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Political conclusions drawn so far from the horrific tragedy of COVID-1,9 and the lamentable UK response, have often been hurriedly deployed in support of a range of political viewpoints.
Perhaps the most common is that the regrettable UK response has been due to the NHS being starved of funds due to ‘austerity’. Per person NHS budgets have been squeezed over a long period, and this almost certainly contributed to the NHS’s problems, and more money is needed, but it cannot be the whole story; or even perhaps the main story.
The UK spends the same or more on health, and a larger proportion on state health, than many other OECD countries, including Finland, South Korea, New Zealand and Australia.
Many OECD countries that have very much lower per person spending, such as Greece (about half UK spend), and Slovenia (less than two thirds UK spend), have very much lower ‘deaths per million’ to date from COVID-19; roughly 15 and 50 respectively, versus 480 for the UK.
These figures say nothing about why the fatality rate is so much lower in other comparable countries, they merely cast doubt on the view that austerity was the main cause of the high UK death rate. Would simply raising UK health spend by 7% to match Germany, have brought similar ‘fatalities per million’ rates by itself ?
Another political position claiming support from the COVID-19 tragedy, is Universal Basic Income (UBI); a basic subsistence income paid to all citizens unconditionally. It is claimed that furlough payments, expanded Universal Credit and subsidies for small businesses, demonstrate the desirability of UBI.
UBI is a perfectly sane proposition, capable of being analysed rationally. Like everything there are upsides and downsides, and the scope for unintended consequences. Some upsides do not lend themselves to hard calculation. The main challenges are financial however; on what basis is the level set, how does UBI integrate with taxation, what would be the net cost when independently assessed (£1bn, £50bn, £400bn) ?
Fair assessments by neutral institutions need to consider proposals from advocates on how to address such challenges. The problem is, the COVID-19 pandemic has not as yet shed any light on them.
It might be more politically wise, and indeed a better service to the British public, to start with the evidence, formal & anecdotal, official and ‘whistle-blower’. We need to develop ‘updatable hypotheses’ about solving problems rather than go in the other direction and overlay a ready made political view.
Up to now, we can see that bizarre NHS funding methods left the UK with only a seventh of Germany’s intensive care units per capita. We can see that the extraordinary centralisation and procedure-driven methods of the UK administration made HMG incapable of dealing with an untidy world, preferring ‘big lucrative contracts’.
We can observe the shockingly permissive environment in HMG for cronyist profit-making by civil servants and parliamentarians. We can see clearly the sclerotic and politicised bureaucracy incapable of making quick decisions, while institutions up and down the UK ‘wait for instructions’. We can also clearly see the downsides of HMG’s reliance on upbeat media manipulations and its instinctively obsessive secrecy, and see how the elderly were seen as expendable, as many were shipped back to care homes without testing.
Much of this information comes from brave NHS staff; risking their lives and defying gag orders.
The jury must surely still be out on the global, European and UK lessons from COVID-19, and who knows where UK public opinion will end up ?
We may have an overarching narrative at some point, but as a political party we should eschew any tendency now to ‘fit the facts to our tenets’, grasp at evidence-free conspiracy theories, or most important of all, entertain naivety about the UK administration and polity. We are long past the point where we should give them the benefit of the doubt.
* Paul Reynolds works with multilateral organisations as an independent adviser on international relations, economics, and senior governance.
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6 Comments
Paul,
these are highly salient points. We do ourselves and no one else any favours by glorifying a health funding and centralised management system that has not just proved wanting in this crisis but has done so year after year for decades, despite the best efforts of front-line staff. Universal healthcare (including adult social care) needs to be funded as it is in much of Europe and Japan by a system of social insurance that is not subject to the political vagaries of whatever government is currently occupying 10 Downing Street. Rates and charges are set by a central national body but providers are a mixed market of non-profits and for-profit institutions providing high-quality services (and decent pay) as they are in France and Germany.
Universal basic income is only practical in the form it is employed in places like Alaska where it is a distribution of earnings from natural resources from the land like oil; or as an integrated element of the tax and benefit system providing a minimum income guarantee in the form of a basic universal credit allowance or a tax allowance. The Utopian ideas are best left to futurists that see a tax on robots providing for the basic needs of humanity as we while away our days in pursuit of leisure and cultural activities.
Another factor is the insane centralisation of Government at all levels. Germany by contrast has a System of strong Regional (State) Authorities able to raise their own Taxes & apply their own rules to such things as provision of Care for the Elderly.
@Paul Barker
A Federal UK? Bring it on!
@ Paul Reynolds,
“The UK spends…….a larger proportion on state health, than many other OECD countries, including ….. Australia.”
Having lived in Australia for several years I do know the system there. There is a much greater requirement to fund your own health care. Private health insurance is much more common than in the UK. Visits to the doctor aren’t generally free. Prescriptions are much more expensive. None emergency hospital operations, even in the state sector, are at least partially funded by patient charges.
So if that’s the system you want then please say so. It does have its advantages. It’s like when I take my dog to the vet. I don’t have to wait long at all! And neither would I, at the doctor, if everyone had to pay similar sized bills!
Our institutions are at fault. If we cannot obtain PR then we need a constitution that enables and even encourages a temporary government of national unit for these all encompassing situations. A special committee could report directly to the Monarch recommending such a government to deal with specific issues
Thank you Peter Martin. May I just draw your attention, and that of other LDV readers, to the text in the article, thus; ‘These figures say nothing about why the [COVID-19] fatality rate is so much lower in other comparable countries, they merely cast doubt on the view that austerity was the main cause of the high UK death rate’. I can’t see anything in the text that suggests a recommendation to emulate the Australian system or parts of it, in any way. The overall Australian health system may well be inferior to the UK system, in practice. I have no knowledge of it. On the face of it, health outcomes and hospital recovery rates are better than the UK, but there are many reasons for that, and such statistics alone don’t provide a solid basis for policy decisions about the NHS and overall UK system. My key point is that it would be disbenficial for the British public to conclude that the poor UK outcomes for COVID-19 are the result of austerity alone. I believe that, from my experience, very few senior health professionals would agree that if the UK health spend was 7% higher to match with Germany, outcomes would have been comparable with Germany. It means as a party we have a lot more to do on behalf of the British public than merely campaign for increased spending, accepting that greater funds are nevertheless almost certanly a requisite for improvement.