When Ian Paisley snr finally retired in 2012, he moved into an apartment in Crawfordsburn in a vast Edwardian mansion that had previously been a children’s tuberculosis hospital.
Those in the DUP inclined to trite culture war arguments over Covid should learn more about that building’s history.
The original Stormont government took a quarter of a century to get to grips with tuberculosis. It inherited a network of dedicated hospitals and sanatoriums, such as Whiteabbey, Forster Green and the Tuberculosis Institute in West Belfast, but left tackling the disease to county boards who were barely able to cope. Death rates stayed stubbornly high at 1,200 people per year.
Under pressure from the public and progressive doctors, Stormont eventually set up a health select committee in 1942.
Four years later, its tuberculosis sub-committee recommended creating a central body with an additional 500 beds. The Northern Ireland Tuberculosis Authority (NITA) was established in 1946 and took over full responsibility. It bought Crawfordsburn House in 1948 as part of the expansion of capacity. This was the same year Stormont set up the NHS: tuberculosis was considered important enough - and contagious enough - to have its own ‘NHS’, operating in parallel.
NITA is regarded as an enormous success, turning the UK’s highest incidence of tuberculosis into the lowest within a decade. It was fortunate in its timing, as rates were already in decline due to better housing, diet and public health in general. However, NITA took a broad public health view and helped drive those improvements. Vaccines and antibiotics became available in the 1950s, although an antibiotic ‘cure’ could still mean two years of dangerous, unreliable treatment.
By 1958, with deaths down to 100 a year, NITA was closed and its assets transferred to the NHS. Crawfordsburn became a geriatric hospital.
DUP MP Sammy Wilson called this week for Stormont to “move quickly” towards lifting restrictions because “we always accept some people will die with the flu every year and we’ve learned to live with that.”
Michael McBride, Stormont’s chief medical officer, replied that “Covid is not flu”, adding that up to a third of those who catch it may suffer serious long-term health problems.
It is tempting to compare Covid to flu in the hope we can ‘live with it’ with annual vaccinations and a fingers-crossed approach to winter surges in existing hospitals.
Realistically, for the foreseeable future, the more useful comparison is with tuberculosis: a chronic, communicable disease that will require a permanent addition to healthcare capacity.
The development of vaccines has not brought us to a 1958 moment of closure but a 1942 moment of confronting a long-haul problem. In particular, even a fully-vaccinated population will always be able to overwhelm Northern Ireland’s normal capacity of 100 intensive care beds.
While the historical parallels should not be overdone, some are uncanny. The 1942 Stormont committee heard that tuberculosis sufferers, especially with children, would not report their condition as they could not afford to lose their income through lengthy periods of isolation. The introduction of post-war benefits was crucial to reducing contagion.
Tuberculosis did not come in waves but did have outbreaks, leading to embryonic attempts at track and trace. New treatments, such as lung surgery, saw what might be termed ‘Nightingale hospitals’ and ‘waiting list initiatives’. In 1945, the British Medical Journal proposed this at Greenisland children’s hospital. The same paper proposed “training colonies” for patients “in cooperation with the Ministry of Labour” - a hint at how much social trauma has been forgotten within living memory.
We do not face such hardships today but the challenges of Covid remain daunting. At a time when parts of the health system here have effectively collapsed, it must be rebuilt with a major extension. If this requires in the order of 500 beds, that would be a 10 per cent expansion of current capacity. An extra tenth of health spending would be £700 million a year. Nor is it as ‘simple’ as expanding hospitals: there might have to be dedicated, isolated facilities, plus new isolation measures at existing sites.
There is no need to re-invent NITA. The 2016 Bengoa Report on restructuring the health service imagines regional specialist centres and a broader focus on public health, compatible with setting up a Covid service inside the NHS. Yet just mentioning Bengoa, an executive policy the executive is too spineless to implement, reveals the hopelessness of expecting 1940s-level performance from Stormont.
Wilson is hardly alone in preferring arguments over face masks and flu.
