NHS has become the cause, not the cure

By Richard North

OVER the last few days, a last ritual as the light fades has been to water the garden, during which time I fell into discussion with one of my neighbours.With the conversation turning naturally to the lockdown and matters related – with him knowing where my interests lie – he asked me what I would do if I were in charge. Faced with such a proposition, and after briefly entertaining the idea of commissioning a number of firing squads, the answer I offered would come as no surprise to regular readers here.

First, I argued, we need an effective trace, test and isolate programme – one that actually works, as opposed to the government’s train-crash ideas. Secondly, I said, we need to sort out the hospitals (and care homes). At this stage of the proceedings, with the infection established there, they become reservoirs of infection, re-seeding the communities they serve, and keeping the epidemic going.This is no more than I have stated here and elsewhere on the blog – in this piece on 17 April, I wrote: ‘as long as the hospitals themselves are reservoirs of infection, they will keep the epidemic going, re-seeding the community (together with the care homes). The lockdown, now renewed, is not necessary to protect the NHS. It is needed to protect us from the NHS. Until they sort out the hospitals and care homes, it will be unsafe to lift it.’

Returning to the fray, I found that the government (responding to considerable pressure, and possibly to take attention away from a certain SpAd), has published a bundle of SAGE minutes – not that the media seem to have taken the bait.One exception, though, is the Mail which has read some of the minutes and reports: ‘Coronavirus “R” rate could be as low as 0.5 outside of hospitals – with the national average inflated by the huge infection rate in medical settings, say SAGE scientists’. This is a reference to the twenty-fifth SAGE meeting on Covid-19, held on 14 April – three days before I wrote my blogpost on sorting out the hospitals. It does indeed note that transmission had slowed in the community, while there was ‘significant transmission in hospitals’ which ‘may have been masking the decline in cases in the community’.The difference in the R numbers rather confirms my view that the general use of this index is a complete waste of time. Like the national epidemic curve, it conveys no information of any epidemiological value and, as indicated here, can actually serve to obscure vital detail.That ‘detail’ is indeed vital, such as the observation by the SAGE committee that in some hospitals ‘outbreaks will be self-sustaining’, and the fact that nosocomial [originating in a hospital] cases are ‘making up an increasing proportion of overall cases’.This, of course, puts a completely different complexion on the Covid-19 epidemic which, as it develops, is likely to become increasingly hospital-centred, breaking out occasionally to re-seed the community.Still, though, we get the crass deification of the NHS, an organisation which, in this epidemic so far, may have killed around 6,000 people through nosocomial infection. I suppose it is quite appropriate that they should fly a Spitfire out of Duxford with the legend: ‘THANK U NHS’ painted on its underside – a tribute from one killing machine to another.It is all very well the experts complaining that the lockdown is being lifted prematurely, but until the hospital problem is addressed, any relaxation will always be premature.One way or another, we will eventually have to address the stunningly inappropriate policy of sending highly infectious patients to district general hospitals. If we are to learn to live with Covid-19, we will need a new generation of ‘fever’ hospitals, designed specifically for handling infectious diseases such as Covid-19.As far as I’m concerned, my suggestion of multiple-use buildings stands, with leisure centres and the like built to allow rapid conversion to hospital use when the need arises.But as well as that, we will have to revisit the structure of public health provision once again. The transfer of public health functions to the NHS was a wrong turning and it can never be the case where the most potent cause of infection in the community is allowed to police itself.And this is a point which has been completely missed. Public health is a hard-edged discipline which isn’t interested in the fate of the individual per se, but seeks the greater good. It takes in a powerful law enforcement element which is entirely incompatible with personal healthcare services.So far, therefore, in its handling of the Covid-19 epidemic, this government has got the fundamentals totally wrong, and as long as ministers are obsessed with hospitals and the NHS, things will not get better.Interestingly, this is a point picked up by Richard Vize in the Guardian, who writes of Matt Hancock’s ‘warped priorities’. The pity of it is that he’s writing in the Guardian, where he – like everybody else – will be ignored by this government.Nevertheless, Vize is right. He complains of Hancock seeing everything through the lens of the NHS, marginalising and ignoring local government, and throwing money at private companies to fill the gaps left by public sector cuts.Setting himself up as the champion of the health service, the ‘protect the NHS’ mantra quickly became pivotal to Hancock’s entire approach to the pandemic. This warped priorities and cost lives, says Vize, as the government initially decided to treat the sickness rather than prevent the illness.However, our Guardian man concludes that this pandemic has been an extreme demonstration of why healthcare needs to think and work as a collaborative local system across the NHS and local government. He wants prevention and early intervention at the heart of the system, instead of relying on hospitals to fix us once we are sick.What he clearly hasn’t realised is that the government was (and is still, to a very great extent) working to the flu plan, where attempts to control the epidemic were abandoned at an early stage, in preference to treating the ill while holding the fort until a vaccine turned up.Here, though, there is an essential flaw in perception and in community values. It is easy to applaud the heroic medical teams battling to save lives (even if the effect is to kill a fifth of the patients), but it is less easy to recognise and value the dogged, unglamorous ‘shoe-leather’ work that goes into disease prevention.To that extent, in their deification of the NHS, ministers are playing to the gallery, hoping that some of the gratitude afforded to the NHS will rub off on them. This is why Johnson and Hancock are so keen to be seen in hospital settings.But if ministers don’t go into bat for public health, as well as healthcare, prevention will never get the recognition it needs to be able to function. The trouble is, in the grip of their obsession, they are not thinking clearly – if at all. Thus, they will continue to make their mistakes, and people will continue to die unnecessarily.Next time round, if Duxford wants to mount another fatuous aviation display, it should borrow the Battle of Britain Memorial Flight Lancaster and drop bombs on the nearest housing estate, with ‘NHS’ painted on them. At least this might be a little more realistic.For the moment, though, I feel like Charlton Heston shouting: ‘Soylent Green is people’, only I’m saying: ‘The NHS kills people’. There, I’ve said it. Come, friendly bombs . . .