Creating a ‘health reserve’ to meet surge demand on the NHS


The years to come will be very challenging for the NHS – even after the worst of the pandemic recedes, the burden of the disease will continue to be felt for a long time. The virus is likely to become endemic and it’s predicted that pharmaceutical companies will have to play a game of cat-and-mouse to ensure vaccines catch up with mutations. Consequently, it’s more vital than ever that the NHS be able to flex its capacity to meet surging demand in the face of new strains of coronavirus and flu that the population lacks immunity against.

Creating a ‘health reserve’ is a solution to that challenge. It would:

1. Make the NHS more resilient in winter and in the face of new waves or pandemics, without bringing on full-time staff who might not be needed the rest of the year.

2. Help the NHS get through the huge backlog of non-urgent screenings, treatments and operations that accumulates when the NHS is under strain.

3. Create opportunities for people to serve their country and take pride in their contribution to the community, with the power to appeal and be accessible to a wider range of people than alternatives such as the armed forces.

4. Provide a source of income and rewarding activity for the unemployed, and a potential route into employment through the skills and experience gained, at a time of high unemployment caused by the economic costs of fighting the pandemic.

If it makes sense to keep a military reserve in the unlikely event of large-scale war, doesn’t it make sense to keep a health reserve to fight the likely annual burden of new and existing diseases?


Creating a health reserve will help the NHS cope with future surges in demand that the usual winter pressures plus new variants of COVID-19 are likely to cause. COVID-19 has shown that the real constraint on NHS capacity is not buildings, equipment or beds (all of which have been shown to be expandable remarkably quickly) – but people. This proposal argues that we should develop a health reserve, akin to the army reserve. Health reservists could be trained to perform a number of relatively simple but essential tasks, such as first aid, vaccination, ‘proning’ (turning a patient with respiratory distress onto their front) and basic patient monitoring. They could be called upon to relieve pressure when the NHS is under severe strain. By reducing the risk that the health service is overwhelmed, this proposal also reduces the likelihood that governments are forced into more lockdowns, with their attendant societal damage.

A well-organised, structured approach is needed because, without it, the NHS is simply unable to scale up with the speed and to the extent required. There has been much coverage in recent weeks of the bureaucracy that prevents retired healthcare workers from helping administer the COVID-19 vaccine. Next time round, those retired and prospective health workers could be pre-registered with the reserve and ready to go.

Even more crucially, the pool of retired health workers and medical students is simply not big enough to enable to the NHS to cope with peak pressure. More people need to be trained in a number of basic but essential skills ahead of a bad winter and/or new wave, in addition to the pool of people with existing health experience. The lack of suitably trained staff is the reason that the ‘Nightingale’ hospitals have remained largely empty throughout the pandemic. In addition to managing peak demand, such a reserve could also help the NHS clear the backlog of cancelled operations faster, when surges recede (the number of patients waiting for more than a year to access treatment has skyrocketed from 1,600 in February 2020 to 192,000 in November 2020).

This proposal also brings important non-NHS related benefits. First, there is huge untapped appetite among people to serve their community and country. At the moment, however, the meaning of the phrase and practical opportunities to put it into action are mostly limited to the armed forces – a set of institutions whose reach, appeal and accessibility across ages, gender, ethnic, cultural and socio-economic background is far more limited than the NHS. The desire to serve by helping the NHS was apparent as soon as the COVID-19 crisis hit the country: by mid-April, over a million people had volunteered to help the NHS fight COVID-19. The health reserve would contribute to a renewed sense of community, which polls find is one of a few key positives from the crisis that people hope will outlast the pandemic.

Second, the health reserve could create work opportunities that people can take pride in, at a time of high unemployment caused by the economic costs of fighting the pandemic. The reserve would provide income as well as transferable skills and a route back into economic activity. For many, it may be a much more rewarding alternative than the bureaucratic requirements and minimum-wage offers that working-age welfare claimants must comply with and accept.

For those who might argue that this proposal is too costly, a brief response is that the cost of the reserve would be a fraction of the health and economic costs of delayed diagnoses and referrals, cancelled operations and new lockdowns. The reserve is also by design a very efficient model for rapidly scaling capacity up and down. If it makes sense to keep a military reserve in the unlikely event of large-scale war, doesn’t it make sense to keep a health reserve to fight the likely annual burden of new and existing diseases?

By way of comparison, the army reserve, which could be used as a model, is rewarded as follows:

‘As a Reservist you get paid for the time you spend training, and a bonus payment for completing a certain amount of training days each year. […] If you’ve left Regular service in the last six years, you could rejoin as a Reservist and get incentive payments of up to £10,000.’




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