Somewhat ruefully, the former Conservative Chancellor of the Exchequer, Nigel Lawson, once remarked that the National Health Service is the closest thing that the British people have to a 'national religion.' No doubt he finds such an emotional attachment to a nationalised industry quite irrational. And, no doubt, he is not alone in his party; although it is one of many such thoughts that they have to keep firmly under wraps. During the pandemic, there has been considerable evidence of public worshipping at the altar of this national religion. However, as with all religions, the motives for devotion are often mixed ; and, in this case, as with many cases of piety, guilt plays a part which cannot be overlooked.
Behind the constant praise of medical staff as 'heroes' and gestures such as doostep handclapping (how close is this to prayer ?) , there must lurk a feelings, if not of guilt, then perhaps of anxiety. Have we not asked them to do too much ? Do they have adequate support ? Are there enough of them ? Even if these questions are not precisely formulated in people's minds, they exist in the subconscious. And they lead to other questions. The NHS is indeed almost miraculous in its operations, and its staff are (pandemic or not) expected to perform feats of heroism ; but the achievement exists precisely in the fact that the NHS manages to do so much on the basis of so little resource.
Compared to other states in the Global North, Britain spends less per capita on health care. It could be argued that other countries, with other systems of funding health care, such as social insurance (Germany), private insurance (United States), and many other combinations, in fact waste resources. That could well be so ; and, in the case of the United States, undoubtedly is ( a case of the uncontested efficiency of a natiomalised corporation ?) It could be said that a situation where (pre-pandemic) hospitals had empty beds (as in France) is a grossly inefficient use of resources ; it could also be said that it is a prudent insurance against the service being overstretched in a crisis. The British have never faced up to the persistent underfunding of the NHS. (There are other uncomfortable truths about the NHS, which sit ill with repeated panics about immigration, such as its dependence, since its foundation, on ethnic minority staff and on migrant labour from all parts of the world).
The NHS has to soak up policy failures in other areas which relate to public health. Much premature illness and mortality result from poor employment, housing and environment. This has been known for years ; but we refuse to prioritise these important areas of preventative health policy. Not for nothing did Aneurin Bevan regard his efforts to renew Britain's housing stock after 1945 as being of equal importance as the foundation of the NHS (see Michael Foot, 'Aneurin Bevan', Vol. 2). For him, good quality housing could not be divorced from health care. (It is also worth pointing out, as Foot and David Marquand (in his 'Britain since 1918' (2009) )also make clear, that Bevan encountered much opposition, not least from his own Cabinet colleagues, to the NHS. It was not aleays a 'national religion' : it had to be fought and argued for, like any other worthwhile social and political change.
A glaring example of these policy failures is 'social care.' Perhaps, as individuals, we can be excused our fond hope (or delusion) that we will not suffer prolonged illness and/or infirmity toward the end of life. But society cannot organise itself on the basis of individuals' refusing to face up to uncomfortable realities. Social care, for so long the preserve of local authorities, was not integrated into the NHS in 1948 because the demographic explosion of senior citizens was not predicted. Instead of dealing with the problem when, from the 1970s onwards, it became pressing, it was exacerbated by fragmenting and privatising the sector (a significant part of it being owned by private equity capital) , and by depressing the wages of the workforce. If we decided to prioritise this problem, we could devise a proper system of reward, training and career progression for care staff ; end the fragmentation of the care sector, and even integrate it with the NHS ; and devise some means of paying for it (through some form of social insurance or through taxation). Solutions to this problem are not beyond human capability. Neither should it be impossible for any rational and sensible person to appreciate that, just as we need collective insurance against illness, so it should also be worthwhile and prudent to insure together against the perils of old age.
Only part of the explanation lies in politicians' cowardice or the distorting effects of ideological fashions (e.g. privatisation). Politicians often do not broach uncomfortable subjects, because voters do not want to be bothered by them, especially when they are being asked to shell out. Social care is one such case. As a result, we have periodic rituals of hand wringing about the difficulty of this issue without ever doing anything about it.