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    From Vivien Walsh in Manchester

    Right at the beginning of the lockdown, several of my friends said how concerned they were about the likely impact of enforced social isolation on those who are suffering from domestic abuse. On Monday, the (cross party) Home Affairs Committee of MPs, chaired by Yvette Cooper, reported on this, demanding “that the Government makes domestic violence and abuse a central pillar of the broader strategy to combat the Covid-19 epidemic.”

    Calls to domestic violence helplines, such as Refuge and Women’s Aid, were nearly 50% higher in the week 6-12 April than the average before the pandemic began. Visits to the website of Refuge were three times as high in March 2020 as they were in March 2019. The Home Affairs Committee called for this domestic violence strategy to combine “awareness, prevention, victim support, housing and a criminal justice response, backed by dedicated funding and ministerial leadership”.

    It also made a point of the need for specialist services for different ethnic communities, and for legal aid as an automatic right for women applying for Domestic Violence Protection Orders (DVPOs). An extension of the current time limit for reporting offences is also necessary, since many abused women will be unable to report the abuse they have suffered until after lockdown ends.

    Between March 23 and April 12 there were at least 16 killings of women and children in domestic situations, said the report on Monday. The average number of deaths from domestic violence during lockdown has gone up from 5 per week from a figure of two before. In a year that would be over 250 women killed by the person who is supposed to love them. The Parliamentary Committee had also received evidence that incidents reported were not only more frequent but involved higher levels of violence and coercive control.

    Unless the government takes action to deal effectively with domestic abuse and to properly support the victims of it, we will be facing “devastating consequences for a generation.” Funding is urgently needed to enable a growth in provision of housing for women and children escaping from violence, and to support refuges as temporary accommodation and support. Even before current emergency, England had 30% fewer than the recommended number of beds, and 64% of referrals were turned down in 2018-19.

    There is a National Domestic Violence Helpline (0808 200 247). This is the number to call for  emergency referrals as they are open 24/7. In addition there a variety of services based locally. For example Manchester Women’s Aid (call 0161 660 7999  9:30am-4:30pm Mon-Fri) provides confidential advice and information, safe temporary housing, one to one support for those living in their own homes, access to legal advice and civil orders, specialist workshops for young women 15-25, language workers and access to interpreters, specialist support for women with poor mental health and drug and alcohol misuse. The full list of services in England and Wales is at the end of the article.

    The lockdown is in place to keep people safe from the virus: but it is also providing cover for abusers. Escape from being locked in with an abuser is a matter of life and death. A decade of austerity has not only undermined our NHS, on which we are now so dependent, but has also decimated support for survivors of domestic violence. The Government must increase funding as a matter of urgency – and there will be just as much need for services as abused women and children try to return to “normal” life when the lockdown is over. And Children’s services also need a big increase in funding to make sure children as risk, not only from the mental and physical impact of domestic violence, have access to help and support.

    Amna Abdullatif (whose day job is Women’s Aid lead for Children and Young People, and who is also a Manchester City Councillor) added the following information for the SHA in this blog: “78% of survivors experiencing domestic abuse told us that Covid-19 has made it harder for them to leave their abuser. If you’re feeling trapped, we’re here for you.”

    “Our Live Chat is now open from 10am – 2pm with expert support workers just one click away. You can be reassured that our Live Chat is completely confidential. To access support and advice go to: https://bit.ly/2y7ab0Q

    “If you, or someone you know, is experiencing abuse please read our Covid-19 safety advice for survivors, family, friends and community members https://bit.ly/2yNzqoW

    There are also local services for ethnic groups, such as Saheli Asian Women’s Project in Manchester, which provides advice, information and support services to Asian women and their children fleeing domestic abuse and/or forced marriages.

    The full list of services from the Womens Aid web site is below:

    National Domestic Abuse Helpline

    The National Domestic Abuse Helpline is run by Refuge and offers free, confidential support 24 hours a day to victims and those who are worried about friends and loved ones.

    Telephone and TypeTalk: 0808 2000 247

    Wales Live Fear Free Helpline

    The Wales Live Fear Free Helpline offers help and advice about violence against women, domestic abuse and sexual violence.

    Telephone: 0808 8010 800

    TypeTalk: 18001 080 8801

    Text: 078600 77 333

    The Men’s Advice Line

    The Men’s Advice Line is a confidential helpline for male victims of domestic abuse and those supporting them.

    Telephone: 0808 801 0327

    Email: info@mensadviceline.org.uk

    Galop – for members of the LGBT+ community

    Galop runs the National LGBT+ domestic abuse helpline.

    Telephone: 0800 999 5428

    TypeTalk: 18001 020 7704 2040

    Email: help@galop.org.uk

    Women’s Aid

    Women’s Aid has a live chat service available Mondays to Fridays between 10am and 12pm as well as an online survivor’s forum. You can also find your local domestic abuse service on their website.

    The Survivor’s Handbook, created by Women’s Aid, provides information on housing, money, helping your children and your legal rights.

    Karma Nirvana

    Karma Nirvana runs a national honour-based abuse and forced marriage helpline. If you are unable to call or email, you can send a message securely on the website.

    Telephone: 0800 5999 247

    Email: support@karmanirvana.org.uk

    Hestia

    Hestia provides a free mobile app, Bright Sky, which provides support and information to anyone who may be in an abusive relationship or those concerned about someone they know.

    Chayn

    Chayn provides online help and resources in a number of languages about identifying manipulative situations and how friends can support those being abused.

    Imkaan

    Imkaan are a women’s organisation addressing violence against black and minority women and girls.

    Southall Black Sisters

    Southall Black Sisters offer advocacy and information to Asian and Afro-Caribbean women suffering abuse.

    Stay Safe East

    Stay Safe East provides advocacy and support services to disabled victims and survivors of abuse.

    Telephone: 020 8519 7241

    Text: 07587 134 122

    Email: enquiries@staysafe-east.org.uk

    SignHealth

    SignHealth provides domestic abuse service support for deaf people in British Sign Language (BSL).

    Telephone: 020 3947 2601

    Text/WhatsApp/Facetime: 07970 350366

    Email: da@signhealth.org.uk

    Shelter

    Shelter provide free confidential information, support and legal advice on all housing and homelessness issues including a webchat service.

    Sexual Assault Referral Centres

    Sexual Assault Referral Centres provide advice and support services to victims and survivors of sexual assault or abuse.

    Get help if you think you may be an abuser

    If you are concerned that you or someone you know may be an abuser, there is support available.

    Respect is an anonymous and confidential helpline for men and women who are harming their partners and families. The helpline also takes calls from partners or ex-partners, friends and relatives who are concerned about perpetrators. A webchat service is available Wednesdays, Thursdays and Fridays from 10am to 11am and from 3pm to 4pm.

    Telephone: 0808 802 4040

    Get help for children and young people

    NSPCC

    The NSPCC helpline is available for advice and support for anyone with concerns about a child.

    The NSPCC has issued guidance for spotting and reporting the signs of abuse.

    Telephone: 0808 800 5000

    Email: help@nspcc.org.uk

    If you are deaf or hard of hearing, you can contact the NSPCC via SignVideo using your webcam. SignVideo, using British Sign Language, is available on PC, Mac, iOS (iPhone/iPad) and Android smartphones (4.2 or above). This service is available Monday to Friday from 8am to 8pm and Saturdays from 8am to 1pm.

    Childline

    Childline provides help and support to children and young people.

    Telephone: 0800 1111

    Barnardo’s

    Barnardo’s provide support to families affected by domestic abuse.

    Family Lives

    Family Lives provide support through online forums.

    Support for employers

    Employers’ Initiative on Domestic Abuse

    The Employers’ Initiative on Domestic Abuse website provides resources to support employers including an employers’ toolkit.

    Support for professionals

    SafeLives provides guidance and support to professionals and those working in the domestic abuse sector, as well as additional advice for those at risk.

    Support a friend if they’re being abused

    If you’re worried a friend is being abused, let them know you’ve noticed something is wrong. Neighbours and community members can be a life-line for those living with domestic abuse. Look out for your neighbours, if someone reaches out to you there is advice on this page about how to respond. They might not be ready to talk, but try to find quiet times when they can talk if they choose to. If someone confides in you that they’re suffering domestic abuse:

    • listen, and take care not to blame them
    • acknowledge it takes strength to talk to someone about experiencing abuse
    • give them time to talk, but don’t push them to talk if they don’t want to
    • acknowledge they’re in a frightening and difficult situation
    • tell them nobody deserves to be threatened or beaten, despite what the abuser has said
    • support them as a friend – encourage them to express their feelings, and allow them to make their own decisions
    • don’t tell them to leave the relationship if they’re not ready – that’s their decision
    • ask if they have suffered physical harm – if so, offer to go with them to a hospital or GP
    • help them report the assault to the police if they choose to
    • be ready to provide information on organisations that offer help for people experiencing domestic abuse

    If you are worried that a friend, neighbour or loved one is a victim of domestic abuse then you can call the National Domestic Abuse Helpline for free and confidential advice, 24 hours a day on 0808 2000 247.

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    From Ekua Bayunu, Member of Greater Manchester Socialist Health Association, and selected candidate for Hulme in the next Manchester City Council elections.

    When I joined SHA a couple of years ago I wanted to focus my energies on action against inequalities in the health systems around race, particularly in mental health. We now have evidence of the toxins that were seeping into us from the right, distracting us from actually building effective socialist action on health issues here in Greater Manchester.

    Skip forward and we are slap bang in the eye of the storm of the Covid 19 pandemic and still searching for some strength in our unity to make a difference to our communities. Many of our members are fully immersed in either working on the frontline, in providing care in our institutions, or in volunteering in mutual aid groups, many doing both and I send love and admiration out to us all.

    We lost my neighbour, an elderly Somalian man, to the virus on the last weekend in March. It felt like the storm that was brewing had just swept in and taken one of ours before we barely knew it was coming. Then the statistics started coming in. We are dying in inexplicably large numbers. We? I’m a woman of African heritage, my community is African, South Asian, Working class.

    My close friend, a street away, is a nurse working at MRI, already stressed by the lack of PPE, worrying about her family, the risk she posed to her 3 daughters and husband at home, when she got ill two weeks ago, together with two colleagues from her ward. They got tested. She doesn’t have access to a car, and the only testing is drive-through. No you can’t walk in. No you can’t get in a taxi! She started talking to us about wills and supporting her daughters and all the worries she has for them. Her eldest also works as a nurse, the youngest is only 10. Her cultural background is Turkish, and she knew she might die.

    She is in recovery, but the statistics get worse and worse. The demand for action grows as do the questions and desire for investigation. I read articles in the silo of my social media accounts and watched as it began to break slowly into mainstream media. At first I thought: they are holding back on the narrative, because it doesn’t suit their agenda to highlight how many were dying in service to us all who were from Diasporan African, Asian and other minority communities. We entered this year with forced deportations built on a narrative that these were the communities of criminals and spongers on the state. Suddenly the NHS workforce were our heroes, they put out ads supporting these workers and most of the workers were white. Did you all notice?

    Then as the statistics leaked into a wider societal consciousness, I became openly worried. Information being fed via the television is so absent of any real analysis that it actually begins to shape a eugenicist narrative, which the Prime Minister does little to distance himself from. Our deaths are not real sacrifices based on years of inequalities in education, health care, housing and employment, but gives out a message of our inherent weakness and inferiority! And whilst we all are shut in, angry, confused, needing to have something or someone to blame, in the place of blaming this government for its lack of care in putting profit over people, it is easy to discern they are creating a diversionary agenda.

    It is becoming increasingly clear BAME people are dying disproportionally, on the wards, driving our buses, cleaning our streets, in our care homes. They are presented as the problem, when they are the heroes and victims of the pandemic. Last week the government finally pulled together a commission with PHE to investigate the causes of BAME people dying disproportionally. Do we all assume that the why will lead to how to stop this? To a solution to help us? I can’t.

    Posted by Jean Hardiman Smith on behalf of Ekua Bayunu, Member of Greater Manchester Socialist Health Association

    1 Comment

    From Mark Ladbrooke, of Oxford SHA branch, and formerly chair of Oxford University Hospitals Foundation Trust (OUHT) Joint Union Committee

    Oscar King, Jr. and Elbert Rico, porters at John Radcliffe Hospital, Oxford, and union activists, died two weeks ago of suspected Covid-19.

    Both of them are married to members of the nursing team at the hospital and Twilight, Oscar’s wife, was admitted to hospital, while their 10-year old daughter is being cared for. Oscar and Rico came from the Philippines and had worked at the hospital since they arrived.
    The Filipino community is extremely important to the NHS – after workers from the UK itself and India they make up the largest proportion of the workforce.

    Patients may not notice the porters as much as they notice doctors and nurses, but their role is just as vital, since they take everyone where they need to go, and move equipment and machinery to where it is required. The Labour Movement has supported junior doctors and nurses in dispute with management (backed by government) at various times – but porters, domestics and catering staff are frequently outsourced and are at the end of the queue.

    As long ago as 1982 the Thatcher government brought in competitive tendering for NHS services such as catering, cleaning, portering and estates maintenance. Oxford University Hospitals Foundation NHS Trust (OUHT), of which the Radcliffe is part, signed up to a Private Finance Initiative (PFI) deal, under which management of the porters, domestics and catering staff was transferred to a private company as the hospital was expanded. PFI was dreamed up when Norman Lamont was Tory Chancellor, but took off under the New Labour Government of Tony Blair after 1997.

    A Unison strike in Dudley in 2000 was the seventh against transfer to the private sector, as part of increasing resistance to PFI. The striking workers won important concessions around secondment, nevertheless management was still transferred to Carillion (which went bust in Jan 2018). The John Radcliffe workers threatened strike action in 2015 around pay cuts.
    Industrial action continues to be taken against PFI and its impact on working conditions, most recently this year in Lewisham (because the outsourcing firm failed to pay cleaners, porters and catering staff the wages that had been agreed) and Paddington. In the latter case, porters, caterers and cleaning staff at St Mary’s, with the support of some of the other staff, including doctors, became employees once again of the NHS.

    We, in the Joint Union Committee and local SHA branch knew Oscar, in particular, as a “brilliant rank and file union leader”. The SHA branch is well connected to the workplace and local unions. They help provide the leadership of the branch. The Chair of the SHA branch, Cllr Nadine Bely-Summers, a nurse, who also represents Oxford City Council on the local Health Overview and Scrutiny Committee (HOSC), demanded answers from Bruno Holtof, chief executive of the OUHT, about the deaths of the two porters:


    – How many staff on site are managed by outsourcing companies or agencies?
    – What personal protective equipment (PPE) was provided by the trust to staff managed by outsourcing companies or agencies?
    – What personal Protective Equipment (PPE) was provided by the trust to staff managed by Bouygues and other outsourcers eg G4S? When was this provided?
    – Are staff being put under pressure to return to work while reporting sick?
    – How are the frontline outsourced staff who are vulnerable being treated?
    – Is the Trust legally liable for Health and Safety breaches on its premises including those by outsourcing companies and agencies?

    In response to her demands the Director of Public Health has promised to investigate further.
    BAME Labour activists working with Oxford City’s Labour Council have raised concerns that this may be part of a worrying national picture of an especially high death toll among black and Asian workers, as reported on various TV channels and in several daily newspapers in the last week.

    The local city council has written to the Chief Executive of the NHS Trust asking for an explanation.
    Nadine said “We must seek assurances from all NHS Trusts that there is day-to-day monitoring carried out to make sure there is not a disproportionate impact of the rates of infection and death on ethnic minority workers, and that adequate PPE are being provided at all times to all staff groups”.

    Stop Press!

    The Chief Executive of the Trust has written back to the council saying, among other things:
    We note, however in the case of reporting incidents in relation to Covid-19, that the HSE have indicated that “[in] a work situation, it will be very difficult, if not impossible, for employers to establish whether or not any infection in an individual was contracted as a result of their work. Therefore, diagnosed cases of Covid 19 are not reportable under RIDDOR ( Reporting of Injuries, Diseases and Dangerous Occurrences Regulations )  unless a very clear work related link is established.”

    We are unable to comment in detail on specific individual cases but are able to note that there is not currently evidence to support such a link in relation to these two staff members. However we can confirm that reporting and investigation will take place in line with HSE guidance where a diagnosis of Covid-19 is directly attributed to an occupational exposure.

    Oxford and District Labour Party Executive has asked Anneliese Dodds (Labour Oxford East) to raise this issue in parliament. She reports that Labour is planning to raise such issues on workers’ memorial day.

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    To Members of the West Midlands SHA

    Dear Colleague
    Please find below the Sunday Times Response to the Government
    Courtesy of Spellar News
    John Charlton
    Secretary

    Coronavirus: how the government tried to dismiss Sunday Times investigation

    Senior scientists, a former civil service chief and Tory ex-ministers criticise the official response to our report

    Insight | Jonathan Calvert and George Arbuthnott  Saturday April 25 2020, 6.00pm, The Sunday Times

    The government’s defence of Boris Johnson over his failure to attend five successive meetings of the Cobra national crisis committee on the coronavirus has been dismissed by former Whitehall officials and senior politicians.A former head of the civil service, three Conservative ex-ministers and a former Downing Street chief of staff said it was usual for the prime minister to attend Cobra if he was in easy reach of London.They spoke out after the government issued a 14-point response in a 2,100-word blog to The Sunday Times’s account of the five weeks from late January, detailing how government inaction compromised attempts to tackle the virus.

    The government’s most senior ministers — including Dominic Raab, Michael Gove and Matt Hancock — leapt to the prime minister’s defence and tweeted copies of the blog, which claimed that the Insight team’s report contained a “series of falsehoods and errors”.Gove, the Cabinet Office minister, said on the BBC last week that “most Cobra meetings don’t have the prime minister attending them”.The government’s spin doctors were accused of misrepresentation by a doctor and a scientist who were quoted in the official response as suggesting that the severity of the threat from the coronavirus was not fully appreciated when Johnson missed the first Cobra meeting.The doctor, Richard Horton, editor of the medical journal The Lancet, accused the government of “Kremlinesque” manipulation of his words.The scientist, Martin Hibberd, professor of emerging infectious disease at the London School of Hygiene and Tropical Medicine, said the government’s response used his words out of context, cutting out a sentence calling for urgent action to gather evidence in preparation for a possible pandemic.

    The Sunday Times article revealed that Johnson did not attend his first Cobra meeting on the virus until March 2. He skipped the January and February Cobra meetings despite being in Westminster on four of the days that they were held and an hour’s drive away in Kent on the other.An analysis of more than 40 Cobra meetings on major emergencies that have been published in the decade since the Conservatives came to power shows that prime ministers usually chaired them — unless they were too far away from London to get to the committee on time. Only three were chaired by a secretary of state when the prime minister was in Westminster.

    Lord Kerslake, the head of the civil service between 2012 and 2014, said the prime minister typically chaired three-quarters of the Cobra meetings and the main reason for non-attendance was that they were away from London.He said: “[Cobra] is there for a national emergency and you don’t call it unless there’s something pretty serious. And if there’s something pretty serious, you would expect the prime minister to chair it.”His views were supported by three Conservative former ministers who were familiar with the workings of Cobra and by Jonathan Powell, Downing Street chief of staff under Tony Blair, who said he was not aware of an occasion when Blair had missed a Cobra meeting while he was at Westminster.Powell said: “It’s not impossible for the prime minister to miss Cobra meetings if something is happening in the world that’s more important or he’s out of the country. But the point of missing five is it’s a sign that we’re not taking the problem seriously enough.”

    In Johnson’s defence, the government’s “blog” gave three examples of times when a minister had chaired Cobra instead of the prime minister over the past 11 years. In two of these examples, it has emerged that the prime minister was unable to attend because he was abroad. One occasion was when Gordon Brown was in Poland — and yet he still phoned in to take part in Cobra. The other was when Johnson’s plane had just touched down in New York.The third example given by the government said Gove chaired Cobra over preparations for a no-deal Brexit. This meeting had never previously been acknowledged in public and this weekend Downing Street declined to say when it took place.

    Yesterday, Downing Street responded to our inquiries by sending a short paragraph taken from the 2011 cabinet manual, which states: “In general the chair [of Cobra] will be taken by the secretary of state of the government department with lead responsibility for the particular issue being considered.”However, a 2013 government document gives a fuller description of Cobra’s role. It says Cobra is mostly convened for “level 2” international emergencies — using the example of the swine flu threat — and says these meetings are controlled by the “Strategy Group”, which is chaired by the prime minister, home secretary or foreign secretary.Kerslake said it was customary for the prime minister to chair the strategy group.“Under the emergency planning guidance you would expect the prime minister to attend Cobra over the coronavirus crisis because it is clearly at least a level 2 emergency. Given its seriousness, I would be surprised if it was classified [as] any different from this.”

    Here we reproduce each section of the government’s statement and The Sunday Times’s replies.

     Government statement:

    Claim [by The Sunday Times] – On the third Friday in January Coronavirus was already spreading around the world but the government ‘brushed aside’ the threat in an hour-long COBR meeting and said the risk to the UK public was ‘low’.

    Response [by the government] – At a very basic level, this is wrong. The meeting was on the fourth Friday in January. The article also misrepresents the Government’s awareness of Covid 19, and the action we took before this point. Health Secretary Matt Hancock was first alerted to Covid 19 on 3 January and spoke to Departmental officials on 6th Jan before receiving written advice from the UK Health Security Team.

    He brought the issue to the attention of the Prime Minister and they discussed Covid 19 on 7 January. The government’s scientific advisory groups started to meet in mid-January and Mr Hancock instituted daily coronavirus meetings. He updated Parliament as soon as possible, on January 23rd.

    The risk level was set to “Low” because at the time our scientific advice was that the risk level to the UK public at that point was low. The first UK case was not until 31 January. The specific meaning of “public health risk” refers to the risk there is to the public at precisely that point. The risk was also higher than it had been before — two days earlier it had been increased “Very Low” to “Low” in line with clinical guidance from the Chief Medical Officer.

    The WHO did not formally declare that coronavirus was a Public Health Emergency of International Concern (PHEIC) until 30 January, and only characterised it as a global pandemic more than a month later, on 11 March. The UK was taking action and working to improve its preparedness from early January.

    Sunday Times reply:
    It was indeed the fourth Friday in January, but the date (January 24) was correct. We regret the error. The article does not misrepresent “the government’s awareness of Covid-19” before January 24. The article begins its narrative on January 24 and does not comment on what actions were taken before that date. The rest of this section challenges nothing that was reported in the article.

    ● Government statement:

    Claim [by The Sunday Times–‘This was despite the publication that day of an alarming study by Chinese doctors in the medical journal The Lancet. It assessed the lethal potential of the virus, for the first time suggesting it was comparable to the 1918 Spanish flu pandemic, which killed up to 50 million people.’

    Response [by the government] – The editor of the Lancet, on exactly the same day – 24 January – called for “caution” and accused the media of ‘escalating anxiety by talking of a ‘killer virus’ and ‘growing fears’. He wrote: ‘In truth, from what we currently know, 2019-nCoV has moderate transmissibility and relatively low pathogenicity. There is no reason to foster panic with exaggerated language.’ The Sunday Times is suggesting that there was a scientific consensus around the fact that this was going to be a pandemic – that is plainly untrue.

    https://twitter.com/richardhorton1/status/1220606842449072128?s=19

    Sunday Times reply:
    This is misrepresentation. Mr Horton issued his tweet at 7.18am and the alarming new Chinese study came in later the same day and was published straight away by The Lancet, which is confirmed by a tweet by Mr Horton at 3.05pm. Next day Mr Horton tweeted: “The challenge of 2019-nCoV is not only the public health response. It is clinical capacity. A third of patients so far have required admission to ICU. 29% developed ARDS. Few countries have the clinical capacity to handle this volume of acutely ill patients. Yet no discussion.” Two months later (March 27), Mr Horton said on BBC Question Time: “Honestly, sorry to say this, but it’s a national scandal. We shouldn’t be in this position. We knew in the last week of January that this was coming. The message from China was absolutely clear that a new virus with pandemic potential was hitting cities. People were being admitted to hospital, admitted to intensive care units and dying and the mortality was growing. We knew that 11 weeks ago, and then we wasted February when we could have acted. Time when we could have ramped up testing time when we could have got personal protective equipment ready and disseminated. We didn’t do it.”

    After the government cited Horton in its statement on Sunday night, Mr Horton tweeted on Monday: “Just for the record: the UK government is deliberately rewriting history in its ongoing COVID-19 disinformation campaign. My Jan 24 tweet called for caution in UK media reporting. It was followed by a series of tweets drawing attention to the dangers of this new disease.” On Tuesday Mr Horton told The Sunday Times that the government’s use of his tweet in their response to the article was “redolent of Kremlin-esque manipulation of evidence”. He added: “I find it very funny that Matt Hancock was asked a question about disinformation and he said, ‘we take it very seriously and we need to correct disinformation’. They really are scared that the verdict of history is going to condemn them for contributing to the deaths of tens of thousands of British citizens. And because they know they wasted a minimum of five weeks through February and early March they are desperately trying to rewrite the timeline of what happened. And we must not let them do that.”

    ● Government statement:

    Claim [by The Sunday Times] – It was unusual for the Prime Minister to be absent from COBR and is normally chaired by the Prime Minister.

    Response [by the government] – This is wrong. It is entirely normal and proper for COBR to be chaired by the relevant Secretary of State. Then Health Secretary Alan Johnson chaired COBR in 2009 during H1N1. Michael Gove chaired COBR as part of No Deal planning. Transport Secretary Grant Shapps chaired COBR during the collapse of Thomas Cook. Mr Hancock was in constant communication with the PM throughout this period.

    At this point the World Health Organisation had not declared COVID19 a ‘Public Health Emergency of International Concern’, and only did so only 30 January. Indeed, they chose not to declare a PHEIC the day after the COBR meeting.

    Examples of scientific commentary from the time:

    Prof Martin Hibberd, Professor of Emerging Infectious Disease, London School of Hygiene and Tropical Medicine, said:

    “This announcement is not surprising as more evidence may be needed to make the case of announcing a PHEIC. WHO were criticised after announcing the pandemic strain of novel H1N1_2009, when the virus was eventually realised to have similar characteristics to seasonal influenza and is perhaps trying to avoid making the same mistake here with this novel coronavirus. To estimate the true severity of this new disease requires identifying mild or asymptomatic cases, if there are any, while determining the human to human transmission rate might require more evidence.”

    Dr Adam Kamradt-Scott, Senior Lecturer in International Security Studies, University of Sydney, said: “Based on the information we have to date, the WHO Director-General’s decision to not declare a Public Health Emergency of International Concern is not especially surprising. While we have seen international spread of the virus, which is one of the criteria for declaring a PHEIC, the cases in those countries do not appear to have seeded further local outbreaks. If that was to start to occur, it would constitute a greater concern but at the moment the outbreak is largely contained within China.”

    Sunday Times reply:
    It is unusual for the prime minister not to chair Cobra, although, at times, ministers can stand in for the prime minister, especially when he or she is away. Boris Johnson was in Westminster for four of the five Cobra meetings and was a one-hour drive away in Kent for the other, yet he did not attend any of them. Alan Johnson chaired a meeting of Cobra during H1N1 because Gordon Brown, the prime minister, was in Poland (and phoned in from there). Mr Shapps chaired the Thomas Cook Cobra because Boris Johnson was in New York. Mr Gove chaired a daily “operations committee” known as XO in the Cabinet Office’s Cobra room while in charge of no-deal planning in 2019, but these were not Cobra meetings.

    The use of the two experts for the scientific commentary is selective quotation and misrepresentation. These two quotes are taken from six opinions published on January 24 by the Science Media Centre (SMC), a not-for-profit organisation that provides expert information for journalists. They were issued in response to the decision by the World Health Organisation not to declare the China coronavirus outbreak a public health emergency of international concern.

    It is notable that the government statement did not include Professor Hibberd’s final sentence, which says: “However, all this new evidence needs to be rapidly obtained over the next few days if the world is to be as prepared as possible, so WHO should issue a different type of alert to mobilise a full investigation.”

    Last week Hibberd told The Sunday Times that the government had taken his comment out of context and scientists’ warnings proposing caution and preparedness did not appear to have been acted on sufficiently by the government. He added: “I think all of the comments made on the 24th January in response to the WHO response, including my own full comment, reflected the need to prepare as much as possible for this new virus. While we were still seeking to learn what its full impact might be, we also expected our preparedness plans to be in place and in action, so that we could remain in control of this outbreak as much as possible. This was certainly done by other governments at the time, such as Singapore. We should not be caught unaware, even if we were unsure of the true severity.”

    The government also ignored another of the opinions published by the SMC that day, which amounted to a warning that the situation was very serious. It was by Dr Jeremy Farrar, the director of the Wellcome Trust, who unlike Hibberd and Kamradt-Scott is on the government’s key Scientific Advisory Group for Emergencies (Sage) committee. He said: “This virus has crossed from animals into people. That does not happen often, and it is, without doubt, very serious. People are scarred by the memory of Sars, and a global outbreak of a novel respiratory virus like this, is something experts have warned about for many years.”

    ● Government statement:

    Claim [by The Sunday Times] – ‘Imperial’s [Professor Neil] Ferguson was already working on his own estimate — putting infectivity at 2.6 and possibly as high as 3.5 — which he sent to ministers and officials in a report on the day of the Cobra meeting on January 24. The Spanish flu had an estimated infectivity rate of between 2.0 and 3.0, so Ferguson’s finding was shocking.’

    Response [by the government] – Infectivity on its own simply reveals how quickly a disease spreads, and not its health impact. For that, it is necessary to know about data such as associated mortality/morbidity. It is sloppy and unscientific to use this number alone to compare to Spanish flu.

    Sunday Times reply:
    The article made clear that what made the virus frightening in late January was the combination of the infectivity rate and the high rate of people dying and needing intensive care in the early study by the Chinese scientists.

    ● Government statement:

    Claim [by The Sunday Times] – No 10 “played down the looming threat” from coronavirus and displayed an “almost nonchalant attitude … for more than a month”.

    Response [by the government] – The suggestion that the government’s attitude was nonchalant is wrong. Extensive and detailed work was going on in government because of coronavirus, as shown above.

    Sunday Times reply:
    There are no examples given “above” of the government’s “extensive and detailed work”. Whether the government was nonchalant is a matter of opinion. The Sunday Times reported the facts.

    ● Government statement:

    Claim [by The Sunday Times] – By the time the Prime Minister chaired a COBR meeting on March 2 “the virus had sneaked into our airports, our trains, our workplaces and our homes. Britain was on course for one of the worst infections of the most insidious virus to have hit the world in a century.”

    Response [by the government] – This virus has hit countries across the world. It is ridiculous to suggest that coronavirus only reached the UK because the health secretary and not the PM chaired a COBR meeting.

    Sunday Times reply:
    The article did not say this.

    ● Government statement:

    Claim [by The Sunday Times] – “Failure of leadership“ by [the prime minister, according to an] anonymous senior advisor to Downing Street.

    Response [by the government] – The Prime Minister has been at the helm of the Government response to Covid 19, providing the leadership to steer his Ministerial team through a hugely challenging period for the whole nation. This anonymous source is variously described as a ‘senior adviser to Downing Street’ and a ‘senior Downing Street adviser’. The two things are not the same. One suggests an adviser employed by the government in No10. The other someone who provides ad hoc advice. Which is it?

    Sunday Times reply:
    The source was in a position to observe the prime minister’s leadership style. It is notable that no attempt has been made to deny the prime minister’s absence from key meetings and from Downing Street itself. Michael Gove has confirmed the prime minister missed five coronavirus Cobra meetings.

    ● Government statement:

    Claim [by The Sunday Times] – The government sent 279,000 items of its depleted stockpile of protective equipment to China during this period in response to a request for help from the authorities there.

    Response [by the government] – The equipment was not from the pandemic stockpile. We provided this equipment to China at the height of their need and China has since reciprocated our donation many times over. Between April 2-April 15 we have received over 12 million pieces of PPE in the UK from China.

    Sunday Times reply:
    Downing Street told The Sunday Times before publication of the article that the 12 million pieces of PPE from China was a commercial deal. It was not reciprocation for generosity.

    ● Government statement:

    Claim [by The Sunday Times] – Little was done to equip the National Health Service for the coming crisis in this period.

    Response [by the government] – This is wrong. The NHS has responded well to Coronavirus, and has provided treatment to everyone in critical need. We have constructed the new Nightingale hospitals and extended intensive care capacity in other hospitals.

    Sunday Times reply:
    The Nightingale hospital programme was announced in late March, long after the period in question, and was acknowledged in the article.

    ● Government statement:

    Claim [by The Sunday Times] – Among the key points likely to be explored are why it took so long to recognise an urgent need for a massive boost in supplies of personal protective equipment for health workers; ventilators to treat acute respiratory symptoms; and tests to detect the infection.

    Response [by the government] – The Department for Health began work on boosting PPE stocks in January, before the first confirmed UK case.

    – Discussions on PPE supply for COVID-19 began w/c 27 January (as part of Medical Devices and Clinical Consumables), with the first supply chain kick-off meeting on 31 January. The first additional orders of PPE was placed on 30 January via NHS Supply Chain’s ‘just-in-time contracts’. BAU orders of PPE were ramped up around the same date.

    – Friday, 7 February, the department held a webinar for suppliers trading from or via China and the European Union. Over 700 delegates joined and heard the Department’s requests to carry out full supply chain risk assessments and hold onto EU exit stockpiles where they had been retained.

    – Monday, 10 February, the department spoke with the major patient groups and charities to update them on the situation regarding the outbreak and to update them on the steps it was taking to protect supplies.

    – Tuesday, 11 February, the department wrote to all suppliers in scope of the Covid 19 supply response work – those trading from or via China or the EU – repeating the messages from the webinar and updating suppliers on the current situation relating to novel coronavirus. The NHS has spare ventilator capacity and we are investing in further capacity.

    Sunday Times reply:
    The article reported that the department had placed orders under “just-in-time contracts” on January 30. However, it pointed out that the source said these ran into difficulties because they were with manufacturers in China, which desperately needed its own PPE supplies at the time. Downing Street and the Department of Health confirmed to The Sunday Times that the “just-in-time contracts” were proving difficult. In contrast to what the government is claiming to be “detailed and extensive” activity, it presents no evidence of any further activity on PPE acquisition between February 11 and the beginning of March or any activity before the week beginning January 27. Its failure to point to a single delivery of PPE, testing equipment or ventilators during this period suggests a level of achievement even lower than the article reported.

    ● Government statement:

    Claim [by The Sunday Times] – Suggestion that “lack of grip” had the knock-on effect of the national lockdown being introduced days or even weeks too late, causing many thousands more unnecessary deaths.

    Response [by the government] – The government started to act as soon as it was alerted to a potential outbreak. Mr Hancock was first alerted to Covid 19 on 3 January and spoke to Departmental officials on 6th Jan before receiving written advice from the UK Health Security Team. He brought the issue to the attention of the Prime Minister and they discussed Covid 19 on 7 January. The government’s scientific advisory groups started to meet in mid-January and Hancock instituted daily meetings to grip the emerging threat. We have taken the right steps at the right time guided by the scientific evidence.

    Sunday Times reply:
    The government response does not address whether the lockdown was too late.

    ● Government statement:

    Claim [by The Sunday Times] – Scientists said the threat from the coming storm was clear and one of the government’s key advisory committees was given a dire warning a month earlier than has previously been admitted about the prospect of having to deal with mass casualties.

    Response [by the government] – The government followed scientific advice at all times. The WHO only determined that COVID 19 would be a global pandemic on 11 March. Claiming that there was scientific consensus on this is just wrong. Sage met on January 22 but the first NERVTAG meeting was held on 13 January (NERVTAG is the New and Emerging Respiratory Virus Threats Advisory Group – see here https://www.gov.uk/government/groups/new-and-emerging-respiratory-virus-threats-advisory-group).

    Sunday Times reply:
    These statements of fact contradict nothing in the article.

    ● Government statement:

    Claim [by The Sunday Times] – The last rehearsal for a pandemic was a 2016 exercise codenamed Cygnus, which predicted the health service would collapse and highlighted a long list of shortcomings — including, presciently, a lack of PPE and intensive care ventilators.

    Response [by the government] – The Government has been extremely proactive in implementing lessons learnt around pandemic preparedness, including from Exercise Cygnus. This includes being ready with legislative proposals that could rapidly be tailored to what became the Coronavirus Act, plans to strengthen excess death planning, planning for recruitment and deployment of retired staff and volunteers, and guidance for stakeholders and sectors across government.

    Sunday Times reply:
    The Coronavirus Act received royal assent on March 25 of this year, so any measures brought in under the law were put in place after the virus had seriously taken hold in Britain and almost four years after the exercise itself.

    ● Government statement:

    Claim [by The Sunday Times] – By February 21 the virus had already infected 76,000 people, had caused 2,300 deaths in China and was taking a foothold in Europe, with Italy recording 51 cases and two deaths the following day. Nonetheless NERVTAG, one of the key government advisory committees, decided to keep the threat level at “moderate”.

    Response [by the government] – This is a misrepresentation of what the threat level is. This is about the current public health danger – and on February 21, when the UK had about a dozen confirmed cases, out of a population of over 66 million, the actual threat to individuals was moderate. In terms of the potential threat, the government was clear – on 10 February the Secretary of State declared that “the incidence or transmission of novel Coronavirus constituted a serious and imminent threat to public health”.

    Sunday Times reply:
    If on February 10 the virus was considered — even potentially — a serious and imminent threat to public health, why did the prime minister not attend a Cobra meeting until March 2?

    Leave a comment

    We have seen commentary on “The work of the Labour Party’s Governance and Legal Unit in relation to antisemitism, 2014 – 2019 document”. If the reported content is to be believed, it appears that our work to get Labour to power has been undermined for years, leaving the UK at continued risk from this incompetent and malign government.

    As an affiliated Socialist Society, we are pleased to see that Sir Keir has opened an independent investigation which must examine the contents of the document as well as its leaking and provenance. Our members expect the report to be truly independent and that its full findings will be made known to every party member and to all affiliated bodies.

    The SHA will continue to work with the Party for better health for all through the application of socialist principles.

     

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

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    The SHA started to publish its Covid-19 Blogs on the 17th March and since then have issued weekly blogs. It is extraordinary to reflect on this being our sixth commentary on the socialist health view of the unfolding global pandemic.

    In earlier Blogs we have covered many different topics and each Blog reflects on particular issues that have sprung up over the past week and identified as emerging issues. In this week’s Blog we will look at social care, testing, and possible steps out of lockdown.

    1. Social Care

    This has rightly hit the headlines over the past week as the plight of our care services and their residents have been under the media spotlight. We knew from the early data from China mid January that the C-19 virus seemed to particularly harm older people and particularly adults with underlying conditions such as obesity, diabetes, heart and lung disease. Mortality rates in these at risk groups is comparatively high and 90% of deaths in the UK have been in the over 60 year olds with half of these deaths being in people over 80 years old. This has led the UK government to define vulnerable groups and also those ‘very vulnerable’ people who need to be ‘shielded’ from exposure to the virus. The very vulnerable shielded groups are estimated to a number 1.5m and are self isolating indoors for 12 weeks. Many but not all of these very vulnerable people will be in residential or nursing homes.

    Having identified these at risk populations, attention needed to be directed towards those sub populations of older or vulnerable people who were living in residential or nursing homes. These institutions are high risk as ‘closed communities’ accommodating a group of high-risk individuals who would be at risk of an outbreak of C-19 within that setting.  Decisions have had to be made by the management of these residential and nursing homes to, in many cases,  exclude relatives from visiting.  Some brave and extremely committed care staff have decided to move themselves into the nursing or residential homes to reduce the risk of them bringing C-19 in from their own homes and local community. It cannot be a surprise to hear now about outbreaks in these establishments causing disease and death to workers and their residents. Again like other aspects of this pandemic response – we had early warnings from Italy and Spain about the isolation and risks that this sector faced. Did we do enough quick enough?

    SHA President Prof Allyson Pollock published an Editorial in the BMJ on the 14th April, which identified that social services in the UK are amongst the most privatised and fragmented in the world, and have been underfunded for decades. Between 2010 and 2018 local authority spending on social care in England fell by 49% in real terms. The UK has 5500 providers operating 11,300 care homes for older people and 83% of these care home beds are provided by the for-profit sector, it is more privatised than the US.

    She also reports that care services employ 1.6m care staff (1.1m full time equivalent) of which 78% are employed by the independent sector. Pay is low; 24% of people working in adult social care are on zero hours contracts, and in March 2019 around a quarter were being paid the national living wage of £7.83 an hour or less. The sector is 120,000 workers short, and agency staff, are commonly employed and move from care home to care home. Social care has been a low priority for PPE supplies despite the high risks for residents and staff.

    Valiant efforts have been made by the sector with heroism shown by these low paid workers as well as stoicism by residents, many of whom may well be bemused and depressed as to why they no longer have visitors as well as the unusual PPE equipment being used by staff. It will have been difficult to plan for the various contingencies when cases emerged in homes, to access testing of staff and residents, to successfully isolate cases and discuss whether residents should be moved to hospital to obtain extra levels of care. Such admissions to more resourced NHS facilities should be an option even if cases would not meet eligibility for ITU care or wishing to be subject to that level of intrusive care. There should be options available, rather than simply assuming appropriate care will be delivered in that setting by stretched staff with relatively few registered nurses, no medical presence on site and few resources of PPE and other equipment such as oxygen supplies, oxygen delivery equipment and monitors such as oximeters.

    The SHA has been concerned about the social care sector for years and has developed policies to transform the sector under the banner ‘rescuing social care’. At the 2019 Labour Party Conference the SHA called on a future Labour Government to legislate for a duty to provide a universal system of social care and support based on a universal right to independent living. This should be based on need and offering choice; be free at the point of use, universally provided and fully funded through progressive taxation. This new National Care Service (NCS) should ensure that there are nationally agreed qualifications for staff, a career structure and enhanced pay and conditions of service. Recognition of informal carers is needed too with clarity about rights and support. The policy proposal has many other facets and stops short of integrating the NCS with the NHS. However close working would be built in and integrating data and information into a common system would be expected.

    As for many of the issues that have arisen so far with the pandemic the social care sector has not been in a strong position to push back C-19. The underpaid staff, the high vacancies and the often unsuitable, adapted accommodation is rarely fit for modern care needs. The fragmentation of the sector with ‘for profit operators’ finding it hard with constrained funding has led to vulnerability in the sector as well as the residents. Maybe this will be the time that showed how, rather than a shiny green badge, the social care service should be taken into a publicly funded national care service.

    1. Tracking, Tracing, Testing, and Treating (isolating)

    One of the criticisms we have made of the Government’s pandemic response has been the decision on the 12th March to pull back from testing for cases in the community and contact tracing. It may turn out that this was a policy decision driven by the lack of availability of tests rather than a decision made not to control community spread. On the 24th February there had been 9 confirmed cases of C-19 in the UK and the WHO had announced that countries should ‘ prioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantining of close contacts

    By the 22nd March there were 5683 confirmed cases and yet even then the WHO advice was ‘ find those who are sick, those who have the virus and isolate them. Find their contacts and isolate them’.  In outbreaks you do not always have confirmatory tests available but can make public health decisions based on the history and observation in the context of the unfolding epidemic. We seem to have forgotten the cardinal symptoms of continuous cough and fever.

    We have pointed out in earlier Blogs that countries that have been successful so far in controlling C-19 such as South Korea and Taiwan have been ones that have used widespread testing, tracing contacts and quarantining them. Germany has also been an example of a Western European country that has used this traditional communicable disease control methodology to save lives and protect their health service. Such a public health approach is most important in epidemics like this where there is no vaccine and no effective therapeutics other than sophisticated intensive supportive care.

    It is symbolic that the data that is presented at the daily press briefings has in the main used hospital testing data, hospital admissions and until recently exclusively hospital deaths. TV crews have been crawling over ITUs to get extraordinary footage of these wonderful NHS teams doing outstanding and stressful work. The incredible success of building Nightingale Hospitals in record time has been a reminder of the extraordinary efforts made in Wuhan to meet urgent need.

    However outside hospitals we have had the social care sector relatively unprepared, people self isolating in their homes and having to gauge the seriousness of their symptoms with intermittent telephone calls to NHS111. The disease has been spreading across the country from London to other metropolitan centres and then into smaller towns and rural areas. We could and should have shutdown London earlier as this has been our Wuhan. Local surveillance is limited and active contact tracing thought to be irrelevant even when many areas across England, Wales and Scotland had few cases. Environmental Health Officers in Local Government have not been mobilised. An opportunity missed.

    We have also seemed content to keep our airports and seaports open with little if no border health security. Again other countries who have managed to control this pandemic stopped and controlled air traffic, quarantining arrivals from high risk areas and making basic investigation on history (?cough) and taking travellers temperatures. Not difficult to do and look at Australia and New Zealand for actions on this source of new infections of a virus with high levels of transmissibility. In the UK it is estimated that over 190,000 people flew into the UK from China between January and March with no testing/quarantining.

    1. Evidence of unpreparedness

    The UK seems set to be one of the countries in Western Europe with the worst outcome in regards to mortality rates from C-19 despite the effectiveness of the NHS, which has withstood the pressure. We are often said to have an exemplar emergency planning system, the government had a pandemic as No. 1 risk on the national risk register, kept stockpiles and has computer modellers of world class.

    Yet we do not seem to have acted on the emergency planning exercises such as the 2016 Operation Cygnus (‘swan’ flu). We are now aware that in Sept 2017 the National Risk Register of Civil Emergencies reported that “There is a high probability of a flu pandemic occurring with up to 50% of the UK population experiencing symptoms, potentially leading to between 20,000 and 750,000 fatalities and high levels of absence from work’.

    There have been disclosures recently that are worth referring to that set out the timelines which showed the Prime Minister distracted and absent from COBRA meetings in January/February (A comprehensive countdown to how Britain came to have one of the highest COVID-19 per capita death rates – http://www.bylines.com). Also there has been an Insight team report for the Sunday Times on the 19th April 2020 (Coronavirus: 38 days when Britain sleepwalked into disaster). The current Secretary of State is an actor in this drama and the former Secretary of State for Health Jeremy Hunt who has been a critic of some aspects of the Governments response was of course in power during this time. We are told that ‘pandemic planning became a casualty of the austerity years when there were more pressing needs’ and ‘preparations for a no-deal Brexit sucked all the blood out of pandemic planning’

    1. Getting out of lockdown

    There are various scenarios that are being set out about how to get out of lockdown once the number of new cases decline and the first wave is thought to be ‘over’. This is likely to take time as the curve is flat and the proportion of the population with resistance is thought to be quite low. The government are hesitating about setting out the scenario and talking too much about the delivery of an effective, safe and tested vaccine. This usually takes 12-18 months and can never be guaranteed. They also are talking up the possibility of an effective drug therapy but we all know that viral illness do not lend themselves to highly effective drug treatments as we know with the Tamiflu debate after the 2009 H1N1 pandemic. So really we should again consider more immediate and classic public health control measures that have been shown to work in this pandemic.

    This will need health scrutiny and effective border controls that New Zealand and Australia have used successfully. There will within the country need to be effective systems of testing, contact tracing and quarantining with every day life respecting physical distancing and the use of facemasks. South Korea has shown the way that this can be enhanced and made more bearable by using mobile phones loaded with new technologies. These will warn people if at risk and disclose red, amber or green status. This will allow the economy to restart and people begin to get out and about again. The very vulnerable will in the early phases of this need to be protected.

    Prof Pollock in a recent BMJ editorial (Covid-19: why is the UK government ignoring WHO’s advice) states that ‘this means instituting a massive, centrally co-ordinated, locally based programme of case finding, tracing, clinical observation, and testing. It requires large teams of people, including volunteers, using tried and tested methods updated with social media and mobile phones and adapting the guidance published from China’ and other countries who are implementing such systems.

    This will require a change of mindset in government and from their medical and scientific advisers but as J.M.Keynes said:

    When the facts change, I change my mind. What do you do?”

    20th April 2020

    Published by Jean Smith on behalf of the SHA Officers and Vice Chair’s

    2 Comments

    The pharmacists’ trade union, PDA, has called on all pharmacy employers to immediately adopt a “zero tolerance” approach towards abuse of pharmacists supported with clear statements to patients and 100% enforcement measures that make the safety of pharmacists and their teams a clear and consistent priority.

    The long running PDA campaign to end abuse and violence in pharmacies has recently gained significant prominence as incidents of abuse and violence experienced in pharmacies has increased during the COVID crisis. The campaign has now brought the issue to the attention of politicians, police forces and the general public.  ITV evening news and News at Ten on 9 April reported preliminary results of a PDA survey exposing the reality of abuse of pharmacists and their teams and the PDA are now sharing the final results after the survey finished on Easter Monday.

    PDA Director, Paul Day said “We know this isn’t all patients, nor the experience of a pharmacists every single day, but one incident of abuse or one assault is one too many and suggesting such behaviour can ever be excused creates an atmosphere that puts pharmacy teams at risk of further attacks. How can any pharmacy employer think that this could be acceptable? 

    The survey had more than 1,200 responses in less than a week and revealed the following key results:

    • In the past month more than 90% of respondents have seen incidents where patients/customers have behaved abusively or aggressively towards them or their colleagues.
    • More than 80% noticed that the number of abusive or aggressive incidents has increased in the past month compared to normal levels.

    The survey respondents reflected the scope of PDA membership with respondents from across the UK and across the profession. A majority of respondents from each sector of pharmacy had seen abuse, but those in community pharmacy had seen it significantly more frequently than others.

    The examples provided by respondents to the survey make disturbing reading generating a 40 page report detailing verbal abuse, intimidation, threats, racism, sexism and physical attacks. While the PDA believe decent employers would, and do, naturally want zero tolerance of such treatment of their employees the following two quotes suggest that some pharmacists experience what might be described as the opposite of zero tolerance:

    “Same man has made multiple pharmacy members cry. Was very aggressive and threatened me. Told xxxxx [the major pharmacy employer] about him and they did absolutely nothing. In fact, they offered him vouchers as he complained that we were rude. We literally have no support from anyone especially large multiples such as xxxxx who I work for who will do nothing about it.”

    “I did have a particularly nasty incident whilst working for a large multiple xxxxx . A male customer came in with an incompletely written CD prescription for a relative. It was a Sunday. I told him I couldn’t accept the prescription as it was incomplete and needed to contact the prescriber. This opened up a torrent of abuse. No support staff were nearby and there was no security and I was pregnant at the time. It made me feel very vulnerable. He told me he’d make sure I lost my job and hoped that I got cancer amongst all the f… words. I reported it to xxxxx on the Monday and they said he’d been in touch and threatened to give xxxxx bad publicity. They told me they sent him vouchers !”

    Mr Day concluded: “Any degree of abuse is unacceptable but it becomes even more worrying that we are aware of several very recent incidents that have involved physical attacks after which the police have been involved.  We made sure that the Assaults on Emergency Workers (Offences) Act 2018 carries greater penalties for attacking pharmacists, but our focus is on preventing attacks in the first place

    Being able to abuse pharmacy staff without consequences creates no deterrent for potential aggressors.   This cannot be allowed to continue and employers need to play their part. Introducing a genuine zero tolerance approach would be welcomed by employees and locums who all have a right to go to work without fear of abuse or attack”

    Last week the PDA called on the Company Chemists Association (CCA) to ask it’s members to adopt zero tolerance of abuse of pharmacists,   Read More.

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    Unite national officer for health Colenzo Jarrett-Thorpe said: “At this time of national emergency caused by the coronavirus pandemic, it is right that the legal protections covering whistleblowers in the NHS are highlighted.
    “Unite, which has 100,000 members in the health service, will be monitoring the situation very closely in the weeks ahead and will give maximum support to any member who may face disciplinary procedures as a result of raising legitimate concerns, for example, the lack of personal protective equipment (PPE).
    “The current legislation protecting whistleblowers has been further underpinned by the NHS Staff Council statement of 28 February and the English Social Partnership Forum statement on 1 April.
    “Any NHS worker that suspects they are being victimised for whistleblowing should contact their ‘freedom to speak up’ guardian which every trust in England should have in place. If they are a union member, they should contact their workplace representative or local union office.
    “There have been anecdotal stories on social media that some NHS bosses may have been clamping down on those wishing to expose failings in the system and improve the well-being of patients. If we discover concrete evidence that this is happening, we will act immediately to support our members.”

    The NHS Staff Council statement of 28 February 2020

    https://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-reward/NHS-Staff-Council—Guidance-for-Covid-19-Feb-20.pdf?la=en&hash=70C909DA995280B9FAE4BF6AF291F4340890445C&hash=70C909DA995280B9FAE4BF6AF291F4340890445C

    English Social Partnership Forum Joint Statement on Industrial relation – 1 April 2020

    https://www.socialpartnershipforum.org/media/166314/SPF-Covid-19-statement-final-and-formatted.pdf

    Protection for whistleblowers in the UK is provided under the Public Interest Disclosure Act 1998 (PIDA).The PIDA protects employees and workers who blow the whistle about wrongdoing.

    For more information please contact Unite senior communications officer Shaun Noble

    Email: shaun.noble@unitetheunion.org

    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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    The Socialist Health Association (SHA) published its first Blog on the COVID-19 pandemic last week (Blog 1 – 17th March 2020). A lot has happened over the past week and we will address some of these developments using the lens of socialism and health.

    1. Global crisis

    This is a pandemic, which first showed its potential in Wuhan in China in early December 2019. The Chinese government were reluctant to disclose the SARS- like virus to the WHO and wider world to start with and we heard about the courageous whistle blower Dr Li Wenliang, an ophthalmologist in Wuhan, who was denounced and subsequently died from the virus. The Chinese government recognised the risk of a new SARS like virus and called in the WHO and announced the situation to the wider world on the 31st December 2019.

    The starter pistols went off in China and their neighbouring countries and the risk of a global pandemic was communicated worldwide. The WHO embedded expert staff in China to train staff, guide the control measures and validate findings. Dr Li Wenliang who had contracted the virus, sadly died in early February and has now been exonerated by the State. Thanks to the Chinese authorities and their clinical and public health staff we have been able to learn about their control measures and the clinical findings and outcomes in scientific publications. This is a major achievement for science and evidence for public health control measures but….

    Countries in the Far East had been sensitised by the original SARS-CoV outbreak, which originated in China in November 2002. The Chinese government at that time had been defensive and had not involved the WHO early enough or with sufficient openness. The virus spread to Hong Kong and then to many countries showing the ease of transmission particularly via air travel. The SARS pandemic was thankfully relatively limited leading to global spread but ‘only’ 8,000 confirmed cases and 774 deaths. This new Coronavirus COVID-19 has been met by robust public health control measures in South Korea, Taiwan, Hong Kong, Japan and Singapore. They have all shown that with early and extensive controls on travel, testing, isolating and quarantining that you can limit the spread and the subsequent toll on health services and fatalities. You will notice the widespread use of checkpoints where people are asked about contact with cases, any symptoms eg dry cough and then testing their temperature at arms length. All this is undertaken by non healthcare staff. Likely cases are referred on to diagnostic pods. In the West we do not seem to have put much focus on this at a population level – identifying possible cases, testing them and isolating positives.

    To look at the global data the WHO and the John Hopkins University websites are good. For a coherent analysis globally the Tomas Peoyu’s review  ‘Coronavirus: The Hammer and the dance’ is a good independent source as is the game changing Imperial College groups review paper for the UK Scientific Advisory Group for Emergencies (SAGE). This was published in full by the Observer newspaper on the 23rd March. That China, with a population of 1.4bn people, have controlled the epidemic with 81,000 cases and 3,260 deaths is an extraordinary achievement. Deaths from COVID-19 in Italy now exceed this total.

    The take away message is that we should have acted sooner following the New Year’s Eve news from Wuhan and learned and acted on the lessons of the successful public health control measures undertaken in China and the Far East countries, who are not all authoritarian Communist countries! Public Health is global and instead of Trump referring to the ‘Chinese’ virus he and our government should have acted earlier and more systematically than we have seen.

    Europe is the new epicentre of the spread and Italy, Spain and France particularly badly affected at this point in time. The health services in Italy have been better staffed than the NHS in terms of doctors/1000 population (Italy 4 v UK 2.8) as well as ITU hospital beds/100,000 (Italy 12.5 v UK 6.6). As we said in Blog 1 governments cannot conjure up medical specialists and nurses at whim so we will suffer from historically low medical staffing. The limited investment in ITU capacity, despite the 2009 H1N1 pandemic which showed the weakness in our system, is going to harm us. It was great to see NHS Wales stopping elective surgical admissions early on and getting on with training staff and creating new high dependency beds in their hospitals. In England elective surgery is due to cease in mid April! We need to ramp up our surge capacity as we have maybe 2 weeks at best before the big wave hits us. The UK government must lift their heads from the computer model and take note of best practice from other countries and implement lockdown and ramp up HDU/ITU capacity.

    In Blog 1 we mentioned that global health inequalities will continue to manifest themselves as the pandemic plays out and spare a thought for the Syrian refugee camps, people in Gaza, war torn Yemen and Sub Saharan Africa as the virus spreads down the African continent. Use gloves, wash your hands and self isolate in a shanty town? So let us not forget the Low Middle Income Countries (LMICs) with their weak health systems, low economic level, weak infrastructure and poor governance. International banking organisations, UNHCR, UNICEF, WHO and national government aid organisations such as DFID need to be resourced and activated to reach out to these countries and their people.

    1. The public health system

    We are lucky to have an established public health system in the UK and it is responding well to this crisis. However we can detect the impact of the last 10 years of Tory Party austerity which has underfunded the public health specialist services such as Public Health England (PHE) and the equivalents in the devolved nations, public health in local government and public health embedded in laboratories and the NHS. PHE has been a world leader in developing the PCR test on nasal and throat samples as well as developing/testing the novel antibody blood test to demonstrate an immune response to the virus. The jury is out as to what has led to the lack of capacity for testing for C-19 as the UK, while undertaking a moderate number of tests, has not been able to sustain community based testing to help guide decisions about quarantining key workers and get intelligence about the level of community spread. Compare our rates of testing with South Korea!

    We are lucky to have an infectious disease public health trained CMO leading the UK wide response who has had experience working in Africa. Decisions made at COBRA and announced by the Prime Minister are not simply based ‘on the science’ and no doubt there have been arguments on both sides. The CSO reports that SAGE has been subject to heated debate as you would expect but the message about herd immunity and stating to the Select Committee that 20,000 excess deaths was at this stage thought to be a good result was misjudged. The hand of Dominic Cummings is also emerging as an influencer on how Downing Street responds. Remember at present China with its 1.4bn population has reported 3,260 deaths. They used classic public health methods of identifying cases and isolating them and stopping community transmission as much as possible. Herd immunity and precision timing of control measures has not been used.

    The public must remain focused on basic hygiene measures – self isolating, washing of hands, social distancing and not be misled about how fast a vaccine can be developed, clinically tested and manufactured at scale. Similarly hopes/expectations should not be placed on novel treatments although research and trials do need supporting. The CSO, who comes from a background in Big Pharma research, must be seen to reflect the advice of SAGE in an objective way and resist the many difficult political and business pressures that surround the process. His experience with GSK should mean that he knows about the timescales for bringing a novel vaccine or new drugs safely to market.

    1. Local government and social care

    Local government (LAs) has been subject to year on year cuts and cost constraints since 2010, which have undermined their capability for the role now expected of them. The budget did not address this fundamental issue and we fully expect that in the crisis, central government will pass on the majority of local actions agreed at COBRA to them. During the national and international crisis LAs must be provided with the financial resources they need to build community hubs to support care in the community during this difficult time. The government need to support social care.

    COVID-19 is particularly dangerous to our older population and those with underlying health conditions. This means that the government needs to work energetically with the social care sector to ensure that the public health control measures are applied effectively but sensitively to this vulnerable population. The health protection measures which have been announced is an understandable attempt to protect vulnerable people but it will require community mobilisation to support these folk.

    Contingency plans need to be in place to support care and nursing homes when cases are identified and to ensure that they can call on medical and specialist nursing advice to manage cases who are judged not to require hospitalisation. They will also need to be prepared to take back people able to be discharged from acute hospital care to maintain capacity in the acute sector.

    Apart from older people in need there are also many people with long term conditions needing home based support services, which will become stressed during this crisis. There will be nursing and care staff sickness and already fragile support systems are at risk. As the retail sector starts to shut down and there is competition for scarce resources we need to be building in supply pathways for community based people with health and social care needs. Primary health care will need to find smart ways of providing medical and nursing support.

    1. The NHS

    In January and February when the gravity of the COVID pandemic was manifesting itself many of us were struck by the confident assertion that the NHS was well prepared. We know that the emergency plans will have been dusted down and the stockpile warehouses checked out. However, it now seems that there have not been the stress tests that you might have expected such as the supply and distribution of PPE equipment to both hospitals and community settings. The planning for COVID-19 testing also seems to have badly underestimated the need and we have been denied more accurate measures of community spread as well as the confirmation or otherwise of a definite case of COVID-19. This deficiency risks scarce NHS staff being quarantined at home for non COVID-19 symptoms.

    The 2009 H1N1 flu pandemic highlighted the need for critical care networks and more capacity in ITU provision with clear plans for surge capacity creating High Dependency Units (HDUs) including ability to use ventilators. The step-up and step-down facilities need bed capacity and adequate staffing. In addition, there is a need for clarity on referral pathways and ambulance transfer capability for those requiring even more specialised care such as Extracorporeal Membrane Oxygenation (ECMO). The short window we now have needs to be used to sort some of these systems out and sadly the supply of critical equipment such as ventilators has not been addressed over the past 2 months. The Prime Minister at this point calls on F1 manufacturers to step in – we wasted 2 months.

    News of the private sector being drawn into the whole system is obviously good for adding beds, staff and equipment. The contracts need to be scrutinised in a more competent way than the Brexit cross channel ferries due diligence was, to ensure that the State and financially starved NHS is not disadvantaged. We prefer to see these changes as requisitioning private hospitals and contractors into the NHS. 

    1. Maintaining people’s standard of living

    We consider that the Chancellor has made some major steps toward ensuring that workers have some guarantees of sufficient income to maintain their health and wellbeing during this crisis. Clearly more work needs to be done to demonstrate that the self-employed and those on zero hours contracts are not more disadvantaged. The spotlight has shown that the levels of universal credit are quite inadequate to meet needs so now is the time to either introduce universal basic income or beef up the social security packages to provide a living wage. We also need to ensure that the homeless and rootless, those on the streets with chronic mental illness or substance misuse are catered for and we welcome the news that Sadiq Khan has requisitioned some hotels to provide hostel space. It has been good to see that the Trade Unions and TUC have been drawn into negotiations rather than ignored.

    In political terms we saw in 2008 that the State could nationalise high street banks. Now we see that the State can go much further and take over the commanding heights of the economy! Imagine if these announcements had been made, not by Rishi Sunak, but by John McDonnell! The media would have been in meltdown about the socialist take over!

    1. Conclusion

    At this stage of the pandemic we note with regret that the UK government did not act sooner to prepare for what is coming both in terms of public health measures as well as preparing the NHS and Local Government. It seems to the SHA that the government is playing catch up rather than being on the front foot. Many of the decisions have been rather late but we welcome the commitment to support the public health system, listen to independent voices in the scientific world through SAGE and to invest in the NHS. The country as a whole recognises the serious danger we are in and will help orchestrate the support and solidarity in the NHS and wider community. Perhaps a government of national unity should be created as we hear much of the WW2 experience. We need to have trust in the government to ensure that the people themselves benefit from these huge investment decisions.

    24th March 2020

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    While we welcome the £5bn emergency fund for the NHS and other public services and the open ended commitment made by the Chancellor that the government will provide whatever the NHS needs to meet the challenge of COVID-19; we are concerned to point out three big issues on sustaining an NHS, social care and protecting all workers including those in the gig economy.

    The Chancellor re-iterated the discredited election manifesto statements about 50,000 more nurses while we know that there are already 43,000  funded nurse vacancies. He repeated the mantra about 50 million more GP appointments while recruitment of young doctors to become GPs remains poor and it is not clear how this can be achieved in the short term. He reiterated the discredited election slogan about 40 new hospitals. Both staffing promises ignore the fact that it is not only money that is needed – the legacy of austerity cannot be reversed by a cash injection alone – training a GP/medical specialist takes 10 years. Turn the tap off for 10 years and turn it back on expecting accolades is not good enough.

    We are very concerned too about the immigration health surcharge, which is being increased to £624 per person. The NHS needs to continue to ethically attract health workers into our country for training and service. The surcharge will apply to EU citizens from January next year. This health surcharge is a serious disincentive and opens another pathway for Tories to introduce insurance charging into the NHS. The cost of collection as with all insurance schemes will be prohibitive.

    Social care has been ignored. Everyone involved knows that we should be investing in health and social services and even Jeremy Hunt who presided over NHS austerity is on record as saying that this is a glaring omission in the budget. You need to invest in health and social care and the budget is silent on social care. The budget statement of 8,700 words mentions social care twice only and the manifesto commitment of £1bn/year for 5 years seems to have been lost. Local government leadership role has been ignored such as their role in housing, childcare and social support in communities. The attention given to cars, roads, potholes, red diesel and fuel tax does not signal that the other existential emergency on climate change is being addressed.

    Finally we welcome the steps taken to move entitlement to SSP to day one but worry that the 111 service is already over stretched and should not have the burden of certification forced on them. The health and wellbeing of those who are not eligible for SSP, such as the estimated 2m part time and zero hours workers and the 5m self-employed is inadequately protected: the ESA is probably too small a compensation. Many will feel they have to continue to work, putting their own health and that of their families at risk.

    The SHA campaigns for health and social services to be free at the point of need and to be funded by general taxation. We know that the 10 years of Tory austerity has damaged the fabric of our NHS and we need to invest in capital and training of staff with confidence in long term growth and sustainability. In a modern society the social care services need to be an integral part of our system and should be planned together with joint investment. This budget has missed an opportunity to make this change.

     

    On behalf of the Officers and Vice Chairs

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    Assemble 12:00 Portland Place, London W1A

    In anticipation of the above march and rally we are making preparations for Unite members  to travel to London to support the above march and rally.

    Unite are providing day return train tickets for members  from Manchester Piccadilly station and Liverpool Lime Street, anyone requiring transport to the march and rally should contact Lorna Woods Moses at the Liverpool office by email – lorna.woodsmoses@unitetheunion.org

    Please ensure you provide your name, membership number, contact details and preferred departure point.

    Please note that block bookings will not be accepted and seats are limited.

    Bookings will not be accepted after Monday 10 March.

    Further information about the march route can be found on the Stand Up to Racism website

    http://www.standuptoracism.org.uk/un-anti-racism-day-demo-saturday-21-march/

    or on the Unite website

    https://unitetheunion.org/news-events/events/march-against-racism/

    Kind regards

    Lorna Woods Moses

    Secretary to Deputy Regional Secretary Debbie Brannan  & Regional Coordinating Officer Mick Chalmers

    Unite the Union Liverpool

    Leave a comment

     

    Make the UK the safest place world to have a baby!

    Why is the UK still not in the top ten countries for infant mortality and for maternal deaths? Why? We are a rich country. We have an established high-quality health service. Healthcare is supposed to be accessible to all. How come babies and mothers die or are badly hurt at birth? How come Black and Ethnic minority babies suffer most? Why do poor areas have worse outcomes than wealthy areas? Why is infant mortality rising? (The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births. The neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. These are both common measures of health care quality, but they are also influenced by social, economic and environmental factors). Are there fundamental problems with core policy documents like the maternity review “Better births”? These are painful questions.

    Our campaign wants real improvements for mothers and babies. This posting is not intended as a clinical paper, it is a discussion amongst activists and concerned citizens about where the problems lie. A key set of participants in this discussion are mothers who have given birth, including those who have lost babies, grandmothers and other birth partners, and women who could not conceive.

    Our campaign published our Maternity Manifesto during the election but though well shared on Facebook, it did not get into any parties’ manifesto.

    We also called a national meeting on issues in maternity care.

    What then are the factors that result in UK outcomes at birth worse than other advanced countries?

    The answers include shortage of NHS funding, staffing shortages, poor management in some hospitals, staff in fear of speaking out, some policies and procedures, disrespect towards the women carrying the baby, and, as cited in the East Kent enquiry, a lack of practical understanding by staff and by mums of the need to “count the kicks” in the latter part of pregnancy. The introduction of charges for migrant women has also caused deaths. NHS material seems to centre the cause on mothers who smoke, or who are overweight. (Now smoking in pregnancy is plain stupid, it really is, and most mums would not do so if they were not addicted. Don’t do it!). However, other countries, Greece for example, who smoke more, have better outcomes in pregnancy than does the UK. Wider problems like obesity and diabetes, and even women giving birth older, are mentioned in the literature about this. Again, the age of the mother as a factor, but this is only partly true. Giving birth older is often safer than giving birth too young. Globally it is most often young girls who die in childbirth.

    Answers may lie in the financially and emotionally vulnerable place that pregnant women occupy in our society, including poverty, violence and stress. Poverty and inequality are factors in infant mortality; “The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266).” (Our bold for emphasis).

    The UK is a rich advanced country, with a long history of universal healthcare but we have rising infant mortality. “Rising infant mortality is unusual in high-income countries, and international data show that infant mortality has continued to decline in most rich countries in recent years” and “In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend“.

    Poverty is not the sole cause of high Infant Mortality though, Cuba has good outcomes equal to the UK for infant mortality. Cuba is very poor indeed and the UK is one of the wealthiest economies (sadly Cuba does less well on maternal deaths).  

    Research shows out of 700,000 births a year in England and Wales, around 5,000 babies are stillborn or die before they are a month old”. 5,000 babies each year. There have been major news stories about baby deaths in many hospitals, notably in ShropshireEast Kent and Morecombe Bay.

    Maternal deaths. The UK is not in the top ten countries with the lowest infant mortality rate, neither is it the safest place to give birth. In 2015-17“209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,280,451 women giving birth in the UK. 9.2 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.” In 2016 The UK ranked 24th in the world in Save the Children’s Mothers’ Index and Country Ranking Norway, Finland, Iceland, Denmark, Sweden, Netherlands, Spain, Germany, Australia, Belgium, Austria, Italy, Switzerland, Singapore, Slovenia, Portugal, New Zealand, Israel, Greece, Canada, Luxembourg, Ireland, and France, all did better than the UK. The situation in some other countries is massively worse than here but that is no excuse. But these baby and mothers’ deaths must stop. We cannot sit back and let these deaths continue.

    Let’s be clear, the situation for women in pregnancy and childbirth is massively better than before the NHS, and is head and shoulders better than in the USA today. But maternal mortality is an issue here in the UK, and a huge issue in poorer countries, especially where women give birth without a trained professional being in attendance. Quite rightly professionals and campaigners in the UK participate in international endeavours to improve this situation. The NHS should be training and sending midwives to those countries, instead, it is recruiting midwives from poorer countries. In Europe we have cuts in healthcare through Austerity; in the global south, the same concept of cutting public services to the bone is called Restructuring.

    Why is the UK, a rich country with (almost) universal health care not doing better by its mothers and babies? Look at just this case and see the problems in the provision of maternity care;

    Archie Batten

    Archie Batten died on 1 September 2019, shortly after birth.

    When his mother called the hospital to say she was in labour, she was told the QEQM maternity unit was closed and she should drive herself to the trust’s other hospital, the William Harvey in Ashford, about 38 miles away.

    This was not feasible and midwives were sent to her home but struggled to deliver the baby and she was transferred by ambulance to QEQM where her son died. Archie’s inquest is scheduled for March. (BBC).

    We know that temporarily “closing” maternity units because they are full is a common occurrence. Women then have to go to a different hospital. Induction of labour can be halted because the unit is full. It is not a pleasant situation for mothers. Some maternity units have closed permanently, meaning mothers have to travel further for treatment, at a time when the ambulance service is under great strain (though being in labour is not considered an emergency for the ambulance service!).

    Shortage of Midwives and consequent overwork for the existing staff. The UK has a shortage of three thousand five hundred midwives. The midwife workforce is skewed towards older midwives who will retire soon.

    Gill Walton, general secretary and chief executive of the Royal College of Midwives said “We know trusts are facing huge pressures to save money demanded by the government, but this cannot be at the expense of safety. We remain 3,500 midwives short in England and if some maternity units regularly have to close their doors it suggests there is an underlying problem around capacity staffing levels.

    Training midwives is not just about recruiting new starters to university courses. There need to be sufficient training places in the Hospitals who are already working flat out, leaving little time for mentoring of students, as well as places in the Universities. Alison Edwards, senior lecturer in midwifery at Birmingham City University, who says: ‘It isn’t as simple as recruiting thousands more students as this requires the infrastructure to support it.

    ‘You need more tutors, more on-site resources and, perhaps more importantly, more mentors and capacity in placement areas – which is currently under immense strain.’ 

    One student midwife wrote about her experiences in this letter, where she described very hard work without either pay or good quality mentoring.

    The government and the NHS call for Continuity Care from Midwives. This means the same midwife or small team of midwives cares for the mother through her pregnancy, birth and postnatal period. We too believe this would be wonderful if it were possible. It is however impossible with the existing ratio of midwives to mothers. Providing continuity of care to the most vulnerable mothers is a good step. NICE have reduced this to the idea of each woman having a named midwife. One to One a private midwife company claimed to provide this but was unable to continue trading, and went bust leaving the NHS to pick up the pieces.

    Nationally the NHS is underfunded and looks set to continue so. Much of the problem comes from a long period of underfunding. We spend less than 9.8 per cent of GDP on health. Switzerland, Germany, France, Sweden, Japan, Canada, Denmark. Belgium Austria Norway and the Netherlands all spend more. That places the UK 13th in the list of high spenders on health care. The US spends 16.9 %. (although a lot of that money is diverted from patient care to the big corporations and insurance companies). The NHS was the most cost-efficient health care service in the world.

    Underfunding causes staff shortages. Some errors at birth come from staff being overworked and making mistakes.

    Some, our campaign believes, flow from fundamental flaws in government policy such as in the Maternity Review, where the pressure is on staff not to intervene in labour.

     Listen to the Mother. Some of the deaths are from women not being heeded in pregnancy and childbirth. This is backed up in reports from mothers, including some quoted in the big reviews mentioned above. However, overworked and tired staff who know labour like the back of their hand can easily stop heeding an inexperienced mother.

    Poverty kills mothers and babies. As we said above, some deaths, poor baby health, and injuries come from growing maternal poverty and ill-health. Low-income families find it hard to afford good food. Food poverty affects a staggering number of children. The charity UNICEF estimates that “2.5m British children, or 19%, now live in food-insecure households. This means that there are times when their family doesn’t have enough money to acquire enough food, or they cannot buy the full variety of foods needed for a healthy diet. In addition, 10% of these children are also classified as living in severe food insecurity (the European average is 4%) and as a result, are set to experience adverse health.”

    Studies show that;

    The Independent inquiry into inequalities in health (Acheson 1998) found that a child’s long term health was related to the nutrition and physique of his/her mother. Infants whose mothers were obese had a greater risk of subsequent coronary heart disease. Low birth weight (under 2500 g) was associated with increased risk of death in infancy and with increased risk of coronary heart disease, diabetes and hypertension in later life. Accordingly, the Inquiry recommended, ‘improving the health and nutrition of women of childbearing age and their children, with priority given to the elimination of food poverty and the reduction of obesity’. (NICE )

    A significant number of deaths of new mothers come from mental health issues that spiral out of control. Some of these will be newly developed conditions and some existing conditions made worse by pregnancy and childbirth. Mothers family and professionals must all be on the alert and intervene early. There are good ways to treat mental health in pregnancy.

    Reducing the social and economic stresses around pregnancy would also help reduce the deaths and suffering

    When Birth goes wrong it can be a dreadful experience for everyone involved. In most cases, the panic button brings in a well-drilled team of experts who can solve nearly every problem and do it calmly. At other times, it is dreadful, as described in the coverage of the birth and death of baby Harry Richford. Harry Richford was born at the Queen Elizabeth the Queen Mother Hospital in Margate in 2017 but died a week later. https://www.bbc.co.uk/news/uk-england-kent-51097200

    Sands, the baby death charity explains that there are many causes of babies dying before birth. Crucially important is that mothers are heeded when they are concerned and that everyone Counts the Kicks

     

    Maternity is not the only area of the NHS that suffers. There have been serious mistakes in NHS planning including closing far too many beds. The NHS closed 17,000 beds and now is working beyond safe bed occupancy. There are 100,000 staff vacancies. Waiting times in A and E are dreadful, as are waiting times for cancer treatment. NHS managers and the Government have taken the NHS far from the Bevan model of healthcare (for history read this).

    Press coverage. How does the press cover the NHS, and baby deaths? There are very real problems in the NHS and maternity care but the coverage in the press of these problems seems to switch on and off in strange ways, often to suit Conservative Party political requirements. The NHS and the Government are masters of propaganda and news manipulation. The public needs to learn to judge the news and to look both for actual problems and look out for bullshit and manipulation. Why was news of the arrest of the nurse from the Countess of Chester hospital headlines on the 70th Anniversary of the NHS? Why was the news of the understaffing there not given similar nationwide publicity? Why have we heard little or nothing since?

    If the government can switch the blame to the professionals in the NHS (but not their mates the high admin of the NHS), then they seem to be happy to publicise the problems. In other cases, problems are swept under the carpet.

    Professionals expect to (and do) take responsibility for their own actions. Mistakes will be made. It is impossible to go through life without some mistakes. When we are dealing with life and death mistakes can be catastrophic, even where there is no ill intent.

    Malicious action is rare.   There are the terrible cases of serial murderer Harold Shipman, and the convicted surgeon Ian Paterson who falsely told women, they had breast cancer and operated on them unnecessarily. The hierarchical system in the NHS and the lack of regulation in private hospital, which was described as “dysfunctional at almost every level” allowed that harmWe have not found such a case in maternity.

    Unintentional bad practice, however, has also harmed babies. No one went to work intending to harm in the events publicised in the Morecombe Bay Enquiry into the deaths of 11 babies and one mother. It was said that “The prime responsibility for ensuring the safety of clinical services rests with the clinicians who provide them, and those associated with the unit failed to discharge this duty over a prolonged period. The prime responsibility for ensuring that they provide safe services and that the warning signs of departure from standards are picked up and acted upon lies with the Trust, the body statutorily responsible for those services.”

    The Enquiry described what happens like this “In the maternity services at Furness General Hospital, this ‘drift’ involved a particularly dangerous combination of declining clinical skills and knowledge, a drive to achieve normal childbirth ‘whatever the cost’ and a reckless approach to detecting and managing mothers and babies at higher risk.”

    The Furness General Hospital was pushing for Foundation Trust status at the time and was not exercising the necessary supervision.

    “Maternity care is almost unique amongst NHS services: the majority of those using it are not ill but going through a sequence of normal physiological changes that usually culminate in two healthy individuals. In consequence, the safety of maternity care depends crucially on maintaining vigilance for early warning of any departure from normality and on taking the right, timely action when it is detected. The corollary is that, if those standards are not met, it may be some time before one or more adverse events occur; given their relative scarcity in maternity care, it is vital that every such occurrence is examined to see why it happened.

    So, many factors come into play in such incidents of harm to mother and baby. Professionals too can be emotionally wrecked by tragedy.

    Huge personal and professional lessons can be learned from a detailed review of cases where mistakes are made. There is a whole literature about learning from mistakes. The worst such incidents are referred to as Never Events. This is just one article about such errors but there is a whole field of research devoted to it. Serious Mistake Reviews often happen at the end of shifts, and in the worst cases, may lead to long public enquiries.

    NHS as a research organisation One of the great virtues of the NHS is the research base it offers professionals. What happens in the NHS which covers 62 million people is studied, evaluated, and researched. This is invaluable to staff and above all to patients. Sadly this research is also of interest to big business especially to those who sell health insurance and to the big corporations who have their ‘snouts’ in the NHS ‘trough’. Research for the common good is clearly different from research to make money. We see that regularly in big pharma. Cheap effective medicines do not make money for the companies. Yet the government is giving away our medical data to companies to make a profit.

    There are also “errors” that happen when everyone is following accepted procedures and protocols; “untoward events, complications, and mishaps that resulted from acceptable diagnostic or therapeutic practice”. Procedures within the NHS can be robust and well researched, and problems still occur.

    https://www.mamaacademy.org.uk/news/mbrrace-saving-lives-improving-mothers-care-2019/

    Research matters. Only by studying outcomes can these errors be revealed. A classic example is the once customary practice of episiotomy, cutting a woman to prevent tears to the perineal skin in childbirth, which is now no longer used except in an emergency. Research both formal and informal changed that practice. As another example of such research, Liverpool Women’s hospital has been involved in research about the benefits of leaving the baby attached by the cord if they are born unwell. NHS staff and other health professionals, academics and pressure groups are working hard to improve outcomes for mothers and babies. Each mothers death is reviewed in the MBRRACE-UK report

    https://mamadoc.co.uk/the-maternal-mortality-report-we-should-all-learn-from/

    Never again. The tragedy of the death of a mother and or baby is felt by that whole extended family. Most families want to know it will never happen again. Cover-ups and lies mean it will happen again, so brutal honesty is needed.

     

    The aftermath of medical treatment or neglect which causes real harm is complex. Whether the outcome is death, life long impairment, or long term physical and mental health issues, these are very significant events for all concerned.

    Campaigners in Liverpool campaign for SEN funding to be returned. 2019

    If a baby is born with life-changing impairments, the baby is left facing catastrophic difficulties and the mother and family can face major heartbreak and hardship. The huge love we have for our kids (may it long continue), whatever their issues, does not prevent the financial, housing and employment issues families with disabled children face. Nor does it guarantee the best educational opportunities, SEN is being battered by cuts. but parents and teachers are fighting back.

     

    The cost of financial “compensation” from an injury to a newborn is huge because it is life long. The cost of this “compensation” used to be carried by the government but the system changed to make hospitals “buy” insurance from a government body which is set up like an insurance company. The cost to the hospital is charged on the basis or earlier claims, like car insurance. Obstetrics make the highest claims of any section of the NHS.

    Liverpool Women’s Hospital had a huge case (not about babies) some years ago, arising from a surgeon who left many women damaged after incontinence operations. Their total bill, over 5 years, according to the Echo, was £58.8 million. “The NHS trust has been forced to pay out £58.8m in the last five years for both recent and historic negligence cases.

    The limited work we do, as a campaign, in holding the hospital to account, leads us to believe lessons have been learned by the hospital. However, in every hospital, there are pressures which could lead to problems. These pressures include financial and organisational, problems of management ethos, and the potential for bullying, the distrust by the staff of their management, and disrespect for whistleblowers.

    The NHS has gone through years of reorganisation after reorganisation. In that time the financial and government pressure has been to complete the re-organisation, or face catastrophic consequences so very many hours of admin and senior doctor time has been wasted on this process. That time could have been focussing on saving babies.

    At STP and national level, there are other problems. The NHS is intensely political. There are deep structural problems. (We believe the NHS should return to the Bevan Model of health care)

    The NHS is not only deprived of adequate funding, but it has also been forced to implement many market-based changes, including the internal market, outsourcing and commissions of services to for-profit companies. These market-based structures are expensive.

    The NHS has also seen dire staff shortages resulting from stupid decisions like removing bursaries, not training enough doctors and the hostile environment to migrant staff.

    There are moral and financial issues in all cases of such errors. The hurt to the babies is our priority.

    Baby deaths and severe injury at birth have complex roots. Though what happens in the hospital is crucial, it is not just what happens in the hospitals that matter. The stress, poverty and anxiety many mothers endure during pregnancy do sometimes affect the outcomes for the child. Many women are still sacked for being pregnant but families can rarely cope with just one wage (do fight back against sacking pregnant women!). See Maternity Action for details. Both mums and midwives can call Maternity Action for advice.

    Low pay or the dreaded universal credit can make food heating and rent all too expensive. This can lead to food poverty. Women do not yet have real equal pay but mothers have the worst pay of all  Benefits are no longer allowed for a third child. even though most claimants are working. Whether parents are working or not, every child has a right to food and shelter, be they first or 10th child. The child gets no choice!

    Not every pregnant woman is in a stable caring relationship. Housing, especially private renting, becomes more difficult when women are pregnant. Who can forget the story of the homeless woman giving birth to twins in the street? Pregnancy is often the time when domestic violence is inflicted on a woman but it is the time when women are least able to walk away. Poverty kills babies too.

    Please join us in campaigning for better outcomes for all mothers and babies in the NHS and across the globe. We want this to start a discussion, so please send us your views. and information

     

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