How can we expand NHS capacity to build social solidarity?

(Since improving social solidarity is seen as one answer to building a better response to this and future pandemics, and the NHS is a good example of social solidarity, perhaps we should be reassessing our relationship with it?)

  • During Covid Thursday clapping for the NHS was a real example of solidarity.
  • During Covid Thursday clapping for the NHS was helped by the Government showing a nod towards social solidarity.

Both of these statements are true. This Government spends millions of pounds of public money on focus groups and polling every month and recognised very early on in the crisis, that the NHS was an institution that the public loved. And since that love was almost universal, the NHS represented an institution around which people united. It was National. In the midst of all the daily experience of I, it represented a very powerful we.

And given that the infection crisis was and is a crisis where the we of collective behaviour has to overcome a great deal of the I of what individuals want to do, Covid has made social solidarity vital. Right now, as the libertarian wing of the Parliamentary Conservative Party grapples with the difficult geographic reality of very low infection rates in rural areas being adjacent to high ones in urban areas, the I/ we split is at the heart of the Covid problem for the Government. If my constituency has a group of villages with very few infections, why should they be in tier 3 just because they’re next to a town with three times the rate? (You can see how this plays the ‘we’ that the Prime Minister wants to appeal to against the ‘I’ of where I live).

Since social solidarity has been key to changing our behaviour during the crisis, it is not at all surprising that our iconic NHS has been called into play. In the UK all analysis of opinion shows it is THE institution with which most people feel some individual and familial solidarity.

Let’s try and broaden our understanding of how that works and think a bit about how we can develop this social solidarity as a bigger cornerstone of our society

Since 1948 the NHS has been an institution based upon strong reciprocity. As with all institutions over 70 years old this reciprocity is both real and symbolic. In 2020 British people love the NHS because they and their parents have done so for decades (and still do).

This reciprocity is also real because as an individual I know that if I were to fall ill I would not have to empty my bank account to get treatment. The NHS will look after me. I know it will because I have paid for it to do so over the years out of my taxes.

Then a pandemic hits. I see pictures from Italy of people in hospital gasping for breath and I really hope I don’t get it. But if I do the NHS will look after me.

For 70 years the social solidarity of the NHS has meant that during sickness it will have my back. I think that every month. Then in 2020, in this year of sickness, many people are thinking that every day. The light is shone brightly upon an institution that many people feel they have helped to pay for through taxation (and for which most, if they could trust the tax and spend mechanism, would pay more tax).

So when, in March, the Government was searching for a way of explaining that everyone needs to change their behaviour – they said “Protect the NHS”. If you don’t change your behaviour and the NHS is unprotected, I’m afraid it may not be there for you if you get ill.

They recognise the power of an appeal for social solidarity through a national institution like the NHS.

The reciprocity is vital. We have to do something for the NHS so that it does something for us. The reciprocity of paying taxes is us doing our bit for the NHS. The payment of taxes is our vital part of the relationship. Not only do I pay my taxes but everyone else does as well and that allows us all together to have an NHS. I do my bit by paying taxes – you do your bit by paying taxes – and the NHS does its bit by caring for us all.

In some ways this bargain – taxes for health care whenever we need it – is a good example of reciprocity. But in a deeper way – we – the civilians who don’t work for the NHS – don’t have to do much except pay taxes. That contributes to social solidarity – but if we want to do more we could include other behaviours as well as paying taxes. But at the moment we don’t.

Over the past 70 years this bargain has not been one that has expected much else from the public. Our involvement is in the taking of our money through taxation. And it ends there. The NHS gives us back a range of things for the money alone. The NHS organises itself to look after us and clinicians have the knowledge to do what is necessary to make us better.

If we want more social solidarity from the NHS the bargain needs to be redrawn – as it has been a bit during the pandemic. Alongside the taxes we have continued to pay, the NHS would like us to restrict our behaviour in terms of how we spend time with each other. Wear a mask, social distance and help the NHS. For the first time in a long time the NHS expects as reciprocity behaviour change and not just taxation.

If the NHS wants to increase its power of social solidarity it has to expect more of us in terms of our behaviour around health care.17 million citizens with long term conditions will have to play a bigger role in managing their conditions – and will need to be let into the mysteries of health care if they are going to do it. And more people need to look after their health better to avoid getting a condition in the first place.

The reciprocity of the last 70 years that created the NHS bargain – care for taxation – needs to be deepened to include much more activity from the population than before. Covid has begun to teach us this lesson and in the very near future the NHS is going to have to refashion reciprocity by allowing us all into the mysteries of our health care.