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    This is a collective statement on behalf of SHA bringing together public health evidence and other opinions on a key Covid policy issue.

    The impact of the pandemic on BAME populations and the implications for policy and plans going forward

    1. Key messages:

    • Data collection, transparency and presentation are not good enough:

    o There is concern about inaccurate, incomplete and selective data. All official bodies should adhere to the Code of Practice for Statistics

    o Ethnicity data is not collected in many countries: in the UK for many years there has been a call for greater ethnic monitoring in routine health data and the fact that the ONS had to go back to census data and interpret current health statistics from these assumptions exposes the problem

    o Ethnicity is complex and aggregating all minorities together obscures the true picture

    o Data has sometimes been presented in misleading ways: for example, the death rate for COVID-19 in Black men has been stated as over 4 times the average, without explaining that adjustment for confounding factors such as age and deprivation would change this o Data on occupation is not well collected or presented

    • BAME people are more likely to die of COVID19

    o ONS analysis of COVID-19 related deaths by ethnic group, England and Wales: 2 March 2020 to 10 April 2020, showed:

    o Adjusting only for age: Black males are 4.2 times more likely to die from COVID-19 than White males, while Black females are 4.3 times more likely to die from COVID-19 than White females.

    ■ However, after statistical adjustment for multiple factors (region, rural and urban classification, area deprivation, household composition, socio-economic position, highest qualification held, household tenure, and health or disability) this showed that black males and females are 1.9 times more likely to die from COVID-19 than the

    White ethnic group. Males of Bangladeshi and Pakistani ethnicity are 1.8 times more likely to die; for females, odds of death are reduced to 1.6 times more likely. Individuals from the Chinese and Mixed ethnic group have similar risks to those with White ethnicity

    o The openSAFELY cohort study used national primary care electronic health record data linked to in-hospital COVID-19 death data, which is the largest cohort study in the world, examining 17 million primary care records. This found other ethnicities were more likely to die than white British people, even after adjustments for age, sex and other risk factors

    • Hazard ratios for ethnicities relative to white British were:
    • Mixed 1.64
    • Asian or Asian British 1.62
    • Black 1.71
    • Other 1.33
    • The study suggests that the higher prevalence of medical problems such as cardiovascular disease or diabetes among BAME people, or higher deprivation, is only a small part of the excess risk, and that further research should look at occupational and household exposures

    o In the United States, there is a more marked difference between black Americans and other ethnic groups: For each 100,000 Americans (of their respective groups), 40.9 Blacks have died, along with about 17.9 Asians, 17.9 Latinos and 15.8 Whites. If Black Americans had died of COVID-19 at the same rate as White Americans, at least 10,000 more Black Americans would still be alive.

    • BAME people are more vulnerable through unequal exposure to all the impacts of the pandemic

    o A higher proportion of many minority groups are of working age and therefore affected by the shutdown, they are more likely to be in lower paid, insecure work and in financial insecurity o Bangladeshis, black Caribbeans and black Africans also have the most limited savings to provide a financial buffer if laid off. Only around 30% live in households with enough to cover one month of income. In contrast, nearly 60% of the rest of the population have enough savings to cover one month’s income.

    o In London, BAME workers are much more likely to be key workers,

    • In 2019, 12% of all workers in the UK were from ethnic minority groups, increasing to 34% in London. A greater share of the London population are from black and minority ethnic groups.
    • Workers from an ethnic minority group represent a similar share of all key workers at 13% for the UK as a whole and a greater share at 42% in London. In rest of the UK, similar proportions are in key and non-key worker roles

    o Analysis of occupation and deaths by the ONS showed that there were 2,494 deaths involving the coronavirus in the working age population (those aged 20 to 64 years) of England and Wales up to 20 April 2020. People from BAME communities are more often working in the highest risk occupations:

    • Men working in the lowest skilled occupations had the highest rate of death with 21.4 deaths per 100,000 males (225 deaths); men working as security guards had one of the highest rates, with 45.7 deaths per 100,000 (63 deaths).
    • Men and women working in social care, a group including care workers and home carers, both had significantly raised rates of death with rates of 23.4 deaths per 100,000 males (45 deaths) and 9.6 deaths per 100,000 females (86 deaths).
    • BAME health and social care workers appear to have higher rates of death

    o Although the ONS analyses did not show a higher rate of death among healthcare workers in general, it appears that of those who have died, a very high proportion are from BAME communities.

    o An analysis of 106 workers, identified from many publicly available sources, who had died of COVID related cause up to April 22nd showed that 63 % of cases were of BAME background, and 53% were not born in the UK, which is much higher than the proportion of BAME in the whole workforce. No intensive care nurse or doctor has died, the deaths appear to occur in other patient facing groups of professionals

    Deaths in BAME health workers to April 22nd 2020

    Nurses and midwives Healthcare support workers Doctors and dentists
    Number 35 27 19
    BAME; % 71 56 94
    BAME workforce; %* 20 17 44

    Source: adapted from Tim Cook, Emira Kursumovic, Simon Lennane Health Service Journal 22 April 2020

    • CONCLUSION:

    o Ethnicity data is not collected in many countries, and where it is, differences suggests that genetic factors are less important than the wider determinants of health

    o There are multiple reasons, the most likely seem to be the first two:

    1. Higher exposure: a higher proportion of BAME people are in low paid front line key worker roles, with likely lower access to PPE and other protective measures
    2. Multi-family and intergenerational households, therefore likely to have greater household transmission
    3. Lower socioeconomic status: there is higher mortality in deprived areas as a whole
    4. Higher prevalence of co-morbidities, especially for CVD, diabetes, renal conditions, obesity and complex multi-morbidities
    5. Greater vulnerability to economic and financial impacts
    6. Structural and institutional racism underlying all the above. This can lead to higher levels of persistent stress leading to physical and mental poor health, exacerbated by lower access to services that can mitigate these effects
    • Actions

    o Call for an independent inquiry into ethnicity and mortality from COVID19

    o Improve data collection and analyses: ethnic monitoring should be part of death registration.

    o Make work safe during COVID19; workplaces should be risk assessed, with the inclusion of ethnicity as a risk factor like the NHS is doing, and include those in insecure employment fields, the self-employed and the gig economy

    ■ Key workers with high risks linked to ethnicity should be

    • withdrawn from the riskiest work or
    • should be protected with adequate PPE and multiple other protection measures in workplaces
    • prioritised for testing

    o Decentralise data and decision-making for COVID19: the implementation of measures that aim to control the virus should be decentralised to Local Government led by the Director of Public Health, to ensure that they are sensitive and appropriate for the local communities o Housing: measures should be introduced to improve housing quality and reduce higher risks of household transmission in multi-generational households

    o Community assets: listen to community leaders and nurture grassroots community action that can build on resilience in the long term

    o Address the intersectionality of ethnicity with deprivation: social protection measures for those BAME individuals and groups most vulnerable to financial insecurity, for example Universal Basic Income

    o Commit to a long-term inequalities’ strategy with a multi-faceted approach building on previous Labour success 1997-2010. More ambitious, to tackle the commercial/ structural determinants of health, and on healthy communities and places: reduce reliance on less effective individual behaviour change strategies, and include the intersectionality of disadvantage

    Sources

    o Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities Tony Kirby, The Lancet Respiratory Medicine May 8th

    https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30228-9.pdf

    o Coronavirus (COVID-19) related deaths by ethnic group, England and Wales: 2 March 2020 to 10 April 2020 Office for National Statistics may 7th

    https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/ar ticles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020

    o https://github.com/miqdadasaria/nhs covid deaths/tree/master/figures

    o OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. Posted May 7th 2020 https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1

    o BAME COVID-19 DEATHS – What do we know? Rapid Data & Evidence Review May 5, 2020,

    The Centre for Evidence-Based Medicine

    o https://www.apmresearchlab.org/covid/deaths-by-race

    o Revealed: the NHS’ plan to protect BAME staff from covid-19, HSJ May 6th https://www.hsj.co.uk/workforce/revealed-the-nhs-plan-to-protect-bame-staff-from-covid- 19/7027571.article

    o Black and minority ethnic workers make up a disproportionately large share of key worker sectors in London COVID-19 chart series 7 May 2020 Health Foundation https://www.health.org.uk/chart/black-and-minority-ethnic-workers-make-up-a- disproportionately-large-share-of-key-worker

    o Coronavirus (COVID-19) related deaths by occupation, England and Wales: deaths registered up to and including 20 April 2020 Office for National Statistics May 11th https://www.ons.gov.uk/releases/covid19relateddeathsbyoccupationenglandandwalesdeaths registereduptoandincluding20thapril2020

    o Exclusive: deaths of NHS staff from covid-19 analysed By Tim Cook, Emira Kursumovic, Simon Lennane Health Service Journal 22 April 2020

    o Covid-19 and BAME deaths: A call for action Mark Ladbrooke SHA Blog May 12th https://www.sochealth.co.uk/2020/05/12/covid-19-and-bame-deaths-a-call-for-action/

    o Are some ethnic groups more vulnerable to COVID-19 than others? The Institute for Fiscal Studies Deaton Review 1 May 2020 https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-

    from-covid- 19-analysed/7027471.article

    https://www.ifs.org.uk/inequality/chapter/are-some-ethnic-groups-more-vulnerable-to- COVID-19-than-others/

    Posted by Brian Fisher on behalf of the Policy team.

    SHA Shadow Health team briefing topic 1 BAME V3

     

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    The SHA has been publishing its COVID-19 Blogs weekly since the 15th March. A number of themes have cropped up consistently throughout as actual events have occurred.

    Too slow to act

    The slow and dithering response by the government has been one such theme. This has been exposed with embarrassing clarity by media investigative teams which this weekend include the Insight team. Their detailed report on the dither and delay leading up to lockdown showed that when Italy and Spain locked down on the 10th and 13th March respectively each had over a million estimated infections in their countries. In the UK we had looked aghast at the footage from Lombardy and Madrid as their health and care system was visibly overwhelmed but the government failed to heed their strictly enforced lockdown policies in the 2 weeks warning we had. During this time from the 8th March the Johnson administration allowed the Five Nations rugby matches to go ahead in Twickenham and Edinburgh, the Cheltenham races, the Liverpool/Atletico Madrid football match on the 11th March and two Stereophonics pop concerts in Cardiff held on the 14th and 15th March. All this was apparently following the science…..

    France locked down on the 16th March with an estimated 800,000 infections and Germany locked down on the 21st March with only 270,000. The Johnson government had resisted calls to lockdown at the same time as France on the 16th March. They waited until the 23rd March by which time the estimated number of infections in the community had almost doubled to 1.5m. This dither and delay lies at the heart of our comparatively poor outcome with the COVID-19 confirmed deaths of 37,000 (an underestimate of all excess deaths). This list includes at least 300 NHS and care workers.

    Protect the NHS

    Germany’s earlier decision has reaped benefits alongside their border closure, effective test, trace and isolate (TTI) policies, with sufficient testing capacity, and led by regional public health organisations. They also have sufficient ITU/hospital bed capacity without the need to build new Nightingale Hospitals. Our government did not close borders or introduce quarantining on entry, and turned out not to have used February to build our testing capacity either.

    The strategic attention in the UK has been to ‘Protect the NHS’ but not in the same way Care Homes. Because of the shortage of testing capacity we had to stop the community based test, track and isolate (TTI) programme. The NHS has stood up well through the dedication of its staff and demonstrated the superiority of a nationalised health system. However from a public health policy perspective the COBR meetings should have been thinking about the whole population and what populations were at high risk such as those in residential and care homes.

    The data in Wuhan had been published quickly and had shown that it was older people who are most at risk of disease and death. We knew all this, the Chinese data has been replicated in Europe but the Government failed to follow through.

    The Privately owned Social Care sector

    Unlike the NHS hospital sector, the care sector, of residential and nursing homes,  are a patchwork of large ‘private for profit’ owners, smaller privately owned and run homes and the charitable sector. There is a registration system and some quality assurance through the Care Quality Commission (CQC). The fact that we do not have a National Care Service along the lines of the NHS has led to operational problems during the pandemic between commissioners, regulators, owners and the staff who run the homes. As privately run establishments there were varied expectations about procuring PPE for the staff in the early phase of the pandemic response. There was also a lack of clarity about whether satisfactory infection prevention and control procedures were in place and able to deal with COVID-19. How had residential and care homes undertaken risk assessments, working out how to cohort residents with symptoms and manage their care? What about staffing problems, agency staff and policies for symptomatic staff to self isolate? It was important early on to consider in what respect COVID-19 is the same as or different from influenza or a norovirus outbreak,

    It seems that the Secretary of State for Health and his staff have been too slow in aligning Public Health England (PHE), GPs and primary care infection control nurses alongside the homes to provide more expert advice and support on infection prevention and control.  It seems also that some nursing homes took patients discharged from the NHS who were still infected with COVID-19, when on the 19th March the Department of Health announced that 15,000 people should be discharged to free up NHS beds. There was no mandatory testing or period of quarantining before these patients were discharged. In this way hospital based infections were transferred to nursing homes.

    The scarcity of PPE (caused by the Government’s failure to heed the results of Exercise Cygnus) meant that professionals felt nervous about entering homes to assess sick residents and sadly to be able to certify death and certificate the cause of death. Rationing of PPE in this sector has contributed to the risk of infection in care staff, which would cause transmission in the care home. Most homes had to lockdown too, stopping visiting and in some cases having staff move into the home themselves at personal risk and disruption to their lives. It became clear that transmission from the community to care home residents was occurring through staff. This has been very hard on these undervalued and low paid staff, who began to realise that they were transmitting infection between residents or from themselves.

    Some of the stories of care staff’s heroism and dedication to their residents is extraordinary. It is reminiscent of Camus’s book The Plague, which recounts heroism undertaken by ordinary people doing extraordinary things. Tellingly Camus also suggests that the hardest part of a crisis is not working out the right thing to do, but rather having the guts to get on and do it. Many care home managers and staff had to do just that.

    Follow the money

    A recent report looked at HC-One, which is Britain’s largest care home group with 328 homes, 17,000 residents and so far 700 COVID related deaths. The operating profits of the company are of the order of £57m but, through the financial arrangements with off shore related companies, the profits “disappear” in £50m ‘interest payments’. While global interest rates have been at historically low levels HC-One have apparently been paying 9% interest on a Cayman island loan of £11.4m and 15-18% interest on another Cayman company for a £89m loan. Apparently HC-One paid only £1m in tax to the HMRC last year (Private Eye 22nd May) through this transaction with off shore interests off-setting their profit. This is not however inhibiting them from seeking government support at this time. A better future would be to rescue social care by nationalising the social care sector, bring the staff into more secure terms and conditions of service and sort out the property compensation over time through transparent district valuations.

    Test, trace and isolate (TTI)

    At long last the government has signalled that it wishes to reactivate the community based test, trace and isolate programme that it stood down over 10 weeks ago. Of course, once the virus had been allowed to spread widely within communities, the TTI programme would have had to modify their objectives from the outbreak control of the early stages. However they could have continued to build the local surveillance picture within their communities, help PHE to control residential and nursing home outbreaks with their community based contacts and prepare for the next phase of continuing control measures during the recovery phase.

    They seem to have at last realised the potential of local Directors of Public Health (DsPH) who are embedded in local government and who, after all, lead Local Resilience Fora as part of the framework of a national emergency plan. The DsPH have links to the Environmental Health Officers (EHOs) who survived the austerity cuts. EHOs are experienced contact tracers well able to recruit and train new staff locally to do the job. This is in sharp contrast to the inexperienced staff now being recruited and used by the private sector.

    The local public health teams also work closely with PHE and NHS partners and so can fulfil the complex multiagency leadership required in such a public health emergency. Building on these strengths is far better than drawing on private sector consultants such as Deloittes, or companies such as SERCO, Sodexo, Compass or Mitie. All these private sector groups have an interest in hiving off parts of the public sector. In addition, unsurprisingly, they have close ties to the government and Conservative Party. Baroness Harding, who has been brought in to Chair the TTI programme, is a Tory peer married to a Tory MP who was CEO of Talk Talk. She was in charge at the time of the 2015 data breach leading to 4m customers having their bank and account details hacked. No surprises, then, that she is asked to undertake this role as a safe pair of hands in much the same way that Tory peer Lord Deighton has been asked to lead the PPE work.

    Game changers – and what is the game?

    In last week’s Blog we mentioned that Government Ministers seem to be fixated on game changers whether novel tests, treatments, vaccines or digital apps. We mentioned last week that treatments like Chloroquine need proper evaluation to see if they are safe and effective. A report in the Lancet on the 22nd May found that there was no benefit. Indeed the study found that the treatments reduced in-hospital survival and an increase in heart arrhythmias was observed when used for treating COVID-19

    Vaccines need to be researched, as they may well be important in the future but remember that a 2013 review from the Netherlands found that they take – on average – 10.71 years to develop, and had a 6% success rate from start to finish.

    The mobile apps trial in the Isle of Wight seems not to have delivered a reliable platform, and of course the Government has probably ignored the apps working splendidly in South Korea and Singapore. Meanwhile Microsoft, Google, Facebook, Faculty and Amazon stand ready to move in. There are major risks with getting into bed with some of these players including the data mining company Palantir.

    Palantir

    This company was initially funded by the CIA but has secured lucrative public sector contracts in the USA covering predictive policing, migrant surveillance and battlefield software. These IT and data companies have been drawn into the UK COVID-19 ‘data store’. While working alongside NHSX and its digital transformation unit wanting to assess and predict demand there are concerns over data privacy, accountability and the possible impact on the NHS.

    Palantir has been of interest to Dominic Cummings (DC) since 2015, according to the New Statesman, when he reportedly told the Cambridge Analytica whistleblower, that he wanted to build the ‘Palantir of politics’. The other company Faculty had close ties too with the Vote leave campaign. Cummings is said to want to remould the state in the image of Silicon Valley.

    Conclusion

    So in the turmoil of the COVID-19 response the government has looked to multiple game changers while ignoring straightforward tried and tested communicable disease control measures. It has succeeded in ‘Protecting the NHS’ (though not against the incursion of the private sector) but allowed the residential and care home sector to be exposed to infection. We welcome the belated return to supporting DsPH and local public health leadership, which has been left out for too long. Let us hope – and demand – that there is also more investment in public health services and not allow Government spokespeople to start to blame organisations such as PHE.

    We worry that they are not being alert to safeguard public services by inviting some dubious partners to the top table. On the contrary they are VERY alert – to the opportunity of inserting private capital (and profit) in the NHS and other public sector organisations. One such company new to many of us is the data mining company Palantir – a company named after an all-seeing crystal ball in JRR Tolkien’s The Lord of the Rings. Lurking in the background is of course the Prime Minister’s senior political adviser DC.

    24th May 2020

    Posted by Jean Hardiman Smith on behalf of the Officers and Vice Chairs of the SHA.

    2 Comments
    • Latest national agreement will see firefighters train care staff in infection, prevention and control
    • Request for help came from senior health officials in England

    Firefighters have been called in to deliver special infection, prevention and control (IPC) training packages to care home staff in a move that is hoped will help to halt the spread of coronavirus in the sector.

    Under the new measure, firefighter volunteers will train care home staff directly on IPC procedures, the “donning and doffing” of Personal Protective Equipment (PPE), hygiene measures, hand cleaning, and how to safely carry out COVID-19 tests. Designated care home staff will also be taught how to carry out the same training for their colleagues.

    The agreement will allow support to be provided to nursing and care homes, domiciliary care, supported independent living and sheltered accommodation.

    England’s Chief Nursing Officer and Director of Community Health requested the work, which was followed by a letter from the Westminster Fire Minister.

    While the request only came from the Westminster government, the agreement allows firefighters across the UK to support care staff subject to local negotiation. Local resilience forums, care homes and NHS clinical commissioning groups can now write to their fire and rescue service to request the support.

    It builds on firefighters’ work face-fitting PPE masks for frontline NHS and care staff, delivering PPE and medical supplies to NHS and care facilities, and assisting in taking COVID-19 test samples.

    Firefighters have now signed up to a total of 14 new areas of work including moving dead bodies, driving ambulances, and delivering food and medicines to vulnerable people.

    The agreement contains a number of measures to prevent cross-infection between vulnerable individuals, care home staff and firefighters. Firefighters will take measures to prevent clothing and equipment that may have been exposed to the virus from contaminating fire engines, including using sterilised safety bags.

    All those volunteering for the work will need appropriate training, PPE, and high standards of hygiene and social distancing must be carried out. Services will need to follow a generic risk assessment, provided by the FBU, NFCC, and National Employers.

    More than 11,000 people have died due to coronavirus in UK care homes with the government coming under fierce criticism for allowing infections to spread through the sector.

    Matt Wrack, FBU general secretary, said:

    “The crisis in care homes is a national scandal but our members will do what they can to help. Firefighters, highly trained in the safe use of PPE and infection prevention and control, can provide vital support at this difficult time.

    “We’re coming into wildfire season and can expect an incredibly busy few months for firefighters. But, nonetheless, crews have taken on extraordinary new areas of work to support their communities through this pandemic.

    “While firefighters are here to help care staff and residents through this crisis, we must be clear that it should never have come to this. The government has disgracefully mishandled this pandemic, allowing the virus to spread into care homes unchecked – and thousands have paid with their lives.

    Media contacts

    Joe Karp-Sawey, FBU communications officer

    FBU press office
    press@fbu.org,uk

    • The full agreement between the FBU, NFCC, and National Employers is available here: 2020 may 22 – tripartite 7 – final minus hyperlink.pdf
    • This is the latest of fourteen new areas of work detailed in the full agreement
    • Under previous agreements, firefighters can now construct vital protective face shields for NHS and care staff, drive ambulances in parts of the country, will also now begin transferring both COVID-19 and non-COVID-19 patients from Nightingale hospitals: https://www.fbu.org.uk/news/2020/04/24/firefighters-make-face-shields-health-and-care-staff-and-transfer-patients-and
    • Firefighters are now permitted to assist ambulance services in some specified activities and drive ambulances; deliver food and medicines to vulnerable people; and, in the case of mass casualties due to COVID-19, move dead bodies.
    • Firefighters can also fit face masks and deliver vital PPE and medical supplies to NHS and care staff; take samples for COVID-19 antigen tests; drive ambulances to non-emergency outpatient appointments and to transport those in need of urgent care; and to train non-emergency service personnel to drive ambulances: https://www.fbu.org.uk/news/2020/04/16/coronavirus-firefighters-now-allowed-carry-out-antigen-tests
    • The Fire Brigades Union (FBU) is the professional and democratic voice of firefighters and other workers within fire and rescue services across the UK. The general secretary is Matt Wrack
    • The FBU is on Twitter: @fbunational and Facebook: facebook.com/FireBrigadesUnion1918
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    2020 may 22 – tripartite 7 – final minus hyperlink.pdf

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    Thousands of social care staff in England could be falling through the net when it comes to the provision of the £60,000 payment in the event of death due to Covid-19.
    Serious concern was expressed today (Friday 22 May) by Unite, Britain and Ireland’s largest union, which has combed through the small print as to who the payment applies to.
    According to the government document, Coronavirus Life Assurance Scheme – Death in Service (England only): ‘Any employee who works for a private social care organisation which receives no public funding’ is not eligible for the payment.
    Unite called on health and social care secretary Matt Hancock to clarify and rectify the situation as a matter of urgency, given that more than 300 NHS and social care workers have now died as a result of Covid-19.
    Unite assistant general secretary Gail Cartmail said: “Matt Hancock needs to clarify what the small print actually means, as it is totally unacceptable that possibly thousands of social care workers are barred from this scheme because their place of work has no public funding.
    “We can’t have this two-tier situation where one care worker’s contribution, fighting coronavirus, is regarded of less value than another in a different setting. If you are risking your life in the battle against Covid-19, your workplace and how it is funded are irrelevant.
    “We don’t know the true scale of the problem across England – it could be that thousands of care workers are being denied this cover – but if it is only one, it is one too many.
    “Unfortunately, the health trade unions have not been consulted in drawing up this eligibility criteria in England – if we had been, we would have objected in the strongest possible terms to what is now in place.
    “The government has shown that it is capable of righting a wrong, as was proved yesterday with the U-turn on the £400 charge for NHS migrant workers. This is another case where a ministerial rethink is in order.”
    Last month, Matt Hancock announced that families of NHS and social care workers, who have died after contracting coronavirus in the course of their duties, will receive a £60,000 payment from the taxpayer.
     
    Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
    Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

     

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    Boris Johnson’s hardline stance not to waive the £400 NHS surcharge for overseas health and social care workers combating coronavirus was described as ‘mean-spirited and shabby’ today (Thursday 21 May) by Unite, Britain and Ireland’s largest trade union.
    Unite, which has 100,000 members in the health service, said the hypocrisy of the prime minister was given extra piquancy as he singled out two non-UK  nurses – one from New Zealand and the other from Portugal – for praise after he survived his fight with Covid-19.
    The NHS fee of £400-a-year for care workers applies to those from outside the European Economic Area, regardless whether they use the NHS or not. It is set to rise to £624 in October.
    There is also controversy over the £900m figure which the prime minister told MPs is raised by this charge. The Institute of Fiscal Studies put the sum at a tenth of that – £90 million.
    Unite national officer for health Colenzo Jarrett-Thorpe  said: “Of all people, Boris Johnson should appreciate the wonderful and dedicated work of NHS health and social care professions, including the two non-UK nurses he singled out for particular praise in his fight for survival against coronavirus.
    “Therefore, the fact he won’t waive this £400 fee for overseas health and social care workers is mean-spirited and shabby.
    “With this prime minister warm words of praise come cheap, but a small financial gesture for NHS migrant workers, many of them low-paid, is beyond his compass. His stance is hypocritical.
    “Tonight, we will have the Thursday ‘clap for carers by the people of the UK, many of them who voted for Boris Johnson as recently as last December – there is a big irony here. This charge should be waived immediate.”:
     
    Unite senior communications officer Shaun Noble
    Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
    Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

     

    1 Comment

    The Royal College of Nursing, in its super-polite way, has written a letter to the Home Secretary, Priti Patel, asking her to make sure that those risking their lives for us in the NHS, should not have to pay punitive extra charges if they become ill themselves. For NHS workers have been surcharged for NHS treatment since 2015, if they have come from overseas. There is a petition “How can we expect nurses to come to Britain and fill our NHS vacancies, risk their lives when they have to pay £11,000 to use – the NHS?” which you can sign if you wish: http://chng.it/mkPN7jmwzm.

    Doctors, nurses and paramedics have now been granted a one-year exemption. One year!   But Dominic Raab said on Monday (18th May) that there were no plans to extend even the one year exemption to care workers. The Royal College of Nursing would be entirely justified if they decided to call for a strike or work to rule until this unfair surcharge is removed permanently, as indeed would the unions representing all health related workers, including the porters, caterers and cleaners (whose employment in most cases is contracted out under privatisation introduced by Thatcher). But if nurses and other health workers feel unable to strike (especially now, which no doubt the Government are counting on) other unions could take action in support of all health and care workers!

    Maya Goodfellow, author of the book Hostile Environment (Verso, 2019), wrote in the Guardian yesterday (19.05.20): “By asking them to pay twice for healthcare, the government is betraying the very people it applauds so publicly”. She pointed out that the British Medical Association has consistently been saying that all healthcare workers should be exempt from the immigration health surcharge. They are already paying tax and national insurance like everyone else. So they are paying twice for NHS treatment.

    All the other political parties have opposed this surcharge.

    Today in Parliament, Keir Starmer raised the issue again in Prime Minister’s Questions, pointing out that a care home worker would have to work a 70 hour week to make enough to pay the surcharge. I was watching the BBC broadcast, and heard Johnson say, of course, lots of stuff about the wonderful NHS, and the overseas workers that saved his life. But on the key point about them paying hundreds of pounds extra to use the NHS, in which they are risking their lives to work, Johnson had the gall to say “the NHS needs another £900 million from such sources”. I am not quite sure what the other sources of the £900m were, besides the surcharge from overseas workers, that he had in mind, but this was utterly shocking and disgraceful. I also had the pleasure of seeing the Speaker of the House, Lindsay Hoyle, threaten to throw Matt Hancock (Secretary of State for Health) out of the House for speaking over Keir Starmer, which has now been reported in the papers for tomorrow.

    Vivien Walsh, Manchester

    1 Comment

    Introduction

    This is the tenth SHA weekly blog on the COVID-19 pandemic. We are at an interesting phase of the pandemic when we are moving from Response to Recovery and uncertain how to navigate the tricky waters without the charts and the data dashboard to guide us.

    We have a government that was ill prepared for the pandemic and has been playing catch up from the early days of denial, then delay and a too early departure from building local systems of community testing, tracing and isolating. We are beginning to hear of possible COVID-19 cases in the UK and neighbouring European countries emerging before Xmas so the virus could have been around longer than we have thought. Even so we wasted precious weeks in February and then had the damaging delay between the 10th March to the 20th March, when lockdown proper started during which time the viral spread had been exponential. We now note that England has one of the highest rates of excess deaths of the 24 European countries analysed by Euromomo.

    Game changers

    The government have, in the turmoil, grasped at ‘game changers’ such as the so called home based antibody blood spot test which was scientifically unproven and nevertheless succeeded in getting the Government to buy 3.5m on ‘spec’. We need to know how much Taxpayers money was wasted on that contract and demand a greater scrutiny on such wild contracts without basic safeguards.

    The next ‘game changers’ were the treatments such as chloroquine, which Trump was allegedly pushing on the NHS to treat Prime Minister Johnson. Again these drugs have been shown to be ineffective and potentially harmful treatments. The US Federal Drug Administration (FDA) issued a caution against its use in COVID-19 on the 30th April! There are other drugs being trialled such as remdesivir and favipiravir and some show promise but need properly conducted clinical trials and not be pushed out too soon by politicians anxious to grab a game changer. Remember the risk of Thalidomide, which was used in early pregnancies with disastrous consequences. We have seen with HIV/AIDS that therapies can be successful in controlling a viral disease but the process takes time and effectiveness trials and safety are paramount.

    The other ‘game changer’ is the vaccine which has always been a long shot because there have never been vaccines developed for Coronaviruses such as SARS or MERS. Other viruses such as HIV have also proved impossible to develop a vaccine for and remember each year the Influenza virus ‘flu jab’ immunisation contains three variants which experts assess are the most likely to be circulating during the coming winter months. The effectiveness of the Influenza vaccine is much less than others such as measles in the highly effective MMR vaccine. Furthermore while there are hopeful signs of successful vaccines being developed and some moving into human trials very early on there needs to be clarity about the time these trials take and the manufacturing process as well as mounting an effective vaccination programme. It is not part of the immediate pandemic control measures and with preventive vaccines you need to be very sure of safety as well as effectiveness. We know how the anti vaxxers mislead the public about risks of vaccination and do not want to damage the high uptake of vaccines across world populations.

    Matt Hancock has during his time as SoS for Health and Social Care promoted digital solutions to many NHS issues including promoting companies who in effect were competing as privateers with NHS primary care (Babylon Health). His latest ‘game changer’ application will be the apps being trialled in the Isle of Wight and others elsewhere to assist in contact tracing.  Big players Apple/Google stand ready with their apps to step in! Of course countries like South Korea, Taiwan and Singapore have been using such apps for months and have shown the benefit they confer in the process of Test, Trace and Isolate which the UK government abandoned on March 12th.

    It does seem unbelievable that South Korea has not been subject to lockdown and using testing, tracing and isolation has only had 262 deaths from COVID-19 by the 17th May with a population of 51m people. Their epidemic started several weeks before us and it is not clear what attempts the UK government has made to properly understand their system and learn from it.

    Local Authorities and Public Health

    Local Authority public health capacity has been reduced over the 10 years of Tory austerity and the public health grants reduced in the period leading up to the pandemic. While the Directors of Public Health, through their national body the Association of Directors of Public Health (ADsPH), have been involved with the CMO’s office and Public Health England (PHE) they have not been placed at the centre of the Test, Track and Isolate planning. Again the Government’s default position is to ask their consultancy mates to help design a system from scratch which we have seen with the national testing centres and the Lighthouse laboratories by Deloittes. This is a top down approach rather than a collaborative bottom up development.

    Further work now under a Joint Biosecurity Centre (JBC) is again focused on the digital app and how the information provided can be analysed and communicated. This has all the tenor of a security service GCHQ venture rather than a public health pandemic response! If the testing roll out is anything to go by there will be major glitches in communications with organisations at the heart of it not receiving information and the people themselves left waiting.

    It seems to us that local public health teams under the DPH leadership should have been involved from the beginning working with Public Health England/Wales/Scotland,  and Environmental Health departments to help facilitate test, track and isolate policies locally. They have not been closely involved since containment was abandoned prematurely across the UK despite wide variations in the spread of the virus at that time.

    The government announced that 18,000 staff will be taken on to work on the national test, trace and track initiative run by SERCO but Local PH departments were not asked to build local teams as part of the local response but prepare to help implement the national response. Primary care has also not been part of the model which is another wasted opportunity of bottom up work using local knowledge effectively. The GP surveillance system has shown its worth over many years with respiratory viruses like Influenza and patients know their GP practice as a trusted point of contact.

    We have seen that COVID-19 has spread across the UK unevenly and a UK wide response designed in Westminster has not been appropriate elsewhere where case numbers may have been very low with risks quite different from metropolitan London, Birmingham and Manchester. Of course there needs to be national leadership in the design and procurement of such an app and Public Health England with their counterparts in the devolved nations be part of the design team. However for it to be an effective system there needs to be local leadership and engagement which builds links between partners and particularly with local primary care teams to use test results and develop the capability of mapping clusters and initiating further local investigations within national case definitions to ensure testing is done, contacts traced and people are isolated swiftly as there is a risk that the virus will persist for weeks to come. There are signs that devolved governments such as in Wales may be approaching this in a more joined up way.

    Social Care

    In earlier blogs we have talked about the vital role that the social care sector plays, how their staff often work in difficult conditions on low pay. The impact of the pandemic now has shifted to this sector, which has 17,000 homes and look after 400,000 elderly or disabled people in need of care. This sector is where many of the excess deaths have been occurring and thanks to statisticians outside government who have signposted the excess deaths measure we know that they have accounted for 20,000 deaths so far. Weekly deaths in care homes have tripled in the past month. In Scotland recently it is estimated that 57% of deaths from COVID now come from deaths in nursing or residential homes.

    We have heard case after case of social care providers not having the PPE they require, having to accept hospital discharges who may have been infectious, not being supported in the way you might expect from external agencies. They have had to introduce infection control policies, which seem inhumane when considering the resident’s end of life experience and the memories of their survivor families. We should have a quick look at the risk assessments/processes to allow named next of kin to visit their relatives and be there at the end of life. It does feel that this is the time to grasp the nettle and create a new National Care Service which is publicly run and which does not require rental payments to ‘off shore’ bodies, who have invested in the land and properties rather than the commitment to care. Not all care homes are owned and run by business interests of course but all suffer from chronic underfunding, staff shortages and service gaps between the NHS and their own provision. The CQC is unable to bridge the gap.

    Moving out of Lockdown

    We are all getting tired of having our lives constrained by lockdown while at the same time pleased at the social solidarity shown by most of the population. The trade unions are quite right to ensure that the workforce is not endangered by a hasty return to work without rounded risk assessments.

    Take the school debate for example. It is relatively easy to look at children themselves and declare that they as an age group have been relatively spared the harms of COVID-19. However we know that they do seem to get the infection and harbour the virus in their noses and throats too. We don’t know how contagious they are but there is obviously a risk and scientific studies are understandably scarce. European countries such as Norway and Denmark have had far less cases and deaths than the UK and have got down to very low levels. For example Norway has had 8,244 cases with 232 deaths and Denmark 10,927 cases with 547 deaths. Their schools have had to implement big changes in the way they mix outdoors and indoors classes and have had to physically distance children in classrooms and for school meals. Halving class sizes seems the likely way we would need to go in the UK which might mean two day sessions which would have huge implications for schools.

    But its not just children! Teachers and school staff are at risk and there needs to be proper occupational health assessments to assess individual risks in the staff. Then there are parents and grandparents who may be involved in bringing children to school and mingling with others at drop off. Children may in turn bring back the virus to the home where there may be vulnerable others living there. So rather than the hurried declaration made to reopen fully on the 1st June there needs to be proper discussion and agreement with trade unions and parents and staff/school Governors on the risk assessment and plans. Remember too that schools have been open during this time for children of essential workers and vulnerable children many of whom have not attended. Oh, by the way, Eton pupils will return to school in September and they already have small class sizes!

    Scrutiny of Public Expenditure

    It is estimated that the Government has now built up £300 billion national debt through its Pandemic investments. The furloughing scheme has been widely welcomed, as has the cancellation of NHS (England) historic debt. However there have been some decisions made by harried Ministers that have been misplaced (such as the home based antibody test) as well as some of the spend on ventilators and Nightingale hospitals when it was already apparent that the NHS was coping somehow with the huge demand on ITU capacity. The decisions to contract out some of the tasks on testing, track and trace have been questionable and the investments in the pharmaceutical industry for vaccine production/drug development need to be scrutinised. Contracts worth more than £1bn have been awarded to 115 private companies dealing with the pandemic, without allowing others to bid for the contract. This has been under fast track rules which suspend normal procedures and include contracts to provide PPE, food parcels, COVId-19 testing and to run operations rooms with civil servants. This latter group includes Deloitte, PWC and Ernst & Young!

    The last thing we want is to be plunged back into austerity at the end of the pandemic. Already we hear of withdrawal from the rough sleepers investment in accommodation before alternative plans are in place and indeed before realistic resurgence in tourism happens. The new normal needs to preserve the advances that have been made. Similarly simple calls for people to drive to work risks the modal shift that is possible towards walking, cycling to work if public transport is deemed too crowded for social distancing. Electric cycles can be promoted for those with further to travel or in hilly areas. The reduction in air pollution while helping the carbon load is still not at levels this year required if we want to meet the goals of the Paris Accord and keep global temperature rise to 1.5 degrees.

    The Chancellor and his advisers will be wondering how to get more money into the Treasury. Now is the time to look at a proper wealth tax and to deal with off shore tax avoidance. Dyson tops the Sunday Times Wealth list and remember Sir James moved his head office out of the UK to Malaysia during the Brexit debates. He is sitting on £16.2 billion wealth. The Duke of Westminster has had 300 years in the top spot of property wealth  (£10.3 billion) built on their portfolio of 300 acres of Mayfair and Belgravia (remember the Monopoly Board!). Others in the top 10 include the Coates family who have accrued £7.17 billion through gambling business such as Bet365 and we know the damage to public health that gambling does. Finally lets call out Richard Branson who sought a government subsidy of £500m for his furloughed staff in Virgin Atlantic with his £3.63 billion. He has apparently not paid any personal tax in the UK for 14 years. These super rich need to be taxed on their annual earnings as well on inheritance transfers, which by using Family Trusts subvert the process.

    Finally

    As we think of US billionaire David Geffen on his $590m yacht, who posted on Instagram that he was isolated in the Grenadines avoiding the virus – lets consider a better fairer future.

    The pandemic can be an opportunity for progressive change to reduce inequalities but we know that there are entrenched and powerful interests. The rich are often supporters of entrenched interests as they benefit from the status quo. In the light of the pandemic they should reflect on how sustainable the status quo really is. We also need to clear set out a new road map for a fairer future.

    17th May 2020

    Posted by Jean Hardiman Smith on behalf of the Officers and Vice Chairs of the SHA.

    2 Comments

    Issue: 98

    17 May 2020

    The UK Now Has the 4th Highest Covid-19 Death Rate in the World

    Deaths/Million of Population

    UK: 495

    Some countries which are much more densely populated than the UK have much lower Covid-19 deaths/million rates. These include Bangladesh (2), South Korea (5), India (2) and Israel (31). (Source Worldometer, 14 May 2020).

    Why has this happened? Who is responsible? Is new leadership now required in the UK?

    Covid-19 Care Commissioning/Purchasing/Supply Chaos

    Clinical Commissioning Groups, NHS Trusts, NHS England, Local Authorities, care homes and now DHSC/eBay are all purchasing Covid-19 supplies including PPE.

    Where is the control? Where is the order? Where is the leadership?

    On 1 May 2020, somewhat belatedly, The Department of Health and Social Care (DHSC) apparently wrote to all NHS Trusts stopping them from purchasing supplies. This includes PPE. I’m sure NHS Trusts are not intentionally stupid. They have been buying PPE themselves because the DHSC/NHS England/CCGs were not commissioning/purchasing/supplying PPE!

    The latest supply channel is a joint venture between DHSC and the shopping and auction site eBay. The venture is very new and according to ’Health Service Journal – on 6 May 2020 had supplied just 400,000 PPE items to only 1,400 of the 58,000 UK care service suppliers.

    Ealing Council Leader Julian Bell is alleged to have announced in a Unite Zoom meeting on 12 May 2020 that Ealing Council had been successful in purchasing PPE for four West London Councils’ ‘local care services’. Following recognition of this, Councillor Bell said the Council would soon be the purchaser of all PPE for all London Councils’ local care services. All this seems quite odd when one considers that the vast proportion of care/nursing homes are privately owned. Shouldn’t the owners of the homes be expected to provide PPE for their staff? Surely the same logic applies to the vast proportion of domiciliary care staff who are employed by private companies – their employers should surely provide them with PPE, not Local Authorities.

    On 15 May 2020 ‘The Guardian’ reported on the shambles at the Government’s outsourced PPE depot run by Movianto. Apparently PPE equipment was being stored in a smoke damaged Merseyside warehouse found to contain asbestos. In late March 2020 the Government ordered Movianto to begin distribution of the £500 million PPE stock. However, because of poor management and staff sickness progress was slow, errors were made and as demand grew apparently it became chaotic. The army was called in to sort it out. It didn’t help that during this period the American parent company sold Movianto to a French company. Questions are being asked as to why DHL lost the contract in 2018 and why Movianto, a loss making company for every year since 2010, had managed to win the £10.5 million/year contract.

    Local Resilience Forums (LRFs) Claim Government’s Approach to Them for Covid-19 Has Been ‘Top-down, Uncommunicative and Controlling’

    There are apparently 42 LRF’s in England and Wales. They have been tasked by Government to respond to Covid-19. A review by Whitehall, revealed in ‘Municipal Journal’, is very critical of the Government. The leaked report cited withholding vital data and intelligence on the progress of Covid-19. Research was carried out by Nottingham Trent University for the C-19 Foresight Working Group – a cross-party Government committee.

    Local Resilience Forums – which most people have probably never heard of – were introduced in 2004 in the Civil Contingency Act to provide the means to those involved in preparedness to collaborate at a local level. There is just one LRF in London (serving 9 million residents!) and it’s based at the London Fire Brigade, London SE1.

    Will the Government Mishandle Covid-19 Local Testing/Contact Tracing/Isolation/Quarantining?

    Sadly this is likely.

    Public Health Professor Allyson Pollock at Newcastle University and a member of the King Independent SAGE team has on numerous occasions emphasised that the Covid-19 national epidemic is not homogeneous. It is in fact hundreds or thousands of local Covid-19 outbreaks that are active in this country – all at different stages of ‘diffusion’.

    The key to contact-tracing is local knowledge and meticulous research on the ground. This suggests using Local Authority resources, GPs and the myriad of volunteer groups which already exist in all towns and villages throughout England.

    Allegedly Government outsourcer Serco has assembled/is assembling 15,000 tracers (Call Centre staff?) and 3,000 clinical support staff (recent NHS retirees?). ‘Health Service Journal’ reported on 13 May 2020 that much of the national test centre data/results were not being shared with GPs and Local Authorities. Will Deloitte who run these national test centres hand this test data to Serco?

    Yet another ex-McKinsey & Co employee is joining the fray and in a top position too. Baroness Dido Harding has been appointed leader of the Government’s Covid-19 Test and Trace Taskforce.  Her stint at McKinseys was in the 1980s. However she became notorious for her performance when CEO of TalkTalk for seven years. Her handling of a cyber attack resulted in losses of £60 million, four million customer accounts allegedly hacked, and a loss of 95,000 customers.  Baroness Harding also seems to have kept her role as Chair of NHS Improvement. Maybe with the merger of NHS England and NHS Improvement (NHSI), the NHSI Chair’s role is effectively redundant.

    The Government’s (as yet unnamed) contact-tracing App is still on trial on the Isle of Wight. If it ‘fails’ – on ethical or technical grounds – the Apple/Google App, being used in Europe, is waiting in the wings. And, according to ‘The Times’ of 14 May 2020, there are 43 Covid-19 contact tracing Apps in use worldwide.

    National Audit Office (NAO) Describes £8.1 Billion NHS IT/Digital Transition Spending as Inadequate and Confused

    • 54% of NHS Trusts reported that their staff could not rely on digital records.

    • NAO recommends spending 5% of the total annual NHS budget on IT/digital transformation. NHS is spending 2%.

    • Interoperability between new and legacy systems, especially with repeated changes in national strategies has created a fragmented environment.

    • NHS management of digital transformation at a national level is confused.

    A New Post Covid-19 Healthcare Plan Being Hatched for London

    ‘Urgent Action: System Plans for London’ is the title of a 29 April 2020 leaked memo to the five London Integrated Care System (ICS) Chairs and Senior Responsible Officers (SROs). The author is Sir David Sloman, NHS London Regional Director.

    The memo asked all these bosses to rapidly review their ICS plans in terms of new Cocid-19 challenges and future care strategies. It also asks them to report against 12 expectations contained in a ‘Journey to a New NHS‘ paper along with a set of slides. They had to reply by 11 May 2020. Why the rush one wonders?

    The backdrop to all this is multifarious. Firstly in terms of previous plans we have at least the October 2019 ‘London Vision’, the January 2019 national ‘Long Term Plan’, and the November 2017 ‘London Care Devolution’, and the five London regional October 2016 ‘Sustainability & Transformation’ Plans. In terms of statutory significance the ICSs have no legitimacy at all. In fact in at least one London region (NHS North West London) its ICS will not be formally born until 1 April 2021. (In NHS NWL for example, the only statutory legitimacy lies with the eight CCGs. Ealing’s CCG is strangely quiet at the moment. The last we heard from the Collaboration of the 8 CCGS was that all but Hillingdon CCG were ‘partnering’ with other CCGs. No doubt they are all trying to reduce their combined 2018/19 annual ‘employee benefits’ of some £10 million).

    A bit more NHS NWL flavour here is also relevant. In May 2019 NHS NWL outlined there would be 8 ‘Place Teams’, 8 ‘Local Committees’ and 8 Integrated Care Parnerships (ICPs). One year on, one wonders what’s happened to plans for them? Or is planning and strategy a London-wide only approach now?

    It really does seem an age away in 2013 when NHS bosses were preaching about local commissioning, by local GPs with local knowledge. Their bible then was the 2012 Health & Social Care Act – which ominously is the existing legislation that is being blatantly ignored in spirit and possibly in actuality.   

    Now to the content of the memo. A quick glance at the 12 expectations:

    1. How are you going to deal with non-Covid-19 acute elective and non-elective work? In other words how are NHS Trusts going to carry out the jobs they are paid to do?
    2. A consolidation and strengthening of specialist services. Cancer, paediatrics, renal, cardiac and neurosurgery listed. Does this suggest mergers and closures?
    3. Increase web, telephone and video triage. Never mind the quality – it’s cheaper than actually having to travel from home and meet a patient in a clinical ’setting’.
    4. How will you separate emergency Covid-19 from emergency ‘other’. (Given that some emergency other patients are locked into the ‘stay at home’ paradigm and think NHS UCCs and A&E units are awash with the Covid-19 virus).
    5. Develop virtual by default Primary Care and Outpatients. See 3.
    6. Minimise inpatient length of stay and faster Delayed Transfer of Care. See NHS NWL ‘Shaping a Healthier Future’ case study – seven years and £1.3 billion spend made little progress on this minimalisation.
    7. Address health inequalities – see similar unmet aspirations like Climate Emergency and clean drinking water for all the 7.7 billion inhabitants in our world.
    8. Same expectation as in 2.
    9. Merge corporate support services and clinical support services. Cost savings here.
    10. A workforce plan. Good luck with that one. Too few doctors, nurses, consultants, mental health staff at all levels, and too few support staff. Too many commissioners.
    11. A plan to ‘join together’ NHS institutions and Local Authorities. With different business models, goals, budgets, culture, politics and a shared desire not to open up financial books to each other – little progress on this front visible over the last seven years. No mention of ‘Integrated Care Partnerships’.
    12. Public engagement including ‘deliberate’ forums (e.g. NHS NWL 4,000 EPIC hand-picked sounding board – which is an attempt at regularly polling a representative sample of the 2.4 million NWL patients).

    Revenue and capital cost estimates were asked for. A three phase implementation over 18 months was proposed. But the NHS never meets its timescale projections. A new bit of jargon emerged – ‘London Vision the Touchstone’…….

    The 32 London boroughs commission all London’s social care. However it’s clear from comments heard from the London Borough’s of Ealing and Hammersmith that they have not been asked to comment on these NHS ‘Systems Plans for London’. Yet another painful example of the long running disconnect between healthcare and social care.

    A final postscript on NHS London supremo Sir David Sloman. Google can’t find anything about his life prior to 2009. In 2017 he was admonished by the Government’s data protection agency for illegally giving details on 1.6 million patients to Google Deep Mind.

    Is the Care/Nursing Home Business Model Broken Beyond Repair?

    Most care/nursing homes in England are privately owned. There are 17,000 nursing and residential care homes in England housing 400,000 people (NHS England, 2019). A lot of homes are part of care groups both small (e.g. Abbey Healthcare) and large (e.g. Four Seasons). Some are run by charities (e.g. St David’s, Castlebar Hill, W5). Care is commissioned by Local Authorities (LAs). The homes are regulated by the Care Quality Commission (CQC). Each home has a contract with a local GP practice. Many GP practices are commissioned by NHS England (NHSE). Some GP practices (e.g. the 75 in Ealing) are commissioned by the local Clinical Commissioning Group (CCG). Where local CCGs have been replaced by regional Integrated Care Systems (ICSs) could it be that the succeeding ICS is the commissioner? For over two years now the Department of Health has had social care responsibilities – so the DHSC has overall responsibilities for care/nursing homes. The care/nursing home acronym soup or tangled spaghetti looks like LAs, CQC, GPs, NHSE, CCG, ICS, DHSC.

    ‘Reuter’s’ data analysis up to 1 May 2020 shows at least 20,000 excess deaths in care homes in England and Wales during the pandemic. Is it any wonder then that when the Covid-19 history books are written one of the most painful chapters will be on unnecessary care/nursing home deaths.

    Eric Leach

    Silver Voices

    1 Comment

    Death Rates in France

    Tony Cross, formerly of Radio France International (the French equivalent to the BBC World Service), reports from France in www.theravingreporter.com that the number of deaths per day (from all causes, and not just deaths in hospital) has declined from a high point of 600 a day at the beginning of April, to a lower rate than in the previous two years (see the yellow line, compared to the red and blue lines). This is probably due not only to the decline in Covid-19 deaths as a result of the lockdown, but also to the lower rate of road traffic accidents and lower air pollution from road and air traffic. The statistics come from INSEE, the French National Institute for Statistics and Economic Studies.

    Deaths from Covid 19 in the Care Sector

    Meanwhile, in the UK, Ann Bannister, Secretary of Reclaim Social Care, has just posted death figures from the Office of National Statistics covering Care Homes and Domiciliary Care.

    From March 2nd to May 1st this year, there were 45,899 deaths of care home residents, 27.3% involving Covid-19. 72.2% of Covid-19 deaths of care home residents were in a care home when they died, and the rest had been transferred to hospital. This means that over 9,000 deaths were not included in the totals reported in the press, of all the deaths from the virus, because the press was reporting only hospital deaths.

    Covid-19 was the main cause of death of men in care homes who died during the same period, while Alzheimer’s and other forms of Dementia were the main cause of death in women living in care homes, with Covid-19 in second place. However, Dementia and Alzheimer’s were also the main pre-existing condition in deaths caused by Covid-19 in both sexes.

    The statistics for recipients of Domiciliary Care 10 April – 8 May 2020 show that 3,161 clients of care in their own homes died of Covid-19, which were 1990 more than the average over three years.

    Unison North West are planning a Social Care campaign video conference on 26 May. To register email nwepoc@unison.co.uk

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