The Economist UK - 28.03.2020

28 Britain The EconomistMarch 28th 2020

O

ver thepast few weeks, the National

Health Service has undergone extraor-

dinary, wrenching changes as it prepares

for the coming storm. They involve the

mass redeployment of staff, the rapid pro-

curement of equipment and even the cre-

ation of an entirely new hospital—the nhs

Nightingale—with 4,000 beds in London’s

Excel Centre, which had been due to host

the World Spa and Wellness Convention.

But they also involve smaller adjustments.

Communication from nhsEngland, which

runs the health service, has become notice-

ably terser so as to save time. That is an im-

pressive feat, notes one insider: “Doctors

love nothing more than the sound of their

own keyboards.”

Britain is now on its way up a steep

curve. As The Economistwent to press, there

were 9,640 confirmed cases of covid-19 and

466 deaths. Numbers are rising fastest in

the capital, which is home to more than a

third of confirmed cases. In an attempt to

suppress the growth, the government has

now aligned with much of Europe, in-

structing people to leave the house only to

buy essentials and to exercise once a day. In

a short statement announcing the rules,

Boris Johnson invoked the need to protect

the nhsfour times.

The aim is to avoid a Lombardy-style

collapse. To do this, the nhsis restructur-

ing on a scale without precedent in its 72-

year history. To begin with, its leaders hope

to free up 30,000 of its 100,000 beds by

postponing elective surgery and urgently

discharging inpatients. So that hospitals

can focus on preparations, all inspections

have been halted. The usual “payment-by-

results” mechanism, by which the health

service’s internal market operates, will

cease on April 1st. As Sir Simon Stevens, the

nhs’s chief executive, has written: “Finan-

cial constraints...will not stand in the way

of taking immediate and necessary action.”

The chancellor has announced an extra

£5bn ($5.9bn) for the health service, with

more to come if needed.

Putting this cash to use, the nhshas

struck a deal with private hospitals to ac-

quire 8,000 beds, 1,200 ventilators and

20,000 workers. They will be joined by al-

most 12,000 retired nhsstaff, 5,500 final-

year medics, 18,700 final-year student nur-

ses and a volunteer army, who will deliver

medicine and check on the vulnerable. The

call went out for 250,000 volunteers; with-

in 24 hours, 405,000 had signed up.

The 23 royal medical colleges have iden-

tified what can be trimmed from regular

practice, allowing specialists to be rede-

ployed. Most outpatient and general-prac-

tice consultations are now happening by

videolink or phone. In London, at least one

hospital has been set aside for non-covid

surgery; others will deal solely with those

suffering from the virus. Experienced ob-

servers are staggered by the pace of change.

“Stuff that normally takes a couple of years

has been done in 72 hours,” says one.

Whether that is fast enough remains to

be seen. Hospital chiefs in London are con-

cerned that the extra capacity is already fill-

ing up quickly. Across the country they

worry about shortages of protective equip-

ment and testing, which are forcing staff

with only minor symptoms to go into quar-

antine. The government is desperately try-

ing to buy more ventilators.

Some influential voices are neverthe-

less hopeful. Speaking to a House of Com-

mons committee on March 25th, Neil Fer-

guson of Imperial College London, whose

modelling prompted the government to

enforce a lockdown, said that although

there would be “hotspots” where the nhsis

overwhelmed, his calculations suggest

that overall demand will now be within the

system’s increased capacity. It will soon be

clear whether he is right. 7

A vast, sprawling health service turns

its attention to one task

Health care

National Covid

Service

“N

obody is buyingthe party drugs,”

laments an east London drug

dealer, as he drops two quarter-ounce

bags of cannabis onto a customer’s coffee

table. Pulling off his protective gloves, he

lights up a spliff and settles down for a

short break. Outside, ambulances sweep

past, their sirens spoiling the hazed

ambience. His customer is more than

satisfied. “It locks me down—physically

and mentally,” he says. “It helps me filter

out all this drama.”

The covid-19 pandemic is making

Britain’s dealers jittery. As nightclubs

and pubs began emptying out, cocaine

pushers sent out a flurry of increasingly

concerned text messages. “To avoid

being affected by delays or disappoint-

ment, pre-order NOW!!” went one. Oth-

ers imposed minimum orders of two or

three grams, desperate to shift their

stock in a shrinking market. A regular

user was unpersuaded. “Imagine being

on a comedown during the apocalypse.”

Demand for at least one drug is boom-

ing. Large quantities of cannabis are

being sold to those preparing for a

chilled-out lockdown. “I’ve had so many

calls from people asking for ounces who

usually buy smaller bits,” one dealer

boasts. “Everyone is stockpiling weed,”

says the east London dealer. “They just

want to blaze their way through the

lockdown.” In some parts of the country,

the price of weed jumped by half.

The lockdown is also affecting supply.

A south London dealer messaged his

customers after it was announced, urg-

ing them to order quickly “as there will

now be limits to time and delivery”. As if

he were the boss of a supermarket reas-

suring customers about the supply

chain, another told worried users that he

had been on a recruiting spree to provide

a more efficient service day and night.

These shifts may also play out on the

streets. If revenue dwindles, gangs are

likely to battle it out for the remaining

custom, according to a report published

on March 22nd by Policy Exchange, a

think-tank. Turf has already been more

closely contested in recent years, thanks

to a saturated market and the growth of

online suppliers.

Richard Walton, a former senior cop

who co-wrote the report, predicts that

some gangs will be emboldened if police

are distracted by helping to deal with the

pandemic. “Some street-level criminals

may try to exploit an absence of police

presence,” he says.

Still, some dealers have temporarily

retired from the trade altogether. “I’m

not going outside for a while,” says one.

“I don’t want to be taking any cash that

has had all those dirty hands on it.”

Stay in, drop out

Drugs

The pandemic is changing the drugs market

When it gets mad, stay mellow