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    MASS TESTING PROGRAMMES FOR COVID 19 USING NOVEL TESTS

    SITUATION

    Last week [November 9th] the government proudly announced a major expansion of the UK s testing programme to provide rapid access testing of asymptomatic people for COVID 19 [1].

    They claimed this programme was : –

    • a“ vital tool to help control this virus and get life back to normal “
    • a partnership between national Test and Trace and local public health directors ‘
    • to develop the evidence base on how testing with rapid reliable COVID-19 tests can be delivered at scale

    Liverpool has nearly completed a two -week “pilot” programme to offer rapid testing to the half a million people who live in the city.

    The stated aim of this pilot is to: –

    “identify many more cases of COVID and break chains of disease transmission” and

    “ to protect those at highest risk from the virus and enable residents to get back to their day to day lives

    Meanwhile the Government has also announced following a report by Public Health England / Porton Down [2] that they are extending this pilot and releasing 600000 lateral flow test kits for local authorities to use on asymptomatic people “ at their discretion “.

    So far, 87 Local Authorities have opted to take part in this new pilot programme. Each will receive weekly batches of 10000 test kits

    ASSESSMENT

    The roll out of mass testing on people without symptoms is happening at an alarming pace

    SAGE s advice [14] on 10 September 2020 was that: –

    “Prioritising rapid testing of symptomatic people is likely to have a greater impact on identifying positive cases and reducing transmission than frequent testing of asymptomatic people in an outbreak area”.

    Some highly respected scientists and public health doctors have criticized the conclusions drawn from the evaluation of these novel tests – namely that they are sensitive and specific enough to use on asymptomatic people.

    Others have described these mass testing programmes [originally part of Operation Moonshot] to be “scientifically unsound unethical, unevaluated and a costly mess “ [3,4]

    What are these concerns?

    [Refs 3,4,5,6 7,8]

    1 Accuracy of the tests

    1. The relationship between these novel tests being positive and clinical infectiousness is unknown. [8]

    Sensitivity

    2 The lateral flow tests chosen for mass testing are not sensitive enough to accurately detect infection when used on asymptomatic people.

    Between 1 in 4 and 1 in 2 infectious cases will be missed, when used in the field. Many people will be given false reassurance that they are not infectious and need to have repeat “gold standard” PCR tests to confirm the results.

    Specificity

    3 When infection rates are low or prevalence is falling as it is in Liverpool , a large number of people will falsely test positive and be told to self isolate. Many will experience the harmful and regressive effects of self-isolation.[ 7 ]

    2 Design and evaluation

    The National Screening Committee and National Institute for Health Research (NIHR) have not been involved or asked about the design of this programme.

    Their design lacks transparency and a clear set of objectives.

    No criteria or protocols for evaluation have ever been made available in the public domain.

    Unlike other screening programmes, there is no systematic call or recall of an identified, registered population and no expectations about population reach or uptake.

    [Initial findings from the Liverpool pilot would appear to indicate that those most at risk of being infected have been the least likely to come forward for testing.

    Positivity rates amongst the 110, 000 people tested so far are low [about half that of the current prevalence [ 2.2%] in the north west region [11]

    3 Follow up of positive cases and their contacts

    More cases will generate many more contacts to follow up

    In Liverpool, follow up of positive cases and their contacts has been entrusted to the national Test and Trace system. Over the last 4 months, this national system has only been reaching around 58% of contacts  [10] i.e. well below that required to stop onward transmission.

    4 Ethical issues

    The ethical basis for expanding mass testing using novel tests is very shaky.

    These pilot programmes have not undergone the normal process required for ethical approval.

    People are invited to have a test which has not yet been properly peer reviewed. The results of these tests if positive could have serious consequences for their personal freedoms, income and well-being. [7]

    There are also concerns about the process and practices for gaining consent to participate.

    4 Sustainability

    The government has, yet again, chosen to use a separate and privately run infrastructure to deliver this mass testing pilot programme.

    If rolled out nationally, the Liverpool population mass testing programme would need the equivalent of 260, 000 army personnel to deliver it. It is hugely expensive and not sustainable.

    Other options, such as using existing well distributed highly accessible primary care services [including local pharmacies] to provide rapid access testing should have been explored.

    5 Overload of local authorities and public health teams

    The burden of organizing new testing programmes for asymptomatic people will place another strain on already overburdened local public health teams.

    Their priorities should be to: –

    • Identify and manage clusters of cases /outbreaks in high risk settings such as schools, care homes, prisons and other geographical hot spot areas [12]

    • Improve adherence to isolation through organizing support and accommodation for people who are finding it difficult to self isolate. [13]

    6 Implementation

    Implementation has so far been rushed –leading to long queues of both symptomatic and non-symptomatic people, wrong invitation letters issued by schools and questionable practice in relation to “ informed consent”.

    The lack of rigour and consistency with respect to research design and implementation across different local authorities means that it will be very difficult understand the impact of these new mass-testing programmes on COVID transmission.

    Conclusion

     The widespread introduction of these mass screening pilot programmes using novel tests can have serious consequences for people’s lives.

    Politicians need to understand that concerns expressed about the choice of tests and the design of these programmes are not just a matter for academic debate or professional discussion.

    Accepted standards for design, ethics and evaluation must be adopted – otherwise they could seriously undermine public trust, confidence and future willingness to engage in helping to control this pandemic.

    RECOMMENDATIONS

    1. The continued roll out of these mass screening pilot programmes should be paused immediately.
    2. 2 The UK National Screening Committee should have oversight of their design and implementation
    3. Mass screening ‘pilot “programmes should be funded as research – and undertaken through the NIHR in order to ensure public and patient benefit
    4. Primary care service [including local pharmacies] should be the preferred route for the future distribution of rapid access tests if these are recommended for use by the general population

    References

    1 https://www.gov.uk/government/news/more-rapid-covid-19-tests-to-be-rolled-out-across-england

    2 https://www.ox.ac.uk/sites/files/oxford/media_wysiwyg/UK%20evaluation_PHE%20Porton%20Down%20%20University%20of%20Oxford_final.pdf

    https://www.bmj.com/content/370/bmj.m3699

    Operation Moonshot proposals are scientifically unsound]

    Jonathan J Deeks, Anthony J Brookes, Allyson M Pollock

    BMJ 2020; 370: m3699  (Published 22 Sep 2020)

     

    4 https://www.bmj.com/content/371/bmj.m4436

    https://www.sochealth.co.uk/2020/11/05/asymptomatic-covid-19-screening-in-liverpool/

    6 https://blogs.bmj.com/bmj/2020/11/09/screening-the-healthy-population-for-covid-19-is-of-unknown-value-but-is-being-introduced-nationwide/

    7 Waugh P. NHS test and trace chief admits workers fear “financial” hit if they self-isolate. Huffington Post 2020 Nov 7.

    8

    https://journals.sagepub.com/doi/full/10.1177/0141076820967906

     

    9 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/926953/S0743_SPI-M-O_Statement_on_population_case_detection.pdf

     

    10 https://www.gov.uk/government/publications/nhs-test-and-trace-england-and-coronavirus-testing-uk-statistics-1-october-to-7-october-2020

     

    11 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/6november2020#regional-analysis-of-the-number-of-people-in-england-who-had-covid-19

     

    12 https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/operational-considerations-contact-tracing.html

     

    13 Covid-19: breaking the chain of household transmission. BMJ2020;370:m3181.doi:10.1136/bmj.m3181 pmid:32816710

    14 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/926953/S0743_SPI-M-O_Statement_on_population_case_detection.pdf

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    Attached is the advice / guidance just published by Public Health Wales’ TAC advisory group.

    It reports that infection and transmission rates are higher than previously thought, though the mechanism for this is not well understood.

    Preventive measures such as social distancing, hygiene, face masks for older pupils ( and encouraged in younger pupils) and ventilation must be instituted. Health education should promote good practice outside the classroom and school. The potential of asymptomatic testing should be considered.

    It argues that teaching is a low risk occupation and that school closures are a relatively weak anti-spread measure.

    In view of the negative impacts of school closures, it should be a very last resort.

    https://gov.wales/sites/default/files/publications/2020-11/technical-advisory-group-evidence-review-on-children-and-young-people-under-18-in-preschool-school-or-college-following-the-firebreak.pdf

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    Recently the Chancellor Rishi Sunak won widespread plaudits for altering the terms of his financial support for workers whose jobs are under threat because of the restrictions introduced in response to the pandemic.  The furlough scheme is back, leaving the workers affected with just 80% of their wages, rather than 67%.

    This was simply a tactical retreat.  The government has clearly signalled it is conducting a ferocious attack on living standards but has had to recalibrate what it can impose right now.

    It should be clear that the scale of this attack on the living standards of the working class and poor, is much more ruthless than the austerity of 2010 or in some respects even than Thatcher in the 1980s.  As a result, it should be equally clear that success for the government would be a decisive shift in favour of big business and the rich, at the expense of workers and the poor.

    Since class warfare is being waged, anyone who preaches social peace now is simply making it harder for the working class and its allies to defend themselves against a major defeat.

    Ratcheting down, not levelling up

    The claims that the Boris Johnson government is engaged in ‘levelling up’ poorer areas of the country belong with the falsehoods that he is ‘implementing Corbyn’s policies’, is ‘spending like a socialist’, has ‘abandoned austerity’.  They are all pure hokum. They are proposed by those wishing to blunt any opposition to the government, and repeated by those who clearly do not understand what is going on around them.

    All these claims fall apart as soon as the government meets any resistance, as the excellent campaign for free school meals by Marcus Rashford and others shows.  Donating £12 billion to SERCO, Deloitte’s and other private sector companies, most of whom are intimately connected to the Tory Party, while they for long refused £120 million for free school meals is not levelling up, implementing Corbyn’s policies or socialist spending or any other of the spurious claims.

    Austerity is properly understood as a transfer of incomes and wealth from poor to rich, from labour to capital. So, in the very first austerity Budget by Osborne and Cameron there were £12 billion in cuts to social security while business taxes were cut by almost exactly the same amount.  Clearly, even in simple accounting terms (leaving aside any economic effects) this had nothing to do with reducing the deficit, as was claimed.  But it did transfer government spending from the poor to the rich. Austerity has continued in the same vein, with varying intensity ever since. Previously, Thatcherism used the cloak of monetarism in order to effect exactly the same type of transfer, largely through an assault on the unions and tax breaks for the rich.

    In the same fashion, the overwhelming bulk of every package announced in the current crisis is to benefit big business.  So, of the initial £330 billion emergency package that was finally announced after the March Budget, £300 billion was in the form of loan guarantees to the banks to avoid losses on their business lending.   In contrast, just £1.6 billion is for local authorities who are under enormous pressure both from reduced revenues and much higher outlays to meet the mounting effects of the crisis caused by the pandemic.

    The attack on the working class

    The centrepiece of the class warfare being waged by big business and their government is on wages, hours and employment.  Here, the ratchet down effect is the most wide-ranging in its effects.

    This is easy to demonstrate.  Before the crisis began, however low wages were for workers across many sectors, they did at least receive 100% of those wages.  Under furlough conditions, where work was supposed to be suspended, this has been reduced to 80%.  At the same time, and completely against the rules, many companies committed fraud by forcing staff into work for no additional pay. Up to a third of all employees were asked or forced to come in, according to one estimate.

    In addition, a large number of firms are in the process of making that reduction permanent.  Three high profile employers, British Gas, British Airways and the BBC have all launched fire and rehire schemes to reduce wages and conditions.  Many others are following suit but are less well known.  As the end of the previous furlough scheme approached, the government tried to enforce a reduction to 67% of wages for some topped up by 5% from employers, and no support at all for those caught in the spurious ‘Tier 2’ restrictions.  The fear over the probable immediate collapse in jobs forced a tactical retreat.

    Now that furlough is back, there has been a return to 80%, at least for the time being. But even if this is the full extent of the reduction, it still represents an enormous and dramatic shift from labour to capital.  Nothing on this scale was achieved under austerity.

    The intention of the ruling class and the Tory government is as far as possible to make this reduction permanent.

    Mainstream economists have long studied the issue of the determinants of wages for obvious reasons.  There is a whole literature devoted to what they describe as the problem of rigidities that lead to ‘sticky’ wages, that is the difficulty in driving down nominal wages (here is just one example pdf, there are innumerable others).

    This ‘stickiness’ of wage growth is shown in Chart 1 below.  The annual growth in wages in nominal terms is shown in orange, the growth in wage in real terms (after adjusting for inflation) is shown in blue.  Nominal wage growth hardly fell at all in the last recession.  The brief dip in wages occurred in the first few months of 2009 and began to recover very slowly in later months.  It was only the simultaneous fall in the value of the pound, which drove up prices in an economic slump, which caused real wages to fall over a more prolonged period, from mid-2008 to the end of 2009.  But even wages in these terms began to recover in early 2010.

    Real wages for public and private sector workers fell after the June 2010 ‘emergency Budget’ all the way through to October 2014.  This was a result of government policy.  Only as the Coalition government geared up for an election the following year by loosening government spending did real wages start to crawl higher.  The austerity policy was highly successful in cutting real wages, as it was designed to do.

    Chart 1.  UK Nominal and Real Wage Growth, % change

    If everything else is unaltered, the combination of economic weakness, rising import prices and rising real wages from 2010 onwards was bound to damage profits severely. The centrepiece of the austerity policy was to combat this profits-damaging combination of factors.

    The chosen method was a public sector pay freeze.  Not only did this have the direct impact of cutting real wages (as well as cuts to pensions) for approximately 1 in 6 UK workers (over 5 million of them) in the public sector where union densities are highest, but it also had a ‘demonstration effect’ (pdf), of setting a nominal wage freeze or similar in the private sector as well. With prices still rising because of the effects of the weakness of the currency, real wages for workers started to fall once more.

    However, as appealing as it may be to employers to cut wages if they can, this does not by itself resolve the issue of profitability especially if the overall business conditions are characterised by sluggish growth and rising import prices. The austerity policy of driving down wages was only successful in raising the level of misery. It was not successful in its overall aim of raising profits.

    Worse, from the perspective of the architects and supporters of austerity, nominal wage growth continued to rise at a very modest pace after 2014 and continued to rise until the current pandemic began.  Real wage growth was more erratic, undercut by rising inflation once more in 2017.  But even so, no blow had been struck which cut wages sufficiently to raise profits on an enduring basis.

    This trend in profits is shown in chart 2 below.  Initially, profits fell as they tend to during a recession.  Sales were falling and as noted above wages remain ‘sticky’.  (The ONS data shown is actually a measure of the rate of return on capital, not strictly profits, but it is a useful guide to profitability).  Subsequently profitability did recover but only moderately.

    Yet profitability continues to remain below 2008 levels. And, as regular readers of SEB will know, profitability never rose sufficiently to spark an upturn in private sector investment. From the perspective of the capitalist class as a whole, there is no incentive to raise investment, which means adding to the productive capacity of the economy, if the rate of return on existing investments is depressed below usual levels.

    Chart 2.

    The reserve army of labour

    In the last recession and under the austerity policy real wages fell initially by 6% and only recovered over a very prolonged period. Under Thatcher, real earnings for those in work did not fall at all.  Instead, her policy addressed the problem of low profitability by massive deindustrialisation that created 3 million unemployed.

    The current policy is a combination of these two.  Through government policy wages are being slashed by 20% for very large parts of the workforce, even including those on the National Minimum Wage.  At the same time there is a sharp rise in the level of unemployment, and some businesses will fold.  The combination of these two factors, the sharp reduction of wages and the surge in unemployment is government policy.  It is a new development and its architects will be hoping that one reinforces the other, that much higher unemployment will be a decisive factor in keeping wages low long after the public health crisis is over.

    This mechanism was first analysed by Marx as the creation of the ‘industrial reserve army’ of labour. Marx says the reserve army of the unemployed exists in no previous form of society except in capitalism, and is integral to it.

    “The industrial reserve army, during the periods of stagnation and average prosperity, weighs down the active labour-army; during the periods of over-production and paroxysm, it holds its pretensions in check. Relative surplus population is therefore the pivot upon which the law of demand and supply of labour works. It confines the field of action of this law within the limits absolutely convenient to the activity of exploitation and to the domination of capital.” – Karl Marx, Capital, Volume One, Chapter 25

    In general, high or sharply rising unemployment holds the risk that it may produce social unrest and political discontent.  The government of an advanced industrialised country may choose to engineer a sharp rise in unemployment in an attempt to restore profitability, or it may choose to try to cut wages.  But both stratagems entail high risk.  Combining the two is exceptionally high risk.  Only in a period of desperation and generalised crisis would they be attempted or could they be potentially successful.

    Under the cloak of the public health crisis which their own policies have helped to create, the current government is attempting such a strategy. Naturally it is in the interests of all workers, all the oppressed and vast majority of society that they are not successful.

    By Tom O’Leary

    Article first appeared on Socialist Economic Bulletin on Nov 09, 2020

    https://us3.campaign-archive.com/?e=4aa60afb48&u=c5349f9d4e4d450b6d8558d09&id=2cc2d12870

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    Issue: 111 – 10 November 2020

    Pfizer Covid-19 Vaccine

    This could be the only good Covid-19 news we have had in a very long time. Regulators have still not approved the vaccine though, but allegedly this will happen soon. According to DHSC guidelines issued in September 2020, the top priority list for those being given the vaccine is older adults resident in care homes and care home workers, 80 years of age and over and health and social care workers, 75+, 70+. 65+, and high risk adults under 65.

    The Government has an agreement with Pfizer to buy 30 million doses, with 10 million due by the end of December 2020.

    Very Steep Rise in Secondary School Covid-19 Infection Rates

    The National Education Union (NEU) has analysed Covid-19 infection data published by the Office for National Statistics. The NEU states that Infection rates in Secondary schools in England are an astonishing 50 times higher since September 2020. In Primary schools the rise is nine times. The NEU maintains these figures clearly show that schools are engines for virus transmission.

    The NEU recommends schools staying open only for children of key workers and for vulnerable children during Covid-19 lockdown. The NEU membership is 450,000 teachers, lecturers, educational support staff and leaders. More at:

    https://neu.org.uk

    As a postscript to this, when I researched infection rates across many Ealing neighbourhoods on 9 November 2020 the three highest rates were in neighbourhoods containing secondary schools – Northolt South (349 cases/100,000), Southall Green (310.1) and Cuckoo Park, Hanwell (280.9).

    Hospitals are Breeding Grounds for Covid-19 Infections

    On 9 November 2020, ‘ITV’ reported that of the 12,903 new Covid-19 cases between 18 September and 18 October 2020. 1,772 were acquired in hospital. Of the 700 new hospital cases in south east England, 23% were contracted in hospital.

    It seems for all kinds of reasons hospital staff and patients are not being tested on a regular basis. By 20 November 2020, allegedly, all patient-facing NHS staff will be asked to test themselves at home twice a week with results available before coming to work.

    Covid-19 Lockdowns Impacting the Mental and Emotional Health of Young People

    The NSPCC AND Childline are both reporting increasing telephone and counselling sessions. Young people are increasingly presenting with feelings of isolation, anxiety, insecurity and eating and body image disorders. More at:

    www.nspcc.org.uk

    www.childline.org.uk

    Is Covid-19 Population Testing (Mass-Screening of Asymptomatic People) in Liverpool Simply the Wrong Thing to Do?

    80 test centres and 2,000 troops involved. This sounds expensive. But will it ‘work’? Professor Allyson Pollock, a recognised Public Health expert, has her doubts. On 3 November 2020, as part of the Government’s £100 billion ‘Operation Moonshot’, population-wide Covid-19 testing of asymptomatic people in Liverpool was announced. Eight test centres opened on 6 November 2020.

    Professor Pollock has pointed out that this initiative is at odds with the SAGE advice of 10 September 2020 and with the current World Health Organisation (WHO) guidance. SAGE and WHO favour prioritising the rapid testing of symptomatic people, contact tracing and identification of infection clusters. Her concerns about the Liverpool pilot include:

    • a diversion of public money and resources. The OptiGene tests have cost £323 million.

    • the use of inadequately evaluated Covid-19 tests (direct LAMP test (OptiGene) and a lateral flow assay (Innova)

    • WHO evaluations of similar tests suggest between 1% and 5% of people without infection may get false positive readings. (With 392,000 adults in Liverpool these false positives could number anything between 3,920 to 19,600 adults)

    • there is no evidence demonstrating that Covid-19 mass screening can achieve benefit cost-efficiency

    • smaller pilot studies should have been carried out first before launching a massive pilot study of 498,000 people. (Allegedly a pilot was carried out in Manchester and it was found that half of the infections were missed).

    More at:

    https://allysonpollock.com

    The ‘Sunday Times‘ of 8 November 2020 leaked that three towns would be added to the mass-testing project. One is thought to be in The Midlands and one in the south of England. This would add another 100,000 people to be regularly tested.

    Reduced Support for the Homeless in Lockdown 2

    During Lockdown 1 many homeless people were put up in hotels, hostels and other forms of accommodation. This Government funded ‘Everyone In’ strategy was deemed to be successful in saving lives and reducing Covid-19 infections rates during Lockdown 1.

    Now it appears that money is running out to support the homeless and getting them off the street during Lockdown 2. Almost half of the night sleepers in London are foreign nationals and under the October 2020 post-Brexit legislation they could face deportation if found sleeping in the street.

    One week into Lockdown 2

    On day one of Covid-19 National Lockdown 2 (5 November 2020), I researched the following Ealing Covid-19 infection rates per 100,000 people. A week later I did this again:

    Southall Park: 265.3 became 244.1

    Ealing Broadway: 247.6 became 281.4

    Acton Central: 147.8 became 113.7

    West Ealing: 132.9 became 122.9

    A very small sample I know, but in three out of the four neighbourhoods the rate had fallen.

    Government’s Vaccine Taskforce Chair Spends £670,000 on Public Relations

    Kate Bingham, Chair of the Government’s Vaccine Taskforce, has allegedly hired eight Admiral Associates public relations consultants at £167,000/year each. Ms Bingham, a qualified biochemist and venture capitalist, was hired by the Government in May 2020. She is married to Jesse Norman MP. Bizarrely she reports directly to Prime Minister Johnson.

    Town/Hospital Based NHS Activist Groups Slowly Being Marginalised

    Three main factors at work here. Firstly the demolition of local CCGs. In 2018/19 there were 195 of them. By 1 April 2021 they will all have been closed down and ‘replaced’ be some 42 regional CCGs. Secondly, the Covid-19 response National Lockdown 2 has shifted commissioning from local, through regional, to a national undertaking. Thirdly, Covid-19 has allowed NHS bodies and Local Authorities to remove citizens from any effective, real time involvement in statutory body public meetings. In Ealing, for example, virtual, public Council care meetings employ MS-Teams software in a restricted, unhelpful fashion.

    NHS NWL EPIC

    On 17 December 2019 In NHS North West London (NWL) a public engagement initiative called ‘EPIC’ was launched at a workshop. 80 people attended of whom 34 were ‘patients’. EPIC is being used ‘to gather public opinion about local and NHS activities, involving ‘local residents in shaping and co-producing our services’. NHS NWL EPIC has built a ‘Citizen’s Panel’ of 4,000 north west London residents. The make up of the panel is allegedly representative of the 2.5 million residents in the region. I applied to join this panel but my application was ignored. Another EPIC Citizen’s panel meeting – this time a virtual one – was held 27 October 2020. In this meeting the idea of a ’Patient Forum in each borough’ was floated. The local Healthwatch, the local Council and the local voluntary sector would be invited. No timescale was set and it’s obvious that the forums would have no statutory significance whatsoever.

    Public Involvement Charter (PIC)

    EPIC is also developing its own ‘Public Involvement Charter’ (PIC). The PIC has admirable intentions and ‘core values’ – ‘the right to be involved, influence, improving outcomes, inclusion, engagement as residents want, information and transparency’. And all this as ‘we move more towards the (non-statutory) Integrated Core System (ICS)’.

    With all the generosity I can muster, I find the non-statutory EPIC, Citizen’s Panel and the Public Involvement Charter to be underwhelming, likely to be expensive and probably a complete waste of NHS and citizen’s time.

    Eric Leach

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    The Socialist Health Association is appalled by reports that Kate Bingham, who heads up Boris Johnson’s vaccine taskforce, has charged the government £670,000, for what is described as a ’team of boutique relations consultants.’ Each consultant is reportedly paid £167,000 a year – more than the Prime Minister. There appears to have been no formal process to appoint Bingham to chair Britain’s vaccine taskforce.

    This would appear to be a gross waste of public funds, which are desperately needed to fight the Covid pandemic.

    The Sunday Times reported that Bingham had shared government documents to investors at a $200-a-head virtual conference – an appearance that was not signed off by ministers. At the same time, she manages private investments in companies developing coronavirus drugs.

    We note that Ms Bingham, a venture capitalist, is married to Jesse Norman, a Tory Treasury minister, which only underlines the potential conflicts of interest.

    The SHA calls for the pandemic to be fought through the NHS and other public bodies, and not to be outsourced to private interests.

    https://www.thelondoneconomic.com/politics/kate-bingham-vaccine-tsar-runs-up-670000-taxpayer-funded-pr-bill/08/11/

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    SHA Cymru fully supports the actions of the First Minister and the Welsh Government in their management of the current crisis resulting from COVID 19. During this time SHA officers have had opportunities to meet with a number of Welsh Ministers. We have been impressed with the sheer amount of work they are undertaking and by the collegiate and thoughtful style they have adopted.
    The decision-making process has been clear, evidenced based, and methodical. It stands in sharp contrast to the vacillation of the Prime Minister and his Cabinet. We take some confidence from this that Wales and its people will emerge from the pandemic knowing that the Welsh Government, using scientific evidence available to them at the time, aimed to reduce further significant loss of lives and huge damage to the Welsh economy.

    Any questions or comments to Tony Beddow, tonesue@aol.com

    2 Comments

    This week North West council leaders and MPs wrote to the Chancellor asking him to set out plans for what comes next once this lockdown is over. We have been through so much change and uncertainty we deserve to know what lies ahead so we can plan.

    Today, Sunak announced that the furlough scheme will continue at 80% until March. We succeeded in pushing him to give workers what they deserve, not the 13% less that he thought the North was worth.

    This is what we can achieve when we work together and hold the government to account.

    Posted by Jean Hardiman Smith on behalf of Team North West

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    We  are  writing to you in response to the apparently hurried decision to begin population-wide testing in Liverpool, as part of the £100 + billion ‘Operation Moonshot’, in order to “find positive cases and to break chains of transmission” (Government Press Release, 3rd November 2020).

    This announcement is inconsistent with the SAGE advice at its 56th meeting on 10 September 2020 that it had “high confidence” that “Prioritising rapid testing of symptomatic people is likely to have a greater impact on identifying positive cases and reducing transmission than frequent testing of asymptomatic people in an outbreak area”. This chimes with WHO guidance to focus on contact tracing and identification of clusters, and which does not recommend mass screening.  Proposals for mass screening in their current form will undermine this priority.  

    Searching for symptomless yet infectious people is like searching for needles that appear transiently in haystacks. The potential for harmful diversion of resources and public money is vast. Also of concern are the potential vested interests of commercial companies supplying new and as yet inadequately evaluated tests. If the programme is to proceed, then the contracts awarded, or advertised, should be made public, including their cost to the public purse. (The government is already facing a judicial review for failing to publish covid-19 contracts, brought by your fellow MPs Debbie Abrahams, Layla Moran and Caroline Lucas with the Good Law Project.)

     There is currently no evidence demonstrating that SARS-CoV-2 screening can bring benefit cost-efficiently, and experience shows that unless screening is delivered as a systematic programme with quality assurance for every step of the pathway then any theoretical benefit will not be realised in practice, even where a benefit is possible.

    We would like to ask you what has been decided, and how were decisions reached, regarding the types of tests to be used, what exactly are they aiming to detect, and how has their accuracy been evaluated?  We understand that the Liverpool pilot is likely to use a direct LAMP test (Optigene) and a lateral flow assay (Innova). Currently there is little or no evidence of the accuracy of either of these tests from their use in presymptomatic and asymptomatic cases, or in field settings.  There is substantial uncertainty as to whether they can detect the lower viral loads that are likely in symptomless people, which appears to be the aim of this mass pilot.  If the tests fail to detect cases, then the programme will waste resources and time, and give people false reassurance which could increase transmission.   Similarly, the false positive rates of these tests have not been established in community use and neither have the implications for contact tracing services.  Evaluations of other similar tests by the WHO has suggested between 1% and 5% of people without infection may get false positive findings.  This means that if 1 in 100 people tested in the pilot have asymptomatic infections, as few as 1 in 5 of those getting positive results will actually have Covid-19 – and 4 out of 5 would be false positives and they and their contacts would unnecessarily be told to isolate.

    The accuracy of tests for identifying symptomless infection in a healthy population need to be evaluated in a pilot study with proper research design to assess the extent to which asymptomatic people contribute to overall case-loads, whether they play a significant role in transmission, and whether screening can help. We see no evidence that the Liverpool has such a research design.

    It appears unclear what will happen when people test positive, and negative, whether there will be clinical oversight in interpretation of the results and whether the results will be sent to patients’ GPs and integrated with medical records. What will people be offered? What will they be instructed to do? What support structures are in place to achieve this? It is also unclear how this programme will be integrated into, and affect, the track and trace system, which is already performing poorly.

    Are all the above considerations documented in a format suitable for the lay public to understand as part of an opt-in informed consent process? Is there an option to withdraw from the scheme at any stage, including freeing people of any study requirements? Are participants afforded the right to access their information, to know with whom it is being shared, and to request its deletion – in line with GDPR and the Data Protection Act?

    These are just some of the questions and issues that are concerning us and that need to be pursued, along with asking the government to explain why they are acting inconsistently with SAGE’s advice. We urge you to do so as soon as possible.

    If we can be of any assistance, please do not hesitate to contact us.

    Yours sincerely,

    Allyson Pollock

    Professor of Public Health, Newcastle University

    Anthony J. Brooks

    Professor of Genomics and Bioinformatics, Leicester University

    Louisa Harding-Edgar, General Practitioner and Academic Fellow in General Practice. Glasgow University

    Angela E. Raffle, Consultant in Public Health, Honorary Senior Lecturer in Public Health, Bristol Medical School Department of Population Health Sciences, University of Bristol

    Stuart Hogarth, Lecturer, Department of Sociology, University of Cambridge.

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    Biomedical scientists in the frontline of Covid-19 testing at a Lancashire NHS trust are losing about £7,000-a-year because hardline bosses refuse to pay ‘the going rate for the job’.
    Unite, Britain and Ireland’s largest union, said that the Lancashire Teaching Hospitals NHS Foundation Trust is facing a retention crisis as underpaid biomedical scientists are voting with their feet and moving to other trusts in the north west that pay the correct Agenda for Change (AfC) pay rate.
    Now the 13 biomedical scientists, who carry out vital tests once patients have been admitted to hospital with Covid-19, will be balloted from Monday 9 November for strike action or industrial action short of a strike. The ballot closes on Thursday 19 November.
    The crux of the dispute is that the biomedical scientists have been held back on Band 5 (AfC), despite qualifying for Band 6 (just under £38,000-a-year) due to working unsupervised for a number of years. The majority of Unite’s 13 members have lost about £7,000 annually as Band 5 pays about £30,000.
    Unite regional officer Keith Hutson said: “Our biomedical scientists have had years of training and are highly skilled, but are not paid a fortune. They are in the frontline of carrying Covid-19 related tests once patients are admitted to hospital.
    “Yet, we have a hardline trust management that is not prepared to pay ‘the going rate for the job’ for essential NHS workers at a time of national emergency.
    “This issue has been dragging on for over a year. At the start of the pandemic earlier this year, our members, as an act of good faith, put this dispute on the backburner.
    “When the number of infections dropped in the summer, we raised this issue again – but have been met by a brick wall from a skinflint management. Our members are being ripped off and short-changed which is not a great advert for this trust.
    “The result is that we have a retention crisis at the Lancashire Teaching Hospitals NHS Foundation Trust as our members are voting with their feet and move to trusts, such as in Blackpool and Blackburn, which appreciate their skills and dedication during this challenging time for the NHS – and pay the proper rate for the job.
    “Now, reluctantly, our members will be balloted for industrial action. However, there is a generous window of opportunity for the management to resolve this dispute and Unite’s door is open 24/7 for constructive talks.”
    The trust covers Chorley and South Ribble Hospital, and the Royal Preston Hospital.
    Shaun Noble
    Unite senior communications officer 
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    What Impact Will the Second National Covid-19 Lockdown Have On Reducing Covid-19 Deaths?

    This of course must be one of the key questions. Seemingly no-one wants to predict a future lockdown-induced death rate figure. It’s probable that the Covid-19 death rate will not fall in November 2020 as those about to die will already be infected, unwell and in hospital. Some have estimated that the lockdown might cut down the Covid-19 infection rate by up to 75%. But with hospitals filling up with Covid-19, patients needing care for cancer, strokes and heart attacks might have their treatment delayed or cancelled resulting in an increase in non-Covid-19 deaths.

    The exact nature of the lockdown is being disputed by some. Schools do seem to be a breeding ground for spreading infection. In Ealing of the 98 state-funded schools 70 of them have Covid-19 cases. Is keeping the schools open such a clever thing to do? Most pubs and restaurants have invested money, time and continuing efforts in making their facilities compliant with Covid-19 restriction. There is scant evidence that they are prime areas for Covid-19 spreading. Closing them all down for at least a month could finally finish off those businesses that don’t own their properties, and will damage the ‘social’ health of their customers.

    There are, of course, increasingly alternative voices who are saying that the lockdown will not save lives but just delay Covid-19 deaths. This lockdown could go on for months, and might be followed by a series of lockdowns – until a successful vaccine is universally available. This would destroy the economy and create huge financial, employment, social, housing, mental health and physical health problems. NHS services would be decimated.

    The lockdown might be buying us time – but at what cost?

    MENTAL HEALTH

    £400 Million Announced to Revamp Mental Health Facilities

    This initiative is aimed at replacing ‘dormitories’ with en-suite rooms. 21 NHS mental health Trusts have apparently been identified to receive the first tranche of grant funding. Sadly the two NHS North West London mental health Trusts are not on this list.

    Also, of the 40 ‘new’ NHS hospitals recently announced by Prime Minister Johnson only two of them will be mental health facilities.

    £250 Million committed to Introducing Mental Health Support in Schools by 2023

    The targets are to cover 25% of England (1.5 million children) by 2023 and for CAMHS to see 345,000 young people by 2023/24. (CAMHS stands for Child and Adolescent Mental Health Services).

    2016 to Date the English NHS Mental Health Workforce has Increased by 13,860

    So said Claire Murdoch at the 20 October 2020 Health and Social Care Select Committee meeting. She ought to know as she is the NHS England (NSHE) Mental Health Director. If you find that figure hard to believe, what is more believable is the number of the extra mental health staff she thinks are needed by 2023. It’s 20,000. This would cast £2.3 billion – if the staff could actually be found.

    NHSE Announces £15 Million Mental Health Support for Covid-19 Nurses and Support Staff

    Claire Murdoch again rather coyly adds that in order to supply the service ‘we will be working with another provider’. Presumably what she means is a private company.

    Mental Health ‘999’ Police Call Outs Up by 41% in Five Years in England

    After years of the Police saying how inappropriate it is for them to deal with the mentally ill, answers to a Freedom of Information request have revealed 301,1444 reported incidents in 2019. In 2015 the figure was 213,513. The biggest increases were in Wiltshire and Lancashire.

    The Royal College of Psychiatrists disclosed in October 2020 that 40% of those waiting for mental health support ended up seeking help from emergency and crisis services.

    NHS Test and Trace

    If it wasn’t so tragic it might be amusing. Just how much longer can Baroness Harding hang on as NHS Test and Trace boss? On 27 October 2020 ‘The Independent’ reported that the Sitel software is clearly not that robust. On Sunday 25 October there was a system fault which resulted in Covid-19 cases not being scheduled for clinical assessment and contact tracing. The fault was still in play on the following day.

    In order for a test and trace operation to be successful 80% of identified close contacts need to be contacted and told to self-isolate. Performance figures released on 22 October 2020 show NHS Test and Trace is attaining 59.6%. The Government claims 300,000 Covid-19 tests are taking place daily and that daily figure will soon reach 500,000. Even if we all believe these figures, what’s the point if 80%+ timely contact tracing and self-isolation isn’t happening?

    Only 15.1% of those tested received test results within 24 hours. In June 2020 Prime Minister Johnson said he wanted 100% test results within 24 hours. 7.1 % of those tested were found to be Covid-19 positive – the highest figure yet.

    Seemingly one of the Government’s approaches to problem solving is to throw much more money at the problem. Briefly an advertisement lingered in the public domain searching for a new boss to ’deliver Trace operations’. The recruitment agency Quast’s advertisement stated its client (DHSC)  was offering £2,000/day (£520,000/year?)

    ‘The Guardian’ on 28 October 2020 revealed that 18 year olds with no clinical experience or knowledge are now working as ‘skilled contact tracers’ for Serco. They were recently ‘upskilled’ to perform this role. They are all being paid minimum wage of £6.45/hour. Whistle blowers have reported unskilled teenagers in tears and having panic attacks as they struggle to perform tasks such as like public health risk assessments.

    Professor Allyson Pollock has yet again exposed one of the key failings of the NHS Test and Trace undertaking. This was the Government’s decision to take testing out of public health services and Local Authorities. This overlooked the importance of clinical input, clinical oversight, clinical integration and statutory disease notification.

    NHS North West London (NWL) Finally Persuades West London CCG to Join the Single Regional CCG 

    ‘Health Service Journal’ has reported that although GPs in Kensington, Chelsea and Westminster voted against the merger of local CCGS in September 2020, in October 2020 they changed their minds. The NWL CCG will be the largest in England with 2.5 million patients and a 2020/21 budget of £4.2 billion. By April 2021 there will be just 5 CCGs in London. In 2019 there were 32 CCGs.

    Discover What the Covid-19 Infection Rate is in Your Neighbourhood

    Just type in your post code at:

    https://coronavirus-staging.data.go.uk

    To give you an idea of the range of rates throughout England, Blackburn with Darwen is one of the highest at 752.5/100,000 people and the lowest includes Somerset Wilton at 44.9/100,000.

    Eric Leach

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    What happened during the first wave of Coronavirus and what can be done about it

    In the first wave of the Coronavirus pandemic, mortality rates for people in care homes were shockingly high. Many people living in residential care and nursing homes have cognitive impairments that make it hard for them to agree to their living conditions. In the spring and summer of this year, rights-based legal safeguards designed to protect people seem to have been ignored or set aside. The NHS and adult social care services are currently bracing themselves for a second wave. This article asks whether the safeguards are likely to be more robust this time around, and what can be done to ensure people’s rights are upheld in the future.

    ***

    According to the Office for National Statistics, there were 19,394 Covid-related deaths among care home residents between 2/3/20 and 12/6/20. About half the people in this group were recorded as having a pre-existing condition of dementia. Many will have been assessed as not having the mental capacity to decide where to live, and consequently should have been subject to Deprivation of Liberty Safeguards (DOLS).

    DOLS were introduced in 2009 after a landmark case in the European Court of Human Rights. Deprivations of liberty can be authorised by local authorities where they are proportionate, where there is no reasonable alternative, and critically where they are in people’s best interests. Local authorities have always lacked the resources to process applications, and backlogs began to build up as soon as the safeguards were introduced. Another legal ruling in 2014 held that many more people were being deprived of their liberty than had initially been supposed, putting even more pressure on the system. In 2019 the law was amended to introduce a new, speedier system, though this was contentious because it allowed care home managers a greater role in deciding whether deprivations were necessary or proportionate. This had been due to come in this month (October 2020), but implementation has now been put back to April 2022.

    During the first wave of the pandemic, the larger numbers of people moving into care homes should have resulted in a bigger figure for DOLS applications. Instead, the Care Quality Commission (CQC) recorded a 31% reduction in DOLS applications between April and June 2020 compared to 2019. It seems that the requirement to ensure that restrictions were in people’s ‘best interests’ was being quietly ignored. As well as considering the rights of the 25,000 or so people who were discharged from hospital to care homes with Coronavirus, it’s also important to consider the risks to the much larger number who were already resident. As care home staff struggled to prevent cross-contamination with inadequate PPE and high levels of staff sickness, many residents were confined to their rooms in accordance with government advice. The Mental Capacity Act 2005 may only be used to confine people in their best interests; where the deprivation is for public health purposes different provisions should have been used. Research by Dr Lucy Series showed that public health provisions were only applied a handful of times. The point here is not to second-guess the actions of staff who were clearly doing their best to manage under very difficult circumstances, but to ask ‘What’s the point of legal safeguards if they can just be ignored?’.

    In June the Equality and Human Rights Commission recommended that  the “ … Government should urgently undertake or commission a review into deaths in care homes during the pandemic, in line with its equality and human rights obligations…”. One would have expected that in the pause afforded after the first wave of infections, lessons would have been learned and changes made.  Instead we have an adult social care winter plan that promises (but has not yet developed) a “…designation scheme with the CQC for premises that are safe for people leaving hospital who have tested positive or are awaiting a test result.” It seems that the government is anticipating that people with the virus will be discharged into care homes, but a process for this to be safely managed is not yet in place. At the same time revised guidance that suggests that where new restrictions are imposed to prevent cross-infection “…in many cases [they] will not be…” new Deprivations of Liberty. However, considering the significantly greater risk of mortality under these circumstances, it seems at least reasonable to question whether the original judgements about what is in a person’s best interests would still be valid.

    ***

    The specific issue of DOLS is one of a large number where human rights seem to have been set aside during the initial Coronavirus outbreak. A report from Amnesty International published earlier this week found that the “…UK government, national agencies, and local-level bodies have taken decisions and adopted policies during the COVID-19 pandemic that have directly violated the human rights of older residents of care homes in England—notably their right to life, their right to health, and their right to non-discrimination.” Early on in the Pandemic there was concern that the frailty scale being used to decide whether people would get life-saving treatment was being used inappropriately with younger disabled groups, leading DHSC to issue urgent ‘clarification’. Last week the CQC was asked by DHSC to review the way that Do Not Attempt Resuscitation (DNAR) notices were used by clinicians. ONS data re-analysed by Prof. Chris Hatton shows in-patients with autism and learning disabilities were subjected to more restraints during the pandemic. Organisations such as Inclusion London, Inclusion Scotland and Disability Rights UK have highlighted linked concerns among other groups of disabled people. During the outbreak the majority of disabled people experienced difficulties accessing basic care, medicines and food. Many of these organisations have joined the EHRC and Amnesty in calling for an inquiry into the events of this year, and ultimately for stronger legal guarantees.

    Another important lesson relates to funding. The lack of social work capacity for DOLS authorisations, wider under-staffing and poor pay in the care sector, and the absence of alternatives to ‘congregate’ care have all contributed to the events described in this article. Adult social care services have been subjected to growing demands and reduced resources for over a decade. Why is it that vital local social care services are still facing massive financial shortfalls at the same time that central government is putting record sums into the NHS and privatised test-and-trace services? An urgent solution to funding in adult social care is also a necessary component of any solution. Many argue that this will only be politically viable when social care is seen not as a destination but as a vehicle for helping the people we are and the people we love to lead rich and full lives. These three strands – a brighter vision, a new financial solution, and stronger support for human rights – can form a common ground for campaigning and activism that can help us future-proof social care against similar crises in the future.

    Jon Hyslop, Oxfordshire Branch, 19/10/20

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    Yorkshire Socialist Health Association

    Command and Control Management:

    The Deadly Embodiment of Neo-Liberalism at work in the Public Sector

    John and Joe Carlisle, Mad Management[1]

    Although the Command and Control style of management is a fairly modern phenomenon, like all ideas, its roots go much further back, to a very dominant model of how to discipline and organise institutions. The philosopher Michael Foucault famously uses 18th Century Utilitarian philosopher Jeremy Bentham’s panopticon as a model for how a modern disciplinary society seeks to at all times to survey, or at least give the possibility of surveillance, its populace. The panopticon is a surveillance structure originally designed by Bentham for prisons but reproducible in any environment. The centre is occupied by a watchman who cannot be seen but who is surrounded in the round by the cells or workplaces of those he surveys. Each in their own compartmentalized sections the watchman, or manager, can see everything the prisoners do. As Foucault describes ‘[t]hey are like so many cages, so many small theatres, in which each actor is alone, perfectly individualized and constantly visible.’[2]

    Foucault rightly saw ‘panopticism’ as a paradigm through which individuals could be measured, assessed, marked and surveilled; it was not simply a design for a prison but a “how to” command and control for a whole variety of institutions from schools, hospitals and factories. It is worth quoting Foucault again, this time at length, as he describes the consequences of such a model:

    He is seen, but he does not see; he is the object of information, never a subject in communication… if they are workers, there are no disorders, no theft, no coalitions, none of those distractions that slow down the rate of work, make it less perfect or cause accidents. The crowd, a compact mass, a locus of multiple exchanges, individualities merging together, a collective effect, is abolished and replaced by a collection of separated individualities. From the point of view of the guardian, it is replaced by a multiplicity that can be numbered and supervised. 

    This top down model of designing the workplace was explicitly compatible with industrialization where work was broken down into small repetitive actions that can easily be measured and codified. What is harder to understand is why the model was placed upon all forms of work. Why do so many managers insist upon forcing this model onto industries, such as service, which it does not fit, and more tragically, why use it as the model for management in public services?

    It is now common for most people who work now to have a sense of being monitored. Whether through the ubiquitous CCTV camera, which now often can record audio, to electronic clock ins,’ recordings of all phone calls made in a call centres or on workphones, targets to be hit, milometers which time how long a delivery takes to go from A to B, to IPad’s whose programs must followed to the letter. What this produces is an abundance of data, a mountain of information which can be turned into charts, graphs, and reports. This gives the manager a great sense of control; to him nothing is hidden.

    Except of course a lot is hidden. Data by its very nature hides vast amounts of knowledge. The time it takes to get from A to B does not reveal that the final stage may add 20 mins because there is nowhere to park the lorry. The failure to reach the target may simply reveal the arbitrary nature of the target. In data the whole complexity of the human world is erased, flattened out into a spreadsheet, and the manager ends up mistaking the map for the terrain.

    Not only does it give the illusion of knowledge but command and control management style doesn’t work.  It makes waste rather than reducing it. This article will argue that it is an empirical fact that these modes of supervision fail to achieve what they claim to. Systems thinking is a far more effective way of improving organizations, and ironically, it has the data to back it up.

     Systems Thinking

     In 2003 Professor John Seddon published Freedom from Command and Control. [3] It caused quite a stir, demolishing most of the principles upon which the government had based its efficiency drive – which later morphed into wholly inappropriate and damaging austerity policies. It refuted the top down principle of leadership that is implicit in the New Public Management (NPM), which is a promoter of what Seddon calls ‘the management factory’: ‘The management factory manages inventories, scheduling, planning, reporting and so on. It sets the budgets and targets. It is a place that works with information that is abstracted from work. Because of that it can have a phenomenally negative impact on the sustainability of the enterprise.”

    The case studies gave irrefutable evidence of the damage caused by this neo-liberal mechanism in the public sector. Seddon’s solution was systems thinking as expanded in his next book, Systems Thinking in the Public Sector.[4] Here example after example illustrated the waste caused by NPM, especially as advocated by the likes of Barber (targets etc.) and Varney (shared services – see appendix)

    The research and analysis conducted by Professor John Seddon, which has looked at reasons for diseconomies of scale specifically in service organisations, fundamentally challenges the ‘Command and Control’ logics that underpin much of the public sector. Instead case study after case study confirms that concepts such as ‘designing against demand’, ‘removing failure demand’ deliver outstanding success  , while the typical drive to standardisation and specialisation of function results in inappropriate services being delivered, resulting in turn in escalating monitoring, management and correction costs.

    This, however, requires a change of thinking about how organisations work best in this the 21st century. Over a hundred years ago the workforce was only one generation removed from an industrial culture. Their understanding of industrial production and its organisation was very limited. Consequently even the best designers of organisations, e.g. Henry Ford, the Quakers, Cadburys, Rowntree’s and Clarks, were at best paternal, and at worst, reductionist pragmatists, i.e. treating workers as intelligent tools. However, even the latter did not mean not trusting them or attempting to look after them. After all, Henry Ford doubled the wages of his workforce overnight and refused to allow women to labour after 5pm so they could look after their families. He was also sued by his major shareholder for doubling his workers’ wages at the expense of dividends. The shareholder won.

    Today, we have a workforce that is literate and numerate and is at home with modern organisations, BUT are managed as those of 100 years ago. Why is this? The reason is the Command and Control style is more comfortable for those leaders whose upbringing (conditioning) and training at Business Schools has brainwashed them into feeling that being in charge means taking control. As they cannot be everywhere they therefore use measuring as a proxy for their physical presence. This usually translates into columns of comparative data or run charts, tick boxes compliance, and often targets to be reached as evidence of success of failure.

    So, who is the guardian in the panopticon? It is HR. In many public sector organisations HR has seized this opportunity to become the enforcer of compliance for the board. Rejoicing in their power they have abandoned their traditional role of looking after the workforce and now “guard” it.

    Politicians are entranced by these governance measures. They can conceive of nothing more confidence boosting than setting targets for, e.g. hospital waits, housing allocations, repairs completed. Their mental model is captured in the Table 1, below, in the left hand column. It is informed by their neo-liberal mindset, something they have imbibed from exposure to the right wing press; the fascination with material success, for example Peter Mandelson, playmaker of the Labour party said twenty years ago that he was “intensely relaxed about people getting filthy rich as long as they pay their taxes”; privatisation continues even though it is clearly an utter failure; and cost-cutting  and targets are the first knee jerk reactions to perceived public sector overspend.

    But there is another way. It comes in the form of a System of Profound Knowledge, first propounded by the great management philosopher, Dr W. Edwards Deming, whose principles are best presented in the work of Professor John Seddon, head of Vanguard.

    The Seddon Vanguard model, constructed from his research into effective organisations is the right hand column (Table 1).

    Table 1. The two conflicting models of management

    The question is why, in particular do UK politicians favour the Command and Control model? Our theory is that it is the “control” element that matters most – and, which has caused the most waste, and managers and politicians in particular are comforted by the illusion of control even when it clearly causes so much damage to people and resources as the examples below illustrate. [5]

    • Western Australia’s Department of Treasury and Finance Shared Service Centre promised savings of $56 million, but incurred costs of $401 million.
    • A National Audit Office report said that the UK Research Councils project was due to be completed by

    December 2009 at a cost of £79 million. But, in reality, it was not completed until March 2011, at a cost of £130 million.

    • The Department for Transport’s Shared Services, initially forecast to save £57m, is now estimated to cost the taxpayer £170m, a failure in management that the House of Commons Public Accounts Committee described as a display of ‘stupendous incompetence’

    Covid-19 has made the flaws are even more obvious. That greatest of all control freakery, the centralising state, has been shown for disaster that it is. The Health Secretary has kept control of all the testing and tracing administered from the centre, and it is failing at every level. The report from the Independent SAGE, a group of 12 leading scientists headed by former UK Government chief scientific advisor, David King, said the governments test, track and trace system is not “fit for purpose”.

    The government’s current approach to this system, including the contact-tracing app, is “severely constrained by lack of coordination, lack of trust, lack of evidence of utility and centralisation”, it adds. “The effective operation of this subsystem is also complicated by the apparent failure of the app that was designed to facilitate identification of contacts of those who have Covid-19” (Digital Health, June 16, 2020). We are talking here about thousands of British lives and further damage to a reeling economy.

    Dr W Edwards Deming summed it up perfectly: “Most people imagine that the present style of management has always existed and is a fixture. Actually, it is a modern invention – a prison created by the way in which people interact.”  He then asked the question:

     How do we achieve quality? Which of the following is the answer? Automation, new machinery, more computers, gadgets, hard work, best efforts, merit system with annual appraisal, make everybody accountable, management by objectives, management by results, rank people, rank teams, divisions, etc., reward the top performers, punish low performers, more statistical quality control, more inspection, establish an office of quality, appoint someone to be in charge of quality, incentive pay, work standards, zero defects, meet specifications, and motivate people.”[6]

    Answer: None of the above. (Will someone please tell our politicians.)

    All of the ideas above for achieving quality try to shift the responsibility from management. Quality is the responsibility of management. It cannot be delegated. What is needed is profound knowledge. A transformation of management is required, and to do that a transformation of thinking is required – actually the neo-liberal paradigm is so entrenched that that nothing less than metanoia (a total change of heart and mind) is needed.

    When this transformation happens almost miraculous levels of performance occur. For example, when left to the medical staff only, the level of delayed bed days fell from over 12,000 per month to under 6000 in a year (2017/2018) – an over 50% reduction! Much less command and control leads to much more economic and effective activity. It is time all the politicians learned to trust their public servants much more, and abandon the illusion of control foisted on them by neo-liberal ideologists from Labour and Conservatives. It is a political thing, not a party thing. The whole system of government must be overhauled.


    References

    [1] https://jcashbyblog.wordpress.com

    [2]Michel Foucault, Discipline and Punish, trans. A. Sheridan (Vintage books, New York, 1995) p. 200

    [3] Seddon 2003 ‘Freedom from Command and Control’ Vanguard Education

    [4] Seddon 2008 ‘Systems thinking in the Public Sector’ Triarchy: Axminster

    [5] John Seddon 2012 submission to the Local Government and Regeneration Committee – Public Sector reform and Local Government. 2012

    [6] Deming, W.E. (1993) Out of the Crisis, MIT: Cambridge

     

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