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    This is our twentieth weekly blog the series where we have commented on the course of the pandemic and the political context and implications from its impact on our country. The SHA has submitted our series of blogs to the All Party Parliamentary Group (APPG), Chaired by Layla Moran (LD, Oxford West and Abingdon), who are taking evidence to learn lessons from our handling of COVID-19 in time for the high risk winter ‘flu season’. The Labour MP Clive Lewis is on the group

    This is an edited version of the seven main points we have submitted:

    1. Austerity (2010-2020)

    This pandemic arrived when the public sector – NHS, Social Care, Local Government and the Public Health system had been weakened by disinvestment over 10 years. This was manifest by cuts to the Public Health England budgets, to the Local Authority public health grants and lack of capital and revenue into the NHS. In workforce terms there was staff shortages in Health and Social Care staffing exceeding 100,000.

    1. Emergency Planning but no investment in stocks (Cygnus 2016)

    The publication of the 2016 Operation Cygnus exercise has exposed the lack of follow on investment by the Conservative government which led to problems of PPE supplies, essential equipment such as ventilators and in ITU capacity. The 2016 exercise was a large-scale event with over 900 participants and occurred during Jeremy Hunt’s tenure as Secretary of State. There needed to be better preparation too on issues such as border controls as we note 190,000 people from China travelled through Heathrow between January-March 2020. Pandemics have been at the top of the UK risk register for years and the question is why were preparations not undertaken and stockpiles shown to be insufficient and sometimes time expired.

    1. Poor political leadership (PM and SoS Health)

    During the pandemic there has been a lack of clarity on what the overall strategy is and inconsistency in decision-making. The New Zealand government for example went for elimination, locked down early, controlled their borders and took the public with them successfully. We have had an over centralised approach from the Prime Minister and SoS for Health such as the NHS Test and Trace scheme and creating the Joint Biosecurity Unit. Contact tracing and engaging the Local Directors of Public Health was stopped on the 12th March and only in the past few weeks have their vital role been acknowledged. Ministers have been overpromising such as the digital apps, the antibody tests, the vaccine trials and novel drug treatments. Each time the phrases such as World Beating and Game Changers have been used prematurely. The Ministerial promises on numbers of tests has been shown to have become a target without an accompanying strategy and the statistics open to question from the UKSA.

    1. Social care

    From the early scientific reports from Wuhan it was clear that COVID-19 was particularly dangerous to older people who have a high mortality rate. A public health perspective would raise this risk factor and plan to protect institutions where older people live. Because of the distressing TV footage from Lombardy (Italy) the government’s main aim was to Protect the NHS. This was laudable and indeed the NHS stood up and had no call on the Nightingale Hospitals, which had a huge investment. The negative side of this mantra was that social care was ignored. As we have seen 40% of care homes have had outbreaks and about a third of COVID related mortality is from this sector. There have been serious ethical questions about policies in Care Homes as well as discharge procedures from the NHS that need teasing out. The private social care sector with 5,500 providers and 11,300 homes is in bad need of reform. Some of the financial transactions of the bigger groups such as HC One need investigation, especially the use of off shore investors who charge high interest on their loans. The SHA believes that the time is right to ‘rescue social care’ taking steps such as employing staff and moving towards a National Care Service.

    1. Inequalities

    It was said at the beginning of the pandemic in the UK that the virus did not respect social class as it affected Prince and Pauper. Prince Charles certainly got infected as did the Prime Minister. However we have seen that COVID-19 has exploited the inequalities in our society by differentially killing people who live in our more deprived communities as shown by ONS data. In addition to deprivation we have seen the additional risk in people of BAME background. The combination of deprivation and BAME populations put local authorities such as Newham, Hackney and Brent in London as having been affected badly. The ONS have also shown that BAME has an additional risk to the extent of being double for people of BAME heritage even taking statistical account for deprivation scores. Occupational risk has also been highlighted in the context of BAME status with the NHS having 40% of doctors of BAME heritage who accounted for 90% of NHS medical deaths. The equivalent proportions are 20% NHS nurses and BAME accounting for 75% deaths. The government tried to bury the Fenton Disparities report and we believe that this is further evidence of institutional racism.

    1. Privatisation

    The SHA is strongly committed to a publicly funded and provided NHS and are concerned about the Privatisation that we have witnessed over the last 10 years. We are concerned about the risks in the arrangement with Private Hospitals, the development of the Lighthouse Laboratories running parallel to NHS ones and the use of digital providers. In addition we feel that there needs to be a review of how contracts were given to private providers in the areas of Testing & Tracing, PPE supplies, Vaccine development and the digital applications. There are concerns about fraud and we note that some companies in the recent past have been convicted of fraud, following investigations by the Serious Fraud Office yet still received large contracts during the pandemic.

    1. Recovery Planning

    During the pandemic many of us have noticed the benefit of reduced traffic in terms of noise and air pollution. Different work patterns such as working from home has also had some benefits. The risk of overcrowded and poor housing has been manifest as well as how migrant workers are treated and housed. Green spaces and more active travel has been welcomed and the need for universal access to fast broadband as well as the digital divide between social class families. With the government having run up a £300bn deficit and who continue to mismanage the pandemic we worry about future jobs and economic prosperity. There is an opportunity to build a different society and having a green deal as part of that. The outcome of the APPG review should on the one hand be critical of the political leadership we have endured but also point to a new way forward that has elements of building a fairer society, creating a National Care Service, funding the NHS and Public Health system in the context of the global climate emergency and the opportunities for a green deal.

    Lets hope that the APPG can do a rapid review so we can learn lessons and not have to wait for years. The Grenfell Tower Inquiry remember was launched by Theresa May in June 2017, and we still await its key findings and justice for those whose lives were destroyed by the fire. The Prime Minister has been pointing the fingers of blame on others for our poor performance with COVID-19 but has accepted that mistakes were made and that an inquiry will be held in the future.

    However often these are mechanisms to kick an issue into the long grass (Bloody Sunday Inquiry) and even when completed can be delayed or not published in full such as the inquiry into Russian interference in our democratic processes. So let’s support the APPG inquiry and the Independent SAGE group who provide balance to the discredited way that scientific advice has been presented. As one commentator has pointed out there are similarities to the John Gummer moment when in 1990 he fed his 4yr old daughter a burger on camera during the BSE crisis. The public inquiry into the BSE scandal called for greater transparency in the production and use of scientific advice. During this crisis we have seen confusion whether on herd immunity, timing of lockdown, test and trace, border and travel controls and the use of facemasks.

    NHS and NIHR

    For the SHA we have been pleased with how the NHS has stood up to the challenge and not fallen over despite the huge strain that has been put under. Despite the expenditure on the Nightingale Hospitals and generous contracts with Private Hospitals these have not made a significant difference. These arrangements certainly helped to provide security in case the NHS intensive care facilities became overwhelmed and allowed some elective diagnostics and cancer care to be undertaken in cold hospital sites. However the lesson from this is the superiority of a national health system with mutual aid and a coherent public service approach to the challenge compared to those countries with privatised health care. The social care sector on the other hand, despite some examples of excellence, is a fragmented and broken system. The pandemic has shown the urgent need to ensure staff have adequate training, are paid against nationally agreed terms and conditions and we create an adequately resourced National Care Service as outlined in our policy of ‘Rescuing Social Care.

    Another area where a national approach has paid off is the leadership provided by the National Institute of Health Research (NIHR) which helps to integrate National R&D funding priorities and work alongside the Research Councils (MRC/ESRC) and Charitable Research funding such as from the Wellcome Trust and heart/cancer research funders. These strategic research networks use university researchers and NHS services to enable clinical trials to be undertaken and engage with patients and the public. It is through this mechanism that the UK has been able to contribute disproportionately to our knowledge about treatment for COVID-19 and in developing and testing novel vaccines.

    For example the Recovery trial programme has used these mechanisms to enlist patients across the UK in clinical trials. The dexamethasone (steroid) trial showed a reduction in deaths by a third in severely ill patients and is now used worldwide. On the other hand Donald Trump and Brazil’s Jair Bolsanaro’s hydroxychloroquine has been shown to be ineffective and this evidence will have saved unnecessary treatment and expense across the world.  Such randomised controlled trials are difficult to undertake at scale in fragmented and privatised health systems. The vaccine development and trials have also been built on pre-existing research groups linked to our Universities and Medical Schools. Finally while Hancock’s phone app hit the dust in the Isle of Wight, Professor Tim Spector’s COVID-19 symptom app has managed to enlist 4m users across the country providing useful data about symptoms and incidence of positive tests in real time. This is all from his Kings College London research base reaching out to collaborators in Europe. Ireland has launched the Apple and Google app created with the Irish software company NearForm successfully and it is thought that Northern Ireland is on the way to a similar launch within weeks too!

    A wealth tax?

    In earlier blogs we have drawn attention to the huge debt that the government have run up and we are already seeing the emerging economic damage to the economy and people’s livelihoods when the furloughing scheme is withdrawn in October. Already people are talking about up to 4m unemployed this winter and what this will mean in terms of the economy and funding public services like local government, education and health. The UK’s public finances are on an ‘unsustainable path’ says the Office for Budget Responsibility.

    There is a lot of chatter about the value of a wealth tax and there are some variations to the theme. It is estimated that there is £5.1 trillion of wealth linked to home equity. It is also said that the unearned gains on property are a better target for new taxes than workers earned income. Following this through a think tank has proposed – a property tax paid when a property is sold or an estate if the owner has died. A calculation could be made by taxing at 10% on the difference between the price paid for the property and the price at which it was sold. The % tax could be progressive and increase when the sum exceeds £1m for example. Assuming property rise in value by only 1% per annum this tax would raise £421bn over 25 years. If this sounds like an inheritance tax – that is true but for years now such taxes have become a voluntary tax for those with access to offshore funds and savvy accountants. In the USA, inheritances account for about 40% of household wealth. Fewer than 2 in 1000 estates paid the Federal estate tax even before Trump cut it in 2018. Trusts and other tax havens abound. Apparently Trump’s own Treasury Secretary has placed assets worth $32.9m into his ‘Dynasty Trust 1’

    Inherited wealth has been referred to in earlier blogs in relation to the Duke of Westminster family wealth. Another study which shows how this type of wealth transfer passes down the generations comes from Italy where in 2011 a study of high earners found many of the same families appeared as in the Florence of 1427!

    Populism and COVID

    In our blogs we have pointed to the fact that those countries, in different continents, which have had a bad pandemic experience are ones such as the UK, USA, Brazil, India and Russia. What unites them is a leadership of right wing populists. A recent study has started to analyse why this occurs and what the shared characteristics are:

    1. The leaders blame others – the Chinese virus/immigrants
    2. Deny scientific evidence – use ineffective drugs/resist face masks
    3. Denigrate organisations that promote evidence – CDC/PHE/WHO
    4. Claim to stand for the common people against an out of touch elite.

    What the authors found was that these leaders were successfully undermining an effective response to the pandemic. Sadly there is a risk that populist leaders perversely benefit from suffering and ill health.

    Taking lessons from history and the contemporary global situation we need to continue to speak out against these political forces and advocate for a better fairer recovery.

    27.7.2020

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

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    In this week’s blog we will look again at the emerging Blame Game which is attempting to divert attention away from the PM and Health Secretary, raise again the unbelievable issue of the national Test and Trace scheme not sharing information on test results with local Directors of Public Health, salute the letter to the National Audit Office about PPE procurement and applaud the Vaccine Research group at Imperial College for creating a Social Enterprise company committed to sharing the vaccine globally.

    Blame Game

    The Prime Minister’s innate self-interest is exercising his mind at present and with the support of his political adviser Dominic Cummings is casting around to identify who he can blame for the very poor outcome of the pandemic in the UK, particularly in England. Commentators have pointed out that if a man/woman from Mars dropped in they would struggle to work out whether Cummings or Johnson was the Prime Minister (PM). Dom will do whatever it takes to insulate the PM from criticism says a senior civil servant.

    Local Authorities and their Public Health teams

    Once the PM and Secretary of State, Hancock realised that the COVID-19 first wave ‘sombrero’ had not been flattened, we have not eliminated the virus and the population are likely to continue to suffer from local upsurges of COVID-19 cases. They want to shift the blame onto others. The Local Authority based public health teams had been left out of the loop from the start of the pandemic and their role has been as a local megaphone for central guidance or to help out regional Public Health England with local outbreaks.

    The Department of Health started to get involved in Local Outbreaks and twiddled their thumbs when they noticed increasing positive test results in Leicester. Rather than share the data and engage local leaders they wondered what actions they could take from their Whitehall village and became alarmed and made an emergency announcement in the evening to Parliament declaring a local lockdown. At the same time they passed the buck to the surprise of the local Director of Public Health (DPH) and Local Authority leaders.

    With more test result data ‘passed down’ to the local team things have started to settle and local tracing and community engagement has blossomed. The local DPH and Mayor of Leicester have stood up and accepted the challenge and are dealing with it with the support of Public Health England and local communities.

    Local data

    The whole pandemic response has been top down and now that has been shown to be ineffective and expensive they are shifting the responsibility onto local teams, who welcome the recognition that they should always have been the place for an effective population response. However there remain issues to do with sharing fully and quickly all the necessary information for local teams to plan their prevention campaigns specific to the at risk populations. The national test and trace scheme has been shown to be very expensive and has poor outcomes in terms of speed of test results and their contact tracing efforts. Despite that there seems to be reluctance still in proper sharing of test result details on the basis of information security, which the government in England have failed to comply with.

    Public Health specialists have worked with person identifiable data for decades and the system is compliant with data security. Just get on with it and don’t put the spotlight onto Leicester, Kirklees, Blackburn and Pendle without sharing the data that is available from the testing sites.

    It is estimated that in June a quarter of the 31,000 people who had their case transferred to the Test and Trace scheme were not reached. Almost a third of those who were did not provide any contacts. Compare this to the success rate of local so called Pillar 1 NHS hospital testing system where nearly 100% contacts are traced.  It is time that the Test and Trace budget be devolved and that local DsPH manage the testing arrangements they require and ensure that the most useful information is obtained when samples are taken and ensure that the local public health department gets the results as well as the GPs who need to be drawn into the campaign. In Wales and other devolved nations much better systems are in place.

    Remember the hype about the Isle of Wight phone app? Lord Bethell, the Health Minister responsible for the Google and Apple technology, is now quoted as saying: “We are seeking to get something going for the winter, but it isn’t a priority for us at the moment”.

    If this wasn’t enough the government have had to recall thousands of Randox test kits as a health and safety risk. These were contracted by the Baroness Harding Deloitte’s Test and Trace outfit and used in Care Homes and for home testing. Another embarrassment to add to all the rest!

    Why didn’t they invest in local NHS laboratories linked to local GPs and Public Health teams, who would have got the results back quickly with the information required for effective locally based contact tracing? Centralisation and Privatisation have not worked and have cost the taxpayer billions.

    Workers and Employers

    The Chancellor has been enjoying himself when announcing hand-outs of government resources (in Tory language tax-payers money). Public sector borrowing stands at its highest peacetime level in 300 years. Four million people could be unemployed by next year which according to the Office of Budget Responsibility will be the worst jobs crisis in a generation. The furlough scheme, which is helping pay wages for 9.4m people will end in October. The annual deficit is set to rise to £350bn and economic contraction of 25% in the last 2 months. So it is not surprising that the PM wants to get the economy going again. However his call to open up the offices again and get people spending money in town centre shops by 1st August carries with it huge risk to public health and a burden on employers to make the workplace COVID secure.

    John Phillips of the GMB union has stated: “The PM has once again shown a failure of leadership in the face of this pandemic. Passing the responsibility of keeping people safe to employers and local authorities is confusing and dangerous.” Frances O’Grady of the TUC said that: “The return to work needs to be handled in a phased and safe way. The government is passing the buck on this big decision to employers. Getting back to work safely requires a functioning test and trace system and the government is refusing to support workers who have to self isolate by raising statutory sick pay from £95 per week to a rate people can live on.”

    Civil servants

    The third group of people who have a finger pointing at them are civil servants. The sacking of Mark Sedwill, head of the civil service, is one top of the tree example. His generous departure settlement is the same amount as he would have been entitled to if he had been made compulsorily redundant. In his letter to Mr Sedwill the PM stated that Sedwill was ‘instrumental in drawing up the country’s plan to deal with coronavirus’.

    The PM has reluctantly agreed to have an inquiry into the handling of the pandemic but has lobbed the date into the long grass. He said that: “There are plenty of things that people will say that we got wrong and we owe that discussion and that honesty to the tens of thousands who have died before their time”. We all know that when the blame is distributed it will be civil servants, scientists, public health officials, and some Ministers who will be scapegoated for the outcome that has seen more than 45,000 deaths and left the British economy facing the biggest recession of any European nation. In addition the recent Academy of Medical Sciences report estimates that the risk of a second wave mid winter is of the order of 120,000 excess deaths.

    National Audit Office

    In earlier Blogs we have drawn attention to the potentially fraudulent way that millions of pound contracts have been awarded, sometimes to shell companies or companies that have no history of having undertaken such roles such as PPE suppliers. We are delighted that Rachel Reeves MP and Justin Madders MP of the Labour Shadow team have written to the National Audit Office (NAO) requesting investigation into waste and fraud with especial focus on the PPE procurement, which amounts to £1.5bn. The letter draws attention to many concerns such as awarding the contract to Deloitte without competition. In emergencies governments are entitled to use something called a ‘single bidder emergency procurement process’ to avoid delays that arise with competitive tendering.

    It won’t surprise SHA members to learn that this, EU based measure, has been used by the UK government more than 60 times during the pandemic compared to twice in Spain, 11 times by Italy and 17 times by Germany. The sloppy allocation of contracts to best buddies in the commercial world and Tory Party supporters must be called out and lets hope that the NAO accepts the request and does a speedy audit on some of these contracts.

    Vaccines and global health

    We have already, in previous blogs, pointed out how Trump’s ‘Make America Great Again’ and ‘America First’ is illustrated in examples such as Remdesivir. This antiviral drug, which shortens hospital stays in patients with COVID, was basically bought up by the USA. It was reported at the end of June that the US had bought up virtually all stocks for the next three months leaving none for the UK, Europe or most of the rest of the world. The Trump administration has shown that it is prepared to outbid and outmanoeuvre all other countries to secure the medical supplies it needs. This has implications for the vaccines being actively developed across the world.

    Geopolitics is already at work with reports of Russian cyber crime attacks on the UK based vaccine researchers in Oxford. It was therefore great news to hear that the Imperial College based researchers with Philanthropic and UK government funding have formed a social enterprise. This not for profit arrangement aims to ensure fair distribution by waiving royalties for low income countries so that the poorest get it for free and the richest pay a bit more. Human trials of their vaccine start in October and Imperial are looking for volunteers.

    This group are a reminder that it doesn’t need to be profiteering and greed and stands alongside others who have come through the pandemic with gold stars such as Tim Spector’s C-19 symptoms app group in Kings College London who are using an app that actually works!

    Gramsci

    Finally Michael Gove caused a stir when he recently quoted from Antonio Gramsci, the Italian Marxist intellectual:

    The crisis consists precisely in the fact that the old is dying and the new cannot be born; in this interregnum a great variety of morbid symptoms appear”.

    This quote is from Prison Notebooks, written by Gramsci during his imprisonment in the time of Mussolini. You could look at this quotation in a completely different perspective to those like Michael Gove and Mr Cummings.

    20.7.2020

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

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    On Saturday July 4th, the day before the 72nd anniversary of the founding of the NHS – we demonstrated, jointly with Manchester Trade Union Council, with Unison, Unite and any other unions involved, with Keep Our NHS Public and with Health Campaigns Together (with PPE and social distancing) against the privatisation of the Department of Reproductive Medicine at St Mary’s Hospital Manchester.

    NEXT EVENT

    VIRTUAL PUBLIC MEETING: No privatisation of Manchester’s fertility service!
    Monday, 20 July 2020 from 19:00-20:30

    Details at the end of this article

    Women in the Labour Movement have been campaigning for at least 100 years on issues of maternal health and the right to choose whether and when to have children, and to use any technological advances that might make those choices easier, or even possible. From 1924 onwards the Women’s Labour League annually and unanimously supported birth control. The men in the Labour and Trade Union Movement were not always so unanimous, or so interested in the subject.

    In 1924 the first Labour Government was elected, and the League bombarded John Wheatley – the first Labour Minister of Health – with demands for improved health care in childbirth and after, and for the provision of free, state birth control clinics. They organised meetings and major demonstrations. They kept reminding him that giving birth had four times the death rate of working in the mines, the most dangerous job for men, and twenty times the likelihood of permanent disability.

    However, it was not until 1974 – another 50 years later – that women achieved the right to free contraception on the NHS, irrespective of age or marital status, by which time I had joined the Labour Party and it was one of the issues I was campaigning for myself, first through the Young Socialists and then the Labour Women’s organisation . Nowadays, men can also get free vasectomies  and, whether for contraception or protection against HIV, free condoms on the NHS, also irrespective of age. None of these successes, in areas where some people like to make moral rather than medical judgements, was easy or straightforward.

    For example, even after the beginning of the decriminalisation of homosexuality for men in 1967, homophobia was still rampant for many years. Thus, more than 20 years later in 1988, Thatcher was able to introduce Clause 28. Roy Trevelion (London SHA member) in Age UK’s Opening Doors London, likens the mental health of many HIV positive men – as a consequence of the AIDS epidemic and ongoing homophobia – to Post Traumatic Stress Disorder. Most gay men who obtained free condoms would have been more likely to get them from organisations like the Lesbian and Gay Foundation in Manchester (and similar ones elsewhere), which is registered as a charity and raised money to provide them on that basis. Many gay men would have been more able and less anxious to get their condoms from peer-support charities like this than to risk accidentally outing themselves at the doctor’s or clinic.

    The post World War II economic boom brought rising employment of women and improved living standards, and with increased confidence, women demanded recognition for their contribution to society and the right to control their own lives. These led to the Abortion Act 1967 as well as to Equal Pay (1970) and Sex Discrimination (1975) legislation, and the right to paid maternity leave (1975). The Abortion Act did not give women the right to choose, but made it legal for abortions to be carried out with the approval of two doctors under certain circumstances. In effect it decriminalised what women had been doing for centuries, just as the 1967 Sexual Offences Act (partially) decriminalised homosexual acts between men.

    Making abortion illegal in 1861 had not stopped it, and the 1967 Act did not encourage it: it just made the difference between a woman dying as a consequence, or surviving. (In Romania, abortion was illegal until 1989: but abortions still outnumbered live births – in 1987 by four to one.) I remember providing accommodation to Spanish women coming to the UK for abortions before 1985, when it became legal in Spain, and from the Republic of Ireland before the end of 2018 when it was legalised there.

    However, the 1967 Abortion Act, like the 1967 Sexual Offences Act, was not the end of the matter. There were several attempts to repeal or considerably amend the Abortion Act, such as the White Bill, the Corrie Bill and the Alton Bill, which gave rise in turn to their own protest movements. A very large demonstration against the Corrie Bill was called by the TUC (on the initiative of the Women’s TUC) in 1980, the first time in the world that a major trade union federation had called a demonstration on abortion rights; and another against the Alton Bill in 1988, again with the support of the trade union movement. None of these Private Member’s Bills was successful, but in the end the period during which abortion could be legally carried out was reduced to 24 weeks in 1990, by the Human Fertilisation and Embryology Act.

    The Human Fertilisation and Embryology Act, based on the recommendations of the Committee of the same name, chaired by Mary Warnock, was passed in 1990. When it was originally passed it allowed access to infertility treatment, such as Artificial Insemination or In Vitro Fertilisation, at a cost (in money and patience, especially with IVF) but it also required the women who wanted medical assistance to become mothers, to conform to a very traditional view of motherhood and the family, as reflected in the attitudes of doctors, hospital ethical committees and the Warnock Committee at that time, and laid down in Codes of Practice. These were not medical decisions but social and moral ones.

    For example, to be “suitable” for treatment, a woman had to be living in a stable relationship with a man, and usually had to be able-bodied. Some clinics were reluctant to treat couples where the man was not in work, or the woman not prepared to give up work. Single women and lesbian couples were not usually eligible.  Tory MP David Wilshire made it clear in his speech that he was particularly concerned that “assisted conception” would not produce families dependent on the state, and another amendment was passed to include “the need of a child for a father”.

    Why is Reproductive Technology a Political Issue?

    Thirty years ago I wrote those words in a book called “Whose Choice?”, published at the time of the Human Fertilisation and Embryology Bill which became law in 1990. The question was why the Labour Movement should take up issues such as contraception, abortion and treatment of infertility, which were often seen as purely personal matters.

    My answer, on behalf of the (then) Manchester and Liverpool Labour Women’s Councils, was that it was our belief that decisions about whether or not to have children, how many to have, whether or not to have an abortion or use any of the technologies available to overcome or by-pass infertility, or to avoid having a child with disabilities, or to enable those of us who were lesbians to become parents, were all personal decisions to be taken by the individuals concerned, and not by the Church, the State or the Medical Profession.

    And since it is women who give birth to children and even now usually bear the main responsibility for child rearing, these decisions must primarily be theirs. As socialists we argue for women to have the maximum choice possible in the decisions that shape their lives.

    The campaign then – and still is now – was not just for legal rights, but for the practical means to realise them. In order for a working class woman to have the choices already available to richer women, she must have the economic means (a living wage or income), and necessary social arrangements, such as childcare and decent housing, so that she can choose to have a child. It means expanding the NHS, taking back control of the services that have been contracted out to the private sector, resisting any further attempts to privatise parts of the NHS, and running the NHS democratically so that women can have access to free and safe abortion, contraception, artificial insemination and IVF treatment.

    It means carrying out the research to find contraceptives that meet the needs identified by both women and men; research to enable women to have earlier abortions and make them safer; research into causes of infertility and its prevention; research into chromosomal and genetic disorders and their prevention; and research into products and services that would improve the lives of disabled people.

    All these things are entirely reasonable and technically possible; but they raise, in turn, important – essentially political – questions. Who does the research and in whose interests? The rubber goods manufacturers (for decades before the 1960s, clandestine or even illegal): the vulcanisation of rubber revolutionised birth control as well as road transport; but  nowadays research is dominated by the pharmaceutical industry. And of course the research is done to make a profit.

    The drug industry is one of the most research-intensive sectors: but it spends more on marketing and advertising than on research. That was the case when the last official UK Government report on the industry was published (The Sainsbury Report, HMSO, 1967) and it was even more the case, according to the most recent figures (OECD Main Science and Technology Indicators, annual, covering all OECD member countries in the year of publication.)

    Pressure to be first to market can lead to corner-cutting in testing: the most notorious case where this happened was Thalidomide, a tranquilliser that had been declared safe, and was explicitly prescribed, for pregnant women. But it caused major deformities in their babies who were, most notably, born either without some or all of their limbs or with major deformities in them.

    Although it was known by then that some drugs could cause foetal damage, it was not yet specifically a legal requirement to test for them, and the tests were not done. (Only the USA’s Food and Drug Adminstration refused to grant a licence for thalidomide to be prescribed, because the FDA official responsible insisted on having evidence on the foetal effects of the drug, which were not available.) Criticism of government “interference” in the affairs of business is very common in the United States (often framed as interference in the public’s right to choose – except women’s right to choose abortion). Today the FDA is still the butt of criticism of lack of freedom from government interference.

    The Warnock Report, on which the Human Fertilisation and Embryology Bill was based, commented on the lack of research into causes of infertility. This is still the case to some extent, though knowledge in this area has been increasing since the discussions around the Warnock Report and the debates on the Human Fertilisation and Embryology Bill.

    But we can be sure that thorough studies, once publicised and popularised, will lead to increased demands for improved health and safety at work; and for the replacement of industrial processes, chemicals and other materials causing infertility; and that responding to these demands would threaten profits. A thorough study would also raise questions about the under-funding of the NHS and the number of diseases that are not adequately diagnosed, or possibly not adequately treated, and which lead to infertility.

    The issue of women’s rights in reproduction is therefore a political and class question: not just because it is mainly working class women and men who are affected by lack of choice and unsafe working conditions, but also because the ability of all women to have a real choice will only be possible as a result of the struggle of working class women and men to change society. This means campaigning on reproductive rights as well as on better housing, higher wages and defence of the NHS. It especially means we must control the resources of society and organise them for need rather than profit.

    St Mary’s Department of Reproductive Medicine (DRM) – Summary of Background Briefing

    St Saint Mary’s Hospital, Manchester, was founded in 1790. Today it provides a wide range of medical services, mainly for women, babies and children. It is highly regarded for teaching and research, and has an internationally recognised Genomics Centre and Department of Reproductive Medicine (DRM). The DRM employs 70 staff and delivers clinical, laboratory and counselling services for about 3000 patients a year. Most of St Mary’s services and research activity is carried out in a building dating from the late 1960s. In 2009 paediatric services were transferred to the newly built Royal Manchester Children’s Hospital on the same site.

    The issue at the centre of the protest is that the DRM is housed in the Old St Mary’s Building (also on the same site) which dates from just after the death of Queen Victoria, and is in desperate need of repair. Manchester University NHS Foundation Trust (MFT) believes that relocation of DRM within the Trust could cost up to £10 million just in capital expenditure, and is talking about privatisation.

    DRM offers a fertility assessment and infertility service. Artificial Insemination and IVF are offered to women who may benefit, on referral by a GP. This can be both NHS funded and private – the latter for women for whom it is clinically appropriate but whose CCG would not fund the necessary cycles of treatment. It offers a fertility preservation service for patients who wish to preserve eggs or sperm while having medical treatment – eg for cancer – that might affect future fertility. DRM offers sperm-testing and specialist treatment for patients whose sperm has been identified as presenting fertility issues; and on the other hand post-vasectomy checks.

    An anonymous or by-arrangement sperm-donation service is also offered to lesbians, and to heterosexual women either without a partner or who cannot conceive with their partner’s sperm for any reason. The Department also offers a reproductive endocrinology service which focuses on the way in which hormones affect fertility; and specialist counselling to any of the patients using their services. DRM runs the national proficiency scheme involving distribution to other reproductive medicine labs across the country and checks that the results are consistent. Finally, the Department makes a significant contribution to fertility research in conjunction with the University of Manchester.

    In early March the Trust briefed all service staff that they would undertake a 12 month options appraisal exercise to identify whether the service should remain within the Trust or be re-commissioned elsewhere. (Since the pandemic this has been put back.) The unions argue:

    • that there would be significant capital costs involved in privatising the service, which would have to be borne by the hospital (eg to store embryos – the store would need to remain on the site and continue to be run, inspected and managed by MFT, because the cost of doing otherwise would be prohibitive).
    • that the service is unique in Greater Manchester, and to a large extent in the entire North West Region.
    • It has significant associated capital and operational costs so other NHS trusts are likely to be reluctant to bid to host the service.
    • The private sector may offer an option that appears to be cheaper, but offers a far lower level of service than that currently provided at St Mary’s – but the NHS might be obliged to accept the private bid, because it is lower.

    The unions are also concerned about the impact of any potential future privatisation of the service for many reasons, including:

    • St Mary’s offers specialist care to a number of people with Protected Characteristics under the Equality Act 2010, which might not be available under private sector provision.
    • The services offered by St Mary’s are highly specialised – Trafford CCG ring-fenced them on behalf of all the CCGs in Greater Manchester, not requiring them to participate in an IVF procurement exercise in 2019 for this reason.
    • The andrology service works with eg men with Cystic Fibrosis who are often infertile and need surgery if they wish to have a chance of creating a family, and another specialist service involving the only UK-based partnership with the long established FAIRFAX cryo-spermbank.
    • The National External Quality Assessment Scheme for reproductive medicine is currently based in the DRM laboratories. If DRM was closed or moved, this would need a new home, too.
    • The kind of research investment and relationship with academic institutions that St Mary’s has would not be replicated in private sector provision where profits have to be made.
    • Despite assurances from MFT, the unions believe that the terms and conditions of the staff in the private sector, if they had to move and could do so, would not be as good as those in the NHS under the Agenda for Change national pay system.
    • In other areas where NHS services have been privatised, there has often been an erosion of terms and conditions, and of collective bargaining, either through attrition over time or an aggressive stance by employers. Unions believe that this is a significant risk.
    • The cost to fee-paying patients is less than the alternative provision in the private sector, and for NHS patients, the NHS pays via CCGs around £4000 per IVF cycle at St Mary’s, but significantly more (£5-6,000) to private providers per cycle.
    • The DRM is part of St Mary’s and both are located on the MFT Oxford Road Campus next to the University of Manchester. Patients with co-morbidities and other conditions which may have an impact on their fertility and associated treatments, can benefit from the expertise and clinical care available within MFT close to their fertility treatment. At the same time, staff can benefit from the close proximity of other specialisms which may be relevant to a patient’s ongoing care.

    The Next Stage in the Campaign to Save St Mary’s

    There will be a public meeting (via internet) hosted by Keep Our NHS Public as below. Please join us via Greater Manchester Keep Our NHS Public (GM KONP)’s Facebook page.

    PUBLIC MEETING: No privatisation of Manchester’s fertility service!
    Monday, 20 July 2020 from 19:00-20:30

    https://www.facebook.com/events/280845443022548/

    The fertility service provided by the Department of Reproductive Medicine at St Mary’s hospital, Manchester, faces privatisation. According to reports, Manchester Foundation Trust announced earlier this year that the service would go over to a private company in 2021. This would be a disaster for the service and future patients.

    Now the Trust has begun an “options appraisal” over the future of the service. We insist that the #1 option must be keeping it public and keeping it where it is. We demand a public consultation so the people of Manchester have their say.

    Join our online public meeting to hear about the situation and how we can campaign to win. There will be discussion after the speakers, who are:

    Denise Andrews, Unison union rep, DRM
    Liz Holland, Unite the Union branch secretary, MFT
    James Bull, Unison union regional officer

    Pia Feig, a feminist perspective
    Chaired by Caroline Bedale, Greater Manchester Keep Our NHS Public and Greater Manchester Socialist Health Association.

    This will be a Facebook Live event broadcast through the event page.

    Mailing address for

    Keep Our NHS Public Greater Manchester

    c/o KONP national, Unit 12-13 Springfield House 5 Tyssen Street

    LondonE8 2LY

    United Kingdom

    Vivien Walsh (Greater Manchester SHA)

    Comments Off on Privatisation Protest at St Mary’s Hospital, Manchester

    This is now our 13th weekly Socialist Health Association Blog about the COVID-19 pandemic. Many of our observations and predictions have sadly come true. The leadership group of the UK Tory government remains extremely weak, without a clear strategy or plan of action. Policy announcements at the Downing Street briefings are aimed at achieving media headlines. The Prime Minister has declared that he is taking charge but on questioning in Parliament was unclear who had been in charge up to this point!

    In this Blog we look at the poor political and scientific leadership and lack of a credible strategy; the faltering start of Test Trace and Isolate (TTI); the demands for an urgent independent inquiry of the pandemic and financial audit of government investments in the private sector; and solidarity with Black Lives Matter.

    Lonely Ministers

    The last Downing Street briefing on Friday the 5th June found Matt Hancock (the Secretary of State in charge of the nation’s health) on his own, reading out the slides and reporting on the continuing high number of new cases and relentless roll call of COVID-19 related deaths. The PMs ‘sombrero’ epidemic curve’ has been suppressed but not flattened as it has in other countries in Europe. Deaths remain stubbornly high here as care home outbreaks continue to spread with 50% now affected and there is belated recognition that hospitals and care homes are places of work where transmission occurs. Transmission occurs between staff, patients/residents, within households and the local community.

    The UK Statistics Authority (UKSA) has challenged the way that statistics are presented at these briefings, and are arguably MISLEADING the public. Remember the international evidence presented on deaths, which was fine when we were on the nursery slopes of the epidemic but became embarrassing when we overtook Italy, France and Spain? World beating in terms of total deaths was probably not what the PM had in mind. Last week the total number of deaths in the UK exceeded that of all the EU(27) countries put together. We are now flying alongside Trump (USA), Bolsanaro (Brazil), Modi (India) and will shortly be joined I expect by Putin (Russia) as a group of the world’s worst performers.

    One of the areas of misrepresenting statistics that has exercised the UKSA has been reporting the number of daily tests. We have drawn attention in earlier blogs to how ridiculous it is to snatch a large round number out of the air and declare it as a target. And so it was with the 100,000 tests per day target and more recently the PMs 200,000 target. The challenge of meeting the Government targets meant that officials and private contractors started to count tests sent out in the post to households rather than completed tests. This was rephrased as test capacity. A similar change in data definition happened when we approached the end of May grasping for the 200,000 target. Suddenly antibody tests and the swabbing antigen tests were both included in the total figure. Ministers did not mention that that these tests have different applications and many thousands are used as part of epidemiological surveys rather than diagnostic tests on individuals as part of track and trace.

    What is the strategy?

    There are calls from politicians and in the media for there to be an urgent and time limited independent inquiry into what has gone wrong here. This is not to punish individuals but actually to help us learn lessons urgently and maybe make changes to the way we are conducting ourselves ahead of a possible second wave. One thing that is missing is a clear strategy that government sticks to and criteria that are adhered to in decision making. The Cummings affair has been a disgraceful example of double standards but the acceleration of changes in opening up the economy, increasing lockdown freedoms and reopening schools are examples where the scientific advice and the published 5 stage criteria are being disregarded. Wuhan eased their lockdown when RO was 0.2. (RO or R zero, where R is the reproductive value, the measure used to track how many people, on average, will be infected for every one person who has the disease.)

    Led by the science?

    The other noticeable change has been the change of mood amongst the scientists advising government through the SAGE committees. Many of them now seem willing to speak directly to the mainstream media and engage in social media interactions. The Independent SAGE group that we referred to last week has become the preferred source of scientific advice for many people. It has been interesting to see how many Local Authorities and their Directors of Public Health (DsPH)have not been urging schools to open up if not ready and the local RO is near or at 1.0. The Chief Scientific Adviser (CSA) has lost control and must be reflecting nostalgically back to when he was at GSK earning his £780,000 pa salary (Ref. Private Eye). But he has managed to shovel a shedload of resources to old colleagues and friends in the industry involved in the endeavour to develop a safe and effective vaccine ‘game changer’.

    The CSA was absent from duty last Friday and so too the CMO and his two deputies. One wonders whether this is a short lived change but maybe they too realise that that they are being set up with the SAGE advisers to take the blame for the UK’s dismal record. The CMO needs urgently to catch up with his public profile and face the media on his own and build some trust with the population, now anxious to be able to believe in someone at the centre of government decision making. Finally there is the NHSE Medical Director who could not be there – no doubt to be the one to remain standing when the SoS announced at 5pm on a Friday evening that all staff in the NHS should wear surgical face masks and all visitors to wear face coverings! An impossible  logistical and supply issue for an organisation which employs over a million workers in many different settings of care. And there was no consultation with the leaders of the NHS or Professional bodies such as the RCN and Medical Royal Colleges or Trade Unions like the BMA/Unite. What a shambolic way to run things – you couldn’t make it up!

    Test, Trace and Isolate (TTI)

    Test, Trace and Isolate (TTI) continues to have a difficult ‘rebirth’ from when it was put down in mid March with a comment from a deputy CMO as a public health approach more suited to third world countries. Baroness Dido Harding (past Talk Talk CEO and wife of Tory MP John Penrose) is meant to be leading this.  She had an uncomfortable time at the Health Select Committee when she had to admit that she had no idea how many contacts had been traced by the 25,000 tracers who had been fiddling on their home computers for days after having self administered their on line training. Typically Ministers had announced the launch of TTI to the usual fanfare and she had to admit that the end of June was a more likely date for an operational launch.

    It is extraordinary that the programme is being run by private contractors, who have had no prior relevant experience. We are already witnessing the dysfunction in passing timely, quality assured information to Public Health England and local DsPH. Local public health contact tracing teams need information on names, addresses, ages and test results to get started on mapping the spatial location of cases, exploring their occupations and contact history. Local contact tracers may need to actually visit these people to encourage compliance after the Cummings affair. They should really get this information straight from local laboratories and be resourced to employ local contact tracers familiar with the local area.  Local DsPH would then look for support from the regional PHE team and not be dependent on the PHE or the GCHQ- sounding Joint Biosecurity Centre.

    This is what happened in Germany, where local health offices (Gesundheitsamter) were mobilised and local furloughed staff and students were employed to form local teams. We have positive examples of local government being proactive too such as in Ceredigion in Wales where rates have been kept extremely low. In the post-Cummings era local teams will get drawn into discussions about the civic duty to disclose contacts and of adhering to isolation/quarantining. Difficult for an anonymous call handler to undertake against the background sounds of Vivaldi.

    Auditing misuse of public funds

    One aspect that an independent inquiry will need to look at is the investment of public funds into private companies without due diligence, proper contracting and insider dealing. We have already referred to the vaccine development and governments and philanthropic organisations have provided over $4.4bn to pharmaceutical organisations for R&D for COVID-19 vaccines. No information is available about the access to vaccine supplies and affordability as a precondition of the funding. The deal with the Jenner Institute at Oxford and AstraZeneca has received £84m from the UK government. Apparently AstraZeneca owns the intellectual property rights and can dictate the price (Ref: Just Treatment). We gather that the company has refused to share the trial data with a WHO initiative to pool COVID-19 knowledge! National governments cannot manage alone this longstanding problem with global pharmaceutical companies who are often unwilling to invest in needed but unprofitable disease treatments, even though they often receive public funds and benefit from close links with University Researchers and Health Service patients and their data. There need to be global frameworks to govern such investment decisions.

    BAME communities and COVID

    We have referred in previous Blogs to the higher risks of developing severe illness and death in Black, Asian and Minority Ethnic (BAME) groups. The Prof Fenton report was finally published this week as a Public Health England report. The report is a useful digest of some key data on COVID-19 and BAME populations and confirms the higher relative risks of severe illness and death in these populations. The report steps back from emphasising the extremely high risks of death by accounting for other factors such as age, sex, deprivation and region. Even taking these factors into account they find that people of Bangladeshi ethnicity had twice the risk than people of White ethnicity. Other South Asian groups such as those of Indian, Pakistani or Afro-Caribbean descent had between 10-50% higher risk of death.

    There has been some controversy about whether this report was edited heavily by Ministers, and in particular whether sections that might discuss structural issues of racism had been cut. Certainly by taking ‘account of’ deprivation and place of residence or region it is possible to choose not to see racism as part of health inequality. Many people will remember the early evidence from Intensive Care Units, which showed that while BAME communities make up 14% of the overall population they accounted for 35% of the ITU patients. How can we forget in the early stages of the pandemic, seeing the faces of NHS workers who had died from COVID? You did not have to be a statistician to notice that the majority of the faces seemed to be BAME people. The BMA have pointed out that BAME doctors make up 44% of NHS doctors but have accounted for 90% of deaths of doctors.

    To be fair, the NHS was quick to send a message out across the health system asking that risk assessments be done taking account of individual risks such as ethnicity, co-morbidities such as obesity/diabetes as well as occupational exposure to risk of transmission. Adequate supply of PPE and good practice does work as very few if any ITU staff have succumbed. As ever it is likely to be the nursing assistants, cleaners, porters, or reception staff who get forgotten.

    The recent demonstrations of solidarity with the Black Lives Matter campaign in the light of the dreadful murder of George Floyd under the knees of US policemen is a reminder that there is a global and long standing issue of racism. The government and all organisations including the NHS need to reflect on the findings of the McPherson report (1999) following the death of Stephen Lawrence that defined institutional racism as:

    The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people’.

    We must work to rid our country of racism in individuals, communities,  organisations and government. It will only be achieved through commitment throughout the life course and by stamping out racism and inequalities to achieve a fairer society for all our people.

    7.6.2020

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

    2 Comments

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

    The government ‘s centralised programme in England for testing and tracing – and the use of outsourcing

    1. Key messages:

    • The Government has not yet passed the five tests it set itself for easing lockdown
    • The government said that it would only consider easing lockdown once the country has passed five tests. One of these tests [TEST 5] is “confidence that we can avoid a second peak of infection that overwhelms the NHS”
    • The Devolved Administrations and many scientists and public health professionals doubt whether or not we have “passed this test” They doubt we have the capacity to detect and respond to local surges in infection or control outbreaks as lockdown is eased – and that a second or even third peak of infection will occur. Policy is diverging across the UK with mixed messaging to the public and a high risk of losing a coherent and effective strategy of suppression.
    • To manage our “exit “from lock down we need to be able to recognise new cases when they occur, test and isolate people who are infected, trace and test their contacts – and to have the flexibility resource and leadership to organise responses at a local level.
    • Other countries in Europe are using phased lifting of measures, across regions and settings. The EU Roadmap states that “the lifting of measures should start with those with a local impact and be gradually extended to measures with a broader geographic coverage, taking into account national specificities. This would allow to take more effective action, tailored to local conditions where this is appropriate, and to re-impose restrictions as necessary, if a high number of new cases occurs (e.g. introducing a cordon sanitaire)” For example, why would there be a relaxation of control measures in dense urban areas with crowded public transport at the same time as some parts of the UK that have had no new confirmed cases for 18 plus days and some areas with very few cases? We need detailed stats and maps by district council of all new cases by area of residence over time (at a more granular level than unitary authorities) The Orkney Western isles and Shetland remain in lock down when they have had no cases for 18, 21 and 32 days respectively and when a cordon sanitaire could be put in place
    • Integrated response In order to lift measures while retaining control of the virus, we must identify cases rapidly, isolate and contact trace: so testing is crucial but we must have the ability to test the right people and to rapidly act on the results

    o Prevention of new cases is always better and much cheaper than critical care. Investment in hospitals to respond to COVID19 has been absolutely necessary but will always have less impact on population level health outcomes than control measures.

    o The UK has an excellent public health and primary care system, both of which have been eroded and underfunded in the last 10 years. There are skills and knowledge and capability in these that would provide an effective and efficient response to moving through the next phases of the pandemic, if invested in. However, both these sectors have been excluded and marginalised to the detriment of their local communities

    o For a “test, trace and isolate “ system of control and response to outbreaks to be effective, data must be shared and agencies need to work together at national , regional and local level , coordinate and integrate their response if it is to be effective .No one agency has the knowledge , skills, or resources to do this on their own – and Whitehall in particular needs to recognise that central control is bound to fail.

    o Capacity for testing should provide real time data to help monitor community transmission, link with contact tracing systems and enable local authorities to function autonomously, as well as part of a national response to this pandemic.

    o Much of the infrastructure for testing commissioned by the Government has been led centrally – much of it has been established from scratch. The original drivers for increasing testing capacity were to:

        1. Allow NHS staff to be released back to work on the front line and
        2. respond politically to the growing criticism about the UKs track record on testing o The plight of care homes and the huge death toll from COVID 19 in those institutions is a classic illustration of the failures, which result from over centralization and reliance on hierarchical control and power. This example also illustrates the potential of local government and effective leadership to understand and respond quickly to local circumstances, to innovate, and to “stitch systems “together and make them work.
    • Outsourcing in England Rather than invest or expand our existing laboratory system Ministers chose instead to outsource the provision of testing for COVID 19 in England. They used special powers to bypass normal tendering and award a string of multimillion pound contracts for delivering and processing tests to private companies such as Deloitte, Randox laboratories [£ 133 million] and involved big pharma companies such as GSK, Roche and AstraZeneca and university research teams in creating mega or “ Lighthouse “ labs. These organisations:
      1. Provide swab tests on hospital patients and COVID tests run by NHS labs and Public Health England.
      2. Collect swabs from NHS workers, social care staff and other key workers at 50 drive -in centres and 70 mobile units, which are processed and reported on through a network of 3 mega “lighthouse “ labs
      3. Send out home testing kits for eligible persons with coronavirus symptoms, aged 65 or over, or who cannot work from home
      4. Offer an “on -line portal “through which CQC registered care homes [65 +] can order test kits
      5. Issue serology and swab tests for ONS surveillance and research studies
    • Together Government claims that they can offer 100000 tests a day.

    o However when backlogs develop, they tend to operate as separate “ silos” as illustrated when 50000 tests were sent to the US rather than workload shared between them.

    o More importantly, this testing system does not provide or allow access to test data by local organisations or Public Health England.

    o More than half of tests by May12th have been done by outsourced companies and results are “disappearing into a black hole” A Health Service Journal analysis on May 13th said that recent government testing figures “suggests that in recent days around two thirds of tests have taken place under the commercial lab scheme, for which the data is not available locally. This includes more than 7,000 positive test results in the past three days, and tens of thousands over recent weeks”.

    o Most tests [except for care homes] are demand led, random in nature, and requested by individuals from a wide catchment area. As such, they do not provide useful information for detecting spikes or patterns of infection in a particular geographical area, local “hot spots” or for managing outbreaks. Furthermore, test data are not completely post coded nor are they analysed at a sub-regional or local authority level, local authorities and PHE have found it difficult to get hold of these data.

    • Real time analysis and assessment of infection

    o The Government proposes to establish a Joint Biosecurity Centre with an independent analytical function which will

    o a) provide real time analysis and assessment of infection outbreaks at a community level and collect a wide range of data to build a picture of COVID-19 infection rates across the country – from testing, environmental and workplace data to local infrastructure testing (e.g. swab tests)

    o b) have a response function that will advise on the overall prevalence of COVID-19, identify specific actions to address local spikes in infections, in partnership with local agencies and guide local actions through a clear set of protocols based on the best scientific understanding of COVID-19, and what effective local actions look like.

    o We welcome the commitment to ensure that the Joint Biosecurity Centre [JBC] works closely with local partners. We would like some input into the design of the data platform, as well as discussion about rights of data contributors to access all data sets, which are held.

    o We do not believe that the JBC should have a response function, which “guides local actions surges through a series of protocols. “

    o Lessons from the 2009 H1N1 pandemic about over centralisation and hierarchical control – delays, rigidity, lack of autonomy to act, failure to listen and respond to local intelligence need to be learnt.

    Once again, they have outsourced this analytical function to a large number of private sector organisations. The strategy states that NHS England and NHS improvement have total control over access to all NHS test data will guide and inform the COVID 19 response during lock down – but so far they have not consulted local authorities or PHE about the proposal to create this JBC or involved them in the design, access and linkage to this data store. NHS England has created difficulties and even stopped local agencies from having access to important data sets, such as 111 calls.

    o Contact tracing: Contact tracing at scale can help reduce onward transmission during release from lockdown, if properly resourced by skilled people and well organised. It is unclear how their trace and track system will be integrated with the testing system.

    We are concerned that the Government has

      1. outsourced the call centre to SERCO given its previous track record [breast cancer catch up]
      2. believe that one hour of training as call handler will be sufficient to run this online and phone based contact tracing system,
      3. place so much reliance on an experimental App for contact tracing.
      4. recruited insufficient skilled contact tracers to impact on the “R” number, not made sufficient effort to recruit people with experience of contact tracing e.g. EHOs or retired professionals to the clinical team.

    The government states that for its test and trace system to work, several systems need to be built and successfully integrated. These include:

        • widespread swab testing with rapid turn-around time, digitally-enabled to order the test and securely receive the result certification;
        • local authority public health services to bring a valuable local dimension to testing, contact tracing and support to people who need to self-isolate;
        • automated, app-based contact-tracing through the new NHS COVID-19 app to (anonymously) alert users when they have been in close contact with someone identified as having been infected;

    Conclusions

    o The Testing and Tracing infrastructure which the government has commissioned has been largely been outsourced to private sector organisations and very centralised

    o As such it is a “quick fix which is poorly designed and ill equipped to support the next stage of controlling this pandemic and involving the many agencies which need to play their part as lockdown are eased.

    o The considerable investment which has been made in these new “ temporary “ structures should be channelled over the next 2 to 3 years into building a more robust, flexible , resilient and multilevel , public health and primary care systems , capable of responding to pandemics in the future.

    Sources

    Posted by Brian Fisher on behalf of the Policy Team.

     

    Comments Off on Briefing Topic 3 – Test, Trace, outsourcing

    Dear friends (including many joining in recent weeks)

    Corona Confusion: lies, deceit, trickery and failure

    The shocking and rising UK death toll from the pandemic is now the highest in Europe.

    Wirral, where most DONHS activists are based, is one of the country’s worst-affected boroughs.

    Yet the scale of the heartbreaking human tragedies which result was not inevitable. The crisis has been made worse – and the number of deaths has been multiplied – by the failure of the government to act promptly and adequately in response.

    Their evident incompetence, their arrogant dismissal of criticism, and their litany of lies, deceit, trickery and failure are appalling. The long list below represents a shameful catalogue*.

    What is to be done?

    Well, we’re starting by inviting you to a rally. Yes, it’s a Zoom meeting** which we know many of you are using for social and serious reasons at this time. It’s easy to add to your device and to use.

    The rally will be on Wednesday 3rd June from 7:00pm. We have invited several guest speakers. Professor Allyson Pollock  and Professor John Ashton have confirmed and other names will be announced.

    We are expecting a large attendance so interaction is inevitably limited. But please submit any question for our speakers by email (to the address below) by 27th May at the latest.

    More details and confirmation will be sent over the next two weeks.

    Please visit (from midnight tonight) https://www.eventbrite.co.uk/e/corona-confusion-lies-deceit-trickery-and-failure-defend-our-nhs-tickets-105310370152

    Keep safe

    On behalf of Defend Our NHS

    defendournhswirral@gmail.com

    ………………………………………………………………………………………………………………………………………………………..

     

    • For anyone who still thinks the Johnson government and predecessors have been doing a good job just take a moment to read this. It is an augmented version of a Facebook post by Ray Harris https://www.facebook.com/ray.harris.7946

    The arrogance and incompetence are truly horrifying. This information should be shared widely.

    • 2011 Cameron adviser Mark Britnell, who was appointed to a “kitchen cabinet” advising the prime minister on reforming the NHS, tells a conference of executives from the private sector that future reforms would show “no mercy” to the NHS and offer a “big opportunity” to the for-profit sector.
    • 2012 Andrew Lansley’s Health and Social Care Act is passed with the support of the coalition government. It effectively abolishes a national health service replacing it with a confused jigsaw of clinical commissioning groups (CCGs) and financial regimes and what are now 42 ‘integrated care systems’.
    • The ‘efficiency’ measures of US management consultancy corporation McKinsey and various ‘market-led’ measures are imposed on flailing CCGs.
    • 2014-19 Local authority public health budgets are slashed by 35%. And the 10 most deprived areas in England are hit with nearly 15% of all these cuts.
    • 2016 is the year that Jeremy Hunt lies about and alienates the junior doctors, provoking a series of strikes against the imposition of unsafe working practices.
    • AND the government buries the warnings about the implications of a pandemic from their Exercise Cygnus.
    • The re-disorganisation of the NHS continues apace – with the programme of STP (renamed ‘slash, trash and privatise’ by campaigners) accelerating during the crisis which follows.
    • 2016-2020 UK government stockpiles containing protective equipment for healthcare workers in the event of a pandemic fall in value by almost 40% over six years.
    • December 31st 2019 China alerts WHO to new virus.
    • January 23rd 2020 Study reveals a third of China’s patients require intensive care.
    • January 24th Johnson misses first Cobra meeting.
    • January 29th Johnson misses second Cobra meeting.
    • January 31st The NHS declares first ever ‘Level 4 critical incident’ Meanwhile, the government declines to join European scheme to source PPE.
    • Early February it’s claimed by the Times that Cummings tells a meeting it was all about “herd immunity, protect[ing] the economy and if that means some pensioners die, too bad”
    • February 5th Johnson misses third Cobra meeting.
    • February 12th Johnson misses fourth Cobra meeting. Exeter University publishes study warning the coronaviruscould infect 45 million people in the UK if left unchallenged.
    • February 13th Johnson misses conference call with European leaders.
    • February 14th Johnson goes away on holiday. Aides are told keeps Johnson’s briefing notes short or he will not read them.
    • February 18th Johnson misses fifth Cobra meeting.
    • February 26th Johnson announces ‘Herd Immunity’ strategy, announcing some people will lose loved ones. Government document is leaked, predicting half a million Brits could die in ‘worse case scenario’
    • February 29th Johnson retreats to his country manor. NHS warns of ‘PPE shortage nightmare’. Stockpiles have dwindled or expired after years of austerity cuts.
    • March 2nd Johnson attends his first Cobra meeting, declining another opportunity to join European PPE scheme. Government’s own scientists say over half a million Brits could die if virus left unrestrained. Johnson tells country “We are very, very well prepared.”
    • March 3rd Scientists urge Government to advise public not to shake hands. Johnson brags about shaking hands of coronavirus patients.
    • March 4th Government stops providing daily updates on virus following a 70% spike in UK cases. They will later U-turn on this amid accusations they are withholding vital information.
    • March 5th Johnson tells public to ‘wash their hands and business as usual’
    • March 6th Health secretary Hancock says he has talked to supermarkets to safeguard food supplies.
    • March 7th Supermarkets say Hancock is lying.
    • March 7th Johnson joins 82,000 people at Six Nations rugby match.
    • March 9th After Ireland cancels St Patrick’s Day parades, the UK government says there’s “No Rationale” for cancelling sporting events.
    • March 10th-13th Cheltenham race meeting takes place. More than a quarter of a million people attend.
    • March 11th 3,000 Atletico Madrid fans fly to Liverpool.
    • March 11th Cummings asks technology CEO and business leaders in a Downing Street meeting to share skills and talent with the government in order to tackle the coronavirus pandemic.
    • March 12th Johnson says banning events such as Cheltenham will have little effect. The Imperial College study finds the government’s plan is projected to kill half a million people.
    • March 13th The FA suspends the Premier League, citing an absence of Government guidance. Britain is invited to join European scheme for joint purchase of ventilators, and refuses. Johnson lifts restrictions of those arriving from Coronavirus hot spots.
    • March 14th Government is still allowing mass gatherings, as Stereophonics play to 5,000 people in Cardiff.
    • March 16th Johnson asks Britons not to go to pubs, but allows them to stay open. During a conference call, Johnson jokes that push to build new ventilators should be called ‘Operation Last Gasp’
    • March 19th Hospital patients with coronavirus are returned to care homes in a bid to free up hospital space. What follows is an explosion of virus cases in care homes.
    • March 20th The Government states that PPE shortage crisis is “Completely resolved”. Less than two weeks later, the British Medical Association reports an acute shortage of PPE.
    • March 23rd UK goes into lock-down.
    • March 26th Johnson is accused of putting ‘Brexit over Breathing’ by not joining EU ventilator scheme. The government then state they had not joined the scheme because they had ‘missed the email’
    • March 27th Both Johnson and Cummings admit to developing COVID-19.
    • April 1st The Evening Standard reports that just 0.17% of NHS staff have been tested for the virus.
    • April 3rd The UK death toll overtakes China.
    • April 5th Johnson admitted to St Thomas’s Hospital.
    • April 5th 17.5 million antibody tests, ordered by the government and described by Johnson as a ‘game changer’ are found to be a failure.
    • April 7th Johnson is moved to intensive care with coronavirus. He later says the NHS saved his life. Subsequently it is revealed he was not using a ventilator but extra oxygen, a solution not applied universally.
    • April 10th FT reports that private clinics in the UK selling COVID-19 testing kits insist they are still able to source supplies, despite complaints from the government that shortages have prevented testing being rolled out more quickly.
    • April 16th Flights bring 15,000 people a day into the UK – without virus testing.
    • April 17th Health Secretary Matt Hancock says “I would love to be able to wave a magic wand and have PPE fall from the sky.” The UK has now missed four opportunities to join the EU’s PPE scheme.
    • April 21st The Government fails to reach its target of face masks for the NHS, as it is revealed manufacturers’ offers of help were met with silence. Instead millions of pieces of PPE are being shipped from the UK to Europe.
    • April 23rd-24th Government announces testing kits for 10 million key workers. Orders run out within minutes as only 5,000 are made available.
    • April 24th The Guardian reveals that Cummings, and a data scientist he worked with on the Vote Leave campaign for Brexit are on the secret scientific group advising the government on the coronavirus pandemic.
    • April 25th UK death toll from coronavirus overtakes that of The Blitz.
    • April 28th Hancock says “Of course care homes have been a top priority right from the start.  We’ve strengthened the rules around what happens in care homes and tightened infection control, also making testing available throughout the care centre I think is incredibly important as we’ve ramped up the availability of testing.”
    • April 28th A third of all coronavirus deaths in England and Wales are now happening in care homes
    • April 29th NHS England (London) sneak out a letter accelerating the integrated care system. Their‘Journey to a New Health and Care System’ states that over the next 12-15 months they hope to keep public engagement to a bare minimum.
    • April 30th Johnson announces the UK has succeeded in avoiding a tragedy that had engulfed other parts of the world. At this point, the UK has the 3rd highest death toll in the world.
    • May 1st The Government announces it has reached its target of 100,000 tests – They haven’t conducted the tests, but posted the testing kits.
    • May 4th It is now clear that Deloitte, KPMG, Serco, Sodexo, Mitie, Boots and the US data mining group Palantir have secured taxpayer-funded commissions to manage COVID-19 drive-in testing centres, the purchasing of personal protective equipment (PPE) and the building of Nightingale hospitals.
    • May 5th The UK death toll becomes the highest in Europe.
    • May 6th Johnson announces the UK could start to lift lock-downrestrictions by next week.
    • May 7th Guardian columnist writes that “outsourcing the coronavirus crisis to business has failed – and NHS staff know it”.
    • May 16th Hancock says that “right from the start we’ve tried to throw a protective ring around our care homes.” This is categorically untrue. Care homes were left without testing. Without contract tracing. Without PPE. Without support.
    • May 19th On ITV Piers Morgan once again accuses a cabinet minister, talking about testing, of ‘lying through her back teeth’ to BBC viewers.
    Comments Off on Defend Our NHS: Corona Confusion: lies, deceit, trickery and failure

    The United Kingdom has overtaken Italy with the highest official death toll from the coronavirus, Covid-19 in Europe. New figures released on Tuesday, 5th May 2020 show that this is the trend, we ask, what does this mean for London and Inner London Local Councils?

    London is a vast geographical area and has a complex demography. The inner London boroughs are more diverse, in general and the outer London boroughs are more suburban.

    The incidents of coronavirus in the capital have been measured by the Office for National Statistics.

    The ONS reports that overall, London had 85.7 Covid-19 deaths per 100,000 population, almost double the rate of the next worst-affected region which is the West Midlands at 43.2 deaths per 100,000.

    Nick Stripe, head of health analysis and life events at the ONS, said: “By mid-April, the region with the highest proportion of deaths involving Covid-19 was London, with the virus being involved in more than 4 in 10 deaths since the start of March.”

    The figures for the top ten London Boroughs are:

    Borough SMR
    Newham 144.3
    Brent 141.5
    Hackney 127.4
    Tower Hamlets 123
    Haringey 119
    Harrow 115
    Southwark 108
    Lewisham 106
    Lambeth 104
    Ealing 103

    If we look even closer within each London borough, we can see the how each Super Output Area is affected. Super Output Areas are a small area statistical geography covering England and Wales. Each area has a similarly sized population and remains stable over time. You can take a look at the ONS interactive map here: 

    The Index of Multiple Deprivation (IMD) is an overall measure of deprivation based on factors such as income, employment, health, education, crime, the living environment and access to housing within an area. [NB There are differences between England & Wales]

    Age-standardised mortality rates, all deaths and deaths involving COVID-19, Index of Multiple Deprivation, England, deaths occurring between 1 March and 17 April 2020

    Looking at deaths involving the coronavirus (COVID-19), the rate for the least deprived area was 25.3 deaths per 100,000 population and the rate in the most deprived area was 55.1 deaths per 100,000 population; this is 118% higher than the least deprived area.

    In the least deprived area (decile 10), the age-standardised mortality rate for all deaths was 122.1 deaths per 100,000 population. In the most deprived area (decile one), the age-standardised mortality rate for all deaths was 88% higher than that of the least deprived, at 229.2 deaths per 100,000 population.

    The bar chart shows how much higher each decile is compared with the least deprived decile for all deaths and deaths involving COVID-19.

    For deciles 4 to 9, the percentage increase in age-standardised mortality rate of deaths involving COVID-19 is similar to that of overall deaths.

    The rate of deaths involving COVID-19 is more than twice as high in the most deprived areas compared with the least deprived

    Local responses will involve contact tracing. This graphic from Public Health England gives a brief description of the process.

    contact tracing is part of a public health approach

    Professor Allyson Pollock of Public Health at Newcastle University has been campaigning to raise the profile of a more localised approach, in a letter she has said that a massive increase in testing and tracing should be the next phase, but decades of cuts and reorganisations have whittled away the necessary regional expertise.

    In the letter the dynamic nature of the pandemic across the country is aptly described as “not homogenous. It is made up of hundreds, if not thousands, of outbreaks around the country, each at a different stage.”

    Her approach champions “classic public health measures for controlling communicable diseases such as contact tracing and testing, case finding, isolation and quarantine. They require local teams on the ground, meticulously tracking cases and contacts to eliminate the reservoirs of infection. This approach is recommended by the WHO at all stages of the epidemic.”

    The history of public health is important including the recent changes in the Health & Social Care Act 2012. This abolished local area health bodies, created Public Health England to fulfil the Government’s duty to protect the public from disease and charged local authorities with improving public health.

    As public health returned to local government, with a sleight of hand, the Government introduced the current programme of public health funding cuts. In 2019/20, the London’s share of the Public Health Grant had fallen to £630 million, representing a per head funding reduction from £80.75 in 2015 to £68.61 in 2019, a fall of 15% and the biggest regional reduction in England.

    “Investing in public health is also hard for governments because the benefits accrue to their successors and there is little to show for spending at the end of the five-year election cycle.”

    “Cutting public health funding would be an act of self-mutilation. If controlling spiralling demand is the priority, for goodness sake don’t cut public health.”

    Luke Allen
    Researcher, Global Health Policy, University of Oxford in the conversation

    A localised response requires political will, expertise and attention to detail.

    Public Health funding and status needs to be revitalised and restored. It is a matter of life and death.

    1 Comment

    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

    This is the 7th week that the SHA has published a Blog tracing the progress of the Coronavirus pandemic globally but more specifically across the UK. Over this time we have drawn attention to the slow response in the UK; the lack of preparedness for PPE supply and distribution; the delay in scaling up the testing capacity and system of contact tracing; a too early move away from trying to control the epidemic and poor anticipation of the needs of the social care sector.

    However we need to start to look at how we can reverse the situation we find ourselves in being one of the worst affected countries in the world. Our deaths in the UK now exceed 20,000 and we have been following Italy and Spain’s trajectory. It is true that while the lockdown came too late – London should have gone first – it has had an impact on suppressing the first wave and the NHS has stood proud and able to cope thanks to the unflagging commitment from all staff. It is good that Parliament has been reconvened so proper scrutiny can be given to government decisions on public health as well as the economy. We look to the new Shadow Team to pursue this energetically.

    It is no surprise that Trump’s USA is a lesson of the damage disinvesting in the Centers for Disease Control and Prevention (CDC) has had. It has led to poor emergency preparation and poor leadership at handling the pandemic at a federal level. From a SHA perspective an example of the superiority too of a nationalised health system as compared with a private health care model in the USA. Compare how it looked in New York City during their peak and the relative calm in London on the 8th April. From his rehabilitation home at Chequers it was concerning that one of the first phone calls PM Boris Johnson allegedly made was to Mr Trump. They share many characteristics but let’s hope that we do not end up second only to the USA in the international table of deaths/100,000 population and tie ourselves too closely with the ‘Make America Great Again’ nationalist neo-conservative movement.

    1. Scientific advice

    One of the characteristics of this pandemic has been the UK Government Ministers repeated claim that they have been making decisions on the best scientific advice. This claim has mystified some commentators who feel that the decisions being made by Ministers has not been in line with WHO advice (test, test, test) and not consistent with comparable EU countries who seem to have managed the pandemic more successfully (Germany and Denmark). We have never said that we cannot compare data published in Germany and Denmark before now!

    Sometimes Governments make bad calls during an emergency and wanting to keep the membership of SAGE secret was one such. There has been mounting concern about the provenance of some of the advice leading to Ministerial decisions. For example the early misunderstandings about ‘herd immunity’ and the fear that the nudge behavioural psychologists were having undue influence leading to the crucial delay in lockdown. Some of these scientists work in government units, which is not good for an independent perspective.

    The mixed messages about the modellers and their estimates of the likely deaths (20,000 to 500,000) which also surfaced before one modeller was allegedly responsible for pushing (thankfully) the belated decision on the lockdown.

    Many public health trained people have begun to wonder who on SAGE had any practical public health experience in communicable disease control? These concerns were prompted by the sudden abandonment of testing and contact tracing, the lack of airport or seaport health regulations used by other countries such as Australia and New Zealand (Australian deaths so far 80 for a population of 25m and NZ 18 for a population of 5m).

    Recently we have also been bemused by the inability to recognise how homemade cloth facemasks might play a part in easing lockdown. While there might be a relative lack of ‘gold standard’ evidence there is ‘face validity’ that a mask will stop most droplets and this will be important as we are finding so many people are infected for days before showing the classic symptoms and signs of fever and cough. Homemade cloth masks would not compete with NHS and Social Care supplies and these do seem to have been part of the strategy that countries that have been more successful at containment than the UK. We suspect that in time the recommendation to wear a cloth mask when going outside your home will become a recommendation!

    After the initial planeload of British nationals from Wuhan, who had been appropriately quarantined, there are no measures in place at all at our airports. The explanation about incubation period does not hold if people are quarantined for 14 days. The precision of temperature measurements should be seen as part of a screening regime, which would include risk assessment of country of origin, symptoms reported on a questionnaire or observed as well as temperature measurement. It is obvious that if a passenger causes concern the less accurate thermal imaging technique can be augmented by other more reliable ways of taking a temperature! It does not seem right that such measures are discounted for the UK and we are one of the worst performers while other countries with competent public health professionals take it seriously. It is estimated that nearly 200,000 people arrived from China to the UK between January and March 2020 with no checks at all apart from general Covid advice. Empty hotels would have been suitable for quarantining people at risk of having the virus. This matters as it is a very contagious virus and can spread before symptoms appear. Such symptoms can also be minimal and hard to detect.

    Now that the membership of SAGE has been leaked we can see that one of the Deputy CMOs is the only person who has had any ‘on the ground’ experience of communicable disease control in communities. This is important when we start to consider how we can get out of lockdown by using the new testing capacity optimally, contact trace effectively and introduce control measures locally. This will require Public Health England (PHE) to begin to strengthen its relationship with local Directors of Public Health (DsPH) located in Local Government. These DsPH can provide local leadership and work with Environmental Health Officers (EHOs) who to date have not been drawn into the pandemic management system.

    The presence of Dom C in SAGE meetings raises concerns. Of course civil servant officials have always attended the meetings to ensure that they are properly organised, agendas circulated and minutes recorded. It is quite a different thing to have an influential Prime Ministerial adviser like Dom C attend the meeting and no doubt interject during discussions and help shape the advice. That should be the Chief Scientific adviser’s (Prof Vallance) job and his role to brief the PM. The trust in SAGE has been damaged by the disclosure of membership, the lack of jobbing public health input as well as the presence and influence of these special advisers (SPADs).

    1. Easing lockdown

    One of the problems in the management of the pandemic in the UK has been the centralised London perspective, which has dominated the options and led to a one-size fits all approach. We have said before in these Blogs that Greater London was our Wuhan (similar population sizes). We should have shut London down much earlier and stopped the nonsense of those crowded tube trains and buses. We have seen from the Ministerial briefings that London has had an almost classic epidemic curve – rising steeply and then levelling off and declining. The devolved nations and English regions have lagged behind. Scotland and Wales got their first cases about 4 weeks after London and the South East. Regions such as the SW region in England, Northern Scotland and the Islands, rural Wales and parts of the North of England have been slow to have cases and even now have had few cases and few deaths. These areas did not need to be locked down at the same time as London and the South East and could have instituted regional testing and contact tracing which would have helped flatten the curve and protect the NHS.  Such a strategy would have built up experience of doing this which we now have realised we need to do to get out of lockdown. However we have an asymmetric situation with the regions showing gradual and flat epidemic curves, which will be prolonged and frustrate a UK alone approach.

    The challenge of easing lockdown will be quite different in metropolitan urban areas with heavily used public transport and metro trains and a more dense housing with fewer green spaces. The picture in more rural areas and small towns is quite different. There is a serious need to engage with local government more appropriately, pull back from central control and set out a framework as has been started in Scotland and Wales which local government partners can start to address via their Local Resilience Fora (LRFs) and emergency control structures.

    There does still need to be a UK wide COBR approach but the strategy needs to be more nuanced to set out the UK framework and allow devolved nations who are a similar size to New Zealand and Denmark and English regions to plan locally sensitive approaches drawing on expert advice from Public Health organisations such as Public Health Wales, Scotland and PHE. Metropolitan areas such as London, Birmingham and Manchester will also want to be able to adapt measures to fit their local complexities. This will be particularly important as we start a system of community testing, contact tracing and control measures. National testing standards and quality will apply and any mobile apps that are developed will need to be agreed at a national level with all the safeguards on privacy and information governance.

    Children have been remarkably resilient to this virus and it seems that back to school is something worth considering as an early venture as long as schoolteacher’s health is safeguarded by not exposing ‘vulnerable’ teachers, and implementing systems to make physical distancing more feasible. It is urgent to look at international best practice and be flexible in our approach.

    Pubs and restaurants will be further down the list as will mass sporting events but widening the retail sector and getting some workplaces back should be planned. Again travel to work should only be necessary for some workplaces and physical distancing, masks and health and safety regulations will need to be updated to suit each work environment before permission to reopen is given. All these steps require enhanced local public health capacity.

    1. Recovery planning

    An important part of emergency planning frameworks is the need immediately an emergency is recognised to begin the ‘recovery planning’. This will depend on the characteristics of each emergency. In the case of Covid-19 we will need to look at the build up of elective care, especially surgical waiting lists. It will also need to urgently review those people with long-term non-Covid conditions who may have had their continuing medical care disrupted. There will also be those casualties of the pandemic who have been traumatised by the pandemic and have mental health issues, burnout, faced economic hardship and PTSD. People who have had Covid-19 and survived a period in ICU and ventilation will also need weeks and sometimes months to recover. So all this adds up to a load for the NHS and associated services to address.

    As we have seen the economy has taken a big hit and many businesses have found themselves having to close down or reduce their workforce/suspend manufacturing output. It is unclear how we measure what has happened to our economic base but we have seen the growth in unemployment, the rise in welfare applications and the stories of those caught out with a sudden loss of employment and income. We know that 12 years after the 2008 financial crash that the legacy remains. This is far bigger so we need to begin to agree how the economy can be rebooted safely while protecting those vulnerable populations and safeguarding the children returning to school or workers to the factory floor. Trade Unions must be key partners of this economic recovery planning challenge.

    The other aspect of a recovery plan is to take advantage of good things we have experienced such as the reduction of air pollution with a reduction of car use and aviation and other transport. The global satellite pictures of Beijing, Delhi and Milan tell the story that life can be better if we reduce our carbon footprint. Working from home, the benefit of fast broadband should all lead to a reappraisal of environmental and other life changes. The growth in cycling and physical activity in green spaces should also be built on.

    Finally the pandemic has once again thrown a light on inequalities with the risks of occupational exposure (bus drivers), risks in hospital environments (porters, receptionists to nurses and doctors) and retail shops (shop assistants/cashiers). Many manual workers have had to go out to work still and in the process through travel and the work environment been at higher risk. Those who live in over crowded households have been at greater risk with fewer opportunities to self-isolate. Many of those in poorer urban housing estates have also been exposed to risk and found safely going to shops, medical centres or exercise much more difficult. We know about the health inequalities gradient and when this pandemic is analysed fully these social economic and environmental determinants will show through. It is pretty clear that BAME communities have been more susceptible to the virus and while this may have some biological features such as cardiovascular/metabolic risks it will also be socioeconomic, cultural and reflect occupational exposure.

    So recovery plans need to be set out to ensure that we do not revert to business as usual but grasp the opportunities that there are to build a better future after the C-19 pandemic. The Beveridge Committee was established relatively early during WW2 and the report was published in 1942 setting out the vision of an NHS and State Education for example. We have an opportunity to push for similar progressive changes after Covid-19.

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

    2 Comments
    1. On PPE. From a Greater Manchester doctor working on a respiratory ward, unofficially renamed by staff the “Coronavirus Ward”, about protective equipment:

    “It’s not so much whether there’s enough, it’s what’s being brought in is really poor quality and advice about what constitutes PPE  is changing daily. Loads of my colleagues have already tested positive…… that’s one good thing my hospital is really on it with testing staff.”

    1. From a Unison rep in NHS Greater Manchester:

    “I am worried about members with diabetes, especially type 1. First of all they were listed in the ‘at risk’ group, not quite as at risk as the ‘vulnerable’ group, but who should still not be asked to work. Now they are being asked to go in. The responsibility has been put on them to observe the recommendations. They are sent on to wards where it is impossible to keep a 2m distance from patients, and PPE is still a problem.”

    And “there are not enough tests for the virus. But it would be possible to identify people with symptoms, and teams could be recruited to monitor symptoms and track contacts. However this is not happening.”

    1. Care workers are also on the Frontline. From a care worker in Scotland who visits patients in their homes. She was very upset because she was not allowed to shop at the time reserved for NHS staff “because she had the wrong uniform”. She has been working double shifts for a month, and will be doing so until July, and at the same time doing shopping for some of her patients, elderly people unable to get out of the house and whose adult children live too far away to help. This has been made more difficult by not being treated as a frontline worker, especially as there are limited occasions when she can do shopping, given her extra workload. She points out she is risking her life and those of her family members, but not being treated as “frontline”.

     

    1. Terror of the Unknown. From another Greater Manchester doctor, a retired consultant: “I have been retraining, but will be back at work full time on Monday. The main thing I noticed last week was the atmosphere of fear amongst the staff. Our hospital are pretty organised, it seems to me, with training and equipment, but not unexpectedly, there is terror of the unknown.”

     

    1. Ventilators and Tory Donors. Andrew Raynor of MEC Medical submitted an application to help the government on 16th March, but “nothing” happened. They are a worldwide supplier of oxygen therapy, suction, flow meters, electric suction, regulators and more. Raynor said the government had, instead, “ploughed loads of money into big consortiums to try and make a cheap, makeshift ventilator”. He did not have a problem with the government wanting to make a cheaper ventilator, but pointed out that his firm was already a ventilator manufacturer, and could “upscale quicker”.

    Instead, on 26 March, the BBC reported that the government had ordered 10,000 ventilators from the vacuum cleaner firm Dyson, which has no experience making the ventilators required. Dyson, working with medical technology firm, The Technology Partnership, has “hundreds of engineers working round the clock to design the ventilators from scratch.” The BBC commented that even if a suitable prototype was produced as a result, it still had to get regulatory approval, and move to production on a significant scale.

    As an anaesthetist commented to us: “simple ventilators allow you to dial in the tidal volume (the amount of air moved into or out of the lungs during each ventilation cycle), the respiratory rate” and the concentration of oxygen being breathed in. The ventilators deliver all the breaths and can be used during surgery or for transferring patients.” That is, for short term ventilation.

    But after several days on these ventilators, usually necessary for Covid-19 patients, “people develop wasting and loss of condition in the muscles responsible for breathing in. This means that patients need to be supported during this time, but support can be gradually reduced as they begin to recover muscle strength and can take progressively larger breaths. “They usually also need a temporary tracheostomy to reduce the amount of dead space, enabling lighter sedation and more effective breathing.”

    However, the Dyson ventilators are very basic and do not allow for weaning of the ventilator. “But he’ll make a lot of money, get a peerage, and make it look like Matt Hancock is doing something.”

    In contrast, “modern Intensive Care Unit ventilators are expensive and take ages to produce. Hancock just wanted a soundbite and a photo-opportunity. He passed over offers from established manufacturers to award contracts to big name companies like JCB and Dyson, with no experience of ventilator production, but owned by Tory donors.”

    Our informant compares the finger-prick antibody tests that Hancock has ordered. “They are totally unreliable, with low sensitivity and specificity, but home testing makes for a good, eye-catching headline, even if it’s a waste of time and money. Hancock is a joke; he is surrounded by sycophants and yes-men at the DHSC.”

    Obviously the production of much-needed ventilators is welcome. But the Government’s choice of manufacturers raises major questions about whether it has prioritised its friends and donors, rather than the specification of the ventilators needed.

    Blog from Vivien Walsh

    Comments Off on News From the Frontline

    Fire and rescue personnel will fit face masks for frontline NHS and clinical care staff and deliver medical supplies to hospitals and care facilities during the coronavirus outbreak after an agreement was made by the Fire Brigades Union (FBU) with fire chiefs and national employers.

    Under the agreement [NOTE 1] specially-trained and experienced fire and rescue personnel will fit protective masks to frontline NHS and clinical care staff working with patients infected with COVID-19.

    Firefighters will now also be able to begin delivering much needed personal protective equipment (PPE) and medical supplies to overstretched NHS hospitals and care facilities.

    These two new areas of work agreed extend the previous agreement reached at the end of March which allows firefighters to be able to begin driving ambulances, delivering medicine and food to vulnerable people, and assist in the movement of bodies.

    The Health and Safety Executive (HSE) recently gave a strong warning [NOTE 2] that the incorrect fitting of a protective face mask can increase the risk of COVID-19 infection and ‘lead to immediate or long-term ill-health or can even put the RPE [Respiratory Protective Equipment] wearer’s life in danger.’ Firefighters have been wearing respiratory masks for decades and the specialist trainers are certified to undertake the face-fit testing.

    During a face fit testing, the ‘tester’ must ensure that the RPE is clean and functioning and that the seal with the wearer’s face is tight and can prevent hazardous substances getting into an individual’s airways. [NOTE 3]

    Under the new areas of work, the agreement states that the facemask fitting practitioner and the candidate must not come into skin-to-skin contact or be in close proximity to the exhaled breath of the other without suitable protection.

    Under the agreement, firefighters could also be expected to assist in the delivery of PPE to the social care sector which has reported critical shortages of essential equipment. For those delivering PPE and medical supplies, delivery locations must be established that limit the risk of cross-infection.

    The update to the agreements will now see firefighters able to carry out:

    • Face Fitting for masks to be used by frontline NHS and clinical care staff working with COVID-19 patients
    • Delivery of PPE and other medical supplies to NHS and care facilities
    • Delivery of essential items like food and medicines to vulnerable people
    • Drive ambulances and assist ambulance staff
    • Move dead bodies, should the outbreak cause mass casualties

    Firefighters will continue responding to core emergencies, such as fires and road traffic collisions, but under the updated agreement can now provide further additional services specifically related to COVID19. The agreement states that core responsibilities must be maintained throughout the crisis.

    Any activities taking place at a local level must be risk assessed with fire and rescue personnel being given any necessary additional training and the appropriate PPE.

    The additional work taken on by firefighters will be temporary to tackle the COVID-19 pandemic. Initially in place for two months, the agreement can be extended or shortened if agreed between all parties.

    There are around 48,000 firefighters and control emergency staff in the UK.

    Matt Wrack, FBU General Secretary, said:

    “This public health crisis will require all of us to do our bit to get through it, and firefighters rightly want to play as much of a part as they can.

    “We are already driving ambulances, delivering food and medicine to the vulnerable and moving dead bodies, and the new work will see fire and rescue personnel use their expertise to fit protective masks and get vital PPE and medical supplies to NHS colleagues on the frontline.

    “The coming weeks and months will be a huge challenge for all services, not least for fire and rescue services who must continue to respond to emergencies whilst supporting the response to coronavirus. For that reason, testing for the disease must be made available to fire and rescue staff, so that as many healthy firefighters can be kept on the frontline as possible.”

    Joe Karp-Sawey, FBU communications officer

    Note 1 – Updated full Tripartite agreement: https://www.fbu.org.uk/sites/default/files/attachments/2020%20apr%2009%20-%20tripartite%20agreement.pdf

    Note 2 – HSE guidance on fit testing of masks https://www.hse.gov.uk/news/face-mask-ppe-rpe-coronavirus.htm

    Note 3 – Under the Control of Hazardous Substances Hazardous to Health (COSHH) Regulations, ‘respiratory equipment at work’ guidance, proper face-fit testing of Respiratory Protective Equipment (RPE), such as the widely used FFP3 respirators worn by health and care staff, must take place. Firefighters trained in this area will now be able to offer their support to NHS and care colleagues COSHH Regulations, ‘respiratory equipment at work’ – https://www.hse.gov.uk/pUbns/priced/hsg53.pdf

    Note 4 – The FBU called for the priority testing of firefighters and emergency control room staff on 20 March – https://www.fbu.org.uk/news/2020/03/20/covid-19-fire-and-rescue-services-lose-hundreds-firefighters-self-isolation-union

    The Fire Brigades Union (FBU) is the professional and democratic voice of firefighters and other workers within fire and rescue services across the UK. The general secretary is Matt Wrack

    The FBU is on Twitter: @fbunational and Facebook: facebook.com/FireBrigadesUnion1918

    For national spokespeople contact the press office via the details above. For local and regional spokespeople, please contact officials directly. You can find contact details for each region via this webpage: www.fbu.org.uk/contacts

    FBU press office
    press@fbu.org,uk

    Comments Off on FIREFIGHTERS TO FIT FACE MASKS AND DELIVER VITAL PPE AND MEDICAL SUPPLIES TO NHS AND CARE STAFF

    Jeremy Corbyn wrote a long letter to Boris Johnson on 31st March.
    As well as wishing him a speedy recovery, Jeremy made some strong points about aspects of the current crisis, and asked for immediate action on:

    • Full PPE now for Health and social Care workers
    • Test Test Test
    • Expand Social Care
    • Enforce Social-distancing and Protection
    • Bolster Support for Workers
    • Lead a Global Reponse

    (the 4  pages of the letter are attached)

    Posted by Jean Smith on behalf of SHA member Diane Jones.

    Comments Off on A request from Jeremy Corbyn for Urgent Action on the Corona Virus crisis