The social contract between society and the NHS needs rewriting after this pandemic is over, writes Charles Ebikeme

The covid-19 pandemic has shown, once again, the deeply sentimental place that the NHS holds in the collective hearts of the nation, and how inherently political health and its provision have become. The policies that governments put in place ultimately decide—in broad yet definite strokes—who lives, who dies, who lives well, and who carries with them the burden of ill health. This is why in order to save the NHS, we must be willing to destroy it—or, at least, destroy the way our health is framed in society.

England’s previous chief medical officer, Dame Sally Davies, on more than one occasion, said that we focus too much on the NHS as an “illness service.” When we understand health in the UK solely through the familiar infrastructure of hospitals and GP practices, we neglect those elements that lay outside the traditional delivery of health services. We talk about health systems rather than systems for health.

Amid the #ClapForNHS, #TreatOurNHS, and general outpouring of support for the healthcare service lies something unspoken and perhaps uncomfortable in the way that we as a nation have put our vision of the NHS on a pedestal. Of course, during this pandemic, this is not something completely unique to the UK. Many other countries have been following similar rituals of tribute for their healthcare staff (although the distinction between staff and system is the key difference), but perhaps no other nation has made an idol of their healthcare system in the same way. During this covid-19 pandemic, government messaging has urged us to stay at home to protect the NHS, begging the question who is in service of whom? 

This deification of the NHS has come with some unfortunate side effects. We now raise money for our health service, donate goods to it, and even die for it. All this is taking place at a time when we’re truly starting to realise the impact of a decade’s worth of austerity measures and shrinking budgets, which forced the government to write off £13 billion of the NHS’s debt in early April. Let’s be clear that this was a write-off to essentially plug earlier funding gaps.

We cannot continue to pin the health of our nation entirely upon the NHS. With health ultimately affected by obesogenic environments, welfare safety nets, economic outlooks, and other inherent political decisions, governments wield a much wider influence on the health of their populations than they often take responsibility for. Where you decide to put a public space, a school, or a bus stop within communities are as much a part of our health systems as where you put hospitals and GP offices. Arguably, the best thing for the health of the nation would be to undo our deification of the NHS—or at least expand our understanding to include all those other things that also determine our health. 

The NHS isn’t a cure all or superhuman entity, even if many within it have worked under unimaginable conditions during the pandemic. It is staffed by our mothers, our sisters, our friends, our brothers, and our fathers. It is staffed by normal people who took an oath to do no harm and who every day make sacrifices for it. The social contract between society and the NHS needs rewriting after this pandemic is over. We need a rewrite that places the burden of health on the government, corporations, and citizens, and not just at the feet of our frontline workers.

Charles Ebikeme is a policy officer in the Department of Health Policy at the London School of Economics and Political Sciences. Twitter @CEbikeme

Competing interests: None declared.