Prevention measures cost money, and the problem is that it’s very hard to tell that they are working because if successful, bad things don’t happen (or happen less frequently and/or with less impact). And that means when governments are looking to cut funding, they often turn to those services that are at the forefront of prevention: health, social care [2], education and service infrastructure.
This is basically what successive Conservative governments have done for years – in 2018 The King's Fund, Nuffield Trust and the Health Foundation wrote a joint letter to the government stressing that NHS funding needed to be much higher than the current practice [3], this was ignored [4]. And even Labour governments have made cuts, though to a lesser extent. The thing is, that when things are on an even keel, making these cuts doesn’t have a hugely negative impact. Oh yes, it affects some people (usually the most vulnerable), but by and large it isn’t very noticeable because it’s slow.
Then, eventually, something bad does happen; disaster strikes. And the impoverished services can’t cope – they can’t cope with the consequences because they can’t scale up quickly enough. Resources aren’t in place. Supply chains aren’t in place. Plans haven’t been made. It's a lesson in Requisite Variety that governments just never seem to learn!
This is what we have seen with COVID-19. If the NHS and other essential frontline services had been better funded over the years, they would have been able to mount a much faster and more effective response than they did (for example Germany has had a much better testing regime than the UK, able to test around 500,000 people a week in April 2020, whilst UK had only tested about 214,000 by the beginning of April) [5].
What workers in the NHS, police and other frontline services have done is nothing less than miraculous. But they shouldn’t have had to perform miracles; they should already have been well enough resourced.
And now a government that has in the past said it can’t afford to fund the NHS to the tune it needs, is pouring billions into the service. So it wasn’t impossible to do this after all! And if they had done it sooner the impact of COVID-19 would have been better contained. There would have been fewer deaths.
Now I don’t want to “Tory bash” – what I want is that lessons be learned from this and for things to change. After the crisis is over, let’s not go back to the regime of austerity and cuts to our social infrastructure services.
Because an even bigger crisis than COVID-19 is looming. Climate change hasn’t gone away. And if we don’t act in a far better, more concerted fashion than at present, it won’t just be the millions in Africa and India and SE Asia who are suffering already: it will be us too. Globally crops will start to fail, and there will be a worldwide food crisis [6]. Sea levels will continue to rise, and major cities like London will face flooding on a scale never seen before, with new predictions showing that a rise of 2m might occur by 2100 [7].
Learn the lessons of under-funding social infrastructure - and never let our governments make cuts like those of the past again: learn the lessons of not funding prevention measures to the scale they need. We know now what was needed for COVID-19 and magically the money is now being found.
Well we also know what’s needed for climate change: massive funding for green energy, not just the trickle that’s currently in place [8]. And stop fossil fuel exploitation – dead, instead of the rebates and tax breaks [9]. Oh the Shells and BPs and Essos will wail and moan, but things must change. Stop people flying unless they have to. If, as a result of COVID-19, some airlines go bust, let them [10]. Fewer planes and fewer airlines is a good thing. Foreign holidays are a luxury not a necessity!
The madness of HS2 should be cancelled immediately. If it’s allowed to continue it will overspend much much more than it already has (The original estimate was £36 billion, now it’s estimated it’ll cost around £88 billion, but costs are still rising [11]). The money could and should be used for local public transport measures. We don’t need to have to travel long distances at high speeds, we need economies that are based on local communities and local productivity.
Sources:
1. Prevention is better than a cure:
Royal College of Nursing, ‘Prevention is better than cure’(https://www.rcn.org.uk/get-involved/campaign-with-us/prevention-is-better-than-cure)
2. Social Care funding:
The King’s Fund, 21 November 2018, ‘Prevention is better than cure – except when it comes to paying for it’(https://www.kingsfund.org.uk/blog/2018/11/prevention-better-cure-except-when-it-comes-paying-it)
3. NHS funding:
The King’s Fund, 6 June 2018, ‘An open letter: a long-term funding settlement for the NHS’(https://www.kingsfund.org.uk/publications/pm-letter-funding-settlement-nhs)
4. NHS funding:
Full Fact, 9 July 2019 , ‘Spending on the NHS in England’(https://fullfact.org/health/spending-english-nhs/)
5. COVID-19 testing:
Guardian online, 7 April 2020, ‘UK must learn from German response to Covid-19, says Whitty’(https://www.theguardian.com/world/2020/apr/07/uk-must-learn-from-german-response-to-covid-19-says-whitty)
6. Climate change and crop failure:
Science Advances Vol. 5, no. 7, 3 July 2019, ‘Synchronous crop failures and climate-forced production variability’(https://advances.sciencemag.org/content/5/7/eaaw1976)
7. Climate change and sea level rise:
PNAS Vol 116 (23) 4 June 2019, ‘Ice sheet contributions to future sea-level rise from structured expert judgment’(https://www.pnas.org/content/116/23/11195)
8. Renewable energy funding by government:
Energy Voice, 13 February 2019, ‘UK Government increases renewables funding following review’(https://www.energyvoice.com/otherenergy/192634/uk-government-increases-renewables-funding-following-review/)
9. Tax breaks for fossil fuel producers:
Energy Voice, 8 April 2020, ‘UK regime sees Shell pay no taxes on North Sea business in 2019’(https://www.energyvoice.com/oilandgas/north-sea/233416/uk-regime-sees-shell-pay-no-taxes-on-upstream-business-in-2019/)
10. COVID-19 impact on airlines:
Guardian online, 15 March 2020, 'UK airlines call for multibillion bailout to survive Covid-19 crisis'
(https://www.theguardian.com/world/2020/mar/15/uk-airlines-call-for-multibillion-bailout-to-survive-covid-19-crisis)
(https://www.theguardian.com/world/2020/mar/15/uk-airlines-call-for-multibillion-bailout-to-survive-covid-19-crisis)
11. HS2 costs:
Oakervee Review of HS2, December 2019 (para 7.4)(https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/870092/oakervee-review.pdf)
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