Category Archives: NHS

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.

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

The NHS Staff Council statement of 28 February 2020

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

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

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

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

For more information please contact Unite senior communications officer Shaun Noble

Email: shaun.noble@unitetheunion.org

Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.
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PROTECT ALL FRONTLINE HEALTHCARE WORKERS

31/03/2020 cllralanhall BlogPress Leave a comment

Personal Protective Equipment, known as PPE is in demand. There are reports that there is a shortage in hospitals and care facilities.

The Daily Mirror reports that hospitals listed as having shortages include Rotherham General Hospital, Bristol Children’s Hospital, Hillingdon Hospital in Uxbridge, Royal Devon and Exeter Hospital and at St Thomas, Lewisham and two other unnamed hospitals in London.

“The correct PPE must be made available at every site that might require it. This is vital in order to protect our patients but also to protect the lives of the life-savers.”
DAUK’s Dr Natalie Ashburner in @DailyMirror @nashburner#COVID19 #testNHSstaffhttps://t.co/Mhd2UISZeF

— The Doctors’ Association UK (@TheDA_UK) March 19, 2020

The view from the NHS frontline is explained here:

https://youtu.be/WphmagWsCUI

Dr Samantha Batt-Rawden, an intensive care doctor and president of the Doctors’ Association UK, told Nick Ferrari that more doctors will die unless they get proper equipment.

In a further twist, healthcare workers who raise their concerns are facing being “gagged”. Helen O’Connor, GMB says in The Guardian “It is scandalous that hospital staff speaking out publicly face being sacked by ruthless NHS bosses

who do not want failings in their leadership to be exposed. Suppression of information is not just a matter of democracy, it is now a major public health issue.”

The Local Government Association has sent a letter to the Secretary of State for Health, Matt Hancock MP. It says that there is an urgent need for Government to move faster in making PPE available for the adult social care sector. Sufficient supplies that are of acceptable quality are needed immediately. Councils and their provider partners also need concrete assurances about ongoing supplies for the days and weeks ahead.

Councillor Alan Hall has written to the Director of Public Health for Lewisham seeking reassurances for both hospital and social care staff locally. The full letter is below:

Catherine Mbema
Director of Public Health – Lewisham

Dear Catherine,

I have been informed that the lack of Personal Protective Equipment for cleaning staff at Lewisham Hospital is a real concern. Trade Unions say that there is a shortage of supply and that staff are very worried. It has been described as “a total nightmare”.

As the Public Health Lead across Lewisham, I would be very grateful if you could raise the shortage of supply with the NHS and the Hospital and reassure us that PPE will be available.

Whilst I write, personal carers have reported shortages and inadequacies nationally. Can an assurance that all Lewisham Council and NHS staff have been provided with effective PPE?

May I take this opportunity to thank you and your team for all the incredible work that has been placed upon you. I have always campaigned against Public Health cuts and the short sightedness of this is surely been borne out now.

Kind regards,

Alan

Cllr Alan Hall

In an article on the United Nation’s website, there is a chilling message:

“COVID-19 will not be the last dangerous microbe we see. The heroism, dedication and selflessness of medical staff allow the rest of us a degree of reassurance that we will overcome this virus.

We must give these health workers all the support they need to do their jobs, be safe and stay alive. We will need them when the next pandemic strikes.”

Please help: NHS Staff need adequate PPE now https://t.co/XLsLDNaz5g via @socialisthealth

— Alan Hall (@alan_ha11) April 1, 2020

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Britain’s charities and voluntary organisations urgently require a financial support package from government so they can play their part in the coronavirus fight  and help some of the most vulnerable affected by the pandemic.
The call came from Unite, Britain and Ireland’s largest union, today (Tuesday 31 March), which represents tens of thousands of not for profit workers, as charities experience a dramatic slump in funding at a time when demand for their services, from housing to mental health, is soaring because of the virus.
Unite has joined forces with the National Council for Voluntary Organisations (NCVO) in calling for emergency funding for the sector. The NCVO has estimated that the sector could lose £4.3bn in income over the next three months.
Unite national officer for the community, youth and not for profit sector Siobhan Endean said: “Our members are keen to play their part in combating the coronavirus which will impact on some of the most vulnerable in society. Demand for charities’ services, from housing to mental health, has greatly increased.
“The voluntary sector is facing a crisis in funding, while meeting an unprecedented demand to support our communities. Our members are working incredibly long hours, with a lack of personal protective equipment and under immense pressure.
“We need urgent action from the government to ensure that the voluntary and not for profit sector and those employed in it are protected amidst the current crisis we find ourselves in.
“That’s why Unite has joined forces with the NCVO to call for a comprehensive financial package to underpin the sector at this extraordinary time.
“Government has rightly identified our members as ‘key workers’ and that’s why chancellor Rishi Sunak must unveil specific measures to assist the sector as a matter of urgency.”
Unite and the NCVO are making these key demands:
  • Emergency Mobilisation funding for frontline charities and volunteers supporting the response to the coronavirus crisis in the UK and globally through grants with a swift application process.
  • A ‘stabilisation fund’ for all charities to help them stay afloat, pay staff and continue operating during the course of the pandemic which would be  administered through the National Lottery.
  • Confirmation that charities should be eligible for similar business interruption measures announced by the chancellor for businesses and access to government rescue schemes.

Unite senior communications officer Shaun Noble

 

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Health visitors and community nurses going into the homes of families with children and babies urgently require personal protective equipment (PPE), Unite, Britain and Ireland’s largest union, said today (Tuesday 31 March).
Unite also wants PPE to go to the thousands of staff working in social care settings, such as care homes, who feel forgotten by ministers.
Unite assistant general secretary Gail Cartmail said: “Health visitors and community nurses need PPE equipment today as they offer high-level professional advice on home visits to the parents of tomorrow’s generation of adults.”
Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA), has joined the chorus of frustration from unions and professional organisations over the slow roll-out of PPE to NHS staff.
Unite assistant general secretary Gail Cartmail said: “The government needs to provide urgently an immediate, adequate and free-flowing supply of PPE to the hospital and community sectors of the NHS.
“And ministers should not ignore the forgotten army of thousands of dedicated workers employed in social care settings, who are often low-paid.
“We urge a redoubled effort by ministers to cut through the logistics’ logjams and get this equipment to the frontline where our brave doctors, nurses and other healthcare professionals are risking their health to save others.
“It is sometimes forgotten that health visitors and community nurses are out there every day visiting parents in their homes offering excellent advice on new born babies and young children.
“And while it is generally accepted that children are relatively immune from Covid-19, they or their parents may unwittingly have picked up the virus.
“The health visitor and community nurse role is particularly important now as parents are, quite rightly, extra anxious about their own health and that of their children.
“The least we can do is to see that the community nurse workforce has the right protective equipment.”
Unite lead professional officer for health visiting Obi Amadi said: “Our community practitioner members are working really hard to provide services in the community. In many areas, they have been struggling to keep themselves and those they are visiting safe because of the lack of PPE.  There is also a reported lack of hand sanitisers.
“The health and care staff working in the community play a vitally important  role, but feel they have not had access to enough PPE, nor been sufficiently recognised for their tireless below-the radar efforts at this time of national emergency.”

 

Unite senior communications officer Shaun Noble

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

  1. Global crisis

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

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

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

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

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

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

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

  1. The public health system

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

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

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

  1. Local government and social care

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

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

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

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

  1. The NHS

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

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

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

  1. Maintaining people’s standard of living

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

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

  1. Conclusion

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

24th March 2020

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All hospital car parking charges for NHS staff in England should be abolished this week as they combat the coronavirus, Unite, Britain and Ireland’s largest union, said today (Monday 23 March).
Unite, which has 100,000 members in the health service, said that NHS trusts in England were charging employees an estimated £50-to-£200 a month for the privilege of parking at their place of work.
Unite contacted shadow Labour health and social care secretary Jon Ashworth this afternoon asking him to raise the issue of abolition of the parking charges for NHS staff for the duration of the coronavirus emergency with his Conservative counterpart Matthew Hancock.
Unite said such a move, ideally this week, would remove the additional worry for NHS staff concerned about travelling on restricted public transport networks.
Unite national officer for health Colenzo Jarrett-Thorpe said: “It is a long-standing Unite policy that NHS staff should not be charged to park their cars for coming to work to look after the sick, injured and vulnerable.
“This is even more important and relevant, given that NHS staff are already risking their lives round the clock to save those suffering from COVID-19.
“We have been in touch with Labour’s shadow health and social care secretary Jon Ashworth this afternoon asking him to raise this with his counterpart Matthew Hancock as a matter of urgency.  
“NHS staff don’t need the additional worry of parking, especially when there are restrictions on public transport and it is safer in these times to drive to work than risk infection on trains and buses. 
“Many NHS staff are not well-paid and the fact that NHS trusts in England  are charging them £50-£200-a-month to park in normal times is wrong – in this exceptional period of national emergency, it is doubly so.”
Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.
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I sent this letter to the Scottish First Minister and health spokesperson with the PQs attached and and copied it to Welsh First Minister and Health spokesperson.

21 March 2020

Dear Nicola and Jean,

I am writing as a public health physician who is increasingly concerned about the apparent failure to implement fundamental public health measures to address the COVID-19 outbreak – specifically, community contact tracing and testing – and about what seems to be one of the knock-on effects of this failure, namely the blanket closure of schools.   

Tracing and testing of contacts, isolation and quarantine are the classic tools and approaches in public health to infectious diseases. According to the WHO, they have been painstakingly adopted in China in response to the COVID-19 outbreak, with a high percentage of identified close contacts completing medical observation; and they have been strongly recommended by the WHO for other countries.

In England, there are a lack of data – contact tracing appears to have been adopted only initially. According to modelling conducted by the authors of one of the papers published by the government yesterday, ‘The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19) (Keeling et al.) they expect that it would enable the outbreak to be contained :
“Aggregating across all individuals and under the optimistic assumption that all the contact tracing can be performed rapidly, we expect contact tracing to reduce the basic reproductive ratio from 3.11 to 0.21 – enabling the outbreak to be contained (figure 2). Rapid and effective contact tracing can therefore be highly effective in the early control of COVID-19, but places substantial demands on the local public-health authorities.”

The basic reproductive ratio, R0, is a standard epidemiological construct for understanding the epidemic potential of an infection; the higher the ratio, the more difficult it will be to control its spread. Ideally, R0 should be 0. If R0 is less than 1, an infected person will transmit the infection to less than one other person, and so the epidemic potential is critically reduced. On the basis of this modelling, if contact tracing is not being rigorously conducted now, the possibility of critically reducing the epidemic would be missed. The Keeling paper when taken together with the New York academics Shen et al  critique  raises serious questions about the validity of  Prof Fergusson’s  model (whose apocalyptic numbers were was used by the Westminster government to justify its approach.)  

I am truly concerned that contact tracing, testing, quarantine and isolation have not been exhaustively carried out before taking the blanket decision to close all schools. I have sent the opposition spokespeople for health at Westminster some suggested PQs that my colleague Peter Roderick and I have drafted, which I attach.

It is important to note that many areas in Scotland and elsewhere have a low number of cases and so at this stage by taking an area approach to vigorous and meticulous contact tracing and testing it should be possible to contain the disease – in Singapore, the BBC reports that the army has been called in to help with this. This would in time, with other measures, allow local areas on a school-by-school basis to safely consider reopening – and uphold each child’s right to education.

One of the major differences in this outbreak is that the outbreak is being managed centrally rather than being coordinated centrally, with insufficient foot soldiers on the ground. In England local authorities and Directors of Public Health cannot tailor responses to the local situation and are subject to central policy decisions. My colleagues in public health in local authorities say they have received very little information. This, combined with the devastating cuts to community-based communicable disease control and the changes wrought by the HSC Act 2012 which carved out public health from health services in England and then further fragmented communicable disease control by removing it to PHE have created a perfect storm.

I urge the Scottish government immediately to institute a massive centrally-coordinated, locally-based contact tracing and testing programme; and to discuss with local authorities, health boards, trade unions, public health and communicable disease control experts, schools and colleges and universities how this tried-and-tested classic approach would, with other measures, enable the blanket school closure decision to be modified in favour of a locally-based strategy.    

Scotland has been a pioneer for public health measures –it is important to reassert its expertise.
 
Yours sincerely,
Allyson Pollock

Professor Allyson Pollock, Professor of Public Health, Faculty of Medical Sciences, Newcastle University



Suggested draft PQs to the Secretary of State for Health and Social Care on contact tracing and testing

Summary

Contact tracing, testing of contacts and isolation are the classic tools and approaches in public health to infectious diseases. They have been adopted in China in response to the COVID-19 outbreak, and have been strongly recommended by the WHO. In England, there is a lack of data – contact tracing appears to have been adopted only initially, whilst the authors of one of the scientific papers published by the government today state that they expect that it would enable the outbreak to be contained.  

China

In February 2020, 25 experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, the US and WHO undertook a 9-day Joint Mission on COVID-19 to China.
It stated the following on contact testing:

“China has a policy of meticulous case and contact identification for COVID-19. For example, in Wuhan more than 1800 teams of epidemiologists, with a minimum of 5 people/team, are tracing tens of thousands of contacts a day. Contact follow up is painstaking, with a high percentage of identified close contacts completing medical observation. Between 1% and 5% of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location.

For example:
• As of 17 February, in Shenzhen City, among 2842 identified close contacts, 2842 (100%) were traced and 2240 (72%) have completed medical observation. Among the close contacts, 88 (2.8%) were found to be infected with COVID-19.

• As of 17 February, in Sichuan Province, among 25493 identified close contacts, 25347 (99%) were traced and 23178 (91%) have completed medical observation. Among the close contacts, 0.9% were found to be infected with COVID-19.

• As of 20 February, in Guangdong Province, among 9939 identified close contacts, 9939 (100%) were traced and 7765 (78%) have completed medical observation. Among the close contacts, 479 (4.8%) were found to be infected with COVID-19” (pp.8/9).

During the second stage of the outbreak, “[m]easures were taken to ensure that all cases were treated, and close contacts were isolated and put under medical observation” (page 15).

It is not clear from the report whether all contacts were tested, though they were apparently quarantined. Contacts have been both tested and quarantined in Singapore, where the army has been called in to help with tracing, according to the BBC.

In considering next steps for other countries, the report states (emphases added):
“3. Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts,and an exceptionally high degree of population understanding and acceptance of these measures.

Achieving the high quality of implementation needed to be successful with such measures requires an unusual and unprecedented speed of decision-making by top leaders, operational thoroughness by public health systems, and engagement of society.

Given the damage that can be caused by uncontrolled, community-level transmission of this virus, such an approach is warranted to save lives and to gain the weeks and months needed for the testing of therapeutics and vaccine development. Furthermore, as the majority of new cases outside of China are currently occurring in high and middle income countries, a rigorous commitment to slowing transmission in such settings with non-pharmaceutical measures is vital to achieving a second line of defense to protect low income countries that have weaker health systems and coping capacities. The time that can be gained through the full application of these measures – even if just days or weeks – can be invaluable in ultimately reducing COVID-19 illness and deaths. This is apparent in the huge increase in knowledge, approaches and even tools that has taken place in just the 7 weeks since this virus was discovered through the rapid scientific work that has been done in China.”

The mission recommended countries outside China with imported cases and/or outbreaks of COVID-19 to “[p]rioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts” (page 21).
England

Blogs by PHE CEO (Duncan Selbie) and PHE’s Deputy Director, National Infections Service (Nick Phin) in mid-February state that contact tracing was being undertaken:
“PHE now has a very extensive and complex contact tracing operation underway with health protection teams around the country diligently talking to people that might have been in close contact with carriers of the virus to assess their risk, provide advice and ultimately prevent further spread.”
“So far in the UK we’ve seen a small number of novel coronavirus cases.  At the moment we undertake contact tracing to prevent the infection spreading further. Contact tracing is a fundamental part of outbreak control that’s used by public health professionals around the world.”

There was no statement that those traced would be tested, isolated or quarantined, and apparently this would be done only if the contact developed symptoms:
“When we get in touch with a contact we provide them with advice on what to do if they become unwell or develop certain symptoms.  This way they can speak to the right health expert, so that the right advice can be given and right action taken.
If we believe a contact is at higher risk of infection they may be asked to self-isolate, remaining in their home and staying away from work, school or public places and we contact them daily until they can be given the all-clear.
If the person being monitored does develop symptoms, we would test them and provide them with specialist care if they have the novel coronavirus.”
There is also an implication in Nick Phin’s blog that as more cases develop, less contact tracing might be undertaken (emphasis added):
“Our experts have considerable experience at using contact tracing to prevent and contain outbreaks and to keep the public safe.

However, it does involve a lot of resources so as part of our comprehensive approach to tackling novel coronavirus in the UK, we’re putting extra resources into our contact tracing efforts. If the virus becomes established in the UK then we mayneed to move to a different phase of the response which focuses less on containment – but we are a long way off that.”

Concern has been expressed about the UK’s approach to contact tracing and testing – see, for example,  Martin Hibberd, professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine, quoted in The Guardian on 12/3/20 as saying that “the UK’s response ‘has clearly not been sufficient’. He and other experts called for much more extensive testing and tracing of the contacts of those diagnosed with Covid-19”.

The government published today the scientific evidence supporting its COVID-19 response. According to modelling conducted by the authors of one of the papers published, entitled ‘The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19) (Keeling et al.) :
“Aggregating across all individuals and under the optimistic assumption that all the contact tracing can be performed rapidly, we expect contact tracing to reduce the basic reproductive ratio from 3.11 to 0.21 – enabling the outbreak to be contained (figure 2). Rapid and effective contact tracing can therefore be highly effective in the early control of COVID-19, but places substantial demands on the local public-health authorities.”

The basic reproductive ratio basic reproductive ratio, R0, is a standard epidemiological construct for understanding the epidemic potential of an infection; the higher the ratio, the more difficult it will be to control its spread. Ideally, R0 should be 0. If R0 is less than 1, an infected person will transmit the infection to less than one other person, and so the epidemic potential is critically reduced. On basis of this modelling, if contact tracing is not being rigorously conducted now, the possibility of critically reducing the epidemic would be missed.  

We have not been able to find any data on contact tracing, the testing of contacts, isolation or quarantine in any part of the UK, and have not been able to find any PQs on the subject so far (despite the hundreds already tabled).

Draft PQs (1) and (2) below are therefore aimed at obtaining those data for England.

Draft PQ (3) directly addresses the government’s response to the expectation of the Keeling et al. paper published today.

Draft PQ (4) has been prompted by personal knowledge and conversations with other public health professionals, and concern that public health expertise in infectious diseases and in disease control more generally has been disappearing in local areas. 

Draft PQ (5) is wider than testing of contacts, but cost may very well be a factor that might have contributed to a lack of testing, and so we have suggested framing the question more broadly.

Draft PQs


(1) To ask the Secretary of State for Health and Social Care if he will specify, by local authority area, the contact tracing that is currently underway in England in relation to those who have been, or are suspected as having been, infected or contaminated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including (a) the number of personnel carrying out such tracing and (b) the number of close contacts (i) identified and (ii) traced.

(2) To ask the Secretary of State for Health and Social Care if he will specify, by local authority area, the number and percentage of close contacts of those who have been, or are suspected as having been, infected or contaminated with the severe acute respiratory syndrome coronavirus  2 (SARS-CoV-2), who (a) are undergoing testing (b) have tested positive and (c) have been isolated or quarantined.

(3) To ask the Secretary of State for Health and Social Care whether he is ensuring rapid and effective contact tracing in relation to COVID-19, in light of the authors of the Keeling et al. study entitled ‘The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19) published by the government on 20thMarch 2020, stating that “we expect contract tracing to reduce the basic reproductive ratio from 3.11 to 0.21 – enabling the outbreak to be contained”; and if not, why not.

(4) To ask the Secretary of State for Health and Social Care if he will publish the latest data for the numbers of (a) consultants in communicable disease control and (b) community infection control nurses, and c) their location by local authority area.

(5) To ask the Secretary of State for Health and Social Care if he will specify (a) the public bodies and/or (b) the companies which are carrying out the tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and explain the sensitivity and specificity of each test and their cost .
 
Allyson Pollock, Professor of Public Health, Newcastle University
Peter Roderick, Principal Research Associate, Newcastle University
20/3/20

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We have now launched another collaborative petition with the people at Change and have support from Health Campaigns Together and Socialist Health Association. 

It is likely other campaigns will support too in the next few days. Here is the link 

Change.org/NHS4all

Please sign and share widely. Please not only post on your own social media networks (though this is vital) but please include in your local group newsletters and prominently on your local group facebook and twitter pages – it might even be an idea to pin the post to the top of your timelines or facebook walls.

Also please take the time to write an email to your colleagues, fellow campaigners and friends asking them to sign too…

We’ve put together a model email for you to use here so it won’t take you long, it reads: 

 

“Dear ____

Keep Our NHS Public is helping launch a new petition putting six key demands to the government around its response to the Coronavirus pandemic. These demands cover a cross-section of our campaigning priorities, applied to the current moment of crisis  click here to read in full!

In the current climate, this petition could become absolutely huge, so we definitely need to get out the gate fast with sharing it. Please sign your name and share the petition to all possible contacts! SIGN HERE

On Twitter, we’re using the hashtags #NHS4All, #6Demands, #Covid-19, #SafetyFirst, #Coronavirus with #NHS4All as the main one.

Best”

 

Remember our last petition with Change received 1.3 million signatures and helped the organisation widen its reach, recruit unprecedented numbers and raise much-needed funds – so the bigger this is the better for all of us. And in this moment of isolation and likely imminent lockdown – it’s time at last to embrace, social media and digital campaigning!

Good luck and thank you from all the team.

In Solidarity

Tom Griffiths

Keep Our NHS Public

Campaigns Officer

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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
Unite, which has 100,000 members in the health service, strongly supports the call for retired nurses, those who have left the register and students in the last stages of their undergraduate training to volunteer for the fight against the coronavirus.
The Nursing and Midwifery Council (NMC), chief nursing officers of the four UK countries, and the Council of Deans of Health as well as health trade unions issued the call today (Thursday 19 March).
The two key requests are for:
  • Nurses and midwives who had left the profession in the last three years to join the Nursing and Midwifery Council (NMC) Covid-19 temporary emergency register so they can return to practice
  • For students in the final six months of their undergraduate course to work under supervision in hospitals wards and other parts of the NHS.
Unite lead officer for regulation Jane Beach said: “We are facing the worst public health emergency in the UK since the ‘Spanish’ flu at the end of the First World War. This is the supreme public health battle of our generation.
“Unprecedented events demand flexible and rapid responses, that’s why we are strongly supporting this call by the chief nursing officers of the four UK countries, the NMC and the health trade unions.
“We know that making changes to the way student nurses are educated in the last few months is an extreme measure, but we believe it is commensurate with the challenge we, as a society, face and so is the right thing to do.
“We thank our student nurse members for their feedback, which has informed our response to the discussions.
“We will be communicating with our members who have recently retired or left nursing to encourage them to consider coming back to help out during this national emergency.
“It is important to stress that for all, this is a choice. The detail will be in the guidance and we will continue to be involved in the development of this and in monitoring the implementation.”
The NMC has published the attached final joint statements and they are linked to its website which can accessed here www.nmc.org.uk/covid19
For more information please contact Unite senior communications officer Shaun Noble on 020 3371 2060. Unite press office is on:  020 3371 2065
Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

 

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