While Boris Johnson is happy to clap for NHS workers on his doorstep, his government has made it almost impossible for our amazing NHS to tackle coronavirus effectively.

Over the past 10 years, this government has starved our NHS of funds and privatised large parts of it, leaving it in the worst possible state at the start of the crisis. Capacity and morale are both rock bottom.

To make things even worse, the NHS doesn’t have the tests and equipment it needs, and Johnson seems unwilling to lead, co-ordinate, and tell companies what to do. 

Free market fundamentalism is dangerous at the best of times. Right now it’s wildly irresponsible. While Johnson is self-isolating with Covid-19, he needs to rethink his understanding of the role of the state.

In a few short weeks, he’s learned to tell us to stay away from the pub. He could save lives now and in the future by following this four-point plan.

1. Don’t Wait, Co-ordinate

Right now our frontline health staff don’t have the equipment they need to save lives and to keep themselves safe while doing so. The BMA is warning that “within weeks 100% of patients and staff will be infected, and it will be just pot-luck who survives”. NHS workers are heading to DIY stores to protect themselves. Nurses may soon be wearing rubbish bags for makeshift protection, as has been happening in New York City Hospitals this week. 

Meanwhile we know that the NHS will need at least 30,000 ventilators in order to cope with the peak of this crisis – possibly three times that number, as 30,000 is the target for New York state, whose population is only a third of the UK population. We need solutions, fast.

The government’s response to this life-and-death procurement problem so far has been totally inadequate. While the EU has taken decisive, coordinated, top-down approach to procuring safety and medical equipment for the crisis, the UK apparently missed the deadline to join in. 

Instead, UK ministers have taken to Twitter to challenge the private sector to step up its production of key supplies. The government is acting like Alan Sugar setting a challenge for contestants on the Apprentice. Dangling a carrot in front of manufacturers and hoping for the best isn’t a serious solution.

And the government doesn’t even seem to be serious about their own challenge. Several small ventilator suppliers are saying that they’ve made offers to the government and heard nothing. Dyson should be applauded for taking quick action to manufacture 10,000 ventilators. But this is at best only one third of what the country needs – too little, too late. And we don’t just need ventilators, we need a larger supply of protective personal equipment than ever before.

It’s great that innovative companies and voluntary efforts are kicking off. But it’s the government’s job to lead, coordinate and make this happen by whatever means necessary. The invisible hand of the market really is invisible right now.

The government should have been on the case months ago and now it should be pulling out all the stops. It should be telling – not asking – all relevant companies and technical experts what the plan is, and requisitioning every factory and workplace needed to deliver it as quickly as humanly possible.

2. Put People Before Profit

We didn’t end up here as a result of conscientious contingency-planning or a sober-minded assessment of the nation’s healthcare needs. We ended up here thanks to decades of cuts and ideologically-driven pressure on the NHS to outsource.

The NHS needs to be reinstated as a fully public service as soon as this crisis is over.

The UK public is constantly wasting money on privatisation – on the administrative costs of complex procurement processes, on reimbursing Richard Branson when he sues, on paying private company CEO salaries.

The government has agreed to bring private hospitals into public hands to deal with the crisis, but we’re not sure at what cost. The government’s instinctive approach is to reassure private providers about their profits, whether in our NHS or on the railway. This means money flowing into shareholder pockets that could be used directly to save lives.

Putting profit first also means lower standards. For example, outsourcing of hospital cleaning makes our hospitals less safe, directly leading to deaths.

But just as importantly, creating complicated, fragmented quasi-market structures within the NHS makes it difficult to deliver in a crisis and hold people accountable.

While we watch government ministers waffle about ventilator orders on the news, NHS Supply Chain – a key organisation within our health service – is coordinating action. Most of us have never heard of them and the diagram from their website hardly helps us to understand what is going on.

Nine different providers are involved in meeting NHS supply chain needs. Ward-based consumables and infection control equipment are supplied by DHL Life Sciences and Healthcare UK — a subsidiary of a multinational logistics company whose profits were €4.1 billion in 2019, and whose CEO, Frank Appel, is already reassuring shareholders of the company’s determination to protect those eye-watering profits through the coronavirus crisis. 

It’s worth noting that New Labour opened the door to outsourcing of NHS Supply Chain. In 2006 NHS Logistics was privatised and its entire operation handed over to DHL. After DHL held that contract for 12 years, it now sits with Unipart, another multinational logistics company. 

The current paralysing vacuum in leadership and accountability is jeopardising people’s lives. It looks like the privatised, profit-driven, complex NHS Supply Chain, combined with the government’s hands off attitude, is part of the problem. The government should knock heads together as needed and nationalise it as soon as possible.

3. Do it Directly

After insourcing key services, there is no good reason why we shouldn’t have state suppliers of vital equipment and drugs, rather than relying on private companies who answer to shareholders first. Right now corporations are calling the shots and leaving our NHS at the whims of a global market.

Big pharmaceutical companies hold patients and the public to ransom for providing life saving medicines, even when investment has often relied on governments. So the NHS often pays twice, for the original development of the drug and then for the inflated prices.

Gilead Sciences, a pharmaceutical company in the US, has been given an exclusive licence for seven years to profit from its development of a drug that is one of the possible treatments for coronavirus. Just Treatment points out that they now have a monopoly and can dictate the price.

Pharmaceutical giant Roche has signed a deal to help deliver COVID-19 tests to patients and workers across the UK. But in the Netherlands, where it has 80% of the market, it has been unwilling to share information with Dutch testing labs to help them carry out mass testing.

More generally, the NHS has increasingly relied on the private sector in ways that leave it vulnerable. 

There is no UK-owned company among the top 10 hospital bedmakers. There is one (Sidhill) in Halifax which still makes beds but it was taken over by a US private equity firm three years ago just after developing a leading new design.

Since the summer, the NHS has been scrambling around to provide intravenous nutrition to 1300 patients at home, after the main manufacturer, Calea, was found to be unsafe.

We should set up a government-run manufacturer, alongside private suppliers, to ensure that the health system stays fully equipped during times of crisis. It could make large quantities of items we know the NHS will need, and be prepared to leap into action as needed.

We also need a national state owned pharmaceutical company, as put forward in Labour’s latest manifesto, to make sure publicly funded drugs are affordable and accessible to everyone.

These new in house providers can hire the right people, source the right designs, and produce quality product to order. And they can save big with sensible pay for executive staff, instead of bloated private sector salaries. 

The government has already made moves in this direction, setting up a pioneering new Vaccines Manufacturing Innovation Centre.

While corruption is rife in medical equipment deals across Europe, the World Health Organisation points out that in India ‘the presence of the public sector units has prevented cartels’. 

Direct manufacture of essential health products would create an extra level of security in the supply chain, so that when a crisis is looming the government can ramp up production as quickly and directly as possible. This might mean high level equipment like ventilators or more basic products. New York State is producing its own hand sanitiser. Arguably the government should have been producing and distributing paracetamol and thermometers to towns and cities weeks ago, as the shops were running out.

Why would we choose to be at the mercy of complicated global supply chains for vital equipment and drugs that we can make at home?

4. Fund Our NHS Properly

The crisis we are seeing now is the consequence of a slow motion train wreck that started a long way back. The government has slashed funding, leaving the NHS short of 100,000 staff and 17,000 beds. Since 2010, there has been a winter crisis every year.

This is an issue that cuts across party lines. Tens of millions voted for Brexit because they believed that Brexit was the best way to support the financial health of the NHS. Everyone in this country wants a well-funded, fully functioning NHS. And 84% of us want it to be publicly owned, reinstated to its full glory, not privatised and outsourced piece by piece.

In this crisis the government has shown that they can and will mobilise large sums of money in order to save lives. 

A fully-funded NHS, reinstated to work for people not profit should not just be emergency procedure. It should be standard operating procedure.