The pandemic has exploded the narrow bounds of political possibility. Once the immediate crisis has been surmounted, the Government will have the opportunity, indeed the obligation, to ensure that next time we are better prepared.
Boris Johnson said in his message on Easter Sunday that “the NHS saved my life, no question”, and after thanking the “two nurses who stood by my bedside for 48 hours when things could have gone either way”, went on to declare:
“We will win because the NHS is the beating heart of this country. It is the best of this country. It is unconquerable. It is powered by love.”
A few of his most carping opponents may question this declaration, but the public readily accepts its sincerity. His near-death experience, and the way he spoke about it, have demonstrated to most people’s satisfaction that the Prime Minister can be trusted to protect the NHS.
At the same time, the public has learned to its horror that many NHS and care-home staff have had to work without the protective equipment needed to arrest the spread of infection.
Other essential equipment, including ventilators, was in short supply, making good these shortages took longer than it should have done, and various countries, including Germany as noted earlier this week on ConHome, were far quicker to introduce widespread testing for the disease.
So Johnson can say, with perfect truth, that in order to protect the NHS, we have got to make changes. He can mobilise public opinion in a way that none of his predecessors was able to do.
There are two directions in which British policy could go. One is towards greater central command and control.
This would be catastrophic: it would repeat the original error of the 1940s, when it was supposed, as a Labour minister, Douglas Jay, put it, that “the gentleman from Whitehall really does know better what is good for people than the people know themselves”.
The German lesson is that local initiative, and competition between different providers, are indispensable.
Many of those providers are private, and are therefore able to respond to crises with a rapidity and flexibility which are seldom found in the public sector.
The result is not a Wild West, devil-take-the-hindmost capitalism – the caricature of American conditions with which opponents of private suppliers within the NHS seek to terrify us.
Competition between hospitals, and between laboratories, is regulated, each of the 16 federal states retains a considerable measure of autonomy, and an elaborate system of public and private health insurance supplies the necessary funds.
It would be absurd to seek, in detail, to replicate a German system which can be traced back to 1883, and which accords with German traditions.
But our own system proceeds from a planning error of the 1940s – the introduction of an excessive level of central control – which we have never managed to correct, and which is not in accordance with our own best traditions, which have always entailed a high measure of local control.
This tradition of local initiative is not extinct: without it, the hospice movement would not have started. If we had waited for the NHS to provide the care needed by the mortally ill, we would be waiting to this day.
The Conservatives acquired, when they opposed Labour’s proposals for taking central control of hospitals, an unmerited but enduring reputation for opposing the whole idea of a National Health Service.
Johnson is the leader who could show, on the contrary, that the NHS is only safe in Conservative hands. He could become – I realise this will sound like reckless talk – its second founder.
Conservatives are rightly suspicious of grand measures of reform, but here is a moment which deserves to be seized.
For many years before the pandemic, a crisis has been building up over social care. Who is to pay for us when we are too old and infirm to pay for ourselves?
There is much to be said for doing that from a system of compulsory insurance, so that whether or not we need cover ourselves, we help pay for those who do.
That kind of solidarity, and equity, underlay the Beveridge Report of 1942 (composed by William Beveridge, illustrated at the top of this piece), whose insurance provisions could be traced back to what David Lloyd George had done in 1911, who in turn had built on what Bismarck started in Germany in the 1880s.
National Insurance, a great German invention which still exists in vestigial form as an extra tax in Great Britain, is perhaps an idea whose time at Westminster has at last come.
And Johnson is perhaps the first Prime Minister since the 1940s with the boldness and imagination to see this.