Over the last 10 years the British healthcare system came under more pressure than at any time since it was founded in the aftermath of World War II by the Labour government of Clement Attlee with the aim to provide “treatment free of charge for all.” In fact, from 2009 the policies of the successive Tory governments perpetrated a gradual and shocking privatisation of the health care sector and a steady and substantial cut in funding. Two particular issues stand out as emblems of this period: the cuts to hospital beds and the record shortage of personnel.

In a rare public speech Queen Elizabeth II, at the age of 94, addressed Britons in what is believed to be the toughest challenge for their country since World War II. The Queen's address, designed to reassure and to inspire, came few days after her son Charles, the Prince of Wales, was diagnosed with coronavirus and self-isolated for a week after displaying mild symptoms. In her message, the Queen said the UK “will succeed” in its fight against the virus and expressed her hope that in the years to come, Britons would be able to “take pride in how they responded to this challenge.” The monarch also thanked people for staying at home and thanked National Health Service (NHS) frontline staff, volunteers and others carrying out crucial services. “The moments when the United Kingdom has come together to applaud its care and essential workers will be remembered as an expression of our national spirit; and its symbol will be the rainbows drawn by children,” she said. Shortly after the Queen’s historical speech—the fifth in her regency—UK Prime Minister Boris Johnson was admitted to hospital after having persistent symptoms of COVID-19. Unfortunately, the following day Mr. Johnson has been moved to intensive care after his symptoms worsened and Foreign Minister Dominic Raab, previously nominated “designated survivor” in case of prime minister’s incapacity, took over his duties.

An extract of the Queen’s speech displayed in Piccadilly Circus London

Source: Matteo Roma/Shutterstock

The deterioration of Johnson’s health condition—at the moment of writing the prime minister is recovering from the sickness—is raising concerns about the UK government’s response to the pandemic that, even if it has improved in the last weeks, it had a very questionable start. In fact, differently from other European countries, the UK government refused at first to take strict measures to fight the spread of the virus. The relaxed British response was motivated by a debateable theory, embraced by the PM and supported by some of the UK government’s top scientists, according to which the best way to ease the long-term consequences of the COVID-19 pandemic was to allow the virus to spread naturally in order to build up the population’s “herd immunity.” However, as many epidemiologists pointed out, “herd immunity” as a planned measure is usually achieved through a mass vaccination program. But given that a vaccine is at least a year off, it looks like the UK government decided to take a rather dangerous gamble on tax-payers’ lives.

Just few days later, scientists of the Imperial College London, the institute advising the government, subsequently dismissed the theory—mostly keeping an eye on developments coming from Italy where up to 30% of patients hospitalized with the virus required intensive care treatment—warning that it could cause up to 250,000 deaths and have a tremendous impact on the ill-equipped NHS’s resilience. In the light of these considerations, the UK government chose to change course abruptly and on 23 March announced strict lockdown measures in line with most other European countries. Mass testing—a practice that the UK decided to abandon at the beginning of March—has been represented as an effective policy tool, not only helping NHS staff in their work, but also preventing the introduction of the draconian measures adopted in other countries. Health Secretary Matt Hancock—infected by coronavirus himself—announced that the government is aiming to carry out 100,000 tests a day in England by the end of April (but as of 22 April, the country had tested just 559,935 people). The goal is a very ambitious one considering the fact that Germany, the country in Europe that decided to introduce this practice already at a very early stage, is testing 350,000 patients a week and has plans to test 200,000 a day.

It is clear that if Mr. Johnson had a minimal advantage—compared to other countries on the continent—to build up a defence strategy to fight the virus and to prepare the NHS to cope with the epidemic he squandered it. The government hasn’t even been able to provide the healthcare staff with the required personal protective equipment (masks, gloves, ventilators, and the like). Today, the situation across the Channel is dramatic, and while the circumstances in Italy and Spain are easing up the UK is still bracing for reaching the peak. So far 18,100 people have died from the disease in the UK so far, with the number of confirmed cases of the coronavirus reaching 133,495 on Wednesday. The 55-year-old British PM became a victim himself of his recklessness while his misfortune has been a wake up call for many in Britain who now see the sense of the government’s mantra “Stay at home, protect the NHS and save lives.”

Personal measures taken to prevent COVID-19 virus contamination Great Britain 2020.

Source: Statista, licence

Like in Italy and in Spain, also in the UK the country rallied behind doctors and nurses, which embody the real heroes of this fight against the virus, struggling daily in the front line and trying to save as many lives they can. Paradoxically their task has been made more difficult right by the same government that is asking people to limit their freedoms in order to protect healthcare workers. And when the NHS is at stake Britons get emotional. The passion that link Britons to their NHS is way stronger than anywhere else on the continent. For example, when Mr. Hancock asked for 250,000 volunteers to help the NHS through the crisis, three times that number signed up and 11,700 retired doctors and nurses have already offered to return to work. As a matter of fact, the NHS has been the key of success for many politicians and it is the magic tool for whoever aspires to a leadership role in the UK. A former Chancellor of the Exchequer Nigel Dawson, even argued that NHS is the closest thing British have to a religion.

However, in the last decade the NHS had a troublesome relationship with the successive Tory governments and the debate around public services dominated British media and newspapers. But no other leader before has politicized the issue as much as Boris Johnson did. Everybody has still in mind when back in 2016, during the Brexit campaign, Boris Johnson pledged extra cash for Britain’s NHS if the country voted to leave the European Union. The slogan displayed on the side of the famous red buses stated: “We send the EU 350 million pounds a week. Let’s fund our NHS instead.” There is little point in stressing the fact that the potential impact of Brexit on the NHS was hardly discussed during the EU referendum campaign and no many seems really concerned by the fact that Johnson’s airy promises turned to be fake news. At the time the future prime minister was wholly aware that NHS card was a great opportunity to launch him in the race for the Tory’s leadership and now is evident that the accuses of those who criticised him for using a delicate issue only to seek a personal advantage came to naught.

Last year Boris Johnson finally admitted his ‘£350m a week’ claim was wrong

Source: Gina Gina Power/Shutterstock

As expected, instead of being a dividend for the NHS, Brexit, and the economic slowdown and unsureness caused by it, resulted in even fewer funds for the healthcare. On the top of that, if the economic impact of Brexit at the end of the transition period does hit the public finances in the way that has been predicted this will make it even more difficult to fund the NHS properly in the foreseeable future. Obviously, in the speech after his victory in last December's election, Johnson said the NHS would be his government's first priority after delivering Brexit, but very much of his attention for the public service will depend on the deal he will be able to reach with the EU. While the NHS problems currently seem to be strictly connected to Brexit they didn’t begin with it.

Over the last 10 years the British healthcare system came under more pressure than at any time since it was founded in the aftermath of World War II by the Labour government of Clement Attlee with the aim to provide “treatment free of charge for all.” In fact, from 2009 the policies of the successive Tory governments perpetrated a gradual and shocking privatisation of the health care sector and a steady and substantial cut in funding. Health care spending has grown just 1.4% a year in real terms since 2009-10, compared with annual growth of 3.7% in the previous decade. Two particular issues stand out as emblems of the abovementioned Tory decade: the cuts of hospital beds and the record shortage of personnel. When it comes to beds, it is true that many countries have reduced their number as medical care advances, but Britain has cut more than most. Since 2010, the number of NHS hospital beds had fallen dramatically and the UK would currently be the 27th out of 28 EU countries per number of beds, and 20th per number of critical care beds. Health Secretary Matt Hancock recently said that 5,000 more intensive care beds will be soon created and while his efforts have been partially successful so far, with 2,295 more units available, this figure needs to be put in a wider perspective. In fact, an increase in beds is not going to represent a substantial change in the situation if there are not enough trained nurses and doctors in the country. Just suffice to say that it takes over four years of study and specialized training to become a qualified intensive care nurse and currently the system has, only in England, about 41,000 unfilled nursing positions and fewer doctors as a percentage of the population than countries such as France, Germany and Italy. Brexit made the picture even bleaker and the number of nurses applying to join the British nursing register fell by around 96% in the aftermath of the referendum and since then many of them decided to leave. Moreover, since the austerity supported by the Tory government—as a result of the 2008 economic crisis—was imposed in 2010, health workers’ incomes had eroded by up to 15%. It is emblematic that when a proposal for 1% pay-rise cap for nurses was presented in 2017 in the parliament, the Boris Johnson who today is praising the “unbeatable” NHS which he says saved his life, is the same Boris Johnson who voted against the bill and then cheered when the pay rise was eventually blocked. As for the doctors, the UK has a greater proportion of doctors who qualified abroad than any other European country, except Ireland and Norway. Around 200,000 EU27 citizens work in the healthcare sectors, including 10% of all NHS England doctors, 100,000 social care staff and 20,000 NHS England nurses, meaning that any limitation in the free movement following Brexit will exacerbate existing workforce shortages. In fact, the future immigration system (as presented by Johnson at the beginning of the year) will be too restrictive to bring in the skills the NHS needs and the British government’s commitment to reduce low-skilled immigration could affect large sectors of NHS jobs. Thus, as the virus gets more entrenched in Britain, the question is not just whether the NHS can cope, but whether it will be able to cope enough.

It is certainly a good new that the government has decided to triple to over £14billion (€16billion) its emergency fund dedicated to public services—and so to NHS. But it is of uttermost importance to think properly about the future. In the coming years, a larger portion of reserves needs to be allocated and the pandemic might channel greater support among taxpayers for tax rises to fund higher levels of health spending. Once again, the NHS will be the focus of the political debate and very much of Boris Johnson’s political career will depend on his management of the current crisis. If the prime minister will decide to gamble once again with the NHS there will be no more no red buses or other tricks. From Winston Churchill to David Cameron is a short step.