I am now enjoying a short break between jobs. Fortunately (and I know there are many in a less fortunate position) it is a planned break. Originally intended to include the Paris marathon and a lengthy break with the family my plans have changed to pretty much just staying at home. Even the things I can still do are affected. I no longer run in a straight line as I curve around people mutually maximising our social distance. My plans to make up for lost time as a school governor have transformed from lesson walks and observations to video meetings and a focus on health and safety and safeguarding.

If it was a badly timed break it is also a badly timed job start. I am, after a brief dalliance in the private sector, returning to the NHS. I cannot pretend it’s a noble move: it was not COVID-19 motivated and by the time I’ve got to grips with my role, new organisation and relationships we may well be past the pandemic peak but the virus will still make starting a job in any organisation an unusual experience.

But the pandemic does highlight why I am going back to the NHS. I was a late and accidental joiner but felt a strong sense of purpose from my very first day. Part of the reason I’m returning is because, even though remained in healthcare, I never felt that same sense of purpose after I left. The NHS is a huge and complex organisation and my contribution was, and will be, small. But the NHS is the sum of those small contributions and each one is worthwhile.

As I stood at my front door joining in the last night I was reminded of the Nigel Lawson comment that the NHS was the nearest thing this country has to a national religion. He, of course, made that comment with the sneering contempt you would expect him to have for a public sector institution. It was clear last night, though, the public attitude would be very different.

The NHS, despite its imperfections (often introduced, I would argue, in the attempts to ‘improve’ by introducing the market) and years of underfunding, remains one of this country’s greatest assets. I’m very much looking forward to having some time with my family but incredibly proud and excited and just a little impatient to be back in the NHS.

An interesting take in The Guardian on the impact of a decade of reform on the response to Coronavirus. England’s ravaged public health system just can’t cope with the coronavirus:

The impoverishment of the NHS and the public health system in England is not the only depletion that has occurred in civil society that makes us ill-equipped to respond effectively to the greatest global health crisis in a century.

One of the first acts of the coalition government when it came to power in 2010 was to dismantle the regional structures that had provided a coherent mechanism for integrating and carrying out government policy within the English regions…the coalition also stripped the NHS of its regional management tier following the wide-ranging “reforms” of the 2012 Health and Social Care Act.

The result is the absence of any integrational, coordinating or management function at a regional level in England that could operate between Whitehall departments and the various bodies, often very local, that are charged with implementing government policy. The fact that some national bodies have adopted internal organisational boundaries that cover completely different geographical territories has also complicated the situation. This is notably and unfortunately true with respect to the key health bodies, NHS England and Public Health England.

I had been pondering what impact the reforms introduced since 2010 have had. Things like the move of public health from the NHS to local government can make it more responsive to local needs but also more at the mercy of local financing whims and at the cost of losing central control.

I am, by instinct, a localist but there is a lot to the argument that stripping out the middle tier and fragmenting other provision across the public, private and third sector has harmed our initial ability to mobilise against the pandemic.