Breaking Point

All of the developments that have apparently taken the government by surprise during the Covid-19 pandemic were predictable and probable, and I don't just mean exams and public holidays. As early as late January, when the first cases were recorded in the UK, we knew that the virus could spread rapidly: that was the lesson of China where Wuhan was locked down on the 20th and 6,000 cases were recorded nationally by the 29th (the UK Foreign Office advised against all but essential travel there on the 23rd). By the end of the month, 27 countries had confirmed cases. Though it was slow to react, the World Health Organisation declared the Covid-19 outbreak a global public health emergency on the 30th. Given that recorded cases lag actual infections, and considering the rapid spread already seen and the time of year (the flu season), it was likely that this would be a much more serious outbreak than the 2009 Swine Flu pandemic (which hit in the summer, with a second wave in autumn) and that the conditions were already in place for the outbreak in the UK to spread rapidly. It was clearly time for prompt action.

But something changed in offical thinking. The initial moves to quarantine cruise ship passengers and travellers from Wuhan gave way during February to a more laissez-faire approach in which people returning from skiing holidays in Northern Italy were waved through passport control and merely advised to self-isolate if they developed symptoms. By mid-March we started to hear about "herd immunity" and "cocooning". In practical terms, the strategy was supposedly to allow 60% of the population to become infected while protecting the 40% deemed vulnerable due to age or underlying health conditions. At the same time, the government announced that testing outside of hospitals would come to an end. Though the "herd immunity" phrase was soon banned from official communications, it is clear that the government's strategy was based on the assumption that a gradual spread through the population could be tolerated until such time as a vaccine was developed and that its immediate focus should be on slowing the spread, i.e. "flattening the curve". When the measures taken proved insufficient, we entered the first lockdown. This marked an escalation in management but not a change in strategy.

At no point does the government appear to have seriously consided eradication, which would have entailed strict quarantines for travellers, extensive testing and tracing, and repeated lockdowns (though we've ended up pursuing some of these measures anyway). The assumed trade-off for eradication is damage to the economy, though the quid-pro-quo is the potential of a more rapid recovery due to popular confidence. But it's also likely that worries about the state's ability to successfully implement such a strategy also informed the decision. This was excused at the time in terms of the population's anticipated "fatigue", but the claim that such measures would have been alien to a British society raised on tales of wartime fortitude are as risible as the idea that they would have been in conflict with the Prime Minister's "libertarian instincts". The thinking appears to have been: let nature take its course. But there must be more to it than an ideological aversion to state intervention or a belief that plague is a judgement on the undeserving. The government's progress has been characterised by the media as a series of u-turns, but that's just a lazy frame. It would be more accurate to say that the government's handling has been reactive rather than proactive. But why, given that so much was predictable?

Is this simple dither and delay? While Boris Johnson is clearly lazy and reluctant to take difficult decisions, I don't think we can attribute the government's slowness to act solely to the shortcomings of one individual. If that were the only issue, and if other Tory politicians had been urging "action this day", then we would have seen a party coup by now, or at least the first stirrings of one. The previous Conservative Prime Minister faced an internal vote of no confidence and was obliged to promise not to lead the party into the next general election before she was finally pressured to resign. To date, Johnson has faced no serious internal opposition and not even a sustained whispering campaign in the media. If anything, backbenchers and "sources" have been keen to find excuses for his dilatoriness. This indulgence may have been attributable last year to the imperative of "Get Brexit done", and could therefore change in the next few weeks, but while I expect the criticism to mount, I doubt it will coalesce into a clear policy alternative, despite Labour's noticeable absence from the field making it possible for the Covid Recovery Group or others to punt one without fear of benefiting the official opposition. 

Is the government's poor performance due to short-termism? This is more plausible in that there is clearly a lack of vision in Number 10, but I think there is a risk here of interpreting reaction to events as the absence of a strategy. If the purpose all along has been to implement the minimum measures consistent with keeping the NHS just this side of collapse, then trimming policy in response to the pandemic's course is what you would expect to see. Of course, what this highlights is that Conservative administrations since 2010 have deliberately degraded the health service's headroom and therefore its capacity to respond to a pandemic. When Jeremy Hunt cites his management of multiple "winter crises" as justification for his belief that things have now gone too far, he is condemning his own record as Minister for Health in preparing for just this contingency. The inadequacy of the NHS in the face of the current Covid-19 wave is the consequence of deliberate policy, and therefore something that was not merely predictable but anticipated. The problem is the corrosive, long-term bias against public services, rather than the ineptitude of short-term improvisation.

Is this just the Tories privileging capital? If so, you have to explain why, despite advocacy by the rightwing press, they didn't adopt the maximally business-friendly Swedish approach. Instead, the Chancellor implemented a package of measures, from cheap business loans through furlough to the moratorium on evictions, that have been distinguished by caution and conventionality, with the self-employed, SMEs and landlords often unimpressed. This isn't "disaster capitalism" cranking up a gear, nor is it indicative of a belief that capital faces an existential crisis. One suggestive piece of evidence was the early mishandling of care homes. First, the alacrity with which elderly patients in hospital were decanted in order to clear beds, and then the way that the sector's reliance on agency staff created an ideal vector for transmission, which put the interests of the elderly in conflict with those of private equity. This suggests that the chief concern has been to protect the NHS, rather than the care home industry, while the current priortisation of residents for vaccination is an attempt to neutralise the possible electoral consequences of that decision. The mantra "Stay at home, Protect the NHS, Save lives" was quite up-front about this.

The horse has now bolted on an eradication strategy (along with Dido Harding's test, trace and isolate programme) and we're going all-in on accelerating vaccination. There is scope for policy difference on this - the makeup of the priority groups, the length of the interval between jabs, the logistics of delivery - but nobody appears confident enough to promote a distinct plan B at the moment that amounts to anything more than faster, higher, stronger. Tony Blair's "blueprint" is just a confection of business consultancy blather ("harness the private sector"), managerialist fetishes ("a real-time dashboard") and the sort of daft tactical fixes that free market think-tanks trade in ("use empty offices as vaccine stations" will only appeal to commercial landlords). With its aspirational tone and urgent technocracy it's classic Blair, but utterly irrelevant. The reason for its prominence now is simply that the current Labour leader isn't cutting through. Why has Labour been so weak? Starmer's supporters in the media have taken every opportunity to highlight occasions when he has advocated a policy tweak that the government has subsequently adopted, but this has largely been a matter of rhetorical flourishes (e.g. a "circuit-breaker") or opportunistically calling for something once it looks inevitable. 

There has been little divergence on the overall strategy, while on specific areas such as education the Labour leader has gone out of his way to keep closer to the government line than that of domain experts like the teaching unions. Some of this is a fear of being labelled "anti-business" or "unpatriotic", but some of it appears to stem from a belief that the British state is institutionally robust and the economy essentially sound, it just needs better management (Labour won't call for Gavin Williamson's resignation, but it hopes the electorate might take the hint). In other words, a profound critique of the degrading of the public sector's capacities and capabilities isn't on the cards, any more than an acknowledgement that a low-wage and precarious labour market lacks resilience or that force-fed education doesn't lead inexorably to higher productivity. This reinforces the impression that Labour is returning to Blairite orthodoxy: some more money for the NHS, but no less marketisation; a bit more on Universal Credit, but no real change to the sanctions regime; a renewed emphasis on education, but no move away from the productivist obsession with testing and league tables.

For all the amplifying factors - Tory callousness, Johnson's laziness, institutional short-termism - the way that the pandemic has been managed in the UK has clearly been driven by the constraints of the NHS. The failures to date spring from two causes: one the result of design, the other the result of capacity planning. The first, longer-term issue has been the fragmentation of the wider public health capability, including not only the NHS, local authority functions and epidemiological services such as lab testing, but also policy on sick pay and the time taken to process benefit applications. The Tory emphasis on "ring-fencing" should be highlighted here. What it did was "protect" funding for the NHS while underfunding those parts of the wider public health infrastructure necessary to effectively manage a pandemic. Meanwhile the coercive approach to sickness has bred a culture of presenteeism and fear that in turn feeds infection. The failure of test, trace and isolate was therefore predictable, with the government determined to use the private sector instead of proven local authority resources, testing hindered by bottlenecks in outsourced providers, and effective isolation discouraged by inadequate wage support.

The Nightingale hospitals were also illustrative. We could quickly create bed capacity but couldn't provide nursing staff. That these facilities are now being redeployed as overflow for non-critical cases and vaccination looks like the fruits of integrated planning that should have happened well in advance. This lack of planning and coordination - a result of decades of markestisation, outsourcing and privatisation - precluded an integrated public health response, which is the sine qua non of an eradication strategy. The second, more immediate problem was that the service had been run near to the bone for a decade, as capacity failed to keep up with growing demand. This is most obvious now with the news that necessary surgery is being deferred due to a lack of beds and staff, which in turn reinforces the point that excess deaths from all causes will be the ultimate judgement on the country's preparedness and response to the pandemic. That the UK's preparedness to handle a pandemic was scored as second best in the world as recently as 2019 by the Global Health Security Index suggests that both integration and the capacity to flex in the face of an upsurge in demand for hospital care are blindspots in such technocratic assessments. 

The fundamental failure has clearly been the lack of a sufficiently integrated public health strategy. But what's odd is that the political response to this has seen an inversion of traditional roles. For all the u-turns and policy mistakes, it is the Conservative government that has taken the lead on planning and coordination, rather than leaving it to NHS and PHE management or assuming that the private sector will step in to meet demand. The employment of the likes of Deloitte and Serco is the creation of state monopolies, not competitive markets. The TV announcements, the emphasis on collective action, the wartime rhetoric are all the theatre of the interventionist state, hence the identical and competitive efforts in Edinburgh and Cardiff. In contrast, Labour, which has historically advocated integration, notably in areas such as public transport and social care, has been essentially mute on the subject during the pandemic, while its reluctance to champion planning has led to Tony Blair trying to fill the void. What the Conservatives' cack-handed efforts and Labour's timidity alike show is just how weak the British state has become over the last forty years. Hollowed-out from within and now desperately trying to maintain the illusion of control and constructive criticism respectively.