The language of Never Again should resonate – we should not have to mobilise to Save the NHS – that was only necessary because it has been underfunded and successive governments had failed to prepare for the pandemic – although a pandemic was at the top of the UK's risk register

Today is the 72nd anniversary of the founding of the NHS in 1948 as part of the post-war consensus.  For 10 weeks on Thursday evenings large numbers of people have stood at their front doors or on balconies to applaud the NHS expressing their appreciation for the people who deliver the medical care. During the lockdown many people "noticed", many for the first time, the efforts of those whose work enables our society to function. The clapping has been for the NHS staff who worked tirelessly to deliver the health service we and they care for. Today is a day for celebration and remembrance. Clapping is not enough NHS wages for many staff are low and the service, in which the country takes such pride, is underfunded. Dangerously underfunded in its unpreparedness to tackle the Covid-19 pandemic. As we shall see it knew that it was unprepared. There is no realistic prospect of pay rises for NHS staff from porters and security staff to consultants.

As Maurice Glasman has pointed out  one of the consequence of the pandemic has been "the visibility and necessity of the working class." Those who stack shelves, collect the rubbish, maintain the sewers, deliver the post - these workers so often 'invisible'  have been at work throughout the pandemic. They are the working class, the workers who cannot work from home. "Covid-19 has reminded us of the "importance of the working class to our well-being and survival is recognised as it has not been for decades, and labour value has been reaffirmed" writes Glasman.

"People working in elementary jobs faced the greatest risk. Of those, there were more security guard deaths than in any other profession at 74.0 per 100,000, or 104 deaths." Telegraph 

How soon will we forget? It seems likely that we shall forget very quickly. As Edmund Burke, a founding father of Conservatism. pointed out "Those who don't know history are doomed to repeat it.” If we fail to learn from past mistakes we shall repeat them.

The government pledged to give the NHS whatever it needs to tackle the pandemic. The Chancellor will on Wednesday spell out his plans for public spending. NHS England says that it needs and additional £10bn. The annual NHS budget is £140bn, if provided that would be an increase of 7%.  £10bn is the NHS's estimate of the cost of fighting the virus and reopening the normal services. The money would mean the NHS could create extra beds in hospitals, keep the Nightingale facilities on standby, send patients to private hospitals for surgery and provide protective equipment for frontline staff. The sticking point in the negotiations between the NHS/Department of Health and Social Care and the Treasury is reported to be the NHS’s insistence that the Treasury continues to underwrite the £400m-a-month cost of the contract the Department agreed with private hospitals in March to treat NHS patients. The Treasury is insisting that the temporary contract with the private hospitals be maintained for fear of waiting list hitting 10m by Christmas. more

At some point in the future there will doubtless be an inquiry into the government's handling of the pandemic and the preparations for epidemics made by successive governments. However, preparations need to be made now.  There is a significant risk that Covid-19 will return and and that the NHS will again risk being overwhelmed. Much of what follows is based on the Daily Telegraph (DT), widely referred to in the UK as the "Torygraph," the daily paper of the Conservative Party.

There have been many mistakes:

• The Cygnus Report in 2017 and the Silver Swan exercise in Scotland in 2015, both revealed that Britain was ill-prepared to cope with a pandemic. The problems of staffing, PPE and care homes were amongst the issues identified in these exercises. Track, trace and isolate was abandoned in the early stages of the pandemic because of a lack of resources and preparation.
• "Britain prepared for a herd immunity strategy to contain Covid-19, while other countries focused on enhanced testing capacity. The assumption a new virus could not be contained is also explicitly stated in the governments pandemic strategy documents. "We discussed the levels of herd immunity as part of that scenario," a Whitehall source said." The "government formally refused a request for the release of the findings of the 2016 pandemic drill, code-named Exercise Cygnus, under the terms of the Freedom of Information Act."
  "A senior Whitehall official involved in drawing up Cygnus, a major test of this country’s pandemic preparations held in October 2016, admitted lessons from other countries had been “entirely ignored”.  “Everything we planned for was based on the idea that a disease would kill lots and lots of people,” the official told the Telegraph. “We didn’t spend a lot of time exploring how we could prevent it in the first place. Instead we looked at how we could build up mortuary space and intensive care beds after it had already spread. “I can’t remember that we ever discussed what they were doing in South Korea and places like that. It simply wasn’t on our radar. We were sort of ploughing our own furrow. “Given the current lack of testing capacity and PPE, you could say that was a mistake.""While nations in the Asia Pacific region make up 9 percent of the world’s population, they have only experienced 1 percent of the cases, and less than 1 percent of the deaths. Britain, meanwhile, is expected to suffer the highest death rate in Europe. Many Asian nations had already drawn up plans for mass testing using networks of public laboratories to chart the spread of disease, and prevent it spreading, according to documents seen by the Telegraph. DT 18 April 2020
• PPE: "Last week five million surgical masks and more than a million respirators were packed on to EU-registered lorries by one UK wholesaler." DT
  Andrew Pear chief executive of Reliance Medical, a Staffordshire-based PPE supplier which imports from Shanghai, said tighter customs inspections were holding up shipments to Britain. Pear said: “Britain needs to take a long hard look at this and ask whether we can afford to leave our PPE manufacturing supply in the hands of other countries. Shipbuilding, munitions and armaments are almost exempt from free-trade rules because nation-states take precautions in case they need them in the time of war. Britain needs to fight a war against a virus, restarting old industries that make aprons and masks. That’s the only real long-term solution.” DT
• John Edmunds, Professor of Infectious Disease Modelling at the London School of Hygiene & Tropical Medicine, is the first member of Sage to state openly that failing to implement restrictions earlier was a potentially lethal decision. Testing for coronavirus was severely limited at the beginning of the crisis as Public Health England (PHE) struggled to ramp up capacity, and on March 13 community testing stopped entirely, leaving scientists in the dark about levels of infection outside of hospitals. Prof Edmunds also appeared to criticise lack of community testing saying ‘situational awareness’ had been inadequate to gain a better understanding of the epidemic. Speaking at the Science Technology Select Committee, Prof Kay, who has called the decision to stop community testing “the greatest scandal of the epidemic” said: “If we had that data much earlier in the crisis we would have been able to make much better forecasts.  “I think that would be a major subject for investigation. My strong sense is there was an insistence on centralisation of the process of testing and monitoring testing. “There were many university labs that had the capacity to do this work if they were allowed to do it and would have allowed us to ramp up testing.” DT
• "Cleaners, porters and office staff working for the NHS were "super-spreaders" of coronavirus within hospitals, according to initial results from a national screening drive. The discovery has prompted health bosses to examine how lower-paid workers can be better protected from the virus in the event of a second coronavirus wave, he said. It comes amid growing suspicion that a large proportion of virus cases were spread by medical workers rather than in the community."  "...  "surprising" initial figures suggesting that the main vectors of the virus were not necessarily front line medics on intensive care wards but porters, cleaners and backroom office staff." DT
• "In May, NHS England said a fifth of patients with Covid-19 in some hospitals were thought to have contracted the disease while already being treated there for other illnesses. Some of the infections were passed on by hospital staff unaware they had the virus and displaying no symptoms, health bosses said." DT 
• Matt Hancock, the Health Secretary, said hospital patients who tested positive for Covid-19 would continue to be discharged into care homes despite growing evidence that the policy is fuelling outbreaks and deaths.  Mr Hancock claimed no care home residents had "died unnecessarily" from coronavirus despite figures suggesting care home could account for at least a quarter of total virus deaths in the UK. DT
• A paper by the Care Homes Sub group which was submitted to the Scientific Advisory Group for Emergencies (Sage) on May 12th, warned that the new disease cases were linked to the connection between care homes and hospitals. Discharging hospital patients back into care homes was an ‘important source' of infection, government experts have admitted, as new figures show that more than half of care homes have had a confirmed case of Covid-19. The ONS separately released data showing that nearly 20,000 residents in England and Wales have died with coronavirus in their care home. DT 
• "Ministers and Public Health England were warned in early April that staff working in multiple care homes could be unwittingly spreading coronavirus among the elderly – five weeks before the Government finally issued guidance restricting workers to one institution." "An official study conducted in mid-April found that symptomatic staff were self-isolating and being replaced by “bank” staff who worked at multiple homes." "Scientists also recommended effectively quarantining elderly patients in “intermediate” Nightingale-type facilities before transferring them back to care homes, but the idea was never taken up nationally. Government advisers later concluded that discharging hospital patients back into care homes was an “important source” of infection." "the deputy chief medical officer privately warned ministers of the concerns following a meeting on April 9."...call[s] into question Matt Hancock’s claim that “right from the start we’ve tried to throw a protective ring around our care homes". "DHSC’s guidance on controlling the spread of infection in care homes, published on April 16, made no mention of restricting the movement of staff.""At least 19,394 residents died with coronavirus in care homes between March 2 and June 12. " On 15 May [DHSC] published [their] care home support package which followed the latest evidence from PHE and recommended a range of measures care homes could take to limit the spread of the virus. This included limiting the movement of staff.” DT
• The government must have know that Test, Track and Isolate would be an essential part of moving out of lockdown papers from the Scientific Advisory Group on Emergencies show routine testing and tracing of contacts was stopped because Public Health England’s systems were struggling to deal with a handful of cases. At a meeting on Feb 18, advisors said PHE could only cope with testing and tracing contacts of five Covid-19 cases a week, with modelling suggesting it might only be possible to increase this to 50 cases. Advisors then agreed it was "sensible" to shift to stopping routine testing - despite acknowledging that such a decision would “generate a public reaction”. The decision to give up on testing those with symptoms of coronavirus is now seen as the key reason the UK has the highest death toll in Europe. DT
  3 July 2020 "Test and Trace is failing to identify 25 per cent of contacts" DT
• Deloitte was proud to secure the contact for Covid-19 testing. Despite a string of major accounting scandals leading to fines and regulatory investigations, the Big Four accounting firms – Deloitte, EY, KPMG and PwC – are among the most high-profile winners of outsourcing contracts. Deloitte has come under fire from doctors for its work on increasing coronavirus testing capacity for frontline workers and delays in getting results to people who have been tested. Hospital bosses wanted to oust the firm last month because they felt it was doing a poor job. The firm is also working on procurement of personal protective equipment (PPE) by reviewing new manufacturers that may be able to post supplies. DT
• Department of Health  figures report that between 28 May and 17 June 128,566 'close contacts' of people tested positive had been identified. Of these 15,812 were classified as non-complex and contacted through the "wider online and call centre capacity" run by Serco. 112,754 contacts were traced by "local health protection teams[managing] complex cases linked to outbreaks." So the Serco system traced just 12.3% and only the simpler cases.   Serco deployed a 21,000 strong army of tracers funded by a contract worth £45m. There are 3,000 or so public health officials 50 times more productive than the Serco tracers. (Source Private Eye 16 July 2020) "Newly recruited “contact tracers”, who have been hired by outsourced call centre giants Serco and Sitel on behalf of the Department of Health and Social Care, have reported spending hours trying to log into online systems, having no work to do, and experiencing technical and quality issues with the training they received." Personnel Today

Successive governments, including the current one, have said that they will solve the social care problem. Without a solution the NHS will continue to suffer from bed blocking.

The Daily Express on June 3rd published the results of a poll it funded: "A damning survey for the Daily Express reveals two-thirds of those aged 55-plus support the increase. And 41 percent across all age groups agree that a ring-fenced general tax increase is the best way forward. They want an end to the scandal of pensioners handing over their savings and selling their homes to pay for care. The system's failings have been cruelly exposed by the coronavirus pandemic......Our poll found more than half of the 2,094 adults aged 55-plus (58 percent) believe it is unacceptable to force the older generation to sell their family homes to pay care home bills. And 49 percent across all ages agreed. Almost the same number (54 percent) believe it is unfair to put property or a hard-saved nest egg into a means test to qualify for financial help.

The Covid-19 crisis has raised serious concerns about governance and the preparatory planning for pandemics and decision making during this one. Awareness of the crisis in health and social care is now very clear. Although some have presented this as a source of intergenerational conflict, the elderly who have died are the parents and grandparents of people now concerned about their own care in old age.

Never again

There is an urgent need to develop a consensus to tackle some of the fundamental challenges that the UK faces and which require a consistent approach over several parliaments if the UK is to thrive. The collective expression of support for NHS and Social Care staff expressed in clapping on Thursdays at 8 pm for 10 weeks is indicative of public support and love of the service. There is strong public support for the NHS combined with mounting concern for its future.

Failures by successive governments to ensure adequate preparations for a pandemic resulted in the government priority to defend the NHS, just when we should have been able to rely on the NHS to defend us. In the front line, the doctors, nurses, porters and cleaners did defend us, despite the lack of preparation and of the PPE to do it. This was achieved by discharging elderly patients, untested for Covid-19, into Social Care.  One-third of all UK fatalities form Covid-19 were in care homes, 16,000.

Much of the NHS is managed by the developed assemblies in Scotland, Wales and Northern Ireland leaving the UK government to oversee England.

Britain needs to ensure that the NHS is adequately funded and is resilient to cope with pandemics. The scientists expect that there will be further epidemics and pandemics. The next one may be more or less aggressive and deadly. It would be prudent to assume that the next one will be worse and plan for it. Successive governments has failed to reform social care, was unable to ensure the maintenance of adequate stock piles of PPE and ventilators, and failed to provide robust Public Health services, including having a track and trace system in place to scale up in the face of a pandemic. There should have been an app in place prior to the pandemic to facilitate track, trace and isolate.
Covid-19 has revealed significant weakness in the UK’s ability to deal with a pandemic. This has raised some fundamental questions about the competence of government, civil service, Public Health England, local government and the NHS. Funding for resilience is always easy to cut, the important displaced by the urgent.  A system-level review is required to ensure that the UK is prepared for the next epidemic or pandemic.

Between 2011 and 2018, the WHO tracked 1483 epidemic events in 172 countries. The World Bank (09/2019) published A World at Risk, the graphic below comes from page12.  It would be foolish to think that Covid-19 is the last event of its kind. The World Bank concludes that we are entering a “new era of high-impact, potentially fast-spreading outbreaks that are more frequently detected and increasingly difficult to manage.”

As of late May there had been a very significant fall in people's confidence in the government's handling of the pandemic.  Guardian