UK’s Government-Run Health Care Struggles to Combat Coronavirus

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Tim Evans, a professor of business and political economy at Middlesex University London, joins The Daily Signal Podcast today to talk about the impact of the coronavirus in England. Evans addresses how nationalized health care has affected the response and the great economic challenges and opportunities that are now reality amid the COVID-19 pandemic.

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Rachel del Guidice: I’m joined today on The Daily Signal Podcast by professor Tim Evans, professor of business and political economy at Middlesex University of London. Professor Evans, it’s great to have you on The Daily Signal Podcast.

To start off, professor Evans, can you tell us about yourself and your work at the university and if it’s been impacted in any way by coronavirus?

Tim Evans: So I’m professor of business and political economy at Middlesex University, which is a major campus in North London. We have campuses in other parts of the world as well, including Mauritius, Malta, Dubai. We’re the only university in the United Kingdom to have won the Queen’s Award for International Enterprise twice this century.

Our campus in London is, well, shut down because of coronavirus. We’re one of the world’s top 15 most diverse universities, so we have huge numbers of people from the Far East, from the Middle East, from Africa, as well as Europe, the United Kingdom, and North and South America.

We haven’t had a huge number of cases on campus, far from it. We took prudent steps in following the government’s guidelines and closing down three or four weeks ago.

We’re lucky we live in an age of technology where people can carry on a huge amount of their work and the students can carry on studying online.

I hate to think what would have happened if we’d had this pandemic, let’s say, before the age of the internet, maybe 1990, because so many of us wouldn’t [have] been able to carry on working.

But that’s the situation and an awful lot of the U.K. is closed down. People are working from home. The shops, pubs, restaurants are closed and the virus is taking its toll. Not just on human life, but also clearly on our economy.

Del Guidice: You mentioned how restaurants are closed, people are working from home. What is it like right now on the streets in your community? I can imagine it’s very quiet, but can you kind of set the scene for us and what you’ve seen in the past weeks?

Evans: Yep. So I’m someone who was born and raised in central London. If I was to get in a motor vehicle and drive, in about 12 to 15 minutes from now, I’d be absolutely in the center of town—we have Piccadilly Circus in what we call the West End, which would be the equivalent of Times Square or Broadway in New York. So I’m pretty central, really.

The streets, I would say, are much quieter. Generally there’s about 10% or 15% of the traffic that there would be normally.

Children are off from school, they would be this time of year anyway because of Easter holidays. Many of them, of course, have not gone abroad or to other parts of the world. Many are cooped up in their homes.

A huge number of people are working from home. Again, thanks to the internet. Local restaurants, pubs, most shops are closed. There are supermarkets and food stores open. They tend to have queues, they have lines of peoples that are spaced out in what we call physical social distancing.

So things are quiet, but things are working to the absolute necessities. Our pharmacy stores, our chemist shops are working and our food stores are working. And there have been no great shortages.

Of course, where there has been a complete mobilization, where there’s frenetic effort, is with clinical staff, doctors, with nurses both across our hospital sector, our nursing homes, or residential care home sector. There, this is in fact the largest mobilization we’ve had in effect since May 1940, at the early stages of the Second World War.

Del Guidice: So Britain has a government-run health care system. And you’ve previously written about that in a report for The Heritage Foundation. Could you explain quickly to our listeners how the United Kingdom’s health care system works?

Evans: Yeah. As I pointed out in the Heritage paper last year, in 1948, the British government promised that the state health care system, which they called the National Health System, or the NHS, would provide all medical, dental … And they put a leaf in it, they said to every home in the country, everyone, rich or poor, will be able to use it.

Of course, to create that service in 1948, the government came to public ownership at around 3,118 previously independently- or local government-owned hospitals, homes, and clinics.

So it was a huge nationalization and the reality is that the promise of 1948, if you look at the leaf that was sent to every home back then, the promise that was written black-and-white on it has never really been fulfilled.

The NHS never quite managed to do all dentistry. Private dentistry has always remained in the United Kingdom.

In terms of nursing care, well, it’s certainly true that a lot of nursing case provided in NHS hospitals [was] by the taxpayer. But for longer-term care, particularly for elderly people, people who would be what we call social care, that had an awful lot of nursing provision, wasn’t solely provided by the NHS. It was provided either by local government or people who chose to pay for themselves.

Really, the big picture of British health care is that since the 1970s right through the ’80s, ’90s, and beyond, however much money has been pouring into the NHS—and politicians of all stripes and parties have invested very heavily in it—lots more money has gone into it. It has never quite been able to keep up with public expectations or the increasing demands.

So today we have probably 700 or 800 NHS hospitals in Britain. And by math, they do a good job but they’re complimented and to an extent relieved by more than 200 independent or private hospitals. Some of them are for profit, some of them are not for profit.

Also, in this crisis, a third and important fact, I have to say, is the military medical sector.

What’s really happened is that since the beginning and middle of March, the government has being organizing the full integration of the whole of the U.K.’s health care resource right across the NHS and independent sector and the military sector to deal with coronavirus, whilst also at the same time dealing with trauma cases and, of course, we might need ongoing care for things like cancer.

An awful lot of elective acute surgery, things like hip replacements or knee replacements, things like that, have simply been paused and put on hold. That mounting backlog will have to be dealt with later.

But the reality is that probably today, nearly half of U.K. dentistry probably has a major private element to it.

About 1 in 4 people who need long-term care, they invariably go private. Not just in terms of provision but also in terms of funding. Today we have about 16,000 or 17,000 private nursing residential care homes in Britain.

And in this coronavirus, the NHS is backed up by its additional 200 independent hospitals, which are providing thousands of beds and hundreds of intensive care and high dependency beds, ventilators, and all those things.

So that’s the extraordinary mobilization, but it’s a mobilization in economic terms. It goes beyond the NHS and is really mobilizing the fully mixed economy in health care, which in 2020, is the base reality for the United Kingdom. We don’t have that fully fledged nationalization that we knew in the 1950s and ’60s. We have a more mixed economy approach today.

Del Guidice: So right now countries across the world are grappling with coronavirus, and I’m curious if you’ve noticed any significant differences in countries between nations with predominantly private health care and those with government-run health care?

Evans: Well, the first thing is that it’s too early. We don’t have all the data in from around the world.

For example, at the Blavatnik School at Oxford University in the United Kingdom, they have a huge project where they are looking at the interventions and the reactions of pretty much every government around the world to this coronavirus.

And they’re plotting each intervention where the shops are closed or pubs and what different people are doing in different parts of the world.

I’m in the advisory board of that. And about 10 days ago, we gathered 140,000 data points from well over a hundred countries. So it’s going to be really interesting when we get the final toll from coronavirus to understand what happened and, if you will, to do ex post facto rationalizations.

Again, it’s far too early for us to know what the impact of the virus is going to be on overall death rates.

There is, of course, very sadly, a group of people who are vulnerable, some of them old, and had all manner of medical problems. We already can note, though, the real impact, the actual correlation of the causal chain, if you will, between coronavirus and death rates, where we can map those.

The other thing I would say is, we’re also going to have to calculate the knock on effects of the interventions to deal with coronavirus. Let me give you one example.

In the downturn of 2009, that dreadful financial crisis, what the human cost of that downturn was, we now know that an additional 10,000 people in various countries seem to have committed suicide. That’s the number that was just out of kilter of what you normally got in normal years then. So there was a causal link there, we believe.

It’s going to be very interesting when we look at not only government’s interventions, but that data at the end. And then … we can be able to look totally at how different systems perform.

I have to say, Britain is very lucky in that we have not just our state health care sector, but we have a vast plethora of private hospitals, of nursing homes, of charities. We have a very broad and very deep civil society which is responding to compliment that which has been mobilized by the state.

I contrast that, for example, with Canada, where for a long time independent health care has been illegal. You’re not able to have a private hospital in Canada, it’s why so many Canadians go for their private care and treatment down of the U.S. border—something you’ll be familiar with.

The problem is that when you have a coronavirus, when you have a pandemic like this, it is that moment where a society—however your health care arrangements are configured—it’s that moment where health care, by definition, meets the full coercive power of the state. It’s where the health care conjoins with the military.

And if in that moment you have a very broad and deep, often, … state health care sector and some military resource, you have lots of institutions in civil society, and you have, for example, hundreds of independent hospitals that can join the effort. That gives you breadth, depth, [and] flexibility.

I do wonder, it will be very interesting when we do, maybe next year, get to look back, look at the data, of how countries like Canada that don’t have the additional independent or private resources have been able to react.

There are other countries in Europe, like Germany, that has much more localized, much more flexible, and adaptive systems. There are people in our newspapers who are suggesting that localization of German health care, the flexibility, are a much greater mixture of public and private provision, [which] has added to them returning early on seemingly better data.

But I will just say this is very early. We don’t know whether what we’re doing at the moment is the first wave or, indeed, if we could to be facing a second wave coming along in the future.

The strategy in Britain has been to mobilize all our resource as quickly as possible, bolster intensive care, and then try and flatten the peak, and spread it over time to make sure that our health system, all that resource, can do it’s best with this pandemic.

My hunch is that when we do come to ending the lockdown, it will be incremental. We will probably have to wait for a vaccine before we return to complete normality, and we stop shielding the medically vulnerable, and the elderly, and frail.

There will be an incremental return, but so far, I have to say, the conjuncture of the military, the NHS, and the private all mixing together seems to have stood us in good state.

Del Guidice: Well, British Prime Minister Boris Johnson was one of the most prominent people to come down with the coronavirus, and although he was admitted to the ICU at one point, he is now doing better. I’m curious, what was the attitude in Britain during his health crisis?

Evans: The attitude, I think, was a very human response, and it was a human response that transcended political allegiance and political stripe.

Most people thought this is a prime minister in his mid-50s, he’s quite a bouncy and energetic character, he has a young partner, they have a baby on the way, and I think all the people’s hearts went out to them, and I sense a lot of people, right across the political divide, wanted him, of course, to return to health.

There was, I think, a scary 24 or 48 hours, where he was in intensive care, and I think we could all see on the faces of Cabinet ministers … their nervousness. So, there was no surprise when an hour or two later we were indeed told just how serious things became to the prime minister, for a brief window. …

I think, generally, the government in Britain has done fairly well. The labor opposition has been particularly weak. It hasn’t been well led in recent years, and they have a new leader in Keir Starmer, who’s just getting his feet under the table.

The consequence of this is, actually, the Conservatives are riding quite high in the opinion polls. But I have a hunch that, generally, in a time of pandemic—where people become so reliant on government, and the judgments of senior governmental scientists, and senior medical advisers—my impression is that governments around the world, and leaderships, tend to be doing quite well in terms of polling and electoral support.

There is a sense of unity behind whoever is on duty. I certainly think, from the European point of view, that the European Union has not covered itself in glory during this episode.

Lots of barriers have gone up within Europe, between nation states, and there’s been very much a return to the politics of the nation state.

Of course, there are a lot of banking sectors fixing [themselves] in Europe that all have stress on, quickly thinking, the Italian sector, how that plays out when this crisis comes to an end, or what the implications of that are for European projects. I don’t know.

I think the biggest concern, particularly in the United States, will be potentially China. I think lots of companies, lots of organizations, will want to diversify their supply chains in the future, and not, perhaps, always be so reliant on China. So they’ll look to other competitive economies around the world to bolster and diversify their supply chains.

But I think this will play into the hands, politically, of people who have long been wary, dare I say, of China, and who are worried about their governance and that seeming inability to tell the truth.

There was a very interesting article recently in National Review Online, which detailed day-by-day the early goings on of the Chinese government, when, clearly, local doctors were warning the party and the leadership that there was a problem in Wuhan.

These people were vilified, according to police stations. They were ordered to sign pieces of paper that basically tried to shut them up. And the horror of a totalitarian state lying has subsequently become clear for all to see around the world.

So I think China has got a big reputational problem on its hand, and I suspect that will bleed out into trade positions and trade supply chains in the future.

Del Guidice: Professor Evans, we’ve all seen news reports about the shortages of doctors and medical equipment from around the world due to COVID-19, what specifically are you seeing in the U.K.?

Evans: In the United Kingdom we are seeing, I think, some rather clever, ingenious solutions, though they’re not perfect, but we’re not in a perfect world, and we’re not in a perfect moment when it comes to sloughing.

I’ll give you one example. We have, of course, in this country, two internationally recognized airlines, British Airways and we have Virgin, Virgin Atlantic.

Of course, if you are a member of a cabin crew in any reputable airline anywhere in the world, you are in fact trained. You’re trained in resuscitation. You’re trained in first aid. You have a base level of skill, and you have to maintain that level of skill.

So what’s happened at a very practical level in the United Kingdom is that with lots of support from the army and the military, huge, additional medical centers have been put in place. In East London, a huge conference center has been turned into a makeshift hospital. It has the potential to have 4,000 beds.

The cabin crew from airlines have been brought in, and they have been upskilled. In effect, they become care assistants. Junior nurses are rapidly being retrained and certain skills honed, so they’re going up a notch. Very experienced and senior nurses, consultant nurses, senior sisters are in some ways overtaking the role of some aspect of junior doctors. Junior doctors are stepping up a notch, etc.

Now, consultant doctors, people at the top of the food chain in medicine, you could be a colorectal surgeon. You could be someone who is doing plastic surgery.

What happened in recent weeks is you again have done crashes. You’ve been retrained, and you have been brought up to speed again with resuscitation, ventilation, and ICU. So there has been a very, very swift, very clever rejigging of the talent and the human resources available.

So far, we seem to have managed. I can say this as Brit. We’re famed for coming up with solutions in rather dark moments. We’re a country that naturally, if there is a crisis, we sort of pop into our gardens, do some gardening, and then end up in the garden shed where we invent things. I think that’s part of our own self-identity.

This instance, we’ve buckled down. We cut off the crisis. We’ve retooled in rather inventive and ingenious ways lots of the skills that various groups have. So far, we seem to be doing OK.

But I mentioned much earlier in this interview that we do have a growing mountain, backlog of lots and lots of, for example, acute elective surgery. That’s simply not being done at the moment.

When we went into this crisis, the National Health Service was not meeting all its targets. Often, people were not getting cancer care as soon as they should, people waiting too long, and this is with increasing amounts of money that politicians have been investing into it and that taxpayers have been spending on it.

So I think that there has to be a lot of inventive work at the end of this of how we deal with the backlog of the medical work that is accruing.

The only way I can think of dealing with it is that, again, the NHS is going to have to have, for a much, much longer period, a partnership, an ongoing partnership with those independent hospitals and maybe even elements of the military to deal with the backlog because, otherwise, this crisis, in terms of medical need, could go on for many, many years indeed as we get to grips with that backlog.

Del Guidice: Professor Evans, you had mentioned that before the lockdown ends, there might be a need for a vaccine or other measures. What will the lessons, though, you think, be once you all do go back to work and as you look back on what’s happened?

Evans: I think the first thing is, there’s going to have to be a big look-back exercise. This is all around the world. Governments all around the world are going to have to look back at their contingency planning strategies, where they worked well, and where they failed.

I think in some instances, that look-back exercise is going to have to inform elements of, dare I say it, industrial strategy.

By that, I don’t mean some sort of socialistic and onerous central planning doctrine, but I do mean that just as nations like the United Kingdom or the United States go to great lengths to make sure that they have the industrial capacity … so that if you’re in a difficult situation, if you enter a war or that if you are facing a pandemic, you have the industrial capacity to make things you might need.

For example, if Britain found itself in a war, do we have the capacity to produce the steel that our warships or tanks might need? All that kind of stuff.

So I think when the look-back comes, we’re going to have to look back at, in format, contingency planning and we’re going to have to revisit if we really have the equipment, and do we really have the industry to produce the things that we need?

Secondly, we’re going to have to think more clearly, I think, in terms of national security. This is a wake-up call for lots of people who have been interested, not only in pandemics, but potential in the modern world, for example, biological warfare to conjoin with economic warfare.

What can we learn from this as we look forward? I think there’s going to have to be a much broader and pragmatic acceptance that in health care, the NHS cannot do everything. In fact, no one sector can do everything in a moment like this. You have to have a national effort that spans various sectors.

I think there will be an increased role for the [private sector]. In fact, particularly, independent hospitals for many years to come to deal with the backlog and to increasingly relieve the NHS of some of the pressures.

I think also, geopolitically, this is going to be a wake-up call, not only for many democratic governments, but also to many businesses in terms of their supply chains.

Finally, and I’ll conclude on this point, I think that more authoritarian characters, people in Ankara, people in Moscow, people in Beijing, to keep a lid on this and to … for example, for the folks in Beijing, to basically try and cover up mistakes that were made early on in this crisis, they and other more authoritarian regimes are probably going to fall into the trap of becoming more authoritarian.

I don’t think that this pandemic is going to turn, for example, [Russian President] Vladimir Putin into being a more libertarian character. I think that he will likely become more centralizing and more authoritarian.

Ultimately, that might help to shore up some of these leaderships short term and their path to authoritarianism because, as we know from history, authoritarian regimes become fragile. They become brittle. And the more authoritarian they become, they become less agile and also less respected.

They lose not only the moral, intellectual high ground in debate, but they domestically become more fragile. I suspect that’s where countries like Russia, Turkey, Iran, China, and others will head.

Del Guidice: Going back quickly to the economic consequences of coronavirus, once this crisis is over or starts to wind down, how do you think it will change politics and public policy for your country over the months and years ahead?

Evans: I think the United Kingdom has a huge challenge. We were a country that before this crisis had been trying to encourage growth and managing it quite successfully in recent years. Take down our national debt. As a proportion of [gross domestic product], our debt was quite high. It’s around 80%, 85% of GDP. This crisis could easily add 10%, 15%, 20%, maybe even 25%, 30% GDP to our debt.

We won’t know until we get through to June, July, and August what the numbers and the projections are on that. But I do think that the British government is going to have to focus on growth.

It is going to have to either strike a … robust supply-side and free-market, free-trading deal with Europe, or indeed one with the United States.

I think Britain, going into this crisis, was quite lucky that it had stockpiled an awful lot of equipment and supplies in the lead-up in Brexit—we’re lucky—in some instances, we had to maybe use on this pandemic.

I think that, in the short term, the government’s going to have to capture those supply-side reforms and most of our deregulations have been relaxed.

I’ll give you one tiny example to whet the appetite. Until a few weeks ago, if I ran a restaurant in Britain, I couldn’t necessarily also run a take-away service from it. Or, maybe as Americans call it, a takeout service. Now you can.

Another example is, that up until this crisis, I had to have what we technically call on supplies, medical supplies, or protective equipment what was called a CE mark, which is a European Union Kitemark.

Well, there have been some shortages and supplies are being freed up and you don’t necessarily now have to, of course, use those products with that Kitemark. So there is a sort of a dynamism that can come from these moments.

Now, providing the British government is successful in spreading the economic pain of this, in terms of debt, over the long term, and can capture some of the supply-side reforms, go through elements of deregulation, manage taxes sensibly, perhaps reduce corporation tax. But really make Britain stand out as a beacon of enterprise.

… There is a challenge where we balance out the economic prosperity of the southeast of England and the city of London by unleashing … talent in the north of England, and that will require some upfront investment.

If we can do these things well, then I think, just as we’ve gone into this crisis and we’ve gone in quickly and deeply, I hope that the outcome will be dramatic. And that certainly, by the fourth quarter of this year, we will see a return, not only to growth, but hopefully some dramatic growth.

The saving grace of Britain, in a way, is that this will be a moment where we can take stock.

I described how it’s potentially going to see a rather different geopolitical landscape internationally. If companies, for example, want to diversify supply chains, in some instances, pivot away from China, well, how will that feed into opportunities for British manufacturing and talent?

There’s an awful lot that’s coming, I think, in the near future that isn’t just a challenge, but we’re going to be able to benefit from.

But of course, Britain, as one of the world’s most dynamic and most successful economies, will, I think, rise to that challenge—as we’ve done for hundreds of years, economically and in terms of invention and medicine, everything, vaccines, whatever. I think we will punch well above our weight. So I’m quite optimistic, I have to say.

Del Guidice: Lastly, professor Evans, what do you want the United States, as well as the rest of the world, to know about what the U.K. has been through?

Evans: The first thing is, there is an extraordinary dialogue of the deaf when it comes to the Brits and the Americans on the health care. The average American thinks that everything in Britain, when it comes to medicine, is socialized. It’s all nationalized. It’s run by the state. That simply isn’t true.

I repeat, we have about 17,000 independent, or private, nursing, residential care homes in this country. We have 200 independent and private hospitals. We have huge numbers of charities that deal with all kinds of aspects of health and medicine—everything from Parkinson’s Disease Society to Alzheimer’s. And I could go on.

Conversely, a lot of British people make the mistake that they think that everything in North America is private. The average British person has never heard of Medicare, Medicaid, veterans health care.

They don’t understand the enormous sums of money, both at federal and at state level, that the United States spends on its mandated health care schemes and its public health facilities.

So, I would say, the first thing is, it’s always good to overcome dialogues of deaf and to understand slightly more objectively each other.

I think that in the military sphere, the United Kingdom and the U.S. have long been very close together along the Five Eyes community, Australia, New Zealand, Canada. I think that will continue.

And I think that community will probably become ever more relevant, bolstering the liberal democracies, for example, of friends in Western Europe and in parts of Eastern Europe.

I think that the biggest challenge facing Britain and the United States and the democracy, I have to say, is the vast quantities of debt that we are shouldering.

I think the United States is already more into debt than 100% of GDP. Your debt is probably something in the order of $23 trillion. Britain’s debt is in excess of 2 trillion pounds. And if I took the off the balance sheet liabilities, for example, of U.S. pensioners, then your debt is even larger.

I think this is a civilizational challenge that the liberal democracies of the West face. And not just governments, but also levels of private debt amongst private companies and indeed households.

So I would like to think that, as we take stock, as we reflect, as we work through this historic infection … and that’s what often pandemics are, we think slightly more clearly in the future about what governments really can do, what they can’t do.

I think I would have a plea for a greater degree of transparency and honesty.

I do wish politicians of all stripes would simply stop pandering to their bases, promising ever more and then being ever dodgier, if I can use that colloquialism, with balance sheets. Because I really do think that we are playing with fire, if we all simply get into ever more debt.

That isn’t me saying that we shouldn’t spend money on this pandemic, rescue human life when we can. Absolutely and categorically, I believe that we should and clearly we are. But there are other callings in the years and decades ahead that also very, very important.

Del Guidice: Well, professor Evans, thank you so much for sharing that perspective and thank you for joining us on The Daily Signal Podcast.

Evans: My absolute pleasure.


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