Blog

  • Categories
  • Category Archives: NHS Hospitals

    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.

     

    Leave a comment

    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.
    Leave a comment

    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

    Leave a comment

    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

    Leave a comment

    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.

    Leave a comment

    COVID-19 and the NHS – “a national scandal”, comments the Lancet.

    “The gravity of that scandal has yet to be understood.” Reports Richard Horton in the Lancet 28 March 2020 :

    “When this is all over, the NHS England board should resign in their entirety.” So wrote one National Health Service (NHS) health worker last weekend. The scale of anger and frustration is unprecedented, and coronavirus disease 2019 (COVID-19) is the cause. The UK Government’s Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn’t follow WHO’s advice to “test, test, test” every suspected case. They didn’t isolate and quarantine. They didn’t contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The UK now has a new plan—Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come.”

    Please read the full article here. You can download the pdf at this link.
    1 Comment

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

    1. Global crisis

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

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

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

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

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

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

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

    1. The public health system

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

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

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

    1. Local government and social care

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

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

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

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

    1. The NHS

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

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

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

    1. Maintaining people’s standard of living

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

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

    1. Conclusion

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

    24th March 2020

    Leave a comment

    20/03/2020

     

    OPEN LETTER TO THE PRIME MINISTER FROM THE SOCIALIST HEALTH ASSOCIATION

    Dear Mr Johnson,

    The pandemic has exposed the steady destruction of our public services and welfare state which has happened over the last 10 years.

    This is the most unprecedented health challenge in 100 years which is complex and difficult – but as voiced by many experts in the field, we have significant concerns about the way the UK government has hitherto been approaching this national emergency. We hope from now on this will be better co-ordinated. We support frontline staff at this worrying time.

    However the public is finally waking up to the fact that, as a result of government austerity and privatisation policies, we are ill-prepared – with too few ICU facilities, NHS beds, healthcare staff and equipment – to offer a safe and effective response to the virus. Those most at risk also have to use a threadbare social care system which is already bending under the strain.

    The UK should be in a relatively strong position on public health with a comprehensive service, considered one of the best in the world. However, Tory reforms in England destroyed the health authority structure below national level and has slashed budgets but at least Public Health England has a regional organisation and Local Government have Directors of Public Health. We wish to make some key points:

    1. You are placing staff at risk

    There is not enough personal protective equipment (PPE) for clinicians/frontline staff who are now personally at risk every time they go to into work.

    There is insufficient testing of staff who, having been put off work with minor illness and then return to the front line, do not know whether they have had the virus or not.

    1. You are placing patients at risk

    There are too few beds and too few trained intensive care staff and equipment such as respirators. The government appears to have acted too late. We should be requisitioning beds from the private sector, not paying them £2.4 million a day.

    Covid-19 testing has been wholly inadequate. It appears that a combination of inadequate preparation and misguided policy is responsible.

    1. You are placing communities at risk

    Undocumented people, for instance migrants and refugees, have long felt unable to use the NHS for fear of being referred to the police or the Home Office. This will increase risk. Legislate on charging and reporting undocumented migrants must at least be suspended.

    Those precariously employed, particularly gig economy workers, are still not financially protected and may be compelled to continue working inadvertently spreading infection.

    Thousands of excess deaths have occurred in the last few years as a result of the slowdown and reversal in life expectancy. Austerity policies have been a significant cause. It confirms international evidence that cutting the welfare state while at the same time introducing austerity, kills people.

    This pandemic is likely to add to that grotesque toll.

    1. You are placing the NHS at risk

    Government policy has split hospitals from general practices and from each other. It has created an industrial approach to care where staff and patients are increasingly seen as economic units. The newest redisorganisation has opened up the English NHS planning process to the private sector and to the US, especially if we have a trade deal. In addition, it has the potential to split the English NHS into 44 independent units – exactly what we do not want as we fight a global pandemic. If your government’s Long-Term Plan had already been fully implemented doing exactly that, we would not have been capable of a well-coordinated national response to the Covid-19 crisis.

    1. You are placing Social Care at risk

    Too little funding for Local Authorities has put social care on life support. Those most at risk receiving personal or residential care appear to receive the least advice and the least support to combat the virus. Those with Direct Payments, organising their own care with Local Authority funding, appear to be entirely on their own if their carers get ill.

    1. You are placing democracy at risk

    The most recent reorganisation of the NHS has made both formal and informal democracy more difficult. Just when we need all communities to collaborate and contribute to responding to this global challenge, NHS organisations have become more distant and poorly responsive.

    It has been frustrating and confusing to have changing government advice without any formal presentation of the data and evidence behind it. It was patronising and did not inspire confidence.

     

    WE EXPECT YOUR GOVERNMENT TO:

    • Treat us like adults – show us the evidence on which you base your decisions
    • Protect frontline staff right now with clinically appropriate protective gear and systematic testing. Bring testing in line with the WHO recommendations.
    • Protect the population of the UK by permanently increasing NHS staff in hospitals and primary care, increasing hospital beds, increasing respirators.
    • Roll back privatisation and austerity across public services.
    • Seize the opportunity of this pandemic to invest for the long-term in the welfare state, recognising that a thriving society requires a thriving state.
    • Suspend now legislation on the charging and reporting of undocumented migrants.
    • Invest permanently in social care, making it free at the point of use, fully funded through progressive taxation, promoting independence for all and delivered by a workforce with appropriate training, career structure, pay and conditions.
    • Protect those in precarious employment from financial meltdown from the pandemic. All those who should not be at work should have an living income.
    • Ensure that people across the UK have equitable access to the help they need, through their Devolved Administrations
    • Review the Long Term Plan

     

    Faced with this international emergency, we need to combine medical expertise – including support from abroad, with technical investment with practical solutions and community engagement along with emergency economic measures to fight this together.

     

    Chair SHA

    Dr Brian Fisher, London

    Vice-chairs SHA

    Dr Tony Jewell

    Tony Beddow, Swansea

    Norma Dudley, London

    Mark Ladbrooke, Oxford

    Secretary

    Jean Hardiman Smith, Ellesmere Port

    Treasurer

    Irene Leonard, Liverpool

    Co-Chair KONP

    Dr Tony O’Sullivan, London

     

    Co-signatories

    Dr John Carlisle, Sheffield.

    Terry Day, London

    Carol Ackroyd, London

    Corrie Louise Lowry, Wirral

    Caroline Bedale, Oldham

    Hazel Brodie, Dumfries

    David Taylor-Gooby, Newcastle

    Peter Mayer, Birmingham

    Dr Alex Scott-Samuel, Liverpool

    Dr Jane Roberts, London

    Dr Judith Varley, Birkenhead

    Vivien Giladi, London

    John Lipetz, London

    Jane Jones, Abergavenny

    Dr Kathrin Thomas, Llandudno

    Dr Louise Irvine, London

    Dr Jacky Davis, London

    Dr Coral Jones, London

    Dr Nick Mann, London

    Dr John Puntis, Leeds

    Brian Gibbons, Swansea

    Anya Cook, Newcastle,

    Alison E. Scouller, Cardiff

    Punita Goodfellow, Newcastle upon Tyne

    Parbinder Kaur, Smethwick

    Gurinder Singh Josan CBE,  Sandwell

    Jos Bell, London.

    Steve Fairfax Chair SHA NE, Newcastle upon Tyne

     

    The Socialist Health Association is a policy and campaigning campaigning membership organisation. We promote health and well-being and the eradication of inequalities through the application of socialist principles to society and government. We believe that these objectives can best be achieved through collective rather than individual action.

    4 Comments