This could have led us to having, at best, a love-hate relationship with the NHS, but because the health service is ultimately run by the government, we have the convenient option of directing love towards the NHS and hate towards the government. When the NHS gets things right, it is because it is the envy of the world. When the NHS gets things wrong, it is the government’s fault for mismanaging and underfunding it.
The NHS spent £167 billion of our money in 2018 and we all depend on it to some extent, but the average person – myself included – knows almost nothing about the people who manage it. It is difficult to tell whether they are doing a good job and, while we regularly see examples of the service falling short, we can’t tell whether specific problems are due to under-funding, managerial incompetence or systemic failure.
And so we give the NHS the benefit of the doubt and blame the government. If a problem could have been solved by throwing money at it, we blame “chronic under-funding”, and if a problem could have been averted by making a different decision, we blame the Health Minister.
This week’s Panorama was a classic example. In recent weeks, many frontline NHS workers have been short of personal protective equipment (PPE), thereby putting them at unacceptable risk when treating COVID-19 patients. Leaving aside the fact that there is a global shortage of PPE and other countries are struggling with the same problem, the responsibility for managing stockpiles to cope with pandemics lies with the NHS and Public Health England. Neither of these organisations received any criticism from the Panorama team. The title of the programme was not “Has the NHS failed its workers?” but “Has the government failed the NHS?“.
One of the programme’s main allegations was that “the government” took COVID-19 off the list of High Consequence Infectious Diseases (HCID) in March 2020, thereby allowing “the government” to weaken the guidelines on PPE use. This, it suggested, was because “the government” had failed to buy enough PPE to go round.
But the decision to take COVID-19 off the HCID list was not made by politicians. It was made by Public Health England and their equivalents in the rest of the UK, with the Advisory Committee on Dangerous Pathogens in agreement. The guidelines on PPE use by health workers may have been “weakened”, but the guidelines are set by Public Health England, not politicians. And the procurement of face masks, gloves and gowns is not the personal responsibility of Boris Johnson or Matt Hancock, but of officials in the NHS and Public Health England.
Far be it for me to defend the government, but in the absence of any evidence that politicians actively discouraged stockpiling of PPE, it seems to me that at least some of the blame for the shortage should be laid at the door of the people working in procurement at multi-billion pound organisations who are specifically tasked with stockpiling it. But no, let’s just blame “the government”.
It might be comforting to believe that everything would be better if the NHS had more money and a different set of politicians was in charge, but wishful thinking will not prevent the same problems occurring in the future. It is a simple fact that our current set of politicians are going to be in office for the next few years. It is also a fact that the UK spends ten per cent of GDP on healthcare, more than the OECD average. Even before the spending splurge announced by Theresa May, the NHS was not underfunded by international standards and it makes little practical difference whether the Department of Health is nominally run by Matt Hancock, Jeremy Hunt or anyone else.
In a state-run system, the distribution of resources will often be dictated by political decisions. In the broadest sense, the buck stops with politicians. But organisations such as the NHS and Public Health England have a significant degree of autonomy and a vast layer of bureaucrats whose job it is to make decisions. The people at the top of these organisations, many of whom earn more than the prime minister, have power and therefore – as Spiderman fans know – responsibility.
Blaming “the government” for decisions taken at the micro level is not only questionable in itself, but can be unhelpful because it stops us learning the right lessons. It is like a football fan calling for the chairman to resign when the goalkeeper has a bad run of form. In one sense, the chairman is to blame – the buck ultimately stops with him – but the practical solution is to get the goalkeeper to improve, or replace the goalkeeper, or perhaps even bring in a new manager. A change at the top makes no difference unless the team is sorted out.