Ilya Dmitryachev/TASS

The NHS is the new Church — Militant and Triumphant

The clinical decisions rushed through in March had a single goal: to protect the reputation of the NHS

When Nigel Lawson observed in 1992 that “the NHS is the closest thing the English have to a religion, with those who practise it regarding themselves as a priesthood”, he was, I suppose, making a wryly sophisticated joke. But now the joke is on us with a vengeance since the Covid-19 crisis has turned Lawson’s squib into sober, serious reality: the C of E is dead; the new national church is the NHS. It has its own rituals and observances; its own company of heaven; and, above all, it has assumed the full panoply and power of the old ecclesiastical establishment as well.

Still worse, as on occasions in the Middle Ages, this new church militant and triumphant has captured the English/British state and prime minister Boris Johnson lies prostrate before it, as bound and helpless as the Emperor Henry IV kneeling in the snow at Canossa in his three-day penance before Pope Gregory VII.

And, what is worst of all, it is this capture of the English/British state by the transmogrified NHS — not austerity, not dodgy modelling, not ministerial delays or Public Health England’s institutional incompetence, not even media madness and Piers Morgan (Covid-19’s very own Lord Haw-Haw) — that lies at the heart of our disastrous response to the pandemic. We have committed national idolatry and we are paying the price.

All the professions, of course, ultimately stem from the medieval clergy. But the connection between medics and clerics was and is especially close. Both have vocations and deal with matters of life and death. The clergy even called themselves “doctors of the soul” and used avowedly similar methods to their medical colleagues: physicians purged the body of evil humours; theologians invented the torments of Purgatory to cleanse the soul of sin.

In order to carry the “Red Wall” of ex-Labour seats in the north of England, the Tories had to make an unequivocal commitment to the NHS

It cut the other way as well and when women were professionalised as nurses by Florence Nightingale in the nineteenth century their uniform, if not necessarily their chastity, was modelled on the nuns’ habit of the Middle Ages.

So there are deep cultural and historical roots for what has happened — just as there were for Brexit. But as with Brexit a specific conjuncture of political circumstance was needed as well. It was provided by Boris Johnson’s successful revival of Disraelian One-Nation Toryism, about which I wrote in the December issue. This carried him to victory at the 2019 general election. But it came at a price. In order to carry the “Red Wall” of ex-Labour seats in the north of England, the Tories had to make an unequivocal commitment to the NHS and their manifesto duly did so.

The Tories, in the modern parlance, now owned the NHS. Or perhaps it would be truer to say that the NHS owned the Tories.

In the early weeks of 2020, however, the  Covid-19 crisis was a cloud no bigger than a man’s hand. Instead, if you were on the Boris right, there was Brexit Day, 31 January to be celebrated with parties and dinners and speeches. In retrospect the Brexit Day extravaganzas look a bit like the last fête champêtre at pre-revolutionary Versailles.

During February things began to come nearer home as the Covid-19 crisis struck in continental Europe. Especially disturbing were the scenes in Italian and Spanish hospitals as intensive care units were overwhelmed, patients died in droves on ventilators, and the living and the dead piled up hugger-mugger in corridors and storerooms. 

But still, guided by the good sense of the chief scientific adviser on the one hand and Boris Johnson’s natural libertarianism and optimism on the other, the British government stuck to what we can call the Swedish option or, as it was demonised by the leftish press and broadcast media, “herd immunity”.

Then, as so often happens, the situation turned on a pin’s head. The revolution, for it was no less, took place in a matter of hours over the weekend of 14-15 March. Three things happened: the death figures doubled; President Macron threatened to close the frontier unless Britain imposed the same sort of lockdown as France; and, above all as I am informed by a reliable press source, Northwick Park Hospital in north-west London was almost overwhelmed in scenes that bore an uncomfortable resemblance to the mayhem in Italy and Spain. 

A day or two later Professor Neil Ferguson presented his modelling which predicted deaths in the hundreds of thousands if the then policies were persisted with. This was the last straw. It was now sauve qui peut. Or — what amounted to the same thing in view of the Tories’ manifesto pledge — save the NHS. Or, to be more cruelly precise still, save the face of the NHS.

Here the analogy with the medieval Church comes forcibly into play. Properly the Church was the congregation of all the faithful. But too often the laity were forgotten and the Church was identified with the clergy.

In these circumstances, preserving the good name of the institution and protecting the power, privileges and prestige of its staff became an end in itself. As it did in the modern scandal over clerical child abuse.

Not that the clergy were equally important. First came the bishops and the so-called regular clergy of the greater and richer monasteries. Second and a long way behind were the secular clergy: the usually badly-educated and poorly-paid parish priests who actually tended to the faithful.

The resemblance to the power structure of the NHS is remarkable. First come the grand administrative panjandrums and the consultants of the London teaching hospitals and their provincial equivalents. Second are the GPs who ordinarily look after the patients on the ground. They are much better paid and trained than their parochial predecessors but not much better regarded by those at the summit of their profession. And third and very much last are the new laity: the patients themselves.

This last assertion, especially in the present circumstances, will seem outrageous. But consider the clinical decisions that were rushed through in the wake of that fateful March weekend. They had, it is now clear, a single goal: not to save patients’ lives but to “protect the [reputation of the] NHS” by making sure that the chaotic scenes in Italian and Spanish hospitals were not replicated in Britain.

Everything else went by the board. Elective surgery was suspended and even the treatment and diagnosis of major diseases like cancer was put on hold. Any existing hospital patient, especially the elderly, who could be discharged was discharged. A deal was done with the private hospitals that put them out of operation as well. With much fanfare, shiny new field hospitals were built and shiny new ventilators commissioned.

And it worked. Our hospitals were not overwhelmed as in Italy and Spain and institutional face and political skin were duly saved.

But, ungratefully, patients have continued dying. And in embarrassingly large numbers. For cancer and heart disease do not defer to the clinical priorities of the NHS. And Covid-19 does not respect its frontiers either. Instead, slowly driven out of NHS hospitals, it is now rampant in non-NHS care homes — often carried there, it seems, by patients discharged untested and in haste in those mad March days.

It took the Reformation to reprioritise the Church. Will its mishandling of Covid-19 be the crisis that shatters the institutional arrogance and complacency of the NHS? It should be, though alas neither Boris Johnson nor Keir Starmer looks promising as Henry VIII.


David Starkey has spoken about his column with Peter Whittle:

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