haul sent east represents nothing more than a rounding error – and China donated, in turn, far more PPE to the UK than we sent in the other direction.

Other cheap shots are harder to spot: it’s easy, sitting on the sidelines – a much easier task than actually responding to a pandemic – to ask why we didn’t have huge stores of protective equipment sitting ready for an outbreak like coronavirus.

The reality is messier: protective equipment has an expiry date, after which it is less effective and shouldn’t be used.

Different pandemics require different protective measures – it is entirely possible to stock up on the ‘wrong’ equipment.

Imagine a government routinely throwing out, say, £10 million, £50 million, £100 million or more of unused equipment and the media reaction that would provoke – as it did when the government of the time bought millions of doses of Tamiflu, which were eventually not needed and expired.

The UK government had bet instead on a contingency system able to make large orders of emergency PPE at short notice, from international suppliers.

In practice, this system delivered less than they hoped – not least because France seized the large order the UK had made when it requisitioned all supplies in the country, an unexpectedly uncharitable act for a country itself reliant on global trade for vital supplies during a pandemic.

Working out who should have been able to do more, and when, will be a key part of the inquiries after coronavirus – and it should be.

Those real answers will matter, both to achieve closure and for learning how to prevent such mistakes happening again.

But answers aren’t enough.

Despite being insulated from the worst of austerity, the NHS has been breaking apart at the seams for years, with recruitment crises exacerbated by low pay, morale, exhausting conditions and anti-immigration sentiment undermining its multicultural workforce.

Trusts have struggled to fill the gaps left by cuts to other services. Medical professionals have had to pay more towards their training.

And hundreds of thousands of people upon whom the NHS relies – cleaners, caterers, porters, care workers, and more – work in insecure, low-paid jobs, often farmed out to the private sector, and all but forgotten when we thank the people who make the NHS work.

As important as finding real answers, is expressing real gratitude, and that comes from making the NHS work better for the people it serves, but also the people who work for it.

Real gratitude doesn’t come from applause, or from badges – it comes from the pay we give to those workers, the social compact we make with them, and the quality of the service we help them provide.

Anyone hoping to privatise or undermine the NHS has had their hopes set back for a decade at least by the current outbreak. But we owe it to its workers and to ourselves to build something more out of this crisis.

The NHS was born out of the horrors of the Second World War, an event which taught people that the state could and should do more for them, and that the social contract could be rewritten.

What better time for a renewal of that social contract than after a similarly global crisis, during which the NHS served as the UK’s front line?

We know the way we pay for the NHS is broken. We know some of its part-privatisations and outsourcings don’t work. We know many of its staff are underpaid and under-appreciated. And we know our social care system is broken.

Coming out of coronavirus, we don’t just need an inquiry. We need a series of conversations on how to fix and improve the NHS, and the political will to take real action based on what we find.

The NHS is not, in reality, a religion. There is no godlike figure – not even Aneurin Bevan himself – to keep and protect it. The NHS is an idea, born out of crisis and preserved across eight decades. It’s time to reimagine it, refresh it, revitalise it – and keep it going for decades more. That is how we can honour the memory of those who have died in its service, as well as those who still serve and those they care for.