Healthcare staff take a break to join a national "clap for carers" event. Photo: AFP

Amid the Covid-19 crisis, the United Kingdom is swooning. The entire country, it seems, has fallen madly, deeply in love.

The subject of this tsunami of affection? The National Health Service.

Britons have poured onto streets or stood in windows and doorways in nationwide “clap for carers” shows of appreciation. Flags — and even graffiti supporting the NHS — are appearing. Queen (the rump rock band, not the aging monarch) is re-releasing one of its greatest hits, “We are the Champions” with a lyric change to “You are the Champions” , dedicated to the NHS.

And a 100-year-old war veteran, Tom Moore has raised GBP32 million by walking laps of his garden, aided by a walking frame, to thank the NHS for its “magnificent job”. Moore’s epic efforts have won saturation media coverage and plaudits from the Queen (the monarch) and the prime minister.

Not since the death 0f Princess Diana in 1997 have Brits loosened their upper lips to unleash such emotion.

Just some of the 125,000 birthday cards sent to 100-year-old war veteran and voluntary NHS fund-raiser, Tom Moore. Photo; AFP

The United Kingdom did not invent universal health care, but the NHS was the UK’s gift to itself after its Pyrrhic victory in World War II.  Financially ruined and with its empire fading into the sunset, Britain’s global status dwindled, but after 1948 no Briton, however dire his or her financial circumstances, would henceforth lack medical care.

In the years since, the NHS has won near-sacred status. It is the institution of which Britons are most proud, according to a 2018 study.

Today, the NHS frontline staff are risking their own lives to treat others affected by Covid-19. “Greater love hath no man than this…”

Given all the foregoing, the ongoing NHS love fest is a stirring show of support for an embattled body that has lost over 100 carers to the Covid-19 scythe.

So, it might seem churlish to question the work being done by this hallowed institution amid the greatest health crisis in living memory.  

But at a time when intense debate is rising over the government’s role in the crisis, to assume that the nation’s health service can or should somehow be above criticism for its management of a health crisis is illogical and un-democratic. 

And that management does not look good by any international comparison. Even if Brits love a plucky loser, they are not witnessing the work of a “champion.” In fact, stark metrics suggest that the British mishandling of the pandemic may be the world’s worst.

Grim tally

The UK is surging to the top of a trifecta of Covid-19 metrics: total infections; total deaths; and case-fatality rates.

As per data from Johns Hopkins University at time of writing, the United Kingdom (population: 66 million) is fourth in total infections, with 178,685 cases. This compares to the United States (population: 328 million) with 1,103, 781 cases; Spain (population: 47 million) with 213, 435 cases; and Italy (population 60 million) with 207, 428.

When it comes to death toll, the UK looks worse. Leading the world is the US with 62,996. Italy is second with 27,967. The UK is third, with 26,842.

Worst of all is the UK’s status in case fatality rates — ie the rate of deaths among those treated. In that, the UK, with a 15.6 rate, is the second highest in the developed world, behind Belgium (just) with 15.7%.

Meanwhile, Italy’s rate stands at 13.6%,  Spain’s at 11.5% and the US, which does not have universal health care, is at 5.9%. (There are two localities with higher case fatality rates than Belgium and the UK — Antigua and Barbuda with 12.5% and Nicaragua with 21.4% — but both are in the developing world.)

What is going on?

Certainly, Westminster must shoulder some blame for infection rates. This is, to a considerable extent, a result of policy and/or non-policy. Closing borders, halting large gatherings, mandating social distancing, locking down localities, and the timelineness of all the previous measures, are all factors.  

Naturally and reasonably, Boris Johnson’s government is facing heavy flak and being forced to answer questions on this account.  

Prime Minister Boris Johnson – who himself survived a brush with Covid-19 – joins the applause for NHS workers at his official residence, 10 Downing Street. Photo: AFP

But when it comes to deaths, and most particularly case fatality rates, matters are not so simple.  And the latter metric — the ratio of deaths-to-diagnosed — is particularly damning for the NHS.

National age — the biggest risk factor for Covid-19 mortality — cannot be blamed: The UK is only the 25th oldest country in the world.

The metric also relates to the number of tests — the more tests conducted, the more mild cases will be uncovered, lowering case fatality rates. On this front, the UK has done reasonably well.

As of April 30, the UK had conducted 901, 905 tests. That compares favorably with the global gold standard for testing, South Korea (population: 51 million), which had conducted 619,881 tests by the same date.  

So what is left to zero in on, when it comes to explaining the UK’s high case fatality rates? After age and tests, the only remaining factor is medical treatment.

NHS: The champions?

The current ambience of passionate adulation should not camouflage harsh data findings. Nor should it prevent NHS civil servants from facing the kind of grilling that policy makers are undergoing.

Is NHS leadership on point? Are its processes sound? Is its equipment adequate? Are its staffers well trained? Are its treatment protocols correct? Is reform necessary?

These questions are especially germane given the vast resources the NHS currently commands. Not only have hundreds of thousands of volunteers flocked to assist the service, the Armed Forces have also been deployed in their aid.

While it may be too early to ask them now, these questions must be raised. Meanwhile, pre-pandemic international studies don’t award the NHS the kind of high global rankings one might expect, given the UK’s status as a G6 economy.

 A 2020 study by World Population Review found the NHS was ranked 18th worldwide while the Euro Health Consumer Index for 2018 found the UK in 16th place out of 35 European countries.  

The many persons who insist that the clunky state of the NHS is due solely to underinvestment may be shocked to learn that the UK was actually comfortably in the top half of the OECD (16 out of 37) in 2014 when it came to per-capita spending on health. But when it comes to the related question of effectiveness, a 2019 Bloomberg study on the health-care efficiency of 56 economies found the UK in 35th place.

But national self-analysis must extend beyond the government and the NHS.

Health is an issue of personal responsibility and lifestyle-related issues also correspond to coronavirus vulnerability. For example, the UK is the 33rd most obese of 191 countries surveyed by the WHO; it is also the 8th  most obese in the OECD.

The public must also ask themselves if their behaviors and attitudes — toward mask-wearing, personal sanitation and privacy — have added to the butchers’ bill.

A masked pedestrian walks past graffiti thanking the NHS. Photo: AFP

Time for introspection – on steroids

Self-criticism, with the prospect of reform, is a habit that the United Kingdom must urgently cultivate as it stands on the brink of another great challenge.

 At year-end, it embarks upon full-on Brexit (as opposed to the on-paper Brexit announced in January).  Extrication from the EU was never going to be straightforward but all indications are that it is going to be an even more fiendishly difficult process than was ever anticipated.

Covid-19’s rampage could ease or exacerbate this situation. The dire financial straits that British and European governments are going to find themselves in as they add up the colossal costs of lockdowns are going to focus minds.

Hopefully, this will promote sober-minded pragmatism and a win-win solution. Alternatively, it could have the opposite effect, inflaming nationalistic British posturing and bitter European vindictiveness.

Regardless, Covid-19 has made clear that the British ship of state is leaky and creaky compared to others in Europe and around the world.  One can only hope that the health crisis that has exposed so many fractures will be a wake-up call for national introspection.

Introspection, however, requires silence. It can only come after the echoes of hand clapping and Queen anthems have faded away.  

Andrew Salmon, a South Korea-based Briton, is Asia Times’ Northeast Asia editor.