The Government’s original anti-Coronavirus campaign slogan was “Stay Home. Protect the NHS. Save Lives”. It opens up a way of assessing Boris Johnson’s choice as he seeks to balance closing down the disease with opening up the economy.
For as the slogan reminds us, the Government’s aim wasn’t to reduce the virus to the lowest possible level in order to save lives – if only because there is a trade-off between lives lost from it and those lost from cancelled operations for other conditions, or from illnesses for which an operation can’t now be booked in the first place, and so on.
And that’s quite apart from the damage to the economy, jobs and livelihoods that brings illness and, in some cases, death in its wake.
No, the core of Johnson’s aim was crudely political. It was to prevent horrified voters from seeing Italy-style live pictures of people choking to death in hospital corridors or emergency rooms. The uproar from a terrified public would have stampeded Conservative MPs into collapsing the Government, and him with it – for all its majority of 80.
So it came about that the NHS was saved. You may think that this was as much by luck as judgement. Or that the success in hospitals it must be offset by the failure in care homes. But it represents a win for Johnson and Matt Hancock amidst other losses.
The question that therefore follows is whether the NHS is in danger now from the relaxation of the lockdown that is currently taking place – and that is due to gather speed, particularly if the Government scraps the two metre rule, as Rishi Sunak and some other Ministers want.
On this site in April, Bernard Jenkin wrote that “if [the R number] is consistently above one, the disease will spread to the entire population”. Which would certainly overwhelm the NHS were there no plan in place to reduce it – whether a lockdown one or some other.
However, it stands to reason that the R number isn’t the same everywhere. So the national figure for it in Britain is of limited value. It doesn’t tell one who has the disease and where – in other words, what local rates are. This information is vital.
Consider the virus in care homes and hospitals. Last month, we reported that it was driving up R because their own R average was higher to start with, and they therefore represented a greater share of the overall R average. This may help to explain why the Government has recently been in retreat on R.
In his address to the nation on May 11 announcing his new plan for reducing the Coronavirus, the Prime Minister put great stress on bringing down R. He explained that the new Covid alert levels “will be determined primarily by R [our italic] and the number of coronavirus cases”.
However, the new Joint Biosecurity Centre, which was to monitor the Covid Alert System, has only recently been established. And within a week, Jenny Harries, was publicly distancing herself from Johnson’s stress on R. “The real outcome is the reduction in the number of cases, that is our focus, not the R,” she said on May 15.
Which is just as well for the Government, because R has been rising recently in the North West and to a lesser degree in the South West. Certainly, the moves to relax the lockdown have not marched in step with changes in the Coronavirus alert level. It has not moved from level four to level three. It is merely “transitioning” towards it.
Chris Whitty reportedly resisted a downgrade from four to three, and “the scientists” are certainly collectively cautious of lockdown relaxation. We mean it in the nicest possible way when we add: “they would be”. For after all, their aim as government advisers is to reduce the presence of the virus.
It follows that they have no stake in the wider economic – or even healthcare – considerations that Johnson and his Cabinet must mull. Downing Street will be watching them very closely, now that the pre-inquiry blame game has begun.
The Prime Minister will not want bolt-from-the-blue resignations from senior scientific advisers, whether undertaken from high reasons of principle or low reasons of blame-shifting. At any rate, Ministers have recently taken refuge in the claim that the five tests, not the R-rate, is their main determinant for relaxing lockdown.
Which takes us back to the NHS – since only the first and last of those five tests have real meaning, and they are both about protecting the service. (The fifth says: “we need to be confident that any adjustments to the current measures will not risk a second peak of infections that overwhelm the NHS”. The first is about its “ability to cope”.)
It is impossible to estimate how soon a rise in Coronavirus cases would swamp the service. To know that, one would have to know the speed of the increase, and where and among whom it was concentrated. What is certain is that since mid-April the Nightingales have been largely empty.
All in all, it’s clear that Johnson is no longer being “guided by the science” – in the sense of taking his cue from any clearly identifiable measure. He is operating intuitively: holding up his metaphorical finger to the wind; sniffing around the R and infection numbers; watching his back for revolting scientists, Tory MPs and Ministers.
Are we therefore doomed to wait for the Government to slam the lockdown brakes on again having lifted them off, in order to save the NHS from accelerating virus cases? Not necessarily. This is where the new test and trace system comes in.
If it works, local outbreaks will be countered not only by testing people and tracing their contacts, but by local shutdowns. We wanted the Government to experiment with lifting the original lockdown on an area basis. It is set to do the opposite – i.e: to impose new shutdowns on such a basis, as the nationwide one is gradually eased.
The best parallel we can think of is those Michael Gove reforms at education, mimicked later by Jeremy Hunt at health, of putting schools and hospitals in “special measures”. In went Ofsted or new leadership teams from other hospitals to turn everything round.
Local special measures, complemented by test and trace, instead of national lockdown, with crack teams going in from the centre to advise local authorities: that’s the plan. But it depends on tracing and testing working, in a less conformist culture than South Korea’s, and in which the state has less power.
And on those special measures biting, too. In the meantime, Johnson, with the threat to the NHS relatively distant as we write, should move to help the livelihoods on which lives depend, and which ultimately fund the health service in the first place. That means lifting the two metre rule, and classroom restrictions come the autumn.