A rational person would question why Britain has fared so badly in the COVID-19 pandemic. It is a rich country with the sixth largest economy in the world, a proud history of public health and a National Health Service (NHS) arising from the ashes of World War II. This forms the central pillar of the welfare state, providing universal, comprehensive care to all citizens irrespective of ability to pay.
Despite these advantages, there has been an estimated excess death toll of more than 50,000 people, second only to the United States, with the highest deaths per million, in the world.
To understand this catastrophe it is essential to appreciate the neoliberal reforms which have steadily mutated this institution over decades. Having experienced first-hand and studied the treacherous process, as a general practitioner and NHS doctor for close to 27 years, we are shocked, yet not surprised.
Shredding the fabric of society
Two years after the 2008 Global Financial Crisis, the Conservative-Liberal Democrats coalition government embarked on their austerity program. This was an economically illiterate plan, drawing the false comparison between macroeconomics and household finances, an approach popularised by former Prime Minister Margaret Thatcher.
A hoodwinked public accepted their narrative and with it wage stagnation and cuts to public services: a monumental lie transferred the debt burden of bank bailouts onto the shoulders of the weakest. For the NHS, this meant a decade of de-funding and a reduction in the historical average annual increase in spending on health (4%-1%). Simultaneously the NHS was further restructured, a process that started in 1970s but accelerated under the fog of austerity.
A former NHS director-general for commissioning Mark Britnell explained it in 2010 like this: “In [the] future, the NHS will be a state insurance provider not a state deliverer.
“In [the] future ‘any willing provider’ from the private sector will be able to sell goods and services to the system. The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”
The Health and Social Care Act 2012 ensured that advantage was taken, creating a fully marketised NHS. The Secretary of State’s legal “duty to provide” was removed and replaced with a “duty to promote” health services, abolishing the very premise of the NHS. New funding structures replicating United States private health insurance pools known as Clinical Commissioning Groups were set up to force the outsourcing of medical services.
QUANGOS (quasi non-governmental organisations) were created — NHS England and Public Health England — headed up by government appointees. Well established decentralised public health infrastructure was dismantled and institutional memory and expertise cast aside as part of 10,000 redundancies and a £700 million funding cut over five years.
The 2016 referendum on Brexit generated a groundswell of anti-establishment feeling. The pain of austerity was soothed with the balm of nationalism and a rejection of European bureaucracy. This returned a Leave vote, which plunged Britain into a political quagmire and bitter division.
A country in the midst of a productivity crisis, due to consecutive governments dismantling industry, casualising employment and financialising the economy, was also removing vital safety nets. Rising inequality, the vogue for zero hours contracts, and escalating living costs created precariousness with 10 million households without any savings.
By 2019, the NHS was on its knees: a decade of funding squeezes resulted in 17,000 bed cuts; 10,000 doctor vacancies; and 40,000 nursing vacancies. Britain now had the fewest number of doctors and hospital beds per capita in Western Europe.
This weakened health service and weakened population have been left to fend off this pandemic, with a misanthropic “Brexit before breathing” government at the helm.
With the groundwork completed, the profitable remnants of the NHS could now be turned over to business. The poor were no longer secure; their plight foretold by 1980s satirist Rick Mayall. “You see, in the good old days, you were poor, you got ill, and you died. And yet, and yet these days people seem to think they have some God given right to be cured!”
The 2019 general election was a crushing defeat for Labour. The Tories’ simple “Get Brexit Done” message, unremitting allegations of Labour anti-Semitism, a right-wing media onslaught and internal party divisions, led an emboldened Boris Johnson back to power with a landslide.
Preoccupied with Churchillian fantasies, securing his legacy, and relishing the prospect of shredding workers’ rights, environmental and public health protections in a trade deal with the US, his hands were full. Then came news from Wuhan of a deadly novel coronavirus, COVID-19, which caused some sufferers to develop serious breathing problems requiring ventilatory life support. Soon after, human-to-human spread was confirmed. Other countries, including South Korea, started reporting cases and on January 30 the World Health Organization (WHO) declared a “public health emergency of international concern”.
More Nero than Churchill
On April 18, a bombshell article published in the Sunday Times titled “Coronavirus: 38 days when Britain sleepwalked into disaster” revealed that: “Boris Johnson skipped five COBRA [Cabinet briefing] meetings on the virus, calls to order protective gear were ignored and scientists’ warnings fell on deaf ears. Failings in February may have cost thousands of lives.”
Johnson had been preoccupied by personal matters and securing his historic Brexit. Emergency government COBRA meetings were led by others, despite growing international concerns. His ministers and scientific advisers gave multiple reassurances about how well prepared the NHS was and downplayed the significance of the pandemic threat.
The policy of herd immunity, as explained by the Chief Scientific Officer, Sir Patrick Vallance, was to slow transmission to prevent the NHS being overwhelmed as the population built natural immunity by getting infected. Britain was to ignore the fundamental infection control measures of testing, contact tracing and quarantine successfully followed in many countries.
Repeated warnings from the WHO to “test, test, test” fell on deaf ears and the condemned herd immunity policy was summed up by Johnson as: “One of the theories is that, you know, perhaps you could sort of take it on the chin, take it all in one go and allow the disease, as it were, to move through the population.”
By early March, several European countries including Britain had reported coronavirus deaths. Italy and Greece had closed schools and banned public gatherings. Despite the lack of clear government advice, some British organisations and sporting bodies decided to cancel events, however, Johnson chose to attend a Six Nations rugby match with 82,000 others.
Dramatic video footage from Northern Italy showed how its health system was being overwhelmed, despite having double the number of intensive care beds compared to Britain. Anaesthetist friends who worked in intensive care units (ICU) shared their alarm at the reckless inaction and lack of preparedness given the threat.
A survey published by Doctors Association UK showed a staggering 99% saying they felt the NHS was unprepared for the pandemic, and highlighting staff shortages and lack of protective equipment. Of the 18 million people who entered Britain from January to March, fewer than 300 were quarantined. On March 12, the government stopped mass testing and contact tracing.
Johnson had already set out his priorities in a speech on February 3 that went viral on Twitter: “… and when there is a risk that new diseases such as coronavirus would trigger a panic and a desire for market segregation that go beyond what is medically rational to the point of doing real and unnecessary economic damage, then, at that moment, humanity needs some government somewhere that is willing, at least, to make the case powerfully for freedom of exchange.
“Some country ready to take off its Clarke Kent spectacles and leap into the phone booth and emerge with its cloak flowing, as the super-charged champion of the right of populations of the Earth to buy and sell freely among each other.
“And, here in Greenwich, in the first week of February 2020, I can tell you, in all humility, that the UK is ready for that role.”
Johnson’s commitment to freedom of exchange and his views on the threat of overpopulation tallied with his laissez faire approach to the pandemic. Several right-wing commentators warned against damaging the economy, preferring that the elderly and sick should perish for the greater good.
According to the March 22 Sunday Times, the PM’s senior aide Dominic Cummings at a private engagement at the end of February, outlined the government’s strategy. “Those present say it was ‘herd immunity, protect the economy and if that means some pensioners die, too bad’.”
The British government allowed coronavirus to spread to afflict a population already weakened by austerity. Academic analysis estimated an excess 120,000 deaths due to austerity, along with reduced life expectancy and increased infant mortality. Policies intended to replicate the expensive, dysfunctional but highly profitable US health system would inevitably mean many more preventable deaths. The government’s inaction was entirely consistent and deliberate, guided by profit, not the preservation of life.
Vietnam, with its land border with China and population of 96 million, reported no coronavirus deaths. The Indian state of Kerala, with a population of 34 million has only had six deaths [as at May 24]. Both are testament to the effectiveness of simple, intensive efforts that could drastically reduce the spread of the disease and preserve life.
Britain’s approach of squandering valuable time to prepare, mixed messaging and downplaying of risk was having a very different impact. Hospital ICUs were starting to fill up with sick coronavirus patients, with deaths approaching 1000 a day at the peak. Health and care staff remained without adequate supplies of suitable personal protective equipment (PPE), with reports of some resorting to wearing plastic bin bags and home-made masks.
A BBC Panorama documentary exposed how a government decision to re-classify coronavirus from a “high consequence” infectious disease to an infectious disease of lower consequence led to new recommendations that healthcare professionals use only plastic aprons and paper face masks. This was not based on science but on the grossly inadequate stockpiles of PPE.
A pandemic preparedness exercise in 2016 had highlighted the deficient stockpile of ventilators. The report’s recommendations were not implemented. If you fail to prepare, then you prepare to fail. This price was to be paid by more than 220 health and care workers who have so far died from coronavirus.
Multiple tragedies were unfolding. Patients fighting for life in ICUs, community spread unhindered, but perhaps most shocking was the fate of vulnerable, elderly care home residents. Contrary to having a “protective ring” around them, as claimed by Health Secretary Matt Hancock, patients were being discharged to nursing homes irrespective of having been diagnosed with coronavirus or being tested, in policy described as a “stiff broom”, to free up capacity in hospitals.
A cardiologist described it like this: “Our policy was to let the virus rip and then ‘cocoon the elderly’. You don’t know whether to laugh or cry when you contrast that with what we actually did.
“We discharged known, suspected and unknown cases into care homes, which were unprepared, with no formal warning that the patients were infected, no testing available, and no PPE to prevent transmission. We actively seeded this into the very population that was most vulnerable.
“We let these people die without palliation. The official policy was not to visit care homes — and they didn’t (and still don’t).
So, after infecting them with a disease that causes an unpleasant ending, we denied our elders access to a doctor — denied GP visits — and denied admission to hospital. Simple things like fluids, withheld. Effective palliation like syringe drivers, withheld.”
As the 75th anniversary of Victory in Europe Day was being commemorated, the generation that lived through the devastation of World War II was being decimated directly and indirectly, with one estimate of the toll being 22,000.
Epidemiological modelling from Imperial College presented to government and advisory experts on March 12 now predicted that more than 250,000 people could die if the herd immunity plan was maintained, and recommended urgent action.
Other European countries had closed schools and universities. With mounting public and media pressure, it took a further 11 days before schools were closed and public gatherings prohibited. A piecemeal partial lockdown began, but it was too little, too late.
Construction workers were classified as essential and continued working. Public transport provisions in London were reduced, producing crowded trains and buses. Lockdown is a blunt tool without the necessary measures of testing, contact tracing and effective isolation. Herd immunity was continuing in all but name.
With all routine healthcare suspended, workload for general practitioners and NHS hospital laboratories was dramatically reduced. Public resources were available to set up a nationwide decentralised, integrated testing sites and laboratories using experienced personnel and existing IT systems.
Instead, these were overlooked in favour of setting up three new public-private Lighthouse Labs, which according to their website “are being actively supported by pharmaceutical companies GSK and AstraZeneca, who are providing access to data and resources to further increase our capacity as we scale up at record pace. An extensive supply chain of resources including support from Amazon, Boots and the Royal Mail, alongside the Wellcome Trust has been established to bring further resources to our facilities.”
GP surgeries were bypassed in favour of a network of 50 regional testing sites to be run by facilities management giant Serco and management consultants Deloitte. People with suspected coronavirus were directed to the telephone helpline and website of the outsourced 111 service. Experienced NHS doctors were excluded from managing the unfolding crisis and replaced by unqualified staff guided by a computer based flow chart.
Big Tech companies have been awarded contracts, including Microsoft, Google, Amazon Web Services, Palantir Technology UK and Faculty. A controversial contact tracing app produced by Faculty, has been piloted in the Isle of Wight, despite concerns around privacy and cyber security and potential for mission creep towards mass surveillance.
Every problem had to have a private sector solution, rather than the tried and tested public sector now lying idle. The option to rebuild vital public health infrastructure was ignored as Johnson’s government doubled down on privatisation.
Daily briefings from Downing Street revealed the media strategy to be deployed. The three line slogan, “Stay Home, Protect the NHS, Save Lives” was clear and effective, as the majority of the public restricted themselves to essential travel, shopping and working from home where possible.
A furlough scheme guaranteed 80% of salaries for millions of people. Worryingly, accident and emergency departments experienced a significant slowdown in activity and there was an 80% reduction in suspected cancer referrals from GPs. The “stay home” message and fear of catching the virus led to an indirect pandemic toll, as journalists, with few exceptions, failed to cross-examine and scrutinise government decisions.
“Led by the science” became a recurring expression that alerted some of us that perhaps this group would be the future scapegoats. When Imperial College epidemiologist Professor Neil Ferguson was publicly exposed for having ignored social distancing advice by meeting his married lover, it did not come as a complete surprise. It provided an opportunity to undermine his projections that had led to the lockdown.
On VE Day, May 8, the right-wing media were in celebratory mood, fusing the victory over fascism 75 years earlier with victory over the virus and an anticipated easing of lockdown. Two days later, Johnson obliged with a new slogan “Stay Alert. Control the Virus. Save Lives” to accompany his address to the nation. It was no longer deemed necessary to stay home.
Despite high daily new cases of about 20,000, disproportionately low levels of testing and minimal contact tracing, the government was encouraging people to return to work and was planning to reopen schools. The next day, those without an alternative or in greatest need of income were again crowded onto public transport.
Independent experts who had been openly critical warned of a second wave of infection. Teachers and their unions demanded clarity around plans to mitigate risk and maintain social distancing — difficult with young children who could be potential carriers of infection back to their families. Some journalists responded by portraying teachers as being neglectful of their duties.
On the back of a decade of austerity, there has been a rapid cull of the sick and elderly. Even a fool has a 50% chance to be correct with a binary choice. Implement pandemic preparedness report: yes or no? Follow test, trace and isolate policy: yes or no? Ensure adequate PPE for all that require it: yes or no? Prevent the spread of infection to the most vulnerable in society: yes or no? Utilise existing spare public capacity to manage the epidemic: yes or no? Award private corporations contracts to provide services for which they have no expertise or experience: yes or no? Introduce untested tracking mobile phone app with significant concerns: yes or no?
The ideologically-driven British government has worsened the social determinants of health and repeatedly chosen courses of action that would increase the death toll.
Herd immunity strategy is still the basis of the government’s approach. The deliberate crafting of a situation in which thousands of preventable deaths are being allowed to occur has been massaged by a complicit media. Those responsible are protected by Crown Indemnity, immune from prosecution for the decisions taken while conducting their public roles.
This perverse injustice has to change. This is the pandemic public health experts have been warning us about. Preparedness and a timely, robust response are our only defences. In this, the government’s failure has been monumental.
The BBC and much of the mainstream media have failed to scrutinise and hold to account the actions of our leaders therefore we must strengthen and support alternative media voices. We can all be agents of change by explaining to others the reality of our current predicament, and becoming more engaged. We need to break the grip of the Big Tech companies who seek to replace real world services with virtual, unproven technologies with obvious potential for mass surveillance and control.
We need a grassroots movement to push back against neoliberalism, increasingly dependent upon authoritarianism to maintain the status quo. More immediate action should support key workers and the teachers, who are demanding clear and safe measures be taken before they return to work. As a matter of urgency, we must amplify the calls for mass testing, tracing and isolation, and support coronavirus-infected people to remain in isolation, thereby breaking the transmission of this virus.
[Dr Sarah Gangoli is a returning NHS doctor. Dr Bob Gill is a General Practitioner, NHS campaigner and producer of The Great NHS Heist, which is available to view for free during lockdown on Youtube. Follow them on Twitter at: @SarahGangoli and @drbobgill. This article was updated on May 25, to reflect the accurate death toll in the Indian state of Kerala.]