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Possibly the stupidest measure in Sunak’s Budget was the announcement that the ‘migrant surcharge’ has been increased to £641. This is the charge introduced a few years ago that migrants must pay to retain eligibility to use the NHS. It will also extend to European nationals from January next year. This is stupid because the scheme requires huge bureaucracy to administer and raises little money. It is more about posturing to the Tory base and scapegoating migrants for the NHS’s ills than it is about sensible finances.

It’s also stupid because the far more sensible thing to do in response to a public health crisis would be to announce an immediate suspension of the whole of Theresa May’s pointless and cruel NHS charging regime on migrants. This includes a range of charges, not just this surcharge, and leaves many UK residents scared of accessing health services when they need to. In theory, these charges are suspended if migrants are suffering from severe infectious disease like the new coronavirus. But when you’ve spent eight years deliberately cultivating a hostile environment, that fear isn’t going to turn off overnight without a big and bold statement. Sunak’s announcement goes in precisely the opposite direction.

Oh, and it’s also stupid because the surcharge applies to the many foreign nationals who currently work in the NHS, and we’re likely to be relying on them rather heavily in the months to come.

If not now then when?

A threat from a virus should remind us that what we have in common is humanity, and we can only solve this by improving collective resilience – we’re only as strong as our weakest link. So the government needs to start addressing the economic (and legal) inequalities that undermine that collective resilience.

The measures I’ve suggested – raising the level of sick pay from its current paltry level, extending its eligibility to the self-employed and low earners, and suspending the NHS migrant charging regime – could be implemented quickly and would help limit the spread both of the virus and of anxiety. But so far, it seems the government lacks the political will. Common sense is lagging behind decades of knee-jerk shirker- and migrant-bashing.

Others measures vital to improving our collective resilience will take time, as well as political will. It will take time to tackle the austerity-mediated decline in poorer older people’s life expectancy, and their vulnerability to disease. And to clean up the dirty air that’s already taken three years off average life expectancy and weakened people’s respiratory and cardiovascular systems.

Most alarmingly right now, it will take time to reverse the dramatic shortages in trained NHS staff, after what Helen Buckingham, director of strategy and operations at the think tank Nuffield Trust, calls “10 years of underfunding and a failure to understand staffing”. No one thinks we’re going to be able to replicate the Chinese government’s feat of building and somehow staffing hospitals in a matter of weeks.

But time, of course, is one thing we may well not have much of – particularly if the government continues to drag its feet on limiting the spread of the virus.

It’s estimated that up to 80% of the population are susceptible to the virus and that 5% of those who do may need intensive care. That’s about 2.6 million people, in a worst-case scenario. The NHS has only around 4000 intensive care beds, and about four-fifths of them are already occupied. For those requiring hospitalisation but not intensive care, the problem is the NHS has lost far too many beds in the last 10 years and currently has 43,000 nurses fewer than it needs, as large numbers leave a demoralised service.

Sunak’s budget has a £5 billion fund to assist the NHS, councils and other public services deal with COVID-19, as well as £6 billion to begin to meet the government’s manifesto promises over staffing and new hospitals. Those figures will of course need to be unpicked over the coming days to see if it’s genuinely new money and how fast it is likely to materialise.

But however hard the NHS works to tool up, the maths and the timescales are scary. It’s hard to avoid the conclusion that we are going to find out what happens after successive governments weaken our safety net and public services over decades. The poor and marginalised are, once again, the ones who are going to be left with the toughest choices. But no one is going to be able to dodge the impact.

Perhaps it’s not too late for enlightened self-interest to kick in, though. That was, after all, the principle upon which earlier incarnations of the welfare state were founded, when Victorian and Edwardian poverty and disease started affecting the lives of the urban middle classes.

It’s time for fast fixes, as well as solutions for the long haul. If not now, then when?


[1] Tories target Northern voters with NHS message all about blaming migrants | openDemocracy ➤[2] PM urged to tackle ‘national scandal’ of life expectancy gap | Life expectancy | The Guardian ➤[3] Outdoor air pollution cuts three years from human lifespan – study | Air pollution | The Guardian ➤[4][5] Hospital bed cutbacks have gone too far, NHS England boss says | NHS | The Guardian ➤[6] UK coronavirus cases now up to 90 as NHS warns it 'does not have enough nurses' | ITV News ➤