54 Britain TheEconomistJuly10th 2021
Lockdown
Thestrange myth
of liberalEngland
B
orisjohnsoncanoftenchannelJohn
Bull,a ruddycartoonfigurefromGeor
gianEngland.Hepersonifiedtheliberty
lovingEnglishyeoman,inoppositionto
Napoleonic tyranny. Announcing Eng
land’sfirstpandemiclockdowninMarch
2020,MrJohnsonlamented“takingaway
theancient,inalienablerightoffreeborn
peopleoftheUnitedKingdomtogotothe
pub”.Governmentbehavioural scientists
warnedthatBritonswoulddefyevenmod
estrestrictions,andfrettedaboutdisorder
andlooting.
Bull.For 16 monthsBritonshavecom
plieddutifullyand,forthemostpart,un
complainingly.ButonJuly19thMrJohn
sonwillscrapnearlyalltheremainingan
ticovidmeasuresinEngland.Nightclubs
willreopen,capacitycapswillbeliftedon
restaurantsandmaskswillnolongerbe
mandatory.The tabloids havedubbedit
“FreedomDay”.Conservativemps areover
joyed;manyBritonsarenot.
PollingbyIpsosmoriforTheEconomist
suggests twothirds think masks, social
distancingandtravelrestrictionsshould
continueforanothermonth(seechart).A
majority would supportthem until co
vid19iscontrolledworldwide,whichmay
takeyears.Evenmorestrikingly,a sizeable
minoritywouldlikepersonalfreedomsto
berestrictedpermanently.Aquartersay
nightclubs and casinos should never
reopen;almosttwointenwouldsupport
anindefiniteban onleavinghomeafter
10pm“withoutgoodreason”.
Somecautionishardlysurprising.Cas
esarerisingfastandmayreach100,000a
day,accordingto Sajid Javid,thehealth
secretary.Thatwouldbenearlytwiceas
manyasatthepeakofthewinterwave.Sir
KeirStarmer,theoppositionleader,calls
theremovalofrestrictions“reckless”.
YetBritain’sexceptionallyhighvacci
nationratewilllimittheriseinhospital
admissionsanddeaths. Vaccination has
drivencovid19’sfatalityratedownfrom
0.8% of estimated infections to below
0.1%,thesameasforseasonalflu.Unlock
ingnowwillmeantheincreaseincovid19
infectionscomesbeforewinter,whenflu
picksup.Schools,wheremuchtransmis
sionhappens,areabouttogoonholiday.
Publicwillingnesstosacrifice forthe
commongoodina timeofcrisishassur
prisedministers.Oneinsidersayshehas
changed his mind on whether Britons
wouldvolunteerforwar:“I’d alwaysas
sumedthatifmygenerationwasshown
the Kitchener poster, they’d say: ‘No
chance,mate’.”Butthepandemichasalso
revealedJohnBull’sauthoritarianstreak.
ManyBritonsdidnotgooutdancingor
drinking,ortakeoverseasholidays,even
beforethepandemic.Nightclubs,casinos
anddarkstreetsharbourallsortsofwrong
doers.Forsome,itseems,endlesslock
downisanacceptablepriceforeveryone
elsestayinghome.n
Britonssupportedcovidrestrictions.
Somewantthemnevertoend
Sealingclubs
Britain,covidrestrictions,%whosupport*
July2nd-3rd 2021
Source:IpsosMORI *Makinglisted restrictions compulsory
A 10pmcurfew
Nightclubsandcasinosclosed
Check-inforcontact-tracingpurposesinpubsandrestaurants
Socialdistancingintheatres,pubsandsportsgrounds
Foreigntravelonlywithproofofvaccination
Ten-dayquarantineonreturningfromabroad
Masksinshopsandonpublictransport
For a month after July 1th
Until covid-1 is under control globally
Permanently, regardless of covid-1
706050403020100
country, for example, so money has been
set aside for 44 new community diagnostic
hubs in the next financial year. That
should free up equipment for patients in
hospitals. Extra covid19 funding is en
abling hospitals to recruit local private
providers. But the hope is that the health
service can become more efficient, too.
“They are now calling us Bones rUs,”
laughs Krishna Vemulapalli, a surgeon in
east London. Last year his hospital ran a
“bones week” to see how many joint re
placements could be done in seven days,
and to identify bottlenecks. Across six the
atres, ten consultants worked from 8am to
8pm. An extra porter ensured there was no
down time between patients. Lunch breaks
were staggered. The aim was 100 joint re
placements; they managed 135, with most
patients going home the same day. The
hospital has also tried a “gutfeeling week”
(to maximise endoscopies) and is planning
“ent3.0” (three times the normal number
of ear, nose and throat operations).
Bones week was an extreme example of
“highvolume, lowcomplexity” (hvlc)
surgery. The approach originated in Lon
don, helping to explain why the capital has
been quicker than other places to cut wait
ing lists. The surgical process is broken
down into steps, from before patients ar
rive at hospital to their recovery, with hos
pitals benchmarked against the top 10% of
performers for outcomes and efficiency. By
streamlining the simple stuff, time is freed
up for trickier operations. The health ser
vice now wants to spread hvlcacross the
country, and across specialities.
nhsboard papers promise “air cover”
(extra money) to reward top performers
and to support stragglers. Yet cash is not
the only obstacle. Covid19 continues to be
another, because hospitalisations eat up
resources, cases cause staff absences and
precautions slow things down. “Even if it’s
only five minutes to clean the outpatient
consulting room, it’s five minutes on 20
patients, and suddenly you’ve lost an hour
and a half,” says Joe Harrison, chief execu
tive of the Milton Keynes hospital trust.
Mr Harrison credits free parking and
coffee for all staff with helping recruit
ment in Milton Keynes. Across the country,
though, hiring problems will place limits
on the recovery. Recruiting from abroad is
increasingly difficult because of global
shortages, notes Siva Anandaciva of the
King’s Fund, a thinktank. “You can start
expanding training places; you can start
building medical schools, as the govern
ment is doing,” he adds. “But will that bear
fruit between now and the end of Parlia
ment? Probably not.”
Nor is the recovery the only task faced
by hospital managers. A new nhsbill pub
lished on July 7th requires them to forge
ahead with plans to move health care out of
hospitals and integrate it better with social
care. “I was talking to one chief operating
officer,” says Mr Anandaciva, “and he was
saying, ‘I feel like I’ve got two jobs: one is to
go for the biggest elective backlog in two
decades; the other is to make the biggest
transformational shift in how health care
is planned and delivered in 20 years.’”
In fact, reforms introduced in the early
2000s by Labour to deal with waiting lists
are now being undone. Even with the focus
on waiting lists, and lots of cash, it took La
bour the best part of a decade to meet its
targets. Few expect a quick resolution this
time, but one date looms large. “Health
care leaders know that ministers will be fo
cused on the next general election,” says
Mr Hopson. The governmentcameto pow
er promising to protect thenhs. Any fail
ure to do so will be punished.n