One hundred thousand Britons are dead, and we have the worst Covid death rate in the world. Why?
There’s plenty of evidence of catastrophic errors in the short-term: offloading 25,000 untested elderly patients into the care home system, the PPE shortage and keeping the airports open would be top of my list.
But the long-term factors look equally deadly, and equally avoidable. This is a story of spending cuts - to health, councils, elderly care and social housing provision. Cuts that, over the decades, have destroyed our ability to take on health risks collectively, leaving millions of us on our own.
The deadly impact of Covid-19 in Britain can be traced to decades of decay in public services and massive health inequalities as a result.
Cuts to the NHS during the past ten years are a central part of the story. In 2010 there were 144,000 beds in the NHS, of which 22,000 were available.
On the eve of the pandemic there were 122,000 beds and 13,000 available. The spare capacity of our hospital system had been crushed to breaking point.
Whenever you see a graph showing the curve of infections surging past the capacity of the NHS, remember that capacity was shrunk on purpose. Hospitals entered the pandemic with 40,000 nurses short, again with cuts at the heart of the story.
In the two years after the government decided to stop paying nurse tuition fees, in 2015, applications to the nursing and midwifery courses fell by 31%
But the bigger cut was to public health provision. Between 2015 and 2020 spending per head on public health was slashed by a nearly quarter.
That is money spent by local councils on stop smoking campaigns, anti-obesity drives and work with people addicted to drugs and alcohol. Though the total amount is small - £3.2 billion last year - the signal it sends is large: that fighting ill health among the poorest and most vulnerable communities is not a government priority.
The price we’re paying was obvious long before the pandemic hit. Among women in the poorest 10% of Britain’s boroughs, life expectancy actually fell between 2011 and 2018.
According to the country’s leading public health expert, Professor Michael Marmot, the poorer your local area is, the worse the health of the population is likely to be.
The results during the pandemic have been devastating. In study after study researchers found pre-existing heart disease, lung disease, obesity and asthma were associated with death and severe illness from Covid-19.
If we have the worst death rate in the world it is, in part, because we have one of the least effective public health systems and some of the highest inequality.
Local councils, meanwhile, have seen their spending power slashed from £60bn to £50bn in ten years.
Elderly care cuts, which slashed 8% off budgets in the first half of the 2010s, left councils facing a widening gap between demand for care and the supply of it. So when the virus hit the care home sector it was already reeling from a decade of underfunding.
But it is not just cuts, poverty and poor health that have worsened the impact of the pandemic. It is the structure of our jobs market. I’ve heard builders, minicab drivers and fulfilment workers say they’re so terrified of getting a positive test they won’t take one, even when they’re showing symptoms.
And thanks to decades of underfunding of social housebuilding, many of the same workers have to spend their time off in overcrowded housing, and make long commutes at busy times, increasing the danger of transmission.
After World War Two the Liberal thinker William Beveridge called for a war on so-called five “giant evils” - poverty, disease, ignorance, squalor and unemployment. Today the diseases are different: it’s heart, lung and blood diseases resulting from poverty that are amplifying the killing power of Covid. And instead of unemployment it is the gig-economy culture of zero hours and instant dismissal that is putting lives at risk.
But these things are still what Beveridge called them: evils. Politicians need to find both the money and the willpower to fight them.
