Winds Beyond Our Control

A change of Health Secretary (not before time) and a fresh set of messages about reducing the pandemic constraints on life should be welcome developments. The fact they aren’t deserves careful examination.

This pandemic has taken many twists and turns, usually with government unprepared (or at best under-prepared) for the development, and often responding far too late to the data which they claimed was driving their decision-making. The unwillingness to empower local action and to centralise efforts failed, a signal which seems to be ignored.

We now have the situation where infections are climbing once again, with a doubling time of around a week, most of those infected are young people, and government decisions seem to be based on the fact that vaccination response is so good among adults, especially in the older generations, that normality can return. Whatever that normality turns out to be.

There are unknowns. What is going to happen to the hospital admission rate as infections rise? That is already testing some NHS Trusts. The issue of deaths is disregarded, it seems they are going to remain low, but no-one can be certain. A rising incidence in Long-Covid among younger people is a threat that is brushed aside. Potential mass-spreader events are now permitted – acceptable risk?  The UK’s border policy seems more robust than it was, but inaction allowed the Delta variant to be introduced from India and to take hold. Could that happen again?

The dominant political stance is that as so few people (as a percentage of the population) now get seriously affected and vaccination has reduced that to a lowest ever position, we can let go of all constraints on life. The economic impact of the first waves must be overcome and our ‘freedoms’ returned, to be sacredly preserved.

I am worried.

First, because the NHS has been destroyed. It is still there in name but you cannot see a GP (you may get a phone call), your highest risk for getting infected is to visit a hospital, NHS staff are exhausted and stressed, the backlog of unmet need is at its highest level ever, and political shenanigans resulting from the pandemic have tainted a valued ethic.

Second, consequent deaths are a growing issue. Cancer death rates will rise because of delayed diagnosis and treatment, similarly for other conditions. Disability rates in the population will rise because of untreated conditions, or conditions which become too difficult to treat.

Third, inaction on social care means that the NHS will become an old people’s home. It is too much like one already. Government promises to address social care have sounded hollow for a long time but now the growth in the elderly population is about to burst as the post-war baby-boom generation approach 80.

These are structural issues which need a combination of leadership, strong values, integrity, political collaboration, imagination and resources – all of which seem to be in short supply.

But consider that the pandemic is not over yet. The impact on young people is a great concern but perhaps the greater issue is the unknown behaviour of the virus as it mutates. All these other issues could be a minor distraction if a variant emerges which escapes the effect of vaccines. I can respect the cautious optimism of the scientists that they can address variants. Their caution is common sense, qualities absent from politics.

At its worst we could be heading into a healthcare crisis beyond imagination. If, somehow, we can grasp the challenges and start to have good luck with the virus, the damage can be addressed.  It’s a set of fine balances but personally I have no confidence that we can be anything other than blown through the storm by winds beyond our control.