25 November 2020

The case for a new army of Royal Medical Reserves


When I was a student, and enthusiastically political in the way students often are, I sported on my wall a Conservative Party poster that I was quite fond of. 

One of a rather handsome set produced by CCHQ ahead of the 2010 election, it featured a balloon and a ball-and-chain and the words: “There is such a thing as society, it’s just not the same thing as the state.”

It nicely encapsulated the new course David Cameron was trying to chart – in the words of academics Peter Dorey and Mark Garnett, it “sought to distinguish Cameron’s vision of Conservatism from the ‘no such thing as society’ perspective symbolised by Thatcherism, while also attacking Labour’s over-reliance on statist solutions to social problems”.

Ten years on from his entering into Downing Street, little trace of that agenda remains, aside from a handful of schemes such as the National Citizen Service. The idea that society can simply expand to fill the roles vacated by a shrinking state has little currency in today’s Conservative Party, or at the very least is seldom discussed.

Britain, we are told time and again, is simply no longer a society of ‘joiners’. The age of mass political memberships and active civic associations is long past.

Yet the Covid-19 pandemic has complicated this picture. When the Government sent out a call for volunteers to help support the NHS and provide community assistance to vulnerable people, the response was overwhelming. Such was the volume of applications that at one point the Royal Voluntary Service had to stop accepting new ones.

The figures speak for themselves. In addition to some 47,000 former health workers who stepped back onto the NHS front line during the crisis, some 750,000 people tried to sign on as non-clinical volunteers, and 360,000 were approved.

Yet apparently 140,000 of them were never given a single assignment. Whatever portrait that paints, it is not of an indolent nation where the state is forced to do everything itself. If anything, the failure to find a productive role for more than half a million would-be volunteers suggests a deep well of civic spirit which the current state is not competent to tap. In fact, it neatly illustrates a point made by Cameron himself, when he set out his ‘Big Society’ vision in his 2009 Hugo Young Lecture:

“…the size, scope and role of government in Britain has reached a point where it is now inhibiting, not advancing the progressive aims of reducing poverty, fighting inequality, and increasing general well-being.”

But, more bleakly for liberals, it also suggests that this society (big or otherwise) can’t be disentangled from the state, at least not immediately.

Whether or not you share James Bartholomew’s view that the growth of the welfare state strangled the ecosystem of charitable and civic associations that once blanketed Britain, there is no escaping that the landscape he described in The Welfare State We’re In is long gone, and that simply rolling back the state is not enough to revive it. The institutional memory and social habits upon which it was built have been thoroughly unlearned, even if the instincts remain.

Moreover, too often over the past decade ‘society’ just turned out to mean charities which were so dependent on government funding that they were effectively organs of the state – but with even less scrutiny and accountability

But it didn’t have to be this way. Cameron was no libertarian, and recognised that in today’s Britain the state would necessarily have to play a role in harnessing the nation’s civic spirit. Or, in his words, “actively helping to create the big society; directly agitating for, catalysing and galvanising social renewal”. That this was done half-heartedly, and often badly, doesn’t mean it can’t be done.

Looked at this way, there is a clear link between Cameron’s call for “a thoughtful re-imagination of the role, as well as the size, of the state” and the proposals in a bill from Tory MP Alan Mak to formalise the NHS Reserves. According to the Times:

“Under the plans a national NHS Reservists register would be created. NHS Trusts and hospitals would be able to access the register to contact volunteers with the skills they need. Volunteers would range from retired doctors and nurses to drivers, electricians, logistics specialists, IT experts and communications professionals.”

Interestingly, the service is apparently going to be ‘uniformed’. This is in and of itself a good thing – it is a perennial weakness of the self-consciously ‘modern’ that they disdain pageantry. Given the deep attachment of the British people to the NHS, it makes sense to simultaneously give people a new avenue for voluntary service and create a highly visible and popular national institution.

Yet the problem is that, as it stands, it won’t be truly ‘national’. Precious few of our institutions actually are. The ‘National’ Health Service is in fact balkanised along devolved lines. Even the NCS, mentioned above, only operates in England and Northern Ireland.

Devocrats insist that this is how everyone likes it. But again, the public response to the pandemic told a different story. Thousands of people in Scotland and Wales tried to sign up to the Government’s ‘GoodSAM’ app. The British instinct, like the voluntary one, might be suppressed but it is not yet extinguished. The two should be revived hand in hand.

And there is a way to do it. During the pandemic, I suggested running the volunteer programme through the military, one of our few remaining institutions that genuinely operates on a UK-wide basis. It makes even more sense to do so now, when ministers apparently intend to set up a permanent, uniformed service. Why not make the ‘little platoons’, well, actual platoons?

The Royal Medical Reserves could simply be constituted as a specialist regiment, with no overseas obligations and a remit to operate anywhere in the country – perfect if the goal is versatile support for “public health emergencies, winter pressures, large public events, industrial action, and critical incidents such as terrorist attacks”.

Under this proposal, a uniformed identity would come as standard. As the Army has already deployed in Scotland, Wales, and Northern Ireland during the pandemic, this couldn’t be spun as an assault on the ‘devolution settlement’. And if it worked, it could provide a template which could be applied to other areas. Why not give young people from across the country the chance to support British international development work through our own version of the Peace Corps?

Stuff like this is a test of whether or not the Government grasps just how big the task facing it on the Union really is. What’s required is a comprehensive nation-building programme that reaches into every part of the agenda. The ‘social and cultural case for the UK’ can’t just be written up by a ‘Union task force’ – it has to be built, through actions and institutions. Mak’s medics should be the first of many.

Click here to subscribe to our daily briefing – the best pieces from CapX and across the web.

CapX depends on the generosity of its readers. If you value what we do, please consider making a donation.

Henry Hill is assistant editor of CapX.

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