The NHS surcharge debacle reveals a government both cruel and useless | Jonathan Freedland | Opinion

Voters will occasionally forgive a government they deem heartless, if they reckon it has the steel to get the job done. They might even, though rarely, forgive a government they deem incompetent, if they believe its heart is in the right place. What they will never forgive is a government that is both uncaring and useless. And yet that is precisely the judgment that now hovers over Boris Johnson and the administration he leads.

Johnson had surely intuited as much when he performed his rubber-burning U-turn late on Thursday, ditching his previous insistence, reiterated 24 hours earlier, that foreign-born NHS and care workers must pay an extra fee for the privilege of using a service that could not function without them. The notion of such a surcharge reeked of meanness of spirit, the demand that it increase from £400 to £624 stank. The hypocrisy was particularly pungent: even Scrooge didn’t clap on the doorstep for those from whom he was squeezing every penny.

Clearly in-house genius Dominic Cummings is losing his touch if he didn’t see that one coming. Of course, the surcharge policy would have to be ditched. No government could be on the wrong side of health and care workers during a pandemic that has the nation clinging to doctors and nurses as its only protection. That would be true of a government that was handling things well. But it is triply true of a government handling things badly.

No need to dwell on the excess deaths number, which suggests Britain will soon have lost as many people to coronavirus as it lost civilians in the second world war. Contemplate instead the current situation, in which the government has already eased the lockdown in England and plans to ease it more on 1 June, even though it has not yet built a robust system that can find, test, trace and isolate new cases.

Maybe it will all come good on the night. Perhaps at 11.55pm on 31 May, a breathless Matt Hancock will rush towards the Downing Street microphone to announce, still panting, that the contact-tracing app is online and the last contact-tracer is in place. But for now this looks like a government that has seen a cart and a horse and put them in the wrong order. Surely, the first move was to build the system that would keep the lid on any future outbreak and only then – once the app was tested and working, once the tracers were not merely recruited but fully trained, once the local health organisations best placed to run testing were involved – start lifting the restrictions that have kept the virus under relative control.

Instead, the government is now hastily changing its story, explaining that an app previously touted as essential is now merely “the cherry on the cake”, so there’s no need for us to worry if it’s not ready yet. The focus now, they tell us, is on those human contact tracers. Except they’re not fully up to speed either. No wonder the NHS Confederation is warning of “a second surge” if the lockdown is eased any further.

Cart-before-horse has become the repeating pattern. Johnson dumped the simple “stay home” advice for the opaque “stay alert” – prompting the number of Britons who regard the government’s messaging as clear to drop from 90% to 56% – on 10 May while the daily death rate was still grievously high. He said people should be “actively encouraged” to return to their workplaces, before those places had been retooled for physical distancing. The inevitable result was to nudge people back on to trains and buses – regardless of his suggestion that they should avoid public transport – before he’d ensured a sufficient, accessible supply of the face masks that the best advice suggests are necessary for such travel. He’s doing it again now on schools, announcing a return date of 1 June before the extra teachers and classrooms are in place that would allow socially distanced teaching to be viable.

Logic would dictate that you prepare first and, once that’s done, you loosen the restrictions. Johnson’s preferred method is to signal a relaxation, then scramble to put in place the mechanisms that might make that relaxation possible.

The consequences of this “act now, prepare later” approach have been lethal. Witness the decision to release infected patients from hospital and back into care homes unequipped to receive them. Reporting by the BBC’s Lewis Goodall shows that the more expensive homes had the staff, and the space, to keep the virus at bay and keep their residents alive; the cheaper ones worked staff round the clock with no PPE, and the disease duly ran riot. Incredibly, those well-resourced homes kept their residents alive in part by defying government instructions, imposing an early lockdown when the official advice was to keep the doors open.

Add that to the long list of flawed decisions – the 11-day delay to lockdown, the football matches and concerts that were not stopped, the airports that remained (and still remain) open to unhindered arrivals from all over the world, the abandonment of contact tracing in mid-March – and it’s no surprise that the British Medical Journal (BMJ) declared this week that “the UK’s response so far has neither been well prepared nor remotely adequate”. Some of that, the BMJ argues, goes back to decisions taken over several years, such as austerity and the “decimation” of the country’s local and regional public health capacity. That may predate Johnson’s premiership, but it does not predate this government, which has been in power for a full 10 years. This is on them.

So far the public has been patient. It has granted its leaders the benefit of the doubt, allowing that this is a global crisis not of their making. Crucially, it has wanted to believe that the government means well, even if it is stumbling. That’s certainly been the perception of Johnson himself, who came so close to death at the hands of the virus. The surcharge row was a perilous moment because it shook that understanding, casting the government as lacking basic compassion.

More such moments are coming. Why is it right that foreign-born porters, cleaners and care workers are excluded from the automatic visa extension that has rightly been granted to doctors and nurses? Why is an army veteran who served this country, who worked and paid taxes, landed with a £27,000 bill for treatment that would be free to everyone else? How could Johnson praise two migrant nurses for saving his life and then say, “On the other hand …” as he attempted to defend charging them to use the NHS they work for?

He would be wise to learn the lesson of the reversal that was forced on him by an adroit Labour leader this week. Public patience for a government that is incompetent will not last long. But there will be no tolerance at all for a government that is both useless and cruel.

Jonathan Freedland is a Guardian columnist



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