The pandemic has broken the promise of universal healthcare

This week we have been warned again and again that “the NHS is on a knife edge”, that “the next week or so will decide whether the NHS can cope”.

But the mental model we are applying to the question of whether the health and care system “collapses” is the wrong one. When Woolworth collapses, it is open one day, and then a lock across the door stops the shop from opening the next. When a worn-out engine finally breaks, the car stops.

But the NHS and social care are not a shop or a machine. They are people. Hundreds of thousands of people working harder than ever before, to the point of exhaustion and beyond - upset, traumatised, committed.

Watching them stagger on makes your heart ache. But these people won’t stop. And we all owe them a massive debt of gratitude for that. But that means the “collapse” of the NHS won’t look like the collapse of a retail chain which the banks have pulled the plug on.

The NHS is a promise, a contract between the people of this country and its government, that health services will be there to look after you, should you fall ill or experience ongoing ill health. This is the promise of free and universal healthcare.

Because of its incredible workforce, of the steely determination of everyone working in patient care to not give up, the NHS will never close. What does happen, however, is that good quality health and care is withdrawn from millions of people who need it.

At National Voices we have heard from people who had an email from their GP practice saying “all routine appointments are now cancelled, do not call us for the next two weeks”.

Because of its incredible workforce, of the steely determination of everyone working in patient care to not give up, the NHS will never close

We have heard from our members, 170 charities working across a wide range of conditions and communities, that in some places all planned surgery has now been cancelled. We have heard that people with medical emergencies such as heart attacks cannot access intensive care as they normally would and are on general wards.

We have heard that cancer surgery has been cancelled, even where it is urgent and could save someone’s life. We have heard about people not being able to access rehabilitation services after a stroke. This is what it looks like when a health system is not coping.

It is hard to hear these things, and it is hard to say them. We don’t want to deter people from coming forward if they have a health need.

And we want to acknowledge some people are still getting very good care: we have heard about kind and efficient care after a miscarriage; we have heard from cancer patients who have started their chemo in the most challenging circumstances in timely ways and who can’t say enough how kind everyone has been.

It is hard to talk about the failure of our health and care system to meet even basic needs, because we aren’t criticising the workforce, making so many sacrifices and working harder than ever. Saying that the NHS is no longer a service providing universal care feels like kicking those people while they are down.

The NHS is not coping; it is not meeting some very pressing needs of people living with ill health or disability now

But are we doing a favour to exhausted doctors and nurses, to care assistants, physios, to cleaners and porters, if we ask the question whether the NHS will cope? It is not coping; it is not meeting some very pressing needs of people living with ill health or disability now.

The promise to provide universal healthcare to the people of this country has been broken and will be very hard to reinstate, unless we start from a point of truthfulness.

All health systems worldwide struggle with this pandemic, of course, but the UK went into this pandemic with a smaller health and care workforce, with hollowed out and underfunded social care, with more outdated estates, and with far less “slack” in the system than other health systems in comparable countries. This is a well-established fact.

So, at National Voices, we express our solidarity with the health and care system, with its precious and often underpaid workforce, not by maintaining that the system is still “just about coping”, but by acknowledging that in order to maintain and rebuild the promise of a universal health and care system, one that is resilient to future disasters, we need to start arguing now for massive investment in all parts of the system.

First and foremost, a fully funded workforce plan straddling health and social care, a plan to modernise estates and infrastructure, a plan for investment in all care settings – primary, community, care home and hospital.

But before we can collectively turn our attention to how we will prevent the current situation from ever happening again, we need to commit now to a frank assessment of what is possible in the current circumstances, and to honest and detailed communication with communities about what services can be accessed and how.

National Voices, and our brilliant, hard-working member charities with their deep understanding of the communities they serve, stand ready to help.