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    MASS TESTING PROGRAMMES FOR COVID 19 USING NOVEL TESTS

    SITUATION

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

    They claimed this programme was : –

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

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

    The stated aim of this pilot is to: –

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

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

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

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

    ASSESSMENT

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

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

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

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

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

    What are these concerns?

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

    1 Accuracy of the tests

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

    Sensitivity

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

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

    Specificity

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

    2 Design and evaluation

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

    Their design lacks transparency and a clear set of objectives.

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

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

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

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

    3 Follow up of positive cases and their contacts

    More cases will generate many more contacts to follow up

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

    4 Ethical issues

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

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

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

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

    4 Sustainability

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

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

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

    5 Overload of local authorities and public health teams

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

    Their priorities should be to: –

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

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

    6 Implementation

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

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

    Conclusion

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

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

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

    RECOMMENDATIONS

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

    References

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

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

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

    Operation Moonshot proposals are scientifically unsound]

    Jonathan J Deeks, Anthony J Brookes, Allyson M Pollock

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

     

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

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

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

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

    8

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

     

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

     

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

     

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

     

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

     

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

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

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    Issue: 111 – 10 November 2020

    Pfizer Covid-19 Vaccine

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

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

    Very Steep Rise in Secondary School Covid-19 Infection Rates

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

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

    https://neu.org.uk

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

    Hospitals are Breeding Grounds for Covid-19 Infections

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

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

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

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

    www.nspcc.org.uk

    www.childline.org.uk

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

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

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

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

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

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

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

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

    More at:

    https://allysonpollock.com

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

    Reduced Support for the Homeless in Lockdown 2

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

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

    One week into Lockdown 2

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

    Southall Park: 265.3 became 244.1

    Ealing Broadway: 247.6 became 281.4

    Acton Central: 147.8 became 113.7

    West Ealing: 132.9 became 122.9

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

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

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

    Town/Hospital Based NHS Activist Groups Slowly Being Marginalised

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

    NHS NWL EPIC

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

    Public Involvement Charter (PIC)

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

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

    Eric Leach

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

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

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

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

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

    MENTAL HEALTH

    £400 Million Announced to Revamp Mental Health Facilities

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

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

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

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

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

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

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

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

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

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

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

    NHS Test and Trace

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

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

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

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

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

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

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

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

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

    Just type in your post code at:

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

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

    Eric Leach

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    Former Health Secretary, Jeremy Hunt, probably Britain’s worst leader since General Percival surrendered an army of over 80,000 soldiers to 36,000 Japanese soldiers at Singapore in 1942. It was the worst ever British defeat and led directly to the dreadful Japanese concentration camps. Hunt was in charge of over a million highly committed NHS professionals with oversight of Social Care, looking after nearly a million people. He surrendered these to a succession of debilitating neo-liberal reorganisations, privatisations and defunding regimes. Like Percival he could have fought for his people, but chose not to, and England is paying a high price.

    Percival’s reward was the pension of a Major General. Some think Hunt’s reward may be selected as the next Prime Minister. Think again.

    Apart from his duplicity with data, his bullying of Junior Doctors, and his hypocrisy in praising the NHS and shrinking nurse’s pay, there is the question of his ability to manage. Managerial incompetence is a common trait in this Conservative government, as exemplified by Grayling, Hancock, the Prime Minister, Priti Patel and others in the Cabinet.

    Hunt the manager.

    In every good organisation there are key performance indicators whose sole function is to help the executive steer the organisation most effectively. In British Rail one was trains on time. The purpose was to keep the passengers safe and satisfied, as the most important need was reliability, not speed, as the politicians keep getting wrong.

    A key indicator in Social Care was the performance of transferring patients from the hospitals back into their homes and care homes. The indicator was called Delayed Transfer of Care (DToC), which meant that something was preventing the patient from being discharged when they were better. It was measured by the month. It was a very important indicator, for two main reasons:

    • Cost: Each time the transfer from the hospital failed on average it causes up to 31 bed delays, i.e. unavailability. The cost of this is about £400/day, compared with £90/day in a home. So each DToC generates a net loss to the NHS of at least £300×31, i.e. about £9,000. At the time of Hunt’s appointment these Social Care DToCs were averaging 1050/month – a net loss of £9.5 million per month and steady.
    • Care: Patients who are well enough to go back get more ill if they stay in hospital, especially if they are elderly, thus occupying beds for much longer. They also require extra attention from busy nursing staff who are not always used to dealing with the elderly. There is also an increased risk of readmissions.

    The Department of Health details reasons for these delays, 40% of which are generated within Social Care. These are the major reasons, respectively: Awaiting Care Package at Home, Awaiting residential home placement or availability, and Awaiting nursing home placement or availability. As all these delays generate extra bed demands in Acute Care as well as, so to address these immediately would be a win/win, an act of intelligent leadership, especially for an opportunist like Hunt.

    Now, the bad news for Hunt: He has no organisational leadership qualities at all, especially when it comes to doing what is best for the organisation, i.e. the good of the users, the employees and the community. If he had he would have predicted a serious problem emerging in social care, and consequently a rise in the transfer of social care patients into acute care.

    Hunt became Secretary of State for Health in 2012. At that point Care DToCs were running at 1050/month, but trouble was on the horizon. Back in 2011 Nicholson, the CEO, set the NHS and Social Care the challenge of taking out £18 – £20 billion by 2014. Why? It was a classic act of hubris which of, course, the health system paid for. It was to be efficiency savings; but how? The care system was short-staffed, underfunded and, because of the privatisation, in negative productivity. Overworked and underpaid staff, the main source of innovation, were in no position to study ways of improvement. Morale was falling and the staff turnover was 27%.

     

    Hunt should have stopped it, but did not care, or have the nous – or else was confusing fewer staff per user as a sign of efficiency. Either way he should have kept his eye on the statistics. Social Care is a major driver of demand in the NHS. The better the care, the lower the rate of admissions into Acute Care: a very simple equation.

    By 2015 there were ominous signs. The rate of DToCs was beginning to rise in a statistically significant way. The trend was clear. The average was rising to 1250, a 19% increase. Any executive worth their salt would have instituted an instant investigation. Hunt did not. His NHS 10 Point Efficiency Plan mandated the “freeing up about 2000 to 3000 beds by ceasing DTOC delays in social care.” Just like that, like Napoleon instructing his troops to conquer Moscow – winter. There was no strategy, no plan that mapped out the route. Just an edict, and like Napoleon, thing got a lot worse.

    The average for the years 2016 to 2018 rose to 1900 DToCs, 80% greater than in 2012 – so much for “ceasing” DToC delays. It was not a plan but a target, and a silly one. This is worth unpacking. In five years Hunt oversaw an increase of about 900 DToCs from the Care sector alone. This is an increased loss of £8.1 million per month, or close to £100 million a year.

    Just how many staff in Social Care would that have paid for at £25,000 a year? The turnover would have stopped, the facilities enhanced (including private care) and morale and user satisfaction improved.

    These cold statistics disguise the misery of the people involved, nurses, carers, families and, most of all, the users, mainly the elderly. As Neil Kinnock said prophetically of the Tories if they got in:          I warn you not to fall ill, and I warn you not to grow old.”

    In summary, in the first three years of his appointment the total loss due to DToCs was £114 million a year. In 2015 Hunt sat on his hands, no doubt transfixed by Stevens’ unnecessary reorganisation along USA private care lines. Over the next three years the total loss would be £205 million per annum. The damage to the NHS and Social Care is incalculable. And remember we are only looking at 40% of all the DToCs, i.e. half a billion pounds a year. Much of that could have gone into PPE stock replenishment.

    A final irony: In Hunt’s 2016/17 NHS 10 Point Efficiency Plan the target mandated was to “reduce Delayed Days to 4000/day, which translates into 124,000 per month by September 2018”. This equates to 4000 Delayed Transfers of Care per month across the NHS and Social Care – a figure that is actually higher (worse) than they had been achieving regularly in 2010 – 2013! But what makes it even more damning is that it was, statistically, an unachievable demand. The average for 2016/17 was 4560 DToCs and the lower control limit was 4995, which meant that statistically there was less than a 1/1000 chance that it could be achieved. Setting unachievable targets is feature of Hunt’s tenure. Caroline Molloy details these in her withering assessment of Hunt in her article What did Hunt do to the NHS – and how has he got away with it? (Open Democracy, July 13, 2019).

    Matt Hancock now grasps the poisoned chalice Hunt has handed him. Luckily he is an optimist and probably sees it as a great opportunity. One day he may also be rewarded with the Chair of the Health and Social Care Select Committee like Hunt, for the utter failures, especially the disaster of his outsourcing of test and trace to private companies (0ver £10 billion), greatly exacerbating effects of the terrible Covid-19 pandemic in 2020.

    Dr John Carlisle

    Chair, Yorkshire SHA

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    The Camden New Journal (CNJ) have published the sixth article about the NHS written by Susanna Mitchell and Roy Trevelion. You can see it on the CNJ website under ‘Forum’ published on 16 July 2020 here. Or you can read it below:

    Neglect and inadequate excuses lie at the heart of the government’s failures, argue Susanna Mitchell & Roy Trevelion

    It is understood that there will be a public inquiry into the UK’s handling of the coronavirus pandemic.

    This should begin now, and not when the current crisis is over. Criticisms will be focused on the government’s disastrous response:

    Its initial adoption of a “herd immunity” strategy.

    Its failure to provide health care workers and others in front-line positions with adequate personal protective equipment (PPE).

    The shambolic state of its belated testing and tracking operations, including the collapse of its much-heralded app.

    Its reliance on private contractors with no relevant experience to supply services and equipment that they were subsequently unable to deliver.

    Critically, it will be claimed that all the measures taken were put in place far too late. With the result that the UK now has the highest death toll in Europe. The proportion of care-home deaths is 13 times greater than that of Germany.

    All these accusations are currently being met with the excuse that the Covid-19 pandemic was unprecedented. The government claims it has worked to its utmost capacity to control and manage the outbreak.

    But this narrow focus on what was done once the virus had established itself in the country is completely inadequate.

    Rather, any inquiry must examine the long-standing reasons why the country was unable to deal with the situation in a more efficient way. Unless this is done, the necessary steps to improve our handling of future pandemics cannot begin.

    For a start, the argument that government was taken by surprise by a global viral attack is false.

    To the contrary, a research project called Exercise Cygnus was set up in 2016 to examine the question of preparedness for exactly this eventuality.

    Its report was delivered in July 2017 to all major government departments, NHS England, and the devolved administrations of Scotland, Wales and Northern Ireland.

    The report concluded that “…the UK’s preparedness and response, in terms of its plans, policies and capability” were insufficient to cope with such a situation.

    It recommended NHS England should conduct further work to prepare “surge capacity” in the health service and that money should be ring-fenced to provide extra capacity and support in the NHS.

    It also stated that the social care system needed to be able to expand if it were to cope with a “worst-case scenario pandemic”.

    These warnings, however, were effectively ignored.

    One government source is reported as saying that the results of the research were “too terrifying” to be revealed.

    And a senior academic directly involved in Cygnus and the current pandemic remarked: “These exercises are supposed to prepare government for something like this – but it appears they were aware of the problem but didn’t do much about it… basically [there is] a lack of attention to what would be needed to prevent a disease like this from overwhelming the system.

    “All the flexibility has been pared away so it’s difficult to react quickly. Nothing is ready to go.”

    But the reason that the system was too inflexible and unprepared lies squarely with the government’s actions during the last decade.

    The Health and Social Care Act of 2012 ruinously fragmented the system.

    The austerity and privatisation of these polices have lethally weakened both the NHS and the social care services.

    As a result, the NHS is under-staffed, under-equipped and critically short of beds, while the social care service is crippled by underfunding almost to the point of collapse. It is therefore vital that we do not allow any inquiry to be limited to an examination of recent mistakes.

    The government’s bungled handling of the present crisis was virtually inevitable within a public health system depleted and rendered inadequate by their long-term policies.

    No post mortem can achieve a productive conclusion unless it is understood that these policies were the root cause of the shambles.

    If we are to avoid another catastrophe, these policies must be radically changed with the minimum of delay, and public health put back into public hands.

    • Susanna Mitchell and Roy Trevelion are members of the Socialist Health Association.

    Other articles written by Susanna Mitchell and Roy Trevelion are:

    Don’t allow the price of drugs to soar: Drug pricing is still a critical issue for the NHS http://camdennewjournal.com/article/dont-allow-the-price-of-drugs-to-soar?sp=1&sq=Susanna%2520Mitchell

    Beware false prophets: Don’t be fooled by the Johnson government’s promise of new money. It masks a move to further privatise the NHS
    http://camdennewjournal.com/article/nhs-beware-false-prophets?sp=1&sq=Susanna%2520Mitchell

    Brexit and the spectre of NHS US sell-off: Americanised healthcare in the UK – after our exit from the EU – would only benefit global corporations
    http://camdennewjournal.com/article/brexit-and-spectre-of-nhs-us-sell-off?sp=1&sq=Susanna%2520Mitchell

    Deep cuts operation threatens the NHS: The sneaking privatisation of the NHS will lead to the closure of hospitals and the loss of jobs
    http://camdennewjournal.com/article/deep-cuts-operation-threatens-nhs-2?sp=1&sq=Susanna%2520Mitchell

    Phone app that could destroy our GP system: A private company being promoted by government to recruit patients to its doctor service spells ruin for the whole-person integrated care we need from our NHS
    http://camdennewjournal.com/article/phone-app-gp?sp=1&sq=Susanna%2520Mitchell

     

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    A deserved boost in pay for NHS staff, who have battled through the pandemic, is ‘the elephant in the room’ in the latest plan for the health service in England, Unite, Britain and Ireland’s largest union, said today (Thursday 30 July).
    Health and social care secretary Matt Hancock today welcomed the launch of the NHS People Plan as a new bureaucracy busting drive, so staff can spend less time on paperwork and more time with their patients.
     
    Unite, which has 100,000 members in the health service, said that the aims of this latest plan for the NHS would be hampered by the fragmentation caused by the 2012 Health and Social Care Act with its remit for increased competition for NHS services.
    Unite national officer for health Colenzo Jarrett-Thorpe said: “There have been a plethora of plans for the future of the NHS over the years and this latest manifestation neatly avoids ‘the elephant in the room’ – that of NHS pay.
    “NHS staff have worked ceaselessly throughout the pandemic at great risk to themselves and a generous pay rise would recognise that dedication as well as staunch the ‘recruitment and retention’ crisis that is currently afflicting the NHS – for example, there are about 40,000 nursing vacancies in England alone.
    “It is all very well for the plan to trumpet bureaucracy busting measures, but it was the flawed 2012 Act of the then health secretary Andrew Lansley that created the extra bureaucracy by fragmenting the NHS in the first place.
    “One of the key chapters of the People Plan is ‘belonging to the NHS’. This terms rings hollow to thousands of health visitors and school nurses cast outside the NHS; or the catering, cleaning, portering and maintenance staff that have been outsourced to private contractors or dispensed to wholly owned subsidiaries.
    “The English ideological obsession with marketisation and privatisation in the NHS must be terminated without delay and this report does nothing to address this.
    “We, of course, welcome such measures in the plan as boosting the mental health and cancer workforce; full risk assessments for vulnerable staff, including BAEM workers; and all jobs to be advertised with flexible working options from January.
    “But without addressing the issue of pay, highly skilled NHS staff will consider looking for more lucrative work elsewhere, possibly abroad.”
    Last week, chancellor Rishi Sunak awarded up to a 3.1 per cent pay rise for 900,000 public sector workers, including doctors, teachers and police officers. Unite accused the chancellor of having ‘a selective memory’ when it comes to public sector pay, rewarding some, but ignoring hundreds of thousands of others.

    Unite senior communications officer Shaun Noble

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    The damning report by MPs into hospital patients in England being discharged into care homes without a Covid-19 test reinforces the need for a public inquiry, sooner rather than later, into the government’s handling of the pandemic, Unite, Britain and Ireland’s largest union, said today (Wednesday 29 July).
    The influential cross-party Public Accounts Committee (PAC) accused ministers of being slow to support social care during the crisis. The initial decision to allow untested patients into care homes was an ‘appalling error’.
    Unite assistant general secretary Gail Cartmail said: “The committee’s findings are a welcome first step, but MPs need to dig deeper into the long-standing crisis in social care.
    “Covid-19 has heightened attention on the underlying shortcomings in the social care system that have been building up for decades.
    “The pain and distress of families whose elderly relatives died in care homes because of the government’s flawed policy will be forever etched in the nation’s memory.
    “We need swift government action on the broken business model, so prevalent in the world of privatised care, with measures to tackle the underpayment of the workforce and, what Unite members tell us, measures to address the inadequate training they receive in such areas as infection control.
    “The social care sector is predicated on an environment of insecure work leading to multiple work placements.
    “The workforce needs job security, decent pay that recognises their skills and assurances on the basics, such as adequate PPE and sanitation provisions.
    “There also needs to be a safeguarding structure for workers disproportionately at risk, such as those from the BAEM communities.
    “Today, Unite repeats its call for a public inquiry into the government’s handling of the pandemic.
    “This inquiry should happen, sooner rather than later, as we suspect that Boris Johnson wants to play for time before such an inquiry is set-up as it will expose the lamentable failings of his government during this national emergency which has seen more than 45,000 lives lost to Covid-19.”
    The PAC said about 25,000 patients were discharged into care homes in England between mid-March and mid-April to free up hospital beds. After initially saying a negative result was not required before discharging patients, the government then said in mid-April all patients would be tested.

    Unite senior communications officer Shaun Noble

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    Unite NHS members will be at the forefront of a march to Downing Street tomorrow (Wednesday 29 July) to show their anger at being overlooked in the latest round of public sector pay rises – despite more than 500 NHS and social care staff dying from Covid-19.
    The Unite branch at Guy’s and St Thomas Hospital will be marching to Downing Street at 18.00 tomorrow from St Thomas Hospital, Westminster Bridge Road, SE1 7EH to protest at the government’s decision to put off a pay rise for NHS staff until April next year – when the three year pay deal comes to an end. The march will be attended and supported by NHS staff across London.
    Last week, chancellor Rishi Sunak awarded up to a 3.1 per cent pay rise for 900,000 public sector workers, including doctors, teachers and police officers. Unite accused the chancellor of having ‘a selective memory’ when it comes to public sector pay, rewarding some, but ignoring hundreds of thousands of others.
    Unite national officer for health Colenzo Jarrett-Thorpe said: “Nursing staff and other allied health professionals have reacted with anger to being overlooked when pay rises were given to many in the public sector last week and the government not hearing the health trade unions’ call to bring their pay rise forward from April 2021.
    “This sense of anger was heightened, especially in light of their work and sacrifices during the global pandemic which has taken the lives of more than 500 NHS and social care staff across the UK.
    “We are facing a perfect storm for recruitment and retention in the NHS – in a decade of Tory austerity, NHS staff have seen their pay cut by 20 per cent in real terms and many are considering leaving the health service; at the same time, there are about 40,000 nursing vacancies in England alone.
    “This crisis is also being exacerbated by the scrapping of the student bursary, which is putting off many who may have considered becoming one of the next generation of nurses.
    “What we have seen in the last few months is generous praise, warm words, and lots of Thursday evening clapping by ministers; yet we got a flavour of the government’s true feelings with Rishi Sunak’s lack of a pay announcement for NHS staff last week, with no statement dealing with our call to move the pay of NHS workers forward.
    “The public expects – and ministers should deliver – a substantial pay increase for NHS staff that reflects their real worth to the NHS and society more generally. NHS workers shouldn’t have to wait till April 2021.”
    Unite branch secretary at Guy’s and St Thomas Hospital Mark Boothroyd said: “We have called this demonstration to express the anger that so many of our members feel at the government’s derisory treatment of NHS staff.
    “After all our sacrifice during the pandemic, to exclude us from the pay deal and make us wait till April 2021 is a slap in the face, and our members are going to Downing Street to tell Boris Johnson this directly.”

     

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

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

    1. Austerity (2010-2020)

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

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

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

    1. Poor political leadership (PM and SoS Health)

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

    1. Social care

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

    1. Inequalities

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

    1. Privatisation

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

    1. Recovery Planning

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

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

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

    NHS and NIHR

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

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

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

    A wealth tax?

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

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

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

    Populism and COVID

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

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

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

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

    27.7.2020

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

    Comments Off on SHA COVID-19 Blog 20

    The BMA is urging the Government to ensure more people take advantage of routine vaccinations after a concerning fall in coverage rates in recent years.

    In a report published today, the Association says that many immunisation programmes have been disrupted because of the pandemic as the NHS focused on responding to immediate health concerns and now it’s imperative that they are re-started and that people are encouraged to be immunised.

    It also notes that childhood vaccination in particular has plummeted during this time – dropping by around a fifth in total – despite advice that childhood immunisation should continue during Covid-19.

    According to NHS Digital, and highlighted in this report, coverage for the first dose of the MMR vaccine in England was at 94.5% in 2018-19, down from 94.9% in 2017-18 and below the 95% target set by the World Health Organisation (WHO).

    The BMA’s report says that making people aware of the benefits of routine vaccinations, such as the MMR vaccine, is vital. This is not just for their wellbeing, but also when we consider worrying reports about a lack of confidence in a potential Covid-19 vaccine and the implications that could have for general uptake.

    Altogether, the BMA is calling for action to:

    • widen vaccine availability and target specific populations
    • ensure adequate funding to deliver fully resourced immunisation services
    • raise public awareness and understanding of immunisation programmes
    • ensure health service IT supports vaccine uptake
    • increase vaccine uptake among NHS workers

    Dr Peter English, BMA public health medicine committee chair, said: “It’s been incredibly worrying to watch the decline in vaccine rates in the UK over the past few years –  for example, we lost our ‘measles-free’ status in 2019 and the pandemic has of course meant even fewer vaccinations have been carried out as the NHS battled on all fronts to keep the virus at bay.

    “Routine vaccination is so important, and many doctors can remember a time without it. Vaccination against common but often serious ailments has changed the face of public health and are rightly ranked by WHO, alongside clean water, as the public health intervention which has had the greatest impact on the world’s health.

    “That’s why, as we recover from this pandemic, everything must be done to increase vaccine uptake – particularly as we head into flu season and vulnerable people are at greater risk of becoming ill.

    “This means not only making sure the public understands the importance of getting vaccinated, but also resourcing the health service with what it needs to deliver this; adequate funding for immunisation programmes, IT services, and encouraging staff to protect themselves too.

    “Health has never been more at the forefront of people’s minds, and the Government needs to utilise this as a matter of urgency – not just for the sake of the population now, but the generations that follow.”

    Oliver Fry

    The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

    Posted on behalf of the BMA by Jean Hardiman Smith

    Comments Off on More people need to be encouraged to take up routine vaccinations as we recover from Covid-19, BMA warns

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

    Blame Game

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

    Local Authorities and their Public Health teams

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

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

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

    Local data

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

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

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

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

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

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

    Workers and Employers

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

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

    Civil servants

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

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

    National Audit Office

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

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

    Vaccines and global health

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

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

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

    Gramsci

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

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

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

    20.7.2020

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

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