Is there any field where the political debate is further from the concerns of policy wonks than the NHS? For a generation, managers, think tanks and academics have argued that the sustainable route to affordable health care in a fast-ageing society involves more care being provided closer to home, and patients being empowered to manage the chronic and multiplying conditions of old age while still getting on with their lives. In last year’s election, however, Boris Johnson’s flagship promise was to build 40 new hospitals, and the political argument was about how many of those were actually going to get built—not whether hospital building was the right priority.
With the coming of coronavirus, nations have certainly been reminded to be grateful for hospitals. But the terrifying early shortage of ventilators, and the remarkable agility (which minister Edward Argar highlights) then shown in creating the “Nightingales” are reminders that it’s unwise to be too constrained by fixed plans or existing infrastructure. Argar is right to say that the hospital sector pulled the UK back from the brink that was fallen over in parts of Europe: very few hospital patients appear, in the end, to have to been denied life-saving intensive care. But Labour’s Jonathan Ashworth fairly points out that overall Covid-19 death rates rank among the worst in the world, and that the focus on the virus will cast a long shadow of morbidity because of other conditions going untreated.
Perhaps the biggest reason for this apparent mismatch—our hospitals broadly pulling through the crisis, even when so many of our citizens did not—is the neglected backwater of the care home sector, where the tally of deaths is astonishingly high. Again, experts have long called this the system’s weakest link, but politicians have never got beyond vague talk of reform. Gleaming buildings grab attention. But even shiny new hospitals won’t work well until there is somewhere safe and genuinely caring to discharge frail patients to, and without breaking them financially. For me, the “infrastructure” we need to fix first is less to do with bricks and mortar, than the faulty wiring between hospitals and these homes.