We can learn more from our mistakes than from our achievements – and there is much to be learned from the UK’s experience of the Covid-19 crisis.
Nine emergency ‘Nightingale hospitals’ were constructed swiftly and at huge cost to accommodate the most extreme cases. It was a dramatic gesture of determination to win the ‘war’ against the virus. It dominated media coverage for days on end. Costs of the English Nightingales were not disclosed, but judging by Scotland’s bill of £43 million, the full tally was probably nudging towards £400 million for construction and fitting, before paying staff and meeting other operational costs. Within weeks they had been abandoned, for lack of suitably ill hospital patients. Meanwhile, the virus was sweeping through care homes and claiming thousands of lives. Had the funds been invested instead in equipment and support for social care – and in designing systems for preventing illness and death in residential and domiciliary settings – the toll could have been greatly reduced.
Lesson one: avoid bombastic, self-congratulatory projects however much they grab headlines and enthral the electorate.
Lesson two: care for elderly and vulnerable people must never play second fiddle to hospital based treatment. Prevention of illness, treatment of disease, and care for those who are frail and unwell are inter-related parts of the same health system and we ignore that fact at our collective peril.
But the problem goes beyond this immediate failing. Social care in the UK has long been a basket case (to use a technical term) and it was stripped to its bones before the pandemic struck. Most providers of care are private sector businesses whose income is wholly or partly derived from contracts with local authorities. The sector is uncoordinated and dangerously under-resourced. More than 400,000 residents are looked after in 15,517 homes run by more than 5,000 different providers, while some 9,000 regulated providers try to support more than 600,000 people in their own homes. Over the last decade, funds from central government to local authorities have been cut by more than £7 billion as part of the Conservatives’ ‘austerity’ drive. Providers have responded by paring down their outgoings to conserve profits and pay shareholders. Most care workers are in pitifully low-paid and insecure jobs, with low status, poor training and little or no career development. Governing bodies in other parts of the world have found ways of managing and funding social care with better results. Successive UK governments have announced their intention to fix the problem, only to consign it to the ‘too difficult’ box.
Lesson three: a sector bedevilled by profit extraction and public spending cuts cannot rise to the kind of challenge presented by Covid-19.
Lesson four: care workers are just as essential to the nation’s health as nurses and doctors in the National Health Service. They should have comparable pay, recognition and career development.
If the UK ends up with the worst global score for dealing with the pandemic (perhaps rivalled only by the USA and Brazil) it will be due to a toxic mix of ideology and hubris. Since the 1980s, UK governments have been enchanted by the idea of introducing market rules into the welfare state. Individual choice, competition between providers and contracting out a range of functions to private corporations were all thought to improve efficiency and quality of services. The principles of the post-war settlement – collective action, pooling resources and sharing risks so that everyone can survive and flourish – were eroded and eventually obscured, even as the evidence mounted that a market-based system was inequitable, inefficient and unsustainable.
Lesson five: a system of health and care based on market ideology will not give us all an equal chance to flourish. We need collective services available to all according to need not ability to pay.
Lesson six: only strong and sustained support, regulation and co-ordination from governments at local, regional and national levels will ensure that the public interest is properly served. For guidance, a useful framework is set out in The Case for Universal Basic Services, published in February this year.
As the pandemic took hold in Europe, it became widely apparent that we profoundly depend on each other, and that our public institutions must play a central role in addressing a threat that confronts us all. How far we will benefit from these revelations is not yet clear. Our Prime Minister, who models himself on Winston Churchill, talks of fighting a ‘war’ on Covid-19 and likens medics and carers to war heroes. The narrative plays on the sentiments of the British public and gives a false impression of the actual performance of government. The current administration has failed to test and trace on anything like a satisfactory scale, to provide anywhere near enough protective equipment for clinical staff, let alone for care workers, or to establish isolation measures that will not exacerbate a range of other health risks or trigger a devastating economic slump.
Lesson seven: hubris is an enemy of reflection. An over-confident government is less likely to learn from its mistakes.
Lesson eight: addressing a pandemic is not a war fought with sound and fury. Overcoming it will take a combination of scientific wisdom, whole-systems thinking, humility, solidarity and sound judgement.