In the BBC drama This Is Going to Hurt, based on Adam Kay’s memoirs, we see an NHS that is barely holding it together. Doctors and nurses are stretched just above breaking point, so eventually some break. The wiring for emergency alarms in the labour ward is just about functioning, so at some point it fails. There’s only one psychiatrist, so a patient goes home who really shouldn’t.
Quite apart from being extremely dangerous, these crises are expensive, too. Staff gaps are plugged by costly locum (or freelance) doctors. Mistakes made by exhausted staff can result in patients suing the hospital. Patching up the ward’s infrastructure after it breaks costs more than sorting it out in time. In short, giving the NHS just enough to keep it running above the waterline is a false economy – and only keeps it lurching from crisis to crisis.
Yet that is how we run the NHS, and — as our present “cost of living” crisis is making depressingly clear — that is how we run the rest of Britain too.
Like the NHS, the country’s welfare system is operating with absolutely no slack — we are keeping a large number of people on incomes so low they can barely survive from day to day. One of the many problems with this is that whenever there is a shock to the system — a pandemic, a rise in energy bills, inflation — people simply cannot pay their bills and you get a crisis.
In the pandemic, for example, as the author and economic advisor James Plunkett has pointed out, it became obvious there were huge gaps in protections such as sick pay: the self-employed, low paid, and those on zero-hour contracts mostly fell through the net. When it came to benefits, the gap between applying and getting help was too long (people were coping by getting into debt or cutting back on essentials) and payments were simply too low.
The resulting cost of patching those gaps when crisis struck — with measures such as the Job Retention Scheme — was vast. Emergency welfare schemes tend to be more costly than simply making the welfare system adequate in the first place — as in the panic to get money to those who really need it, money often ends up also going to those who don’t.
Now, hard on its heels, another crisis has struck, requiring more ad-hoc scrambling to avoid a section of society falling into abject poverty. No emergency measure is perfect, and the Government’s response here certainly meets that description. The scheme to cope with energy price rises includes a council tax rebate based on property values from 1991 — which could end up benefiting thousands of wealthy households who do not need the help. There is also a loan to everyone, to be paid back over five years.
Yet there are no guarantees energy prices will return to normal, so even more support may be needed. And if people are struggling to get through the week, in a constant state of emergency, they are not going to be able to make long-term decisions that could benefit them and the rest of us.
Londoners, meanwhile, are in the epicentre of two additional crises. This week we received news of the largest annual rise in bus and Tube fares in a decade — a result, as an Evening Standard editorial comment put it, of Transport for London “living hand to mouth”. As the Standard has long argued, rather than being allowed to lurch from meltdown to meltdown, TfL needs a proper settlement. Patching it up, or even managing its decline, is expensive.
The second problem is the cost of renting, which has also spiralled into a “crisis” in London. That of course is the result of a long-term failure to invest in housing and the result will be that young workers can no longer afford to live in the capital, where the best job opportunities tend to be. Another false economy.
Running a crisis economy then — like a crisis NHS — has great human costs, and often makes the root causes worse. There’s another problem too, which is that crises tend to obscure those root causes. In a piece for the New Statesman this week, narrative strategist Nora Mead tells Anoosh Chakelian that crisis language stops people thinking about what is driving the situation. That “plays well for the Government” as a crisis “seems like a situation out of their hands, which couldn’t have been predicted”. But it could have been predicted, indeed we are already predicting the next crises that will come from running the country at breaking point. This week headlines were full of one troubling statistic: birthrates are falling, partly because many young people simply cannot afford to have children. There’s a false economy if there ever was one.
Do you agree that the Government is lurching from crisis to crisis? Let us know in the comments below.
