How do we give thanks for the NHS? The Queen gets it. Do the politicians?

As she always does, the Queen has caught the national mood. Conferring the George Cross on the National Health Service sends the right signal at the right time. Boris Johnson made the recommendation, as is right and proper in a constitutional monarchy, but it is the Sovereign who has put her personal stamp on this award. She knows that words matter and always finds the mots justes.

Writing on Windsor Castle notepaper in a hand that is still remarkably firm, elegant and legible, the Queen expresses the country’s gratitude by bestowing its highest civilian honour on “all NHS staff, past and present, across all disciplines and in all four nations”. With just 80 words in four crisp sentences, she sums up our awe at the “courage, compassion and dedication” of doctors, nurses and other NHS staff “over more than seven decades, and especially in recent times”. When the Queen writes of her “great pleasure, on behalf of a grateful nation” and concludes with “our enduring thanks and heartfelt appreciation”, she evidently means every word. This is perhaps the finest thank-you letter ever written.

It is especially satisfying that health workers, uniquely exposed to risk during the pandemic, should receive an award for gallantry. The George Cross has hitherto been given collectively only twice: once in wartime, to recognise the heroic endurance of Malta under Nazi air assault, and more recently to the Royal Ulster Constabulary (now the Northern Ireland Police Service) for its long struggle against terrorism during the Troubles. The NHS, too, has lost many of its best people to this coronavirus; their sacrifice is not forgotten.

What, though, will the immediate future bring for our National Health Service GC? As the Prime Minister will remind us today, the pandemic is by no means over. Among younger age groups, the Delta variant is still spreading exponentially. What has changed is not the number of cases, but their severity. The vaccination programme has proved to be even more successful than we dared to hope, but scientists are still anxious to see how the hospitals will cope over the coming months once all restrictions are lifted. If the models are correct and the present third wave peaks at 100-150 deaths a day, the UK will be more fortunate than some other European countries, where the Delta variant is only just taking hold and may yet force governments to reimpose lockdowns, curfews or other restrictions.

As winter draws near the NHS, then, will need to remain vigilant on the Covid front. But it also faces a waiting list for other conditions that has swelled to more than five million. This unenviable record will require a huge new effort to overcome. In one of the largest economies in the world, it is simply unconscionable to expect people to wait years for operations, often in great pain and putting their lives on hold.

Most serious of all, the pandemic has revealed the huge disparities in health between regions, social classes and ethnic groups. In the North West, for instance, life expectancy for men fell by 1.6 years in 2020. The poorest have everywhere suffered far more than others, while controversy continues about the underlying causes of higher rates among black and Asian communities. The Government has promised to address health inequality as part of its levelling up agenda, but there is as yet no clear plan. Sajid Javid will have his work cut out to bring about a sea change in the bureaucracies that have allowed these disparities to emerge, while simultaneously keeping the NHS from being overwhelmed by new epidemics and the backlog of patients.

Two areas in particular have been highlighted in recent months, but without sustained attention may slip back out of sight: mental health and social care. “Long Covid” is believed to have afflicted about two million people who have struggled to make a full recovery. To a phenomenon that is not yet well understood by the medical profession must be added so-called “Covid languishing”, which is perhaps as much a reaction to the deprivations, anxieties and solitude necessitated by the pandemic.

The long-term neglect of mental health is no longer acceptable to people and the Government has acknowledged that something must be done, but attitudes take time to change. Some employers, for example, are likely to treat complications arising from Covid as hypochondria or malingering. Employees, however, may take the view that expecting obviously unwell staff to “soldier on” in the office has had its day. Some firms are already demanding that staff come into the office rather than work from home, on the assumption that the latter is second-class — whereas all the evidence suggests that remote working means longer hours and more efficient use of time. We are never going back to a world where commuting and office attire were requirements of employment. Indeed, the energy-guzzling office blocks of today may go the way of the smoke-belching factories of yesterday. The lesson of these Covid years is surely that our previous lifestyles were much unhealthier than we ever knew. So the new normal must reflect an understanding that the way we live and work must change in order to stay ahead of threats to our health and wellbeing.

In practical terms, the NHS will have to go on changing merely to stand still. After the care home crisis last year, however, social care for the elderly cannot any longer remain a Cinderella service, neglected and underfunded by comparison with the NHS. The ignorance displayed by ministers and officials about the way that staff move around the care sector, which was the prime cause of the appalling death rate in some homes, must never be repeated. While that catastrophic failure of government still commands the attention of Number 10 and the Treasury, Sajid Javid has an opportunity to redress the balance. The “dementia tax” debacle during the 2017 election campaign, which derailed Theresa May’s premiership, still haunts politicians. The solution is not to file away the problem, but to address it at a time when the public is prepared to entertain bold ideas as long as they are thought through. A Conservative Government should place the emphasis on families and fairness, self-reliance and choice. Javid should be burning the midnight oil to come up with a Social Care Bill not next year, but this.

With her words and gestures, the Queen has set the right tone. But she knows that these are not enough. There will never be a better time for radical reforms to improve the nation’s health. Our gratitude to the NHS must take a lasting form: it is not enough to acknowledge the individual achievements and collective efforts of staff with well-deserved honours, or even with better pay. We must also take to heart the truism that prevention is better than cure. A Prime Minister who last year came closer to dying in office than any of his predecessors for more than a century should not need reminding that going back to the status quo ante is insufficient. Nothing less than a sustained effort by society as a whole to look after our families, our neighbours and ourselves will do. At 95, the Queen gets it. Do the politicians?

A Message from TheArticle

We are the only publication that’s committed to covering every angle. We have an important contribution to make, one that’s needed now more than ever, and we need your help to continue publishing throughout the pandemic. So please, make a donation.