Will the UK Pay the Cost for Health Security?

World Health Organisation definition of global public health security: “the activities required, both proactive and reactive, to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries”.

The United Kingdom’s government, despite having ample warning of the encroaching coronavirus pandemic as it travelled from China and then through southern Europe, has presided over the world’s highest COVID death rate. The death toll might eventually be higher than that inflicted by the German air assault on Britain in world war two. Looking to move the country out of both the health crisis and the economic recession, prime minister Boris Johnson and chancellor Rishi Sunak will be aware that health security is now a priority for many voters. Will they be willing to make a significant break their commitment to austerity to guarantee improved health security in the UK?


The UK ranks as the sixth largest economy in the world. Arguably the nation’s outstanding achievement and contribution to civilisation is its free-at-the-point-of-use health service, introduced by the post-war Labour government in the National Health Service Act of 1946. Conservative leader Winston Churchill warned that the country could not yet afford such a service, but he was conclusively proved wrong. Too popular to privatise outright, from the late 1970s, successive governments have presided over the slow deterioration of British health security, following the logic of the neo-liberal economic model. Essentially this has meant that governing parties of all colours have implemented different shades of the same ideology, and the UK’s health security has been severely damaged as a result.

Following the banking crisis of 2008, the UK introduced a counter intuitive economic policy called austerity, the rationale of which was to blame the financial crash on public spending. It followed that the crisis could only be reversed by implementing drastic cuts to public spending. This was an ideological, rather than economic, approach but it was accepted by the UK’s political parties, including the Labour party during the period 2010-2016 until Jeremy Corbyn stood on a platform of social democratic reforms.

Since 2010

Under austerity economics de-funding of the NHS accelerated and the annual increase in health spending, which had been 4%, was slashed down to 1%. In 2012, the Conservative-Liberal coalition government’s Health and Social Care Act fully marketized the NHS, with the Health Secretary’s legal “duty to provide” reduced to a “duty to promote” health services. Funding structures in the UK health model resembled those of the United States.

The austerity policy saw inequalities reach new extremes in Britain, leading to at least 120,000 excess deaths in the population.  The promised economic recovery arrived but only for the top few percent in the economy as insecure work and its related negative health consequences spread in an increasingly financialised economy based around the City of London.

In 2016, the government carried out Exercise Cygnus, a drill that tested the country’s readiness for a health crisis on the scale of COVID-19. It is understood that the country's chief medical officer asked the government to act accordingly when the report concluded that the country would find itself ill-equipped for a pandemic, but they ignored the request. The report is understood to have specifically warned about the lack of ventilators in the country, something that became an acute crisis during the COVID-19 outbreak. To date, publication of Cygnus report has been blocked by ministers.

By 2019 the UK had the fewest doctors and hospital beds per capita in western Europe. But the cavalier approach of Conservative governments to serious health issues continued even as COVID-19 arrived in the UK in early 2020. Prime minister Johnson skipped five Cabinet briefings on the pandemic as COVID arrived, ignored calls for investment in personal protective equipment (PPE) and proudly declared that he had shaken hands with, coronavirus patients at hospitals.

COVID-19 in the UK

In early 2020, the British media described with a mix of pity and scorn the devastation Italy was suffering under coronavirus. It seemed impossible that such chaos could visit Britain. Now we learn that Italy, a similarly sized country and weaker economy, has double the number of intensive care beds of Britain. The coronavirus has been far worse in the UK than was predicted in March, both in terms of the severity of symptoms and the government’s ability to navigate the situation on behalf of 70 million people. Medical professionals reportedly being forced to wear bin bags because of a lack of PPE and a death toll of over a thousand a day for twenty consecutive days is a far cry from the founding ideal of the NHS: ‘Freedom From Fear’. The Johnson government made an early shift in messaging to manage expectations from stopping the virus to ‘preventing the collapse of the NHS’.

The chancellor, Rishi Sunak, is now looking to chart a path of economic recovery. Although he has eased up on some areas of austerity to help people during the COVID lockdown, Sunak has warned that the UK faces a “severe recession, the likes of which we haven’t seen.” The changes made by the chancellor have eased some restrictions on housing support and a provided a generous 80% furlough scheme for wages, but these moves have been alongside further privatisation of the country with Serco and Deloitte receiving lucrative public contracts to implement emergency services for which they have no track record of provision.

Health Security?

All UK political parties will have to pledge to protect and bolster the NHS in their public utterances. But the Conservative government appears ideologically allergic to public investment, preferring to bolster the private sector and viewing the spread of insecure employment as an acceptable and even necessary outcome in a society based on material aspiration and private business interests. Even during the worst crisis to hit the UK since world war two, the Johnson government’s instinct was to go for a ‘herd immunity’ approach to allow the coronavirus to spread through the population, supposedly developing a basis of immunity, while those who died (primarily the physically weak and the elderly) were seen as necessary collateral damage in the battle to preserve the economic system. Due to a negative public response, the government backed down from publicly talking about herd immunity, although its mixed messaging since March can be seen to be a way of ensuring that large swaths of the population never fully engaged in social distancing.

As the UK eases its lockdown stage by stage, despite the infection rate not coming down as low as in other comparable countries, the government is rolling out the herd immunity approach it never really abandoned. This confused health messaging comes at the end of ten years of public spending cuts which have left the country vulnerable to any kind of shock event, whether health, economic or political. The UK has experienced all three in recent years, with the pandemic following on from the banking crisis and Brexit.

Having systematically dismantled its industrial base, weakened workers’ rights, financialised its economy to an extreme and removed many of society’s safety nets while raising living costs, the UK has seen a general fall in living standards during the neo-liberal era. In normal circumstances this would be all acceptable to a government whose priority is low taxes and boosting big business, but COVID has brought health security into clear focus. Millions of people have prioritised health over money during the lockdown period and the damaged health infrastructure of the nation has been laid bare.

However, while the majority of the population value healthcare as at least as important as income, their government takes a radically different approach, laid out in a February 3rd by the prime minister:

"… and when there is a risk that new diseases such as coronavirus would trigger a panic and a desire for market segregation that go beyond what is medically rational to the point of doing real and unnecessary economic damage, then, at that moment, humanity needs some government somewhere that is willing, at least, to make the case powerfully for freedom of exchange.

"Some country ready to take off its Clarke Kent spectacles and leap into the phone booth and emerge with its cloak flowing, as the super-charged champion of the right of populations of the Earth to buy and sell freely among each other”.

He volunteered the UK for the role. His government’s actions, before and since that statement, have reinforced the UK’s absolute ideological commitment to profit, even at the cost of massive loss of life.

Sunak and Johnson will be mindful of finding balance as the UK moves towards a post-COVID approach. Will they invest in the health of the country by ploughing serious sums into the NHS, to be overseen by healthcare professionals rather than corporations? Or will they pay lip service to the country’s health security while continuing to pursue a highly ideological commitment to profit and a zealous opposition to public investment?

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