If Britain were a person, they might strike you as a familiar type. They’re the type that slumps on the sofa, letting problems pile up. There’s that rising damp they should get to grips with, there’s that long-term nagging cough. Their marriage has been falling apart for months, they should really look into counselling. They don’t, though. They sit there procrastinating.
But should a sudden crisis arise – a main burst and flood the street, or a neighbour collapse with a heart attack – a change comes over them: a spark to the eye and a flush to the cheek. They become decisive, selfless, competent. They are stoic in the face of danger, generous to others, skilled at giving directions and at following orders. They are good in a crisis.
Britain is good in a crisis, and bad in a slump. Our national life is littered with evidence. Liz Truss’s mini-budget, for example, was a crisis. The effect was immediate – the pound fell to its lowest ever level against the dollar, government bond yields soared. What happened next? Universal outcry and decisive political action. The budget was summarily reversed, and Truss was out of office within the life span of a supermarket vegetable. Briefly, we had a very functioning body politic.
In hindsight, this sequence of events might seem inevitable given the scale of the problem Truss and her chancellor caused. It wasn’t. Larger economic errors go unaddressed. The difference is not scale but speed. Brexit caused greater damage, but Brexit is not a crisis, it is a slump. The effects have crept up on us and set in; little by little, we have grown used to being poorer. Truss pushed us into a cold bath; we got out, if a little worse for wear. But Brexit tempted us to swim out to sea on a sunny spring day. We are now drifting, a little too far from land, no longer feeling the cold. We dimly realise how much trouble we are in, but can’t seem to motivate ourselves to swim to safety.
Or take our attitude to asylum seekers. When crisis strikes overseas – when war broke out in Ukraine, when Kabul was evacuated, when Syrians fled persecution in 2015 – Brits are promptly transformed into generous hosts. Where there is drama, Brits are quick to assume the hero’s mantle. We throw open our homes, and demand that these dispossessed people be granted immediate exceptions to all the anti-asylum laws we usually vote for. Once the crisis tips over an invisible time threshold, though, attitudes revert to normal, even as wars drag on and refugees still clamour for help. The sense of emergency passes. The government reviews its expensive measures, and quietly winds them down. Voters tend not to object.
So it is with the NHS. Covid dropped it into a crisis. Donations soared. Armies of ordinary people offered to help out. The government made many needless mistakes, but it did leap into action. It gave hospital trusts extra funding, and booked out care-home space to relieve pressure on hospital beds. It arranged a system of emergency volunteers to monitor those discharged from hospital. It oversaw a large and effective public health campaign.
Covid has waned but the NHS is still in dire trouble. Yet we have grown used to it. The NHS has been in trouble for as long as most of us can remember. New targets missed, new records of underachievement hit; these, too, are familiar alarm bells. The emergency siren is now background noise. The NHS crisis is now a chronic one. It has stretched into a slump.
Last week, for example, came the news that, although waiting times have fallen, the number of people in England waiting more than 18 months for a referral has grown by 10,000 since December. Cancer waiting times remain a disaster. Since 2020 more than 200,000 have not received lifesaving surgery, chemotherapy or radiotherapy within the NHS’s supposed maximum 62-day wait.
At the start of the year, meanwhile, a Telegraph analysis found that in 2023 almost 53,000 more people died than normal – the highest figure recorded, excluding pandemic years, since the Second World War.
Amid all this is a row over a group of workers brought in to pad the gaps between doctors: physician associates (PAs), or doctor’s assistants, who have not been to medical school. This started as a good idea; there is plenty of work in hospitals that does not require highly trained doctors and nurses. But perhaps it was inevitable that in a stretched NHS physician associates would start operating beyond their brief.
There are reports, now, of these associates illegally prescribing medicine and requesting test results for which they are not authorised. In 2022, a 30-year-old woman died after a PA mistook a pulmonary embolism as anxiety. Her mother said she had not been informed that the person diagnosing her was not qualified to do so. Last week, the Royal College of Physicians called an extraordinary general meeting to discuss the fact that the government wants to expand the roles and use of PAs; according to some reports, it descended into anger and farce.
The NHS is in crisis but it is not being treated that way. In fact, as the Observer revealed last month, plans to double the number of doctors being trained in England by 2031 have been dramatically stalled. What threshold has to be crossed, by what measure does the NHS have to fail, before it qualifies as an emergency? Brits are good in a crisis. When is the government going to declare one?
• Martha Gill is an Observer columnist
• This article was amended on 17 March 2024. An earlier version said that it was the British Medical Association that called an extraordinary general meeting to discuss the fact that the government wants to expand the roles and use of PAs; it was in fact the Royal College of Physicians.
