Unprepared for a catastrophe

by Phil Banfield

The questions the heads of the austerity Government must answer at the COVID inquiry 

Location: UK
Published: Monday 19 June 2023
Phil Banfield

This week, three leading names of the last 15 years of British politics will take the stand at the COVID inquiry. 

David Cameron, George Osborne and Jeremy Hunt will be quizzed on the decade leading up to COVID’s arrival, and their actions as those leading the Government, its spending and the country’s health services. 

As chair of council at the BMA and a consultant obstetrician of more than 30 years I have seen first-hand the damage wrought by years of austerity and a failure to prioritise the nation’s health. The UK was severely on the back foot when COVID took hold, and this proved disastrous – for the doctors I represent and the millions who suffered at the hands of the virus. 

It is therefore critical that Cameron, Osborne and Hunt are taken to task over the decisions they made that left us so unprepared, and to ensure the same mistakes are not repeated when we face our next health emergency. 

The NHS was operating without enough staff, not enough beds and in outdated buildings even before the pandemic. Between 2010/11 and 2019/20 the average daily total of available beds contracted by 8.3%, that’s nearly 13,000 beds, and the UK had less than half the number of critical care beds relative to its population than the average in OECD EU nations.

From 2009/10 growth in health spending stopped keeping up with historical averages. By 2019/20, after a series of austerity-led Budgets, health spending was around £50bn below what it should have been had it matched previous government commitments; this far surpassed the much-vaunted cash injection of £20bn between 2019-2024 as part of the NHS Long Term plan. This was too late and certainly far too little for what was to come. 

Since the Health and Social Care Act 2012, no single entity has been responsible for workforce planning. As a consequence, staffing over the past decade has been poor and disjointed, lacking in the staffing projections needed to ensure we have enough health workers to meet demand.

This has created what Jeremy Hunt has called 'the biggest workforce crisis in history'. In 2016, as health secretary, he announced a minor increase in medical school places – but without a long-term workforce strategy to back it up. The year before he had promised 5,000 more GPs in England. But at most recent count, we in fact have 2,000 less and a recent draft of the NHS workforce plan revealed the NHS was operating with 154,000 fewer full-time staff than it needs.

We still await the long-promised NHS Long Term Workforce Plan, that we understand is being held back over reluctance from the Treasury – now headed by Mr Hunt – to fund it properly. 

This failure to ensure the NHS was properly staffed and resourced in the decade leading up to the pandemic, meant that when it did arrive, there was no capacity to meet the tsunami of demand. 

As one consultant told the BMA’s own COVID-19 Review: 'Get vacancies filled and stop lying about the numbers … what I needed most during the pandemic were the colleagues I was already missing.'

Sickness absence from COVID shrunk an already depleted workforce and the need to separate groups of patients limited capacity further. This meant drastic measures like pausing nearly all routine care in hospitals, redeploying staff and registering medical students early. There’s no doubt that both staff and patients were put in harm’s way because of this historic understaffing and under-resourcing. 

Key decisions from the Coalition years were pivotal in leading to public health services also being ill-equipped to handle the arrival of COVID. As part of the 2012 reforms, public health was separated from the NHS and put into local authorities – and between 2015 and 2020, the Local Authority public health grant fell by around a quarter in real-terms. Between 2016 and 2019, Public Health England’s budget was cut 12%. 

The public health workforce was also not keeping up with demand; by 2021, England needed almost 60% more public health specialists to reach levels recommended by the Faculty of Public Health.

Wholesale restructures – including the abolition of the Health Protection Agency in 2013, replacing it with Public Health England under DHSC (Department of Health and Social Care) control – meant the voice and influence of public health specialists was increasingly stifled, and the value placed in their expertise diminished.

This all impacted the public health response, with capacity quickly overwhelmed, making things like local contact tracing nigh-on impossible. 

The Inquiry must ask why previous Governments ground down and pulled apart public health systems until they were threadbare, and gain assurance from current leaders of how they intend to reverse this disastrous trend. 

'No healthcare system could have come through a pandemic unscathed,' is the defence often parroted by those who were calling the shots. But the question to Cameron, Osborne and Hunt must be: how did you allow the NHS and public health to get to such a parlous state, and fail to prepare so appallingly, that many didn’t stand a fighting chance when the wave crashed over them?

Phil Banfield is BMA council chair