The Economist - USA (2021-07-10)

54 Britain TheEconomistJuly10th 2021

Lockdown

Thestrange myth

of liberalEngland

B

orisjohnsoncanoftenchannelJohn

Bull,a ruddycartoonfigurefromGeor­

gianEngland.Hepersonifiedtheliberty­

lovingEnglishyeoman,inoppositionto

Napoleonic tyranny. Announcing Eng­

land’sfirstpandemiclockdowninMarch

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

anindefiniteban 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%,thesameasforseasonalflu.Unlock­

ingnowwillmeantheincreaseincovid­19

infectionscomesbeforewinter,whenflu

picksup.Schools,wheremuchtransmis­

sionhappens,areabouttogoonholiday.

Publicwillingnesstosacrifice 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  financial  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 efficient, 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 efficiency. 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  five  minutes  to  clean  the  outpatient

consulting  room,  it’s  five  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

coffee  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  difficult  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

officer,”  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