WHEN the pandemic began, the focus was on protecting the NHS and ensuring that it was not overwhelmed.

As a short-term aim, that was correct, but as a general principle, the NHS should serve and protect the population, and not the other way around. It is remarkable that, two years on, there has been no real attempt by either the UK or Scottish governments fundamentally to reconsider the way in which the NHS operates during this emergency.

While the system has been turned upside down, and doctors, nurses and auxiliary staff have made heroic efforts – at great cost to their own well-being – the health service is still teetering on the brink of collapse. We cannot keep delaying operations, suspending clinics, or running what amounts to a skeleton GP service; such measures were needed in initial stages, and when our knowledge of the disease was limited, but they cannot be maintained indefinitely without causing significant damage.

It is true that tackling Covid must remain the priority and that, unless we do so, other treatments will be undermined in any case. But the system is still relying on “sticking plaster” solutions and work-arounds, rather than trying to incorporate what we have learned about the disease into practice.

High transmission and serious illness are most associated with people with pre-existing conditions and the elderly (who account for 85 per cent of hospitalisations); care homes and hospitals are the prime settings for infection. It would seem sensible to consider whether separate, specialist respiratory units would enable hospitals to resume much more of their normal priorities. Strict protocols in care homes and other high-risk settings might obviate the need for them in other areas.

The vaccine programme, one unquestionable success of the pandemic, has been accelerated as a result of the Omicron variant. That is welcome, but more, larger and longer-opening venues would make a huge difference, as would encouraging people to test themselves regularly and manage their own isolation. Most of the population has done this in a responsible fashion, and it is a much better option than compulsory lockdowns, with the damage and costs they bring both for the NHS and the wider economy.

All of this is costly and difficult, but prior experience of mass vaccine venues and the Nightingale hospitals shows that it is achievable, especially if we learn from what aspects of previous interventions worked best. The costs of a further lockdown or of a new wave getting out of control would almost certainly be worse.

We spend more than most other European countries on our health system, yet for years it has been run at maximum capacity. Covid has exposed how little resilience it has, but may also offer lessons in how to improve and reform, if we move swiftly to implement them.

IT is, in its way, an impressive achievement to lose, by 6,000 votes and on a swing of 34 per cent, a by-election in a seat your party has held since 1832, and which only two years ago produced a majority of 23,000. By some calculations, it is the Tories’ second-worst by-election result since the Second World War.

This is not only a richly deserved punishment for them, but one almost completely of their own making. The voters of North Shropshire had the election foisted on them by the refusal of Owen Paterson, the former MP, to accept his suspension and his subsequent exit in the huff.

The Government’s mishandling of that episode (which, had they accepted it, would have been forgotten about by now) was followed, through the campaign, by a quite astonishingly bungled response to last year’s breaches of Covid restrictions. When voters see such blatant disregard for them, compounded by the inability to produce an apology or even mount a competent defence, they are entitled to give the party concerned a bloody nose. Unless the Conservatives adjust their approach, there will be plenty more where that came from.