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Comment Matthew Paul

Cross of irony

“Bread, not the George Cross”. That –scrawled on shattered walls in its capital, Valetta– was the pasquinade of some semi-starved Maltese in response to the island’s receipt, in 1942, of Britain’s highest award for non-military bravery.

Blockaded by the German and Italian fleets and relentlessly bombed, the Maltese suffered appalling privations in WW2. People were reduced to eating rats among the ruins of their homes. The island’s exceptional fortitude in the face of this onslaught merited the medal. 

After Malta, there was only one other collective award of the George Cross; to the Royal Ulster Constabulary on its disbandment in 2000. The award recognised the 302 officers who were killed by the IRA or other terror groups; doing their jobs under the constant shadow of a gunman. The Queen handed the award to PC George Slain. Slain lost his legs in a 1992 attack in Newry, when the IRA fired a mortar bomb at his patrol car. His recently married colleague, Colleen McMurray, was murdered in the attack.

Twenty-one years later, Her Majesty pinned the same cross on the scrubs of the National Health Service, in honour of seventy-three years of public service, and in particular its service to the country through the Covid-19 pandemic.

The Maltese suffered through siege and near-starvation. The RUC enforced the law at daily threat to their lives and the lives of their families. The NHS was awarded the George Cross, it seems, for partial success over the last sixteen months in doing its job of making sick people better.

It is true that NHS workers were put in harm’s way, particularly in the early stages of the pandemic. Procurement of PPE for healthcare workers was a shambles. Infection control in UK hospitals was inadequate. But it was ironic to award the George Cross to an organisation whose workers were placed at risk largely by its own failings, and who didn’t in any event experience a notably higher death rate from Covid-19 than the population at large.

Opening your front door in the morning in the knowledge that you might catch a disease which kills 0.25% of those it infects isn’t quite the same as opening it to go out and scrabble for rats to eat while German bombs fall on your children, or opening it in the fear that an IRA killer is standing there waiting for you. NHS workers are people doing their jobs, not heroes or angels. 

With the established Church a woke irrelevance, Britain has only one thing that comes close to a national religion, and that is the health service. It is after all a point of faith, not reason, that top-down state control is the best way to organise healthcare. It rarely occurs to the faithful that what they believe might not be right.

The NHS has some great virtues. It is cheap. Healthcare spending per capita in Britain is substantially lower than in France or Germany, and less than half of what Americans spend on medical bills. The cost has to be low, because the Government gouges it out of everyone’s taxes, and electoral history has been consistent in demonstrating that there is only so much gouging that voters will put up with.

It’s also obviously better to have a system where everyone gets treated, regardless of means, than a system where the poor go without. No-one wants to be in a situation where the first checks performed on admission to hospital are on your insurance status and credit rating. But if you don’t ration access to healthcare by ability to pay, and don’t have infinitely elastic funding, you have to ration access by waiting list. Post-Covid, those waiting lists are months or years long.

Making people wait months or years for treatment might be ‘fair’, in a Buggins’ turn sense of fairness, but it isn’t fair to people who have paid their taxes in the expectation that they will be treated when they need treatment, and it isn’t efficient to keep people who should be getting treatment immobile, unhealthy and dependent on medication instead. 

Modest suggestions that the UK might have lessons to learn from other countries, or that the involvement of the private sector might not be entirely evil, are howled down by the unions, whose interest it is in to keep the system complex, bureaucratic and over-managed. In Wales, 78000 people work for the NHS. That’s one in ten of the economically active workforce. Nearly the same size as the British Army. Almost certainly, more staff than are needed to deliver healthcare promptly and efficiently to three million citizens.

The NHS is not a perfect system. There is much that could be done better. Germany’s mix of public and private provision ensures that no-one goes untreated or receives substandard treatment because of inability to pay, and treats its customers promptly in clean, modern surroundings with effective infection control. Germans pay more for a system that works better. In England and Wales, we make do with ideology and penny-pinching. 

The NHS probably can stagger on from crisis to crisis indefinitely, and will unless we reform it to create a system that is better funded and more efficiently managed. Carrying on as we have since 1945, while mythologising the system and treating healthcare workers as heroes or angels won’t achieve this. Handing the NHS our highest decoration for peacetime valour, for nakedly political purposes, debases the medal.