Politics, as Covid-19 shows, is scarcely drivable by long-term strategies, no more than it would be tomorrow if there was an accidental but escalating exchange of fire by military units off East Asia. At the same time, events play through existing assumptions and structures, are affected by them, and in turn, affect them. In that process, it is fascinating to see what elements come to the fore and what others remain largely below the horizon.

For the first, Covid-19 has seen the salience of national governments over multi-national organisations. For the second, and related to that salience, the issue of decentralisation has been largely pushed aside. Yet, in all states, there is an inherent tension between centralisation and decentralisation, a tension that encompasses constitutionalism and politics, theory and practice, and the past and the present. There is no ideal solution, either in ideological or in functional terms, and, instead, the norms here are a classic instance of distinctive political cultures, or our German friend, the sonderweg [distinctive path]. This is in tension with another German friend, the zeitgeist [Spirit of the Age], and the latter can greatly affect the reading of the former, not least in labelling certain courses as progressive or anachronistic, still worse reactionary. In practice, subjectivity and politics, the two overlapping but also different, are to the fore in many of these judgments.

From 1945, determination grew to use the state to impose a uniformity in structure, governance, accountability and culture

And so with centralisation in British history. This repeatedly was a matter of politics and its encoding in political culture. More particularly, the rejection, twice of Stuart monarchs, was linked to hostility to what was presented as centralisation, and the definition subsequently of Englishness/Britishness was in contrast to French “bureaucracy” as in intendants and German/Russian “militarism”. The key element in the British Isles, and notably so in England, was of an image of governance in which the local community, usually a shire, was to the fore, both in the localities and in Parliament. In turn, this attitude affected the response to the period of Victorian reform that began in the 1840s with the Boards of Health. They were structured accordingly in a very different fashion to the NHS, and we must be wary of assuming some developmental process at play. So also with the impact of the legislation of ‘New Liberalism’ in the years prior to World War One.

A dramatic change of direction occurred from 1945, with a determination to use the state to impose a uniformity in provision and therefore in structure, governance, accountability and culture. This was driven initially by a compound of particular Labour ideas and the continuance of a resource-rationing situation, but became the norm in health whereas in education, despite efforts, a less centralised structure emerged.

Possibly a reaction might have been anticipated under the Thatcher government, but the reality of municipal opposition to government power, notably in Liverpool and London, instead encouraged centralising measures. So also did the idea of national “contracts” or “compacts” with the electors/consumers in branches of national life, and of national standards as in education.

Yet, alongside a clear direction of travel, there was contingency. This was especially true of referenda. Those which commanded attention are the European Economic Community/European Union referenda of 1975 and 2016 and the Scottish and Welsh ones of 1997. Each is important to our story, as the first ultimately brought the European dimension on regionalism into play, while those of 1997 brought forward the English issue, and therefore the attempt to solve it with an English regionalism which was seen by Labour as an antidote to probable Conservative dominance of an English Parliament.

Two other referenda repay attention. One, a reminder of the UK’s dependence on developments abroad, was the 1969 on local government in France for that became the cause and occasion for Charles De Gaulle’s resignation as President, which was a vital prelude to the UK joining the EEC. The second was the North East England devolution referendum on 4 November 2004 on whether or not to establish an elected assembly for the region. This was in accordance with the Draft Regional Assemblies Bill presented to Parliament that July by John Prescott. The promotion of health and the reduction of health inequalities were powers conveyed in the draft bill. Unitary authorities were to replace two-tier structures for local government. The proposal was defeated by 77.93% to 22.07%, in part due to commitment to the existing system, in part due to an anti-politics, anti-political cost, anti-Newcastle set of views, and in part as an opportunity to express irritation with the government. Referendums had also been planned in North West England and Yorkshire; but were postponed indefinitely. Sub-texts in the eyes of some commentators were that the measure was a way to lessen pressure, in the context of Scottish and Welsh separatism, for an English Parliament, which was not a Labour goal; and secondly that it accorded with EU favour for regional governance, as in Germany.

That was the end of that approach, but regional development provided another opportunity for decentralisation. That, however, again, and inevitably, became entwined with political issues. Popular with few, RDAs were widely portrayed as costly and meddlesome. Thus, the decentralisation of the NHS, however desirable, not least as part of a broader strategy of public health in which communities feel that they have a role, faces the problem of the nature of British, more especially English, local government. Unitary authorities, however, may well find public health a desirable, indeed necessary, course of action and service of ambition and role.