The UK’s catalogue of catastrophes – and what to do next

Eamonn Butler

May 5, 2020

Applauding frontline NHS staff who subject themselves to potentially high viral loads in order to save lives – I have no problem with that. Applauding those who do this despite slim supplies of PPE – absolutely, even though we should not have to, because they should not have to.

Applauding care workers who are looking after elderly people sent back into care homes to clear NHS beds for potential virus victims – definitely. And given that they do it with even less PPE – bravo again, particularly as their needs, and those of their residents, were completely overlooked in the scramble to save the NHS from being overwhelmed. Even if, in the event, it wasn’t.

Applauding all the people who again face some risks in keeping supermarkets and shops open, who deliver to the door when we can’t go out and make sure that all our household utilities keep running – yes, I applaud them.

But I’m not quite so sure about applauding NHS managers and the various quangos that are supposed to plan for this sort of thing. It has been, let’s face it, a catalogue of catastrophes. And it’s no good trying to blame ministers for the shambles, as the BBC Panorama programme did.

Since health secretary Andrew Lansley’s reforms in 2012, the NHS has been effectively self-governing. The plan was to “take the NHS out of politics”, but in reality it was taken out of democratic control, and is now a self-managing healthcare monopoly. Monopolies of any sort are a bad idea, but an unaccountable public monopoly is surely the worst.

Back in 2016, Exercise Cygnus explored what the health system needed to do if a pandemic should strike. So the scenario planning box was ticked. And what was done as a result? Pretty much nothing. Nor was there much effort to reach out to other countries to capture their experiences with SARS, MERS, bird flu and the rest. So while Asian countries were well prepared, the UK was not.

At least, there’s no evidence of it, either from practical experience or on paper. The latter being because, despite all the complaints about China’s lack of transparency on the pandemic, the Cygnus findings are not published. And even the Scientific Advisory Group for Emergencies (Sage), which the government has been relying on for its policy advice, is secretive about its discussions and even about its members – though we now know they don’t include any economists who might have brought a bit of balance to the debate.

To its credit, the army built Nightingale hospitals in no time – not that they were much needed. But had NHS planners ensured there were sufficient PPE supplies? Or ventilators? Or hand sanitiser? Er, no.

It’s all very well to say that it would be wasteful to keep large stocks of PPE because it goes out of date. Quite simply, you keep a large stock, with new stock rolling in at one end and older stock rolling out at the other. And/or, you make sure you have enough local manufacturing capability that you can turn on instantly when you need it.

So you have contracts with the Burberrys and the Dysons and the Brewdogs and can call them to increase supplies in an instant, instead of having them join a queue to get through your switchboard and offer their services. Though, of course, with only one warehouse, the NHS probably wouldn’t have room to store sufficient stocks for a pandemic anyway.

Had our national healthcare managers established secure and resilient supply chains with China – or indeed any other country? No. Did they have a slick commercial procurement system that would meet their needs in a market that was changing fast across the globe – exactly what you might expect in a pandemic, in fact? No, again.

Then there is the testing fiasco. Public Health England, which continued to chide us about eating too much and drinking fizzy pop even as the virus was grabbing hold of us, maintained a “command and control” strategy that left countless private labs frustrated because they had the capacity to help but weren’t even getting their calls returned.

It was only after public and media outrage at this situation – prompted in part by an authoritative Adam Smith Institute report by Matthew Lesh – that PHE was forced to u-turn and let private labs contribute. Only then did testing numbers take off. But the NHS was still slow in getting the tests to the public. Only health secretary Matt Hancock’s make-or-break “100,000 by the end of April” focused the bureaucratic minds.

And now, the NHS is developing its own tracking app so that people can be told if they have been in close contact with a virus carrier. Why? Countries including Singapore, Austria, Germany, Estonia and Ireland already have contact tracing systems in place. Why reinvent the wheel? And why reinvent a wheel that is not even compatible with the technology developed by Apple and Google, who, let’s face it, know a bit about IT and tracking and giving information to large numbers of people.

There is even a suggestion that when flights are resumed, travellers to Europe from the UK will have to quarantine for two weeks because the NHSX app is not compatible with theirs. 

When all this is over, I hope for three things. Firstly, an objective inquiry into how NHS managers prepared for pandemic events such as this. That is, not one that assumes the NHS is “the envy of the world” and uses its deserved praise for the dedication of its frontline staff to disguise the appalling management errors.

Second, a realisation that the NHS is simply too big for anyone to manage and should, like Germany’s healthcare system, be split into much more manageable and accountable local systems – which also allow different approaches to be tried and learnt from, rather than massive mistakes being made across the whole country.

And lastly, an understanding that focusing diverse minds on a subject, and cooperating with others who have complementary expertise, is better than trying to do everything yourself, no matter how enviably good you think you are.


Written by Eamonn Butler

Eamonn Butler is Director of the Adam Smith Institute.


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