18 January 2022

From safety net to straitjacket: the cost of putting ‘health’ above care in Our NHS


Without wanting to jinx anything, it does appear as if the country (or at least England) has turned a corner on Covid-19. The Prime Minister apparently plans to end the current restrictions before the end of the month; his decision not to cancel Christmas seems to have paid off.

But the impact of the past two years will be felt long after we no longer need to carry a mask around in our pockets or make sure we’re stocked up on lateral flow tests – and not just because the extraordinary expenditure needed to support lockdown will cast a long shadow over government spending.

The restrictions, the case made for them, and the public response to them, has also likely wrought – as have previous crises – serious changes in public attitudes towards the proper role of the state, and the ‘biomedical state’ in particular.

We are already seeing, for example, people suggesting that there should be no return to how life was in 2019. Perhaps future variants will be no more danger than flu, but could that not be an argument for doing more to combat the flu?

It should really not have come as such as a surprise to so many on the right that the public has not turned out to consist of stout, liberty-loving yeomen. This is, after all, largely the same nation that in 2011 told pollsters that 33% of voters supported using live ammunition to put down riots.

Nonetheless, there is something deeply unsettling about the Labour Party attacking the Government by quoting a nurse who stopped a man entering a hospital to see his dying wife – and justifying it as ‘for the greater good’.

The revelations about the apparent ‘party culture’ in Downing Street have been so politically devastating precisely because so many people feel they trivialise the sacrifices they made in the early stages of the pandemic. Their anger at Boris Johnson is perfectly understandable.

But the implied criticism from ‘Jenny’, the NHS nurse in the Labour tweet, is different. Because she isn’t actually talking about her own sacrifice. In fact, if anything the tweet weaponises the experience of a man who absolutely wasn’t prepared to make that bargain. It turns his private grief into public theatre, for political ends. It is less ‘I made sacrifices, you did not’, and more ‘I was a better cog in the enforcement machine than you’. By the end of two short paragraphs, the scene described is so problematic in its own right that the intended punchline, ‘as the Government had a party’, feels almost irrelevant.

I’m no epidemiologist; perhaps barring the door to this frantic husband was the right thing to do. Plagues force state actors to make hard choices, and Jenny was scarcely nailing up a house full of people and painting a red cross on the door.

But the tone, and indeed the choice to try and make political hay out of the situation at all, nonetheless leaves a nasty aftertaste, the bitter tang of a modern tendency to venerate ‘health’ at the expense of ‘care’.

‘Healthcare’ is one word, but it bundles together two separate concepts in a way that perhaps blinds us to the fact that there will be times when they conflict. 

Perhaps the best example of this is the decision to ban smoking, and push to restrict access to sugary drinks and similar foodstuffs, on NHS premises. Viewed through the narrow lens of ‘health’, one can see the logic: ‘These things are unhealthful! You dare to defile the temple of health?’

But from the perspective of ‘care’, the balance of the argument is quite different. For who do hospitals cater to but the sick, the stressed, and the scared? And who could possibly be more deserving of creature comforts than them?

The NHS might not approve of your smoking habit. But if you’re waiting at the bedside of a possibly dying relative, the ability to step outside for a cigarette is a blessed relief. A rounded, caring view would recognise that the good that a quick smoke does the individual probably outweighs the very small contribution a single cigarette makes to a long-term health challenge which can be better tackled in other ways.

Yet if you have the misfortune not to find a suitably discreet place to do it, you swiftly learn that ‘defiling the temple of health’ is the governing spirit of the NHS. (Happily, hospital grounds are big places.)

We hear similar stories from care homes, where families have to smuggle treats to relatives in the twilight of their lives because, once again, the staff disapprove of them engaging in unhealthful activities. There is no good argument for forcing an octogenarian to kick their smoking habit, yet too often narrow public health dogma triumphs over a spirit of caring for people as they are.

This imperial attitude extends beyond hospital grounds, of course. It is the basis for the shift from a social safety net towards something which more closely resembles a ‘social straightjacket’, wherein ever more aggressive interventions in our lives and lifestyles are justified on the grounds of reducing pressure on Our NHS.

This tendency reached its apogee with the instruction to ‘Protect the NHS’. Was there any other country where politicians explicitly appealed to the public to act not on behalf of each other, or of the nation, but of the healthcare system itself? Is there another nation so resistant to reforming a public service that it insists every time on trying to reform the public instead?

CapX readers won’t need to be told that our current arrangements are an unsustainable money-pit, a very expensive means of delivering middling outcomes. Conservative politicians acknowledge this too, at least in private.

But after two years of lockdown and claps for carers, we could be further than ever from a place where such reform is politically impossible. Until then, we will have to live with a health establishment with an increasingly hazy grasp on the difference between ‘patient’ and ‘sinner’.

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Henry Hill is Deputy Editor of ConservativeHome.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.