For whom the bell tolls
Covid, Spain and the rise of the public sector
The theatres lie dark. The streets are empty. Restaurant chairs and tables lie stacked against the walls like bones in an elephant graveyard. Even the bright early spring sun can do little to draw us to the coffee patios and sunlit squares of the metropolis. A man emerges from the corner of the square, pushing a broom in front of him, desperately seeking out the silent litter he has made it his life’s work to banish from this once people strewn courtyard. Covid-19 is here and it sweeps all before it.
For a street sweeper, it can be business as usual but for many areas of public life and public service, there is no longer a normal day or a normal job. In a crisis of this nature, there are going to be organisational winners and losers, those who will perform well and those for whom life has become more complicated and more difficult. I thought it might be worthwhile to have a look at the public sector as it stands today and then revisit this in a few months when the dust has settled on what will have been one of the remarkable periods in global history. Whilst we have no idea whether we are a third or a halfway through this unprecedented season we can all agree it has had a major impact on the way we are living our lives today and probably going to live our lives for the next few decades.
The Government has had a successful crisis so far with strong performances from the Prime Minister, the Chancellor and the Health Secretary. Not everything has gone right but in this extreme crisis, things will go wrong. To have mobilised the response they have in the time they have has been a triumph and whilst some things have not been great, the general response from the public, so far, has been accepting of the support and restrictions on their freedom of movement. Who would have thought I would ever write that?
The briefings have been informative, transparent and direct and when it comes to the support for the economy we have ventured into policy thought unimaginable in the post Second World War settlement. Our debt at the end of World War Two was the equivalent of £746bn today — or 27% of GDP. Put this against the 15% of GDP (and there might be more) that the Covid stimulus has created and you can see the scale of what is happening. Incidentally, it is worth remembering that the final debts of the war were only settled in 2006, 61 years after the war ended. How long will it take to pay back the CV debt?
The Government is in the classic ‘no win’ scenario. Do nothing and every death (even if there are not many more deaths than a normal year) will be the fault of the Conservative Party. I was struck by the somewhat sour tone struck by Keir Starmer on his accession to probably the worst job in politics as leader of the Opposition. It is early days for him but looking conciliatory and working across party lines is an equal part of becoming Prime Ministerial and he has not started well. Some have argued that the Government has found it easier not having a functioning opposition in the past few weeks but in these times I don’t expect the public want an active opposition, they want to see them working with the Government on their behalf and not stand on the sidelines criticising. In that sense, the shadow Health Secretary has been supportive of the Government, which must have been welcome — and their new leader needs to think hard about the approach he now takes.
Local Government has quietly got on with the job and yet it is more on the frontline than the public recognises. Councils run public health, they are responsible for getting patients out of the hospital into care settings (very important when the virus disproportionately attacks the elderly) and all the time they are trying to run waste services and keep parks open. Like the NHS, social workers and care workers are on the front line and yet they have been second in the queue for protective equipment and are struggling to hold the services together. Every death of an NHS worker is solemnly recorded by the media, but the same cannot be guaranteed when care workers die for having visited and cared for our older population.
Covid-19 has been like Brexit on steroids for the media. What is becoming apparent is that this crisis is not going to pass quickly and whilst it does not have the daily drama of Brexit, the media is working hard to dramatise every nuance. Now, more than ever they are being exposed for the lack of balanced reporting. I do not mean political balance, but ensuring that they do not scare the public by taking minor stories and blowing them into a national drama. Would the food panic buying have been as bad if the media had not filled our screens with images of empty shelves? Marry that with the media’s apparent keenness to report conjecture and speculation rather than facts. This is a long term issue for the press. The best reporting is now limited to the somewhat more thoughtful journals such as The Economist, New Statesman and Spectator whilst some such as The Times, Telegraph and Guardian have become comic book storytellers with more and more absurd and apocalyptic headlines.
There has always been a debate on who does and who does not support the NHS and the social model of healthcare we have in the UK. I think this crisis has now halted that debate for a generation. This is a shame because despite its massive inherent strengths the reality is that the largest corporate entity in the UK is ridden with inefficiencies and outdated working practices which no government will want to tackle for the next generation — the NHS will get whatever it wants for the foreseeable future. The other thing that more people now recognise is that whatever your political views the NHS cannot survive without the private sector. The staff may work for the NHS but the drugs, the surgical equipment, the protective equipment, the ventilators, they all come from the private sector — and in the time of need, it was the private sector that developed and created more equipment and will, hopefully, create the cure.
Then there is Public Health England, aka, the Nanny State. Most people thought this was just a division of the NHS, but in fact, it is now part of local government. Public Health is not really acquainted with ‘nudge theory’ because when it wants to change your behaviour (stop smoking, stop drinking etc.) it tends to give you a ‘good kicking’. They don’t subtly try to get you to change behaviour, they do it with images and slogans designed to disgust you or make you sit up, or they simply tax you. In my own borough, public health ran a campaign warning against going to another part of SW London (away from genteel Kingston where sex never happens) without taking your contraceptives. The poster screamed in big type: ‘You spent the night in Clapham but you left your pill in Kingston. It might be time to consider the coil.’ Not exactly painting a great picture of Clapham!
Only time will tell whether this has been a good crisis for public health. In a year we will look back and see whether the annual death rate for the country had climbed significantly during this period. If it has then the work will have been worth it and public health can take the plaudits because many more would have died had they not acted. If the death rate has not changed significantly then there will be many questioning why we wrecked the economy on the basis of such flawed science. Of course, a good outcome might well have been a result of their actions but it will certainly start a debate about the cost of economics against the costs of health.
Sitting in my home, waiting out the pandemic I cannot help but ask what is the point of the World Health Organisation? Put another way, ‘who is the WHO?” We can all see we need a global health body, but during this crisis, the WHO seems to have been absent. Maybe its remit excuses it from taking a wider operational role but if it doesn’t then maybe it should? It has been largely silent on the international scene and given that it spends $5bn a year (admittedly on a range of other programmes which are much needed) the question needs to be asked of how it can reform itself to become at the front of the fight against the rise of disease, not seemingly cowering at the back. It is doing amazing work on polio eradication and on mental health, but in this crisis, we maybe need a more interventionist role, because whilst providing advice and research to health ministries globally is a useful support mechanism this crisis required an international response — and as has been demonstrated in the divisions in Europe, that simply has not happened.
It’s clear how much we have become reliant on our public sector but it was not always this way. It was 1940 before the first flu vaccine was produced and this means that in 1918 when the Spanish Flu struck, the only weapon was social distancing and it worked. Let’s hope it works again. Which brings me to my final point. Are we having a good crisis? The public sector is fine, they get the money they need and they deliver. How are we as individuals coping? In my next blog, I intend to cover those issues as well as have a look at who in the private sector is having a good Covid crisis.
This article first appeared on the Nudge Factory website on the 8th April 2020. Click here