The problem with ‘our NHS’

Labour is demanding that Matt Hancock apologise to NHS workers for a ‘disgraceful attack’ on the NHS. In a letter to the Health Secretary, the party’s deputy leader Angela Rayner says Hancock must distance himself from a claim that ‘there is nothing special about the NHS, neither during this pandemic nor at any other time’. She also writes that ‘if you are committed to the protection of our NHS you must take action immediately to assure the NHS and the British people’ that he doesn’t think ‘we should not be grateful for the NHS or thank the NHS and its staff for their work during this pandemic’.

This sounds serious, like the kind of view any health secretary might want to run a mile from. It’s not one he has personally expressed: it comes from the Institute of Economic Affairs, which has published a report called ‘Viral Myths: Why we risk learning the wrong lessons from the pandemic’. This document examines a list of conclusions that its author, Kristian Niemietz, says people are starting to reach about the pandemic, such as ‘the UK was unprepared to cope with Covid-19 because a decade of “austerity” had hollowed out the public sector, thus eroding the state’s capacity to act’ and ‘the NHS has been the star performer of the pandemic, and that we should be more grateful than ever for having it’. It compares the performance of different countries in the pandemic, and looks at the size of their states, the extent to which they are globalised nations, and so on.

Rayner is so horrified by one of the lines in this report that she has demanded Hancock publicly reject it and repay the £32,000 in donations he received from IEA chairman Neil Record. That line reads thus:

One way or another, this is simply not the material that grand narratives are made of. What is safe to say is that there is no rational basis for the adulation the NHS is currently receiving, and no reason to be ‘grateful’ for the fact that we have it. It should go without saying that if the UK did not have the NHS, it would not have no healthcare system. Maybe it would have a public health insurance system similar to the Taiwanese or the Australian one, or maybe it would have a social health insurance system similar to the Swiss or German one. There is no guarantee that this would have served the UK better during the pandemic, but there is certainly no reason to believe that it would have done any worse. There is nothing special about the NHS, neither during this pandemic, nor at any other time.

There are some aspects of British politics that are almost impossible to explain to people from other countries. Chief among them is why a think tank report making this point would be so incendiary that it is being written up as a disgraceful dismissal of the hard work of the people on the front line of the health service, rather than a critique of the structures which have been designed and endlessly fiddled with by politicians.

As well as always being clear how in favour of the health system they are, British politicians also tend to refer to it as ‘our NHS’, a bit like people in some parts of the country refer to ‘our Michael’ when talking about a family member. our NHS isn’t so much an organisation — or collection of organisations — or a policy as it is an expression of our values. To question the way the organisation or policy operates is difficult because it is immediately conflated with criticising the people who work in our NHS and rejecting the values it embodies. Rayner herself repeatedly says ‘our NHS‘ in this letter and even characterises Hancock’s role as being similar to the monarch’s position as ‘defender of the faith’:

As Health Secretary it is your job to protect and defend our country’s greatest institution — our National Health Service — and stand up for our NHS staff who have sacrificed so much throughout this pandemic to save lives and keep us safe.

Rayner is a busy woman, so perhaps she hasn’t read the IEA report in full. Anyone who takes the time will struggle to find any criticism of NHS staff. In fact, the document doesn’t talk at all about doctors or nurses or physios or any of the other people who work in the NHS. It doesn’t talk about the ethos of the health service. It doesn’t praise German or Singaporean healthcare workers as somehow being more committed. All it discusses is models of healthcare provision. It has a very blunt conclusion of ‘there is nothing special about the NHS’ which is rather in keeping with Niemietz’s hobby of winding up the left by making statements which he knows will challenge certain shibboleths. But it simply does not suggest that the public shouldn’t clap health workers. In fact, it is very clear that the health service has been let down by the government repeatedly as it tries to respond to the pandemic, pointing out that lockdown came later here than in many neighbouring countries, that ministers kept airports open, had ‘lax enforcement of quarantining measures’, introduced a ‘misguided’ Eat Out To Help Out scheme and were slow to roll out mass testing.

Our NHS is a set of values and people who Brits admire and feel proud of. The Conservatives have learned that there is little point in engaging in the sort of academic musings that think tanks like the IEA can comfortably pursue because voters just aren’t interested in a debate about different models of healthcare. They like that the NHS is free at the point of access and they like the story behind its creation. Often, they like their local NHS provision so much that they vociferously oppose plans to close a unit and centralise services in order to save lives. Ask any MP whether they’d want to be on the campaign in favour of downgrading a maternity unit or closing the local A&E, and they’ll look at you as though you’ve suggested they spend an afternoon relaxing in a piranha tank. The same goes for discussing whether the NHS as a system — not the our NHS of doctors, nurses and so on — is working as best as it could. Even saying ‘is working as best as it could’ is immediately seized upon as a suggestion that doctors are somehow lazy, when it is merely a question of whether services are structured in the right way, whether there is a proper workforce strategy, whether funding is directed at the right areas and whether procurement of new technology is at all up to scratch.

One figure who knows the importance of paying homage to our NHS is the politician criticised in the IEA report for saying that ‘the NHS is the best gift a nation ever gave itself’ and that ‘it’s been a difficult year for so many, but our collective love of the NHS has brought us all together’. Rayner wasn’t the one who said these words, though. Nor was it one of her Labour colleagues. It was Hancock, who knows just as well as any other Conservative around today that there is just no point in raising the sorts of questions that the IEA can, even if he wanted to.