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    THE GOVERNMENT’S DUTY TO KEEP THE PUBLIC SAFE OUTSOURCED TO THE PRIVATE SECTOR

    HANCOCK INCREASES PRIVATISATION BY STEALTH

    On Monday, the news broke that contact tracking and tracing (the next stage in managing the pandemic) will be outsourced to the private sector in the form of at least two private call-centre operators, one of which is Serco. They are providing 15,000 or more staff who, after one day of training, will be given a script to follow in conversations with people who have been in contact with confirmed cases of Covid-19.

    Ministers have been using the pandemic as an excuse to by-pass “normal” procedures for awarding Government contracts which involve invitations to tender and have been awarding contracts to a string of private companies and management consultants with no open competition.

    Even these “normal procedures” are a way the Tories privatise the NHS – the way they first began to do it – by insisting services which had previously been provided in-house by NHS employees, be “put out to tender”. Which is how firms like Carillion which went bust in Jan 2018 leaving debts of £7 billion, G4S, ISS, Sodexo, Bouygues and others came to be the employers of hospital porters, cleaners and catering services. A privatisation process dating back to 1979 and the Thatcher government and including more recently the Private Finance Initiative supported by the Labour Government of Tony Blair, but accepted as a disastrous debt-generator by subsequent Labour leaders.

    The Government has proved itself totally inept at managing the health crisis caused by the Coronavirus. It ignored the findings of Exercise Cygnus in 2016 which forecast the need – in the event of a pandemic – for ventilators, PPE and all the equipment which the NHS now faces a dangerous shortage of. The Government did not want to spend the money. In fact it has been cutting the NHS to the bone instead.

    Worse than cutting the funding, it has also been cherry-picking lucrative bits of the NHS and offering them to private investors for private gain at the expense of service to patients.

    When Johnson said “The NHS saved my life”, voters may have concluded “the NHS is safe in his hands. The Government understands how important it is now.” They do, but ten years of deconstructing the national service, outsourcing and privatising have gathered momentum and still retain their ideological grip on this government with its zero experience of worry about where the rent is coming from, or the next meal. The NHS has been viewed by the Tories as a potential cash cow for private investors and their already-rich Tory-supporting friends and it still is as these contracts for testing and tracing illustrate.

    At the beginning of the Covid Crisis, the SHA said, as did most of the medical profession and its journals, a range of statisticians, forecasters, epidemiologists and other scientists, that the dismissive and over-confident decisions of Johnson and Trump were seriously ill-founded; that pursuing the idea of “Herd Immunity” would mean that the NHS would be overwhelmed, and that the Government should accept the hand of friendship from the EU and other countries which offered to share sourcing of needed equipment (despite the “we can do better on our own” series of snubs to the rest of Europe, emanating from the UK Tory Government since 2016).

    These commentators urged the adoption of effective measures.

    1. To slow down the spread so the emergency services could cope, hence the lockdown, though the UK Government was slow to introduce it compared to other countries.

     

    1. To test for the virus and trace the contacts of those infected, so the lockdown could be relaxed without a second wave of the epidemic. Again the UK Government was slow to implement this. SHA President and Prof. of Public Health, Allyson Pollock said that tasks including testing, contact tracing and purchasing should be handled through regional authorities rather than central government.

    This was delayed while a private sector plan was cobbled together presumably to pre-empt the NHS, local authorities and other public sector bodies being asked to do the same, though they have a greater range of contacts, experience and expertise in spite of the relentless down-grading of the public health infrastructure and the budgetary strangulation of local councils.

    1. This would give time for a longer-term solution, and the development of a vaccine to reduce the numbers likely to get Covid-19 again, or reduce its severity.

    Firms such as Serco, Mitie, Boots, Deloitte, KPMG, and a US “data-mining” group called Palantir, have already acquired the rights to manage Covid-19 drive-in test centres, the building of the Nightingale Hospitals, and the purchasing of PPE. Deloitte, for example, is a multinational “professional services network” and one of the largest accounting organisations in the world, managed to acquire a contract to advise the Government on PPE purchases a few weeks ago. It thus took more decision-making authority from the NHS and local authorities, and shifted more power from the frontline. “It’s a power grab”, said Rosie Cooper MP, and we must protest in the strongest possible terms.

    Deloitte has had a poor track record in delivering PPE to the front line since the pandemic began, and taking more decision-making from NHS managers and local authorities shifts power further from the frontline and money for services into private pockets  The tax-payer pays for declining service.

    The Guardian said that NHS Trusts have now been instructed by the DHSC to stop buying their own PPE and ventilators or high value equipment for more general use in hospitals such as mobile X-ray machines, CT scanners and ultrasound machines.

    The system of tracking and tracing will be enabled by an NHS app on smart phones that alerts people that they have been near someone known to have the virus, or if they come into contact with an infected person in the future. Calling it an “NHS app” is no doubt intended to reassure people who might not want to use a Serco or Deloitte app for fear of what might happen to data on where they have been and to whom they might have been close. However, most of the contact tracing work will be contracted out to Serco and at least one other private-sector firm.

    The app goes on trial on the Isle of Wight this week. Supporters of the SHA on the Island (currently busy in a cooperative project of people with sewing machines, recycling donated duvet covers and sheets into scrubs for the frontline) tell us that it went live yesterday with NHS and Council staff, and will reach the rest of the Island by Thursday.

    The Isle of Wight was chosen as an area relatively cut off from the rest of the country during the lockdown, so a good place to study the spread of a virus. Currently there are limited ferry services for lorries transporting food and medicine and for ambulances to transfer serious medical cases to Southampton or Portsmouth. In addition the population is older than the UK average and fewer people have smart phones, so if it works reasonably well in those circumstances it should work even better nationally, says Hancock.

    South Korea did not go into lockdown. It adopted a strategy of widespread tracing and mass testing. Take-up would have to be very extensive for this to work here. There will be resistance to detailed personal data being collected by a multinational company. David Blunkett tried to get us to all have ID cards after 9/11 and met strong opposition from civil rights lawyers, trade unions and, indeed, Tories.

    The government is using the pandemic to transfer key public health activities from the NHS and other state bodies to the private sector. In 1977, Nicholas Ridley wrote a pre-Thatcher plan for the Tory Research Department in which he outlined a strategy of “privatisation of the NHS by stealth”.  “Managing” Covid 19 presents a good opportunity for taking this  further, building on the destructive intent of the 2012 Health & Social Care Act enabling a Tory government to give even more taxpayers money to the private sector.

    Testing and tracing is to be given to the public limited company Serco and others as yet undisclosed, but likely to include the security services firm G4S. Serco became infamous   for having tagged thousands of criminals who either did not exist or were dead and “other botched government contracts”, reported The Financial Times in 2015. The chief executive is Rupert Soames, appointed to turn around the business (whose shares had dropped 50%) who in turn recruited Sir Roy Gardner as Chair and replaced almost the entire board.

    Now, Serco has been appointed by the Johnson Administration to perform public health tasks in England for which it has little experience and little credibility with the general public. This tells you all you need to know about the current Government. Forget all the PR post Covid survival thanks to the NHS and the protestations of undying love for it.

    The real values of the Government are revealed in this move to spread public largesse to its own, although it will rely on public support for the NHS to get people to allow data on their every movement to be collected by a spy on their phone

    The reason why the NHS gets such massive support is because the general public use it, see it first-hand, recognise its skill and, crucially, know – in some imprecise way – that it is “theirs”.  It exists to look after all who come to it for its skills, whether Prime Ministers,  homeless veterans, newly born babies, or those beyond cure but never beyond care. And free at the point of use.

    In contrast, however well run Serco might be, and however well it learns in three weeks what it has taken local government and the NHS decades to absorb, its first duty is to its share holders and the need to pay a dividend.   In this century it will never get the trust that the NHS acquired in the last. Trust and values matter, especially where using personal information and getting the co-operation of millions of the public is concerned. The Times  reported Grant Shapps, the Transport Secretary, as saying the Government would have to make downloading the app “a duty to the NHS”.

    Further, at a time when it is abundantly clear that the NHS, local government, and bits of the already part privatised social care system cannot continue with the pre-Covid-19 settlement, the Serco option is as old fashioned as it is unwise.

    This is one part of the Government’s plan that Labour has to expose and oppose. Now!

    Vivien Walsh & Tony Beddow

    Comments Off on News from the Frontline 06.05.20

    Scientists and health experts believe that the government should examine a range of new antiviral technologies while planning their lockdown exit strategy.

    They say that there are at least half a dozen such technologies and strategies that could be combined to help make any exit strategy more effective – and help avoid a second peak in Covid-19 infections and deaths.

    Potentially useful technologies include newly-developed anti-surface-contamination products, virucidal face masks, and new ultraviolet light and virus-detection ioniser systems.

    Health experts believe that plans should immediately be formulated to commission the manufacture and supply of a range of vital equipment that would be needed in order to deploy those technologies – some as part of an exit strategy and others to prevent a potential second pandemic wave later this year.

    “Each technology and strategy is capable of helping to reduce the transmission of coronavirus – but by deploying a range of them, as part of an integrated coordinated national anti-viral program, the impact would almost certainly be much greater,” said Professor Kevin Bampton, the chief executive of the British Occupational Hygiene Society, which represents 1,600 UK professionals involved in disease prevention and health security in factories, offices and other workplaces throughout Britain.

    The full report can be found published on the INDEPENDENT here

    Posted by Jean Smith with the permission of the author.

    2 Comments

    This is now the 8th weekly Blog published by the Socialist Health Association (SHA) commenting on how the Coronavirus pandemic is progressing both locally and globally. The lens we use is a socialist worldview where we aspire to One World and Planetary Health and are as concerned to reduce global as well as local health inequalities. The Covid-19 pandemic has shone a light on local inequalities within the UK as well as stark global inequalities where people find themselves exposed and unable to follow the advice we receive in the UK and other rich countries to social distance and pursue rigorous hand hygiene.

    Health inequalities in the UK

    Last week the Office of National Statistics (ONS) published a report on Covid-19 deaths by local area and by socioeconomic deprivation (www.ons.gov.uk). This covered the period from the 1st March to the 17th April. During this period there were 90,232 deaths in E&W and of these deaths 20,283 involved Covid-19.

    Unsurprisingly London had the highest age-standardised mortality rate with 85.7 deaths/100,000 people involving Covid-19. This is significantly higher than any other region and almost double the next highest rate. In these SHA Blogs, one of our observations has been that London was the early hotspot and should have been shutdown much sooner and been our ‘Wuhan’. Remember all the press reports of bars and restaurants remaining open and people packed into London underground trains and buses?

    In London Covid-19 deaths were 4,950 amounting to 42% of deaths since the beginning of March compared to 1,051 deaths in the South West region of England, which was only 13% of total deaths there. The eleven Local Authorities with the highest mortality rates were all London boroughs with Newham, Brent and Hackney suffering the highest rates. Outside London rates are high in Liverpool, Birmingham and Manchester.

    Newham has the highest age standardised death rate with 144.3 deaths /100,000 population followed by Brent with 141.5 and Hackney with 127.4. In Newham 78% of its population are in BAME groups and 48% live in poverty after rent and household income are taken account of. The three London boroughs are in the most deprived group and across England the most deprived areas have a death rate of 55.1/100,000 compared with 25.3 in the least deprived (118% difference).

    The Index of Multiple Deprivation (IMD) is an overall measure based on income, employment, health, education, crime, the living environment and access to housing within an area. Each area of England is grouped into one of ten deciles and the most deprived is in d1 and least deprived in d10. As we know from work over the last 40 years since the Black report in 1980 – there is a social gradient for mortality and many other indicators of health and wellbeing.  Covid-19 has magnified the difference especially for those in the three most deprived deciles which shows a stark difference between Covid-19 deaths and all deaths. In the least deprived decile the mortality rate for all deaths was 122 deaths/100,000 population, whereas in the most deprived it was 229. The difference between all deaths (classic social gradient) was 88% whereas between Covid-19 deaths the difference was 118%, which is 30% higher.

    A similar picture emerges in Wales where they present the data as differently. The most deprived fifth of areas have a rate of 44.6 deaths per 100,000 involving Covid-19; this was almost twice as high as the least deprived area with 23.2 deaths/100,000.

    The other key finding from the ONS report was on urban versus rural areas. Major urban conurbations had a death rate of 64.3/100,000, which is statistically significantly higher than other categories including urban minor conurbations. The lowest rates unsurprisingly are in rural settings with rates as low as 9/100,000 population. There is a category ONS use called ‘major towns and cities’ in E&W which are built up areas excluding London. Of the 111 major towns and cities the highest mortality rate was in Salford with a rate of 112.6 deaths compared to Norwich with 4.9/100,00. One interesting prosperous market town that was hard hit is Cheltenham with a death rate of 49/100,00, which is significantly higher than the English average!

    Austerity and the slow burning injustice

    In his 2020 report of ‘Health Equity in England: the Marmot Review 10 years on’ Marmot found that the improvement of life expectancy which had been a consistent finding since the turn of the 19th century stalled in 2010 and years spent in ill health increased. He also showed that the social gradient in health became steeper and regional differences increased.

    The two features of Tory government policy during this period was to roll back the State – public expenditure went from 45% of GDP in 2010 to 35% in 2018 – and to be regressive. This meant that the poorer you were the more likely you would be to be disadvantaged by these changes.

    The excuse for the policies enacted from 2010 was the 2008 global financial crisis, which led to a decline in the global economy of 0.1% in 2009. The IMF  has predicted that the global economy will decline by 3% in 2020 on account of the pandemic. Already we have seen Universal Credit claims in the UK rise from 150,000 before the pandemic to 1.4m by the 13th April and rising daily. Marmot points out the risk that it would be a calamity if we face a new era of austerity after the pandemic. We need on the contrary to argue for a better society with less inequality and built by reducing child poverty, improving child health and education, improved working conditions ensuring that everyone has the minimum income to lead a healthy life and creating a sustainable environment in which to live and work creating the conditions for people to pursue healthy living.

    Places affected by conflict and humanitarian crises

    Inequalities are manifest globally as well as locally in the UK. For instance many of the estimated 70m forcibly displaced people worldwide live in insanitary and inhospitable conditions sometimes up to six families living in one tent in a 3sqm area. In these camps people share few latrines and washing facilities and have to queue for food each day. The Covid-19 mantra has been hand washing, social distancing and lockdown. People in conflict zones or refugee camps simply cannot follow this guidance and also have access to very rudimentary healthcare facilities.

    There is an urgent need to put international pressure on warring parties in Syria and Yemen to end restrictions on access to health care and humanitarian assistance. Public health support is needed to provide the conditions that do not allow the virus to spread and substantial financial support to overhaul the present conditions. This is more important and practical than supplying ventilators. The Covid-19 pandemic requires a global response for the most vulnerable populations globally as well as locally in the UK (David Nott Lancet 1st May 2020)

    Another globally vulnerable group are prisoners. In all countries including the UK prisons are a risk being closed communities with people living in crowded and in some countries squalid conditions. Conditions are worse in countries led by leaders like Duterte and Bolsonaro. In the Philippines for example there are an estimated 215,000 prisoners in prisons built for a capacity of 40,000 and in Brazil 773,000 prisoners are crammed into prisons built for 461,000.

    Whether it’s parts of the world with conflict and humanitarian crises or populations suffering from repressive governments there is an urgent need for rich countries to invest in international organisations such as the UN, WHO, UNHCR, UNICEF and AID organisations to try to mitigate the risks that Covid-19 poses on top of already stressed social conditions. It is possible to act locally on health inequalities as well as show solidarity globally.

    So what?

    In our earlier blogs we have been critical of some aspects of the pandemic response in the UK. It is sad to note that the UK is heading to have the worst outcome in Europe with us starting our epidemic behind Italy, Spain and France when Covid-19 hit Europe. The Government have been too slow to take measures such as locking down London and the South East rapidly and should have continued testing, tracking and isolating across the country – especially where the number of cases has been low and well within the capacity of local resources. This would have built practical experience and we would have learnt valuable lessons.

    Now that we have more testing capacity we need to build the programme from the bottom up. Local public health teams in Local Government stand ready to provide local leadership teaming up with professional Environmental Health Officers (EHOs) who have the skills and local knowledge to provide local leadership. Resources need to be targeted at areas of greatest need as we have illustrated through the excellent ONS report. Certainly smart apps will play a part as well as national leadership from COBR on the key features of the test, trace and isolate programme. However there has arguably been too centralised and London based approach to pandemic management. The time is ripe to allow local authority public health, supported by specialist PH resources to work with their Local Resilience Forum (LRF) using their local skills and knowledge to try to bring the pandemic to heel using classic communicable disease control methods of epidemic controls. This will help eliminate the virus, protect the NHS allowing it to reopen for normal business and enable the economy to start up again as soon as practicable.

    Pandemics kill in three ways says Jonathan Quick of the Rockefeller Foundation:

    The Disease kills,

    Disruption of the health service kills

    and the

    Disruption to the economy kills”.

    3.5.2020

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

    Comments Off on SHA COVID-19 Blog 8

    From Vivien Walsh in Manchester

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

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

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

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

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

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

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

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

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

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

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

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

    National Domestic Abuse Helpline

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

    Telephone and TypeTalk: 0808 2000 247

    Wales Live Fear Free Helpline

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

    Telephone: 0808 8010 800

    TypeTalk: 18001 080 8801

    Text: 078600 77 333

    The Men’s Advice Line

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

    Telephone: 0808 801 0327

    Email: info@mensadviceline.org.uk

    Galop – for members of the LGBT+ community

    Galop runs the National LGBT+ domestic abuse helpline.

    Telephone: 0800 999 5428

    TypeTalk: 18001 020 7704 2040

    Email: help@galop.org.uk

    Women’s Aid

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

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

    Karma Nirvana

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

    Telephone: 0800 5999 247

    Email: support@karmanirvana.org.uk

    Hestia

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

    Chayn

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

    Imkaan

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

    Southall Black Sisters

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

    Stay Safe East

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

    Telephone: 020 8519 7241

    Text: 07587 134 122

    Email: enquiries@staysafe-east.org.uk

    SignHealth

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

    Telephone: 020 3947 2601

    Text/WhatsApp/Facetime: 07970 350366

    Email: da@signhealth.org.uk

    Shelter

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

    Sexual Assault Referral Centres

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

    Get help if you think you may be an abuser

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

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

    Telephone: 0808 802 4040

    Get help for children and young people

    NSPCC

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

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

    Telephone: 0808 800 5000

    Email: help@nspcc.org.uk

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

    Childline

    Childline provides help and support to children and young people.

    Telephone: 0800 1111

    Barnardo’s

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

    Family Lives

    Family Lives provide support through online forums.

    Support for employers

    Employers’ Initiative on Domestic Abuse

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

    Support for professionals

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

    Support a friend if they’re being abused

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

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

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

    Comments Off on News from the Frontline 01.05.20

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

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

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

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

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

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

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

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

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

    1 Comment

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

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

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

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

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

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

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


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

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

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

    Stop Press!

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

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

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

    Comments Off on News from the Frontline 29.04.20 (1)

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

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

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

    1. Scientific advice

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

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

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

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

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

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

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

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

    1. Easing lockdown

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

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

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

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

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

    1. Recovery planning

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

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

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

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

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

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

    2 Comments

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

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

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

     

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

    1 Comment

    “Thanks to all those who continue to provide rapid feedback from their frontline experience. Also for the forensic questions you provide. You are helping the Labour Party challenge where needed”.

    Brian Fisher ( SHA Chair )

    EXPERIENCE FROM THE FRONTLINE 26 4 20

    Social distancing at the Stanlow / Ellesmere Port petrochemicals plant is impossible as the staff need to work in pairs or larger teams to do their work, often one on top of another, that’s the nature of the work.  My contact thinks much of that work is un-necessary at this time, it is not just about securing the site etc.., but workers are threatened with losing their jobs if they don’t come in.  I have seen photographs of lunch or tea breaks during this emergency, with staff in high vis clothing sitting sardined together on benches at refectory type tables.

    Even those with asthmatic conditions have been refused time out.  It looks to be completely irresponsible of management.  I understand similar situations are to be found at similar plants elsewhere in the country

    Guide dog training has been stopped, so people waiting for a replacement dog or to have one for the first time cannot.  I know several elderly blind or partially sighted people in this situation who are now trapped at home, probably indefinitely.  They are aware that if they stop walking they may never start again as muscle tone and bone mass are soon lost without exercise

    PPE

    Masks for the public when going into public spaces. The govt appear frightened of this because of concerns that it will divert surgical masks away from hospitals. They are confounding PPE, expensive, scarce and required by carers to prevent their catching the virus, with simple face coverings, in cotton or linen, cheap, washable and effective at reducing onward transmission. Trisha Greenhalgh has done an excellent explainer that sets out the evidence on this:  https://www.fast.ai/2020/04/13/masks-summary/   It is endorsed as policy by the CDC   https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html

    Sadiq Khan has also been ahead on this promoting cloth masks for the public on London transport.  There will need to be a lot of them – but textile companies are not selling many clothes and could churn out millions pretty quickly –  but they need to be asked. Govt thinks public not grown up enough to understand advice for cloth not surgical masks.  My view is that masking up in public will have to be an important component of any exit strategy – and they need to get on with it.


    Locally I find from contacts that those who are doing care support in the homes do not seemingly have any kind of PPE at all which is not surprising but also alarming.

    LA councillor

    TESTING

    We are waiting for ‘test test test’ but that is feeling as though it will be a very long wait.  While we are waiting we need to recruit and train an army of contact tracers.  This needs to start now, almost certainly through local authorities.


    We shall have to do case detection syndromically if the necessary volume of testing is not available when transmission has fallen significantly through the lockdown, with whatever limited testing support is available. This will be easier as we leave the seasonal respiratory viruses behind.  It is not perfect, but perfection is not necessary, just reducing the transmission rate.


    Given that TESTS are supposed to be the start of this action” chain “ it less than clear where this chain is supposed to start and how it will relate to any denominator population / geographical community. It is clear that Ag and Ab tests are not going to be available in local communities  through the 7500 GP practices in England in the foreseeable future .

    So it looks like Govt expect the management of the pandemic, exit from lock down and the inevitable second pandemic wave to be done via:

    • our 50 mass drive in test centres – [ ie for that segment of the population which has cars ]  – so our understanding and contact tracing for spread will be the ill defined catchment areas of these test centres
    • and / or through home based test kits …..in which case it could be completely random / Brownian in shape / dynamics

    How will home-based tests connect with the new army of contact tracers which is being recruited by PHE – and their “assault “ on the spread of the virus  in local communities but it seems essential to involve general practice in our response to  COVID . I suppose it depends on how important you believe community spread generated though care and nursing homes is at periods of high community transmission in which case Public Health England may get a grip with additional support.

    It appears that there are currently no  plans nationally to use our unique infrastructure of 7500  general practices to do Covid 19 testing. In Birmingham during swine flu in 2009, GP consultations and reports provided public health / health protection agency with “ hot knowledge “ about new cases ;  did swab tests and  gave us insight into the geography of spread across the city during the containment phase.

    Apparently Ribera Salud integrated health care model in Valencia Spain has been able to mobilise and use flexibly all health care staff [ public health , primary care and hospitals ] during this crisis.

     

    QUESTIONS

    Is the government prepared to cope with the wave of mental health problems which are about to hit us as we pass the peak? I work as a mentor of GPs and keep in touch with issues on the front line. I am actually more concerned about care workers who have not been trained in the same way as doctors and nurses. If doctors are struggling with what they are seeing, how will a care worker cope with the loss of their charges in the homes from this terrifyingly overwhelming illness? What support will be available for their mental health?

    Have the 3 RAF aircrafts returned from Turkey with the PPE? Did the government lie / mislead the country last Friday? Can the government confirm when the order was placed? It’s been reported that the Turkish government say the order wasn’t placed until Sunday.

    Can the Government confirm whether the story in the Telegraph today about a British firm exporting 750k pieces of PPE because the Government hadn’t got back to them is correct or not

    Is there any country which has a reliable antibody test? 

    What is the preparation for accelerating the implementation of the postponed electives, treatments etc. as we transition to “normal”? Also, how to research the status of people who have avoided presenting themselves to their GP or A&E? These need to be well managed.

    Apparently 15,000 a day are flying into the country with little regulation while we are all self isolating at home. Not to mention the rich arriving at private airports. How can we not be restricting air traffic at this time?

    What arrangements is the minister putting in place to strengthen local and regional public health management of continuing cases to prevent subsequent new waves of the epidemic? The containment phase was ended in Mid-March and  lockdown applied nationally, despite considerable variation of reported disease transmission regionally throughout the UK.

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

    Comments Off on FRONTLINE EXPERIENCE AND TOUGH QUESTIONS 26 4 20

    We are being fed a narrative. The story is that “we are all in it together.” Like the “spirit of the Blitz”. But we are not. The Government is spinning a story to make itself look like the helpless victim of events outside its control, at worst. And in a superhuman flight of fancy, actually IN control at best. Meanwhile it has been systematically cutting NHS funding to the bone, ignored the findings of its own pandemic drill, Exercise Cygnus, and preferentially awarding contracts to firms which are big Tory Party donors, as we have reported in previous blogs.

    We are not “all in it together” any more than, during World War II, our parents, grandparents and great-grandparents were. No wonder those who had borne the brunt of the war elected a government in 1945 that would introduce the National Health Service, the Welfare State and free education for all (to the age of 24 or more  for those who could benefit from it, thereby benefitting the country at the same time).

    The Tory line is that everyone in the world wants PPE and ventilators, and it’s not the Government’s fault that there are shortages. “It’s a competitive market out there,” said Dominic Raab. Yes. But why then did the Government behave as though it had all the time in the world in January, and in February, and in March? On 13th April, The Guardian listed THIRTEEN occasions when the UK was invited to meetings with EU countries to share “bulk-buying” procurement of necessary items, and either attended but did not join in the shared action, or did not attend at all.

    Meanwhile, the Government (finally) asks British Industry to help in the production of 30,000 more ventilators and the BBC reports on 26th March, that the Government has ordered from  Dyson (which makes vacuum cleaners). Rather than a firm in the medical equipment industry which already makes ventilators. The technology for sucking up dirt is quite different from that required for ventilating people whose lungs are not properly functioning, as I explained in an earlier blog; but Dyson is a friend and donor of the Tory party.

    NHS budgets have been cut relentlessly since Thatcher was Prime Minister. Following the forecasting Exercise Cygnus, the government’s advisers recommended that in the event of a pandemic , personal protective equipment (PPE) should be provided “for all hospital, community, ambulance and social care staff who have close contact with pandemic influenza patients”. But recorded minutes of a then-Department of Health (now Dept Health and Social Care) meeting, quoted by The Guardian on 27th March, have revealed that in 2017 the advisers were told to “reconsider their advice” because of the cost involved: “following these recommendations would substantially increase the cost of the PPE component of the pandemic stockpile four-to six-fold”.

    Then reports of deaths of frontline workers from Covid-19 start appearing in the press and on TV and Radio news. On 10th April Hancock says “PPE must be treated as a precious resource.” Can he be blaming the medical profession for wasting PPE? On 11th April nineteen deaths are recorded among health care workers. This is the day after the press were told that it was inappropriate to record such information.

    17th April BBC News announces medics have been asked to re-use gowns. Some hospitals report that they will run out in 24 hours. Then the following day Sky News also reports that NHS staff were advised to “re-use PPE ahead of the expected weekend shortage.”

    Public Health England (PHE) guidelines until now were that doctors and nurses treating Covid-19 patients should work with protective, waterproof, full length surgical gowns, plus a mask, a visor or goggles and double gloves – so that droplets containing the virus did not get into their mouths or noses.

    These guidelines have now been reversed and doctors and nurses asked to wear washable medical gowns, or non fluid-repellent equipment, with a thin plastic apron when proper gowns run out.

    An anaesthetist after a shift reported to us that Intensive Therapy Unit (ITU) nurses were still using bin-liners as improvised PPE. And that a lot of the outsourced staff had totally inadequate protection. He confirmed that the big issue was PPE and the other consumables: drugs, infusion equipment, breathing systems, and body bags – as well as experienced ITU nurses, and hardware like haemofilters” (which are used to do the work of the kidneys in intensive care in the case of renal failure).

    Although the Guardian is the main source of our timescale, the same newspaper gave Chris Hopson of NHS Providers a platform to start re-framing the PPE shortages and to try and blame the shortages on China. Our informant told us that the shortages were predictable and avoidable, and far more widespread than we realised. It seemed to him that Number 10 was controlling the news agenda: stories about the nurses who took care of Johnson displaced criticism that could have been made when the death toll passed 10,000; and  deaths in New Hampshire displaced the news of dead NHS workers.

    No employer should ask staff to undertake work that is unsafe for them – and in the case of Covid-19, unsafe for patients. Doctors and nurses are within their rights to refuse to endanger themselves. Nursing Notes on 26th March reported that the British Medical Association’s Chair of Council, Dr Chaand Nagpaul had said: “A construction worker wouldn’t be allowed to work without a hard hat and proper boots. Even a bee-keeper wouldn’t inspect a hive without proper protective clothing. And yet this Government expects NHS staff to put themselves at risk of serious illness, or even death, by treating highly infectious Covid-19 patients without wearing proper protection. This is totally unacceptable.” So far, however, neither the BMA nor the Royal College of Nursing has called on workers to refuse to work without proper PPE.

    We – and they – must support staff who do refuse to run major risks, and place the blame where it lies.

    The anaesthetist we spoke to said that the Tories had mismanaged COVID on a monumental scale. The UK has far fewer ITU beds than other EU countries. He told us that Hancock thought putting ventilators next to beds created thousands more ITU beds: he didn’t realise you need other equipment and trained staff! (this is the Minister of Health.) And then he lied to the public, saying there were thousands of empty ITU beds. He doesn’t realise there’s more to intensive care than ventilators. The doctor told us they had run out of equipment, staff, drugs and PPE…. And his department agreed that they could not allow colleagues to be coerced into entering ITU areas without adequate PPE.

    Later he went on to say that that we never had the resources to provide intensive care on the scale required…. That rationing care was something nobody wanted to do, but that it was impossible to provide safe care on the scale required. This was always going to happen. It was already happening with haemofiltration. There are not enough machines for the number of patients with renal failure. They are now moving devices (intended for continuous use) around between patients, giving them intermittent filtration, which would be impossible to defend at an inquest.

    Hancock has tried to grandstand, with rhetoric about being on a war footing. It would have been better to have used eligibility criteria for organ support but the Tories worried about adverse PR and headlines eg about age discrimination. So instead of any criteria, it is a case of first come first served. The worst sort of rationing.

    Comments Off on News from the Front Line 21.04.20.

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

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

    1. Social Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    1. Evidence of unpreparedness

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

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

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

    1. Getting out of lockdown

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

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

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

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

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

    20th April 2020

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

    2 Comments

    Health Secretary Matt Hancock has announced that firefighters, police, prison staff and Department of Work and Pensions (DWP) workers will now be eligible for coronavirus testing, in a session of the Health and Social Care Committee.

    Responding to the announcement, Matt Wrack, Fire Brigades Union (FBU) general secretary, said:

    ‘We’re pleased to see that the government has listened to the FBU and finally agreed to open up some testing to other key workers, including fire and rescue personnel. However, it is a shame it has come this late, with thousands of firefighters already self-isolating – this is something that could have been easily avoided.

    ‘We are awaiting further details but it is clear that there are questions around the functioning of the scheme that is now open to more key workers . The health secretary said fewer NHS staff were coming forward to be tested than hoped, but this is surely an issue of accessibility, rather than frontline staff not wanting to be tested. Many of the testing centres are far out of town and require extended trips in a car – if this is a barrier to nursing staff, it will also be a barrier to other key workers.

    “It is also clear that this testing scheme will only identify the virus in those individuals presenting symptoms or living with others who are. Many key workers who have been exposed through their work will have contracted the virus yet remain asymptomatic. Frequent and accessible testing of key workers who are at high risk of exposure is also needed to reduce the risk of spread in workplaces.

    “To ensure that fire and rescue services, and other vital services can continue to operate in this crisis, we don’t just need access to these testing schemes, but to also see the capacity of the schemes themselves increase. There need to be more tests available full stop.”

    Joe Karp-Sawey, FBU communications officer

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