Britain Is Once Again the Sick Man of Europe

It needs radical changes in health and elderly care, the economy and its constitution.

London England
View of the City of London, England from The Shard at night, June 13, 2018 (Unsplash/Tim Arterbury)

During the 1960s and 70s, Britain, economically stagnant and losing its empire, was known as the sick man of Europe. With COVID-19, the sickness has returned — and this time it may be even harder to heal.

More than 300,000 cases of coronavirus have been confirmed in the United Kingdom. 41,000 Britons have died of the disease, giving the country the second-highest per capita death rate among major countries. British economic output fell 20 percent in April, the worst rate by far among industrial nations.

This comes after a decade of austerity and on top of the economic fallout of Brexit.

It was the tough medicine of Thatcherism that allowed the United Kingdom to recover from its previous bout of ill health and find a new faith in itself — “Cool Britannia” — under New Labour.

But the seeds of the current malaise were planted in the same era.

Failing care

The British disease is hubris. The belief that this country is greater than it is — and doesn’t have much to learn from others.

The reason Britain has suffered so many COVID deaths is that its health- and elderly-care systems are on the brink.

The government-run National Health Service is held in high regard by many, but it has suffered repeated cuts and poorly thought-out reforms.

Neither the Conservatives nor Labour will take responsibility for the cuts and changes they have made. Both parties reject the relaxing of state control and reform of the wider National Insurance system. Both are needed.

Instead, Labour accuses the Conservatives of wishing to privatize the health service while the Conservatives accuse Labour of wasting money.

Elderly care is mostly in private hands and not fit for purpose in an aging society. Fees can reach £2,000 per month.

When Prime Minister Theresa May proposed in 2017 to make wealthy retirees tap into their savings in order to make the system more affordable, she was excoriated. Including, somewhat hypocritically, by Labour, which would simply tax those same retirees. The misstep probably cost May her majority in that year’s election.

Economic weaknesses

The recession has brought a number of structural weaknesses in the British economy to the surface.

London and the region around it dominate the economy, contributing as much as a quarter to the country’s GDP. This is larger than any other European capital.

Little has come of initiatives and proposals to “level up” the rest of the UK.

The gap between white-collar workers with full-time contracts and social benefits and low-paid “gig economy” and service-industry workers on zero-hours contracts has been allowed to grow for years. Many of the former now work from home due to the pandemic. Those formerly employed in hospitality and retail have become dependent on what is left of a once-generous social safety net. Cleaners and nurses have no choice but to go to work, at low pay.


The constitutional architecture of UK, with autonomy for Northern Ireland, Scotland and Wales, but not England, and an executive that is relatively unchecked when it has a majority in Parliament, is in need of renovation.

Devolution was meant to stem a rising tide of dissatisfaction with the union, but support for independence has gone up in Scotland and Wales and support for joining the republic has gone up in Northern Ireland. Social democratic Scotland in particular feels more and more separate the longer the Conservatives rule in Westminster.

Learn from others

To heal, Britain needs to accept it is no longer a world-leading power. It can learn from its neighbors.

The Netherlands, Nordic countries and Switzerland provide higher-quality health care to all their citizens without a centralized, one-size-fits-all system.

British politicians have talked for years about imitating the German model of on-the-job training to lift blue-collar workers up, but they haven’t done it.

Paris plays an outsized role in the French economy, and in French culture, but regional autonomy and a system of high-speed trains allow cities like Bordeaux, Lyon, Marseille and Toulouse to thrive.

The Spanish model of quasi-federalism isn’t perfect. Catalonia still feels constrained by it. But the Basques have taken full advantage of it, and Basque support for independence is down.

New consensus

Britain probably won’t be cured in a one-term government. It needs — to borrow a favorite phrase from reformers in the United States — bipartisan solutions to its long-running problems.

Margaret Thatcher’s pro-market reforms were so influential that the Labour government that came after her kept them in place.

Thirty years earlier, Clement Attlee had succeeded in erecting a welfare state in Britain when the Conservatives accepted social democracy.

Both were radical breaks with the past. Both succeeded in reviving Britain.

The country needs such a radical break again.