{"id":3834,"date":"2020-05-20T02:10:02","date_gmt":"2020-05-20T01:10:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3834"},"modified":"2020-05-20T02:10:02","modified_gmt":"2020-05-20T01:10:02","slug":"what-are-matt-hancock-and-boris-johnson-talking-about-when-they-talk-about-protecting-the-nhs-and-why-does-it-matter","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/05\/20\/what-are-matt-hancock-and-boris-johnson-talking-about-when-they-talk-about-protecting-the-nhs-and-why-does-it-matter\/","title":{"rendered":"What are Matt Hancock and Boris Johnson talking about when they talk about protecting the NHS? And why does it matter?"},"content":{"rendered":"

By Piyush Pushkar<\/p>\n

<\/h5>\n

What is the NHS?<\/strong><\/p>\n

\u201cStay home. Protect the NHS. Save lives.\u201d<\/p>\n

The UK government\u2019s public health messaging from 20 March to 10 May was short and direct. The brevity suggests clarity of meaning, but that clarity begins to dissipate when one asks, \u201cWhat is the NHS?\u201d The short answer is that the NHS is the UK\u2019s tax-funded, state-run healthcare system. (Commonly, the NHS is used to refer to England\u2019s NHS, as Scotland, Wales and Northern Ireland have independent healthcare systems.)<\/p>\n

This article provides an alternative viewpoint on what the NHS is. For the political activists with whom I did ethnographic research in 2017 and 2018, the NHS was important to them because it symbolised something important to their ethical worldviews. If we consider that the NHS is a symbol, as well as a healthcare system, then we must remember that the meanings of symbols change in response to how we use them.<\/p>\n

 <\/p>\n

Stay home. Protect the NHS. Save lives.<\/strong><\/p>\n

The UK\u2019s lockdown has been accompanied by the tagline: \u201cStay home. Protect the NHS. Save lives.\u201d The message is designed to encourage compliance with the lockdown and \u201cflatten the curve\u201d. The purpose of flattening the curve is to reduce demand on health services, thus giving said services a maximal chance of being to cope with an unprecedented crisis.<\/p>\n

Social distancing and lockdowns are well recognised public health strategies<\/a> being employed in multiple countries. However, lockdown has been experienced in different ways by different states. Each place has its own specific social and historical context in which public health strategies play out. The UK context was one in which the health services being protected had seen restrictions<\/a> in funding<\/a> for many years, at the same time as an increasing need for healthcare from an ageing population<\/a>.<\/p>\n

 <\/p>\n

Protect the NHS\u2026 from what?<\/strong><\/p>\n

In 2017 and 2018, I spent 13 months doing ethnographic fieldwork with people who protested against recent NHS reforms. I was investigating how they brought their own ethical worldviews into their political campaigning, and vice versa. As well as interviewing them, I attended protests, internal meetings, leafleting sessions, social gatherings, and appointments they organised with healthcare managers and politicians.<\/p>\n

The activists all disapproved of the aforementioned restrictions in funding<\/a>, which they described as \u201ccuts\u201d. Most of them also objected to privatisation of health services, which they felt was morally wrong, for multiple reasons I have explored elsewhere<\/a>.<\/p>\n

Years before COVID-19, these activists also spoke of protecting the NHS. They were attempting to \u201csave\u201d or \u201cprotect the NHS\u201d from cuts and privatisation. The meaning of protecting the NHS has now turned on its head. Rather than protecting the NHS from being diminished, the new usage of the phrase means to protect the NHS from being overwhelmed by the people it is meant to serve. The government is using the exact same rhetoric as the people who were protesting a reduction in capacity. The irony is that had resources and capacity been maintained, as requested by the activists, the NHS (and England\u2019s public health infrastructure, which was separated from the NHS<\/a> in 2013, but still subject to fiscal restraint) would have been better prepared for COVID-19.<\/p>\n

The difference in meaning raises an interesting question regarding the meaning of the NHS. What exactly are activists and the UK government talking about when they talk about protecting the NHS? For the activists with whom I did research, it was an icon of the kind of society that they felt the UK has been in the past, and ought to be in the future. They referred to their own memories of the NHS, and used these memories as comparators against which they could judge the contemporary NHS. Their memories of a past NHS were powerful because they facilitated an understanding not just of what a good state ought to<\/em> provide, but also what it could<\/em> provide. Free, comprehensive, universal healthcare was not just ethically desirable. It was politically possible.<\/p>\n

What was the nature of the icon that they considered the NHS to be? For them, the NHS symbolised the values of a solidaristic society in which people cared for and took responsibility for one another. The UK government\u2019s recent references to the NHS also invoke a spirit of solidarity and mutual responsibility. Citizens are encouraged to stay home in order to protect others. The UK government\u2019s messaging can be made to fit Prainsack and Buyx\u2019s definition of solidarity<\/a> as \u201can enacted commitment to carry \u2018costs\u2019 (financial, social, emotional or otherwise) to assist others with whom a person or persons recognise similarity in a relevant respect\u201d. Citizens are showing solidarity with fellow citizens by being willing to put up with the costs of staying home, to protect everyone\u2019s health by protecting the NHS. So how does this recent messaging differ from how NHS activists conceived of the NHS and solidarity?<\/p>\n

The key difference lies in how solidarity is achieved and how responsibilities are fulfilled. For my research subjects, the NHS showed that the state could and should intervene to foster a good society, and provided a model for how. Thus they sought to protect the NHS from a government that they felt was malignantly undermining solidarity, as they imagined it. Conversely, the current UK government uses the same symbol, conscious of its rhetorical power<\/a>, to redirect responsibility for public health back to the citizens themselves. In this new framing, it is the irresponsible person who has left the house unnecessarily who has undermined solidarity.<\/p>\n

 <\/p>\n

Conclusion<\/strong><\/p>\n

I have compared how activists campaigning against cuts and privatization used the symbolism of the NHS to how it is currently being used by the UK government. Clearly, the different usages lead to different moral arguments and different political conclusions, and thus would be likely to lead to different policy prescriptions and health consequences. Therefore, it will be important for us to monitor how and why state actors are talking about the NHS. As we begin to plot possible pathways out of lockdown, the UK government\u2019s messaging has changed<\/a>. Although the new slogan has been criticized for a lack of clarity, protecting the NHS remains a key discursive backbone<\/a> of the government\u2019s justifications for current and future actions. For us to evaluate those actions, we must continue to ask what they mean when they talk about the NHS.<\/p>\n

 <\/p>\n

Author:<\/strong> Piyush Pushkar<\/p>\n

Affiliations:<\/strong> The University of Manchester<\/p>\n

Competing interests:<\/strong> I have no financial interests to declare.<\/p>\n

Social media accounts of post author: @DrPiyushPushkar<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By Piyush Pushkar What is the NHS? \u201cStay home. Protect the NHS. Save lives.\u201d The UK government\u2019s public health messaging from 20 March to 10 May was short and direct. The brevity suggests clarity of meaning, but that clarity begins to dissipate when one asks, \u201cWhat is the NHS?\u201d The short answer is that the […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":353,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8070],"tags":[304],"class_list":["post-3834","post","type-post","status-publish","format-standard","hentry","category-pandemic","tag-public-health"],"yoast_head":"\nWhat are Matt Hancock and Boris Johnson talking about when they talk about protecting the NHS? 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