The fundamental challenge presented by the current pandemic is that, left unchecked, the healthcare resources required to treat all those affected are far in excess what is available even in a wealthy country with an adequate health service.
The only response available has been to reduce healthcare demands during the pandemic by imposing socially and economically damaging restrictions on all our lives. These restrictions have had, and will continue to have, severe negative consequences far beyond the period of the pandemic.
It is neither feasible nor desirable to maintain a healthcare system at the levels needed to cope with extreme events just in case another pandemic comes along. Therefore a solution is required where resources can be dramatically increased in times of dire need; a pool of resources (both physical and human) which is held in reserve until such time as they are needed.
This model for dealing with national and international crises which threaten to overwhelm public resources is not without precedent. In the global conflicts of the twentieth century, the mobilisation of large swathes of society was instrumental to our efforts and ultimately our successes.
Most directly, there was the use of conscription to temporarily swell the ranks of the armed forces. However, the Spitfires that defended our shores were not just flown by pilots who had never flown before, but were constructed by workers who had never constructed aeroplanes before. Factories and people were temporarily repurposed to ensure Britain had the capacity to meet the immediate challenge.
More generally, the use of amateurs is interwoven with our professional public services:
The Territorial Army, now the Army Reserve, has been an integral part of our armed forces for over 100 years.
The close relationship between the Royal and Merchant Navies ensures we have non-military physical resources such as troop transporters and hospital ships in times of conflict.
School governors are essential to the running of our schools.
The criminal justice system relies on jurors taken from the general public to decide on cases both mundane and highly complex.
And now we face the challenge of vaccinating a nation, volunteers are again being called upon through the programme run by St John Ambulance.
During this pandemic, the main problem faced by the NHS has not been one of expertise or commitment but one of capacity. It is the same problem we faced at Dunkirk and in the fields and factories of wartime Britain. And we solved those problems by mobilising a new, temporary workforce assembled from a willing and resourceful nation.
It is the concept of the Army Reserve and possibly the echo of military conscription which I suggest could be used to prepare for future healthcare emergencies where again we are facing overwhelming issues of capacity.
The NHS Reserve would be an organisation working with (or within) the NHS, possibly with the help from volunteering experts such as St John Ambulance.
The aim would be to dramatically increase the capacity for critically ill patients by 10’s of thousands with as little as a few weeks’ notice in times of national emergency.
The NHS Reserve would be staffed by volunteers who had trained alongside NHS staff in their free time just as Army Reservists do. They would have gained and maintained up-to-date skills and experience. And again, as with the Army Reservists, these would be people willing and able to work on the frontline, directed by and alongside professionals.
In terms of physical assets, “Nightingale” sites (conference centres, hotels etc.) would be identified in advance and set up with all the services required in case they were needed to act as fully functioning hospitals. Existing buildings would need to have extensive adaptations made to them. New buildings created as we regenerate our town and city centres would be designed with both their primary function and their healthcare reserve function catered for.
The idea would be to have a physical and human reserve which, with little notice, could drastically expand the frontline capacity of the NHS in a time of crisis.
Even if we are fortunate enough never to have another pandemic like this one, the education and involvement of a large number of us in our healthcare system will have other benefits. We would better understand our own healthcare needs, be able to care for our loved ones with greater skill and knowledge and it would undoubtedly create a feeling of involvement and cohesion which would benefit us all.
As we begin to emerge from the shadow of this pandemic, people are better informed and more involved in the issues of care and health than ever before. The creation of The NHS Reserve would capitalise on these sentiments and allow us all to feel that we were helping reduce the risk to our society from the inevitable challenges of the future.
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