A cynic, wrote Oscar Wilde, is somebody who “knows the price of everything and the value of nothing”. Nowhere do those words appear truer than in the matter of human life itself. What could be more distasteful than attaching a price tag to a person – as though their worth can be measured in pounds and pence? A human life, surely, is priceless; no amount of mere money or stuff comes close.
The pandemic has destroyed such simple certainties. First, we stared in collective disbelief as Covid ravaged northern Italy. Next, we recoiled at the grotesque implications of achieving “herd immunity” by allowing the virus to race unchecked through the UK population, culling those deemed expendable by covert decree and government inaction. Quickly though, counter-narratives emerged. Lockdowns were pernicious and caused more harm than good. Economic Armageddon was deadlier than allowing older and economically unproductive people to die. The nation’s mental health mattered more than anything. This death was worth it, to avoid that one over there.
As we now approach our second winter with Covid-19, these debates – if you can call them that – have never been more poisonous. Healthcare workers in particular are subjected to slurries of hatred and abuse. Newly qualified nurses, volunteers at vaccination hubs and even children on their way to school have all been harangued in person by Covid anti-vaxxers. Perhaps the only thing anyone agrees on for certain is that we are all sick to death of the virus. Moral absolutes – such as clapping for key workers – now seem like ancient history.
In this febrile context, it is easy to dismiss the current dire warnings from the NHS frontline – or to use them to push the case for privatisation. As the Telegraph’s associate editor, Camilla Tominey, puts it: “We have now locked down three times for the NHS. How many more do they need? Taxpayers are already pouring £3bn a week of their hard-earned cash into the health service … Forgive me, but what on earth have they been doing for the past six months, when the NHS hasn’t been overwhelmed by Covid?” A Times editorial goes one step further, declaring “the pandemic has intensified pressures on the service’s budgets. There is no realistic alternative to charging for treatment and extending the role of private insurance.” Confusingly, the health secretary, Sajid Javid, claims to the contrary that Covid plan B measures are not necessary since the NHS does not, apparently, face unsustainable pressures.
From the perspective of NHS staff, Javid’s assertion feels like an outright denial of reality. I do not know a single colleague who thinks conditions inside the NHS right now are anything other than desperate. We are striving to address the vast backlog of care postponed due to Covid, but the truth is that the NHS has been in crisis for months now. Many hospitals – my own included – have been on black alert virtually continuously since early summer. This means that every bed in the hospital is full. Until a patient is discharged, no one new can be admitted.
The knock-on effects for patients are pernicious. Paramedics are spending entire 12-hour shifts trapped on hospital forecourts, unable to hand over their sick patients to A&E. This means that some 999 calls are going unattended. Patients are dying at home or in the back of stationary ambulances, never receiving the hospital care that might have saved them. Last week, an anonymous paramedic in Cornwall said: “Imagine if we piled the bodies that have died because we have arrived too late outside the hospital next to each other so that everyone could see how badly the system is failing the public, then there would be public outcry … if they knew how many were dying needlessly then it would be on the front pages of every national newspaper.”
These are “never events” in NHS parlance: these are events that fall so far short of acceptable standards of care they should not occur even once, let alone routinely. Never events are blighting cancer care too. For months, cancer operations have been intermittently cancelled due to lack of intensive care beds, but now even chemotherapy is being rationed too. Lucy Gossage, a consultant oncologist based in Nottingham, recently described her anguish at being forced to reserve chemotherapy for only those patients whose cancer is deemed curable. “Currently, we are unable to offer chemotherapy that aims to prolong life or palliate symptoms for many people with advanced cancer,” she wrote. “We hope this is very temporary, but it’s indicative of a system on its last legs.”
If you are lucky enough to be brimming with health – the kind of person who rarely needs to see a GP, let alone pay a visit to hospital – all of this may feel remote and esoteric. It is very easy to turn a blind eye. In the NHS, though, we do not have that luxury. Ours is a gut-wrenching, zero-sum game in which there is absolutely no spare capacity. It does not matter that there are fewer Covid inpatients now than in January, when we are frenetically trying to deliver business as usual. Every patient in hospital with Covid takes resources away from another patient with cancer, heart disease, a stroke or sepsis.
All of this highlights a fundamental truth. Human life, however much we want to pretend otherwise, most definitely has its price. We may feel squeamish voicing it out loud, but society permits some people to die because the cost to others of preventing those deaths is deemed too high. In short, we place a monetary value on human lives every day. Democratic elections simply set the parameters.
The question we all need to ask as winter looms is: how much dying are we happy with? Are we OK with A&Es too full to function properly? Or with cancelled cancer surgeries and rationed chemotherapy? And if not, then what costs are we willing to incur so that these “never events” do not become routine occurrences? These are hugely difficult and uncomfortable conversations, with no glib or easy answers. It is our immense misfortune to have a prime minister who chooses to dodge rather than answer them.
Rachel Clarke is a palliative care doctor and the author of Breathtaking: Inside the NHS in a Time of Pandemic