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    NINE TESTS OF THE AUTHENTICITY OF HOLYROOD’S COMMITMENT TO HUMAN RIGHTS

    Joint authors:  Colin Slasberg and Peter Beresford

    We have previously set out why we believe the Feeley review of Adult Social Care in Scotland has the potential to be truly ground breaking. Its first and primary recommendation is that social care should be established on a human rights basis. Whilst it also makes recommendations about structural change, the report recognises that structural change without cultural change is no change at all.

    While the rhetoric of human rights has littered social care policy for at least two decades, Feeley is not the first to recognise it simply hasn’t happened. Whilst there are examples of excellence, they are not the norm. However, what makes the Feeley report different is that it goes further. It pinpoints the practical changes required. These focus on the process of assessment, support planning and resource allocation. Three recommendations are of particular importance;

    1. ‘People should understand better what their rights are to social care and support and “duty bearers”, primarily social workers, should be focused on realising those rights rather than being hampered in the first instance by considerations of eligibility and cost.
    2. A co-production and supportive process involving good conversations with people needing support should replace assessment processes that make decisions over people’s heads….that does not start from the basis of available funding. Giving people as much choice and control over their support and care is critical
    3. Where not all needs can be met that have been identified as part of a co-production process of developing a support plan, these must be recorded as unmet needs and fed into the strategic commissioning process’

    Delivery of these three recommendations alone would have far reaching consequences. They would amount to the abolition of eligibility criteria to identify ‘need’ and control spending. This would lead to the re-purposing of the entire system from its current protection of public resources to one that serves to promote the human rights of older and disabled people, whatever level of funding the democratic system happens to make available to it.

    The early responses

    The Feeley report was warmly welcomed by all parties in a debate in Holyrood on February 16. The Scottish Government committed to working toward a way forward ahead of the May elections.

    However, there remains deep scepticism amongst activists and academics. For some it is born of many years of national and local government talking the talk of rights whilst walking a very different walk. For others there is disappointment Feeley did not demand funding to meet all need as the precondition of a system based on human rights, or to the structural changes they favour, or to renationalisation of social care as the solution its ills.

    The following sets out nine key tests by which to judge the authenticity of the Government’s intentions in how they respond to Feeley. They set out the practical steps required if Scotland is to deliver the Feeley recommendations.

    Nine key tests

    1. Government will establish the principle that in social care, as in the NHS, need will precede resources. A founding principle of the NHS was that clinicians must be free to identify clinical need and the resource consequences must follow. People generally trust that NHS clinicians will indeed identify to the best of their knowledge what modern medicine can do to give them the best possible health. This is not the case in social care where decisions about ‘eligibility’ are made ‘above people’s heads’. If Government declares that social care will join health care in putting need before resource, social workers will be free in line with their professional ethic to identify what will give people the best quality of life their circumstances allow. This, in itself, is arguably the single most transformative change that will deliver for social care the ‘1948 moment’ Nicola Sturgeon says she is seeking. The following eight all rise from and are a consequence of this one change.
    1. Government will declare the end of the eligibility system. The eligibility system, whereby ‘need’ is defined against so-called ‘national’ criteria, ostensibly exists to deliver equity. The scale of the inequity in levels of provision between councils identified by the Feeley report is testament to its failure. What ‘critical and substantial’ means varies from council to council according to their resources. The durability of the eligibility system is owed therefore, not to the pursuit of equity, but to control of spending. Success in controlling spending in this way comes at the expense of the resource-led and controlling practices the Feeley report so roundly condemns.
    2. Government will declare a commitment to fund all needs for people to have a dignified quality of life to the best of its ability. The Feeley report does not recommend Government commits to funding all needs. No public service is guaranteed the funds to meet all its responsibilities, not even the NHS. However, the necessary process of prioritisation should not and need not lead to loss of vision and moral purpose. Government should lead the way in ensuring the needs of older and disabled people compete on a level playing field with all other public services, currently denied by the eligibility system.
    3. Government will require systems are established that aggregate and report unmet need. Unmet need is the inevitable consequence of adopting the principle of need preceding resources. The NHS equivalent is waiting times. At the operational level waiting times provide the safety valve when need exceeds resources. At the strategic level, they tell political leaders the level of funding they need to make available. In social care the eligibility system denies them such information. Unmet need must be seen as the social care equivalent of waiting times in the NHS. Information about unmet need must be in the public domain, easily accessible and able to hold political leaders to account.

    Councils have sometimes in the past experimented with boxes on assessment forms for social workers to record unmet need. The information languishes in filing systems, goes nowhere and quickly falls into disuse. Government must avoid repeating such a mistake.

    1. Government must acknowledge that regional equity depends on the level of resources available to local authorities and is a national responsibility. Whatever else a National Care Service may comprise, national government must accept responsibility both to ensure that resource levels minimise unmet need, and are fairly allocated regionally.
    2. Government must require councils to establish systems that control spending without compromising assessments. No matter how large or small the gap between needs and resources, it is a fact of life than spending will have to be contained within budgets. Case by case decisions to determine eligibility as the means to do so must be replaced with case by case decisions that determine This will require a complete re-engineering of the decision making infrastructure, including financial and IT supports. Whilst equitable allocation of resources at individual budget holder level will continue to be important, it will be joined by value for money as no less important a challenge. A budget holder’s task will be to achieve the greatest quality of life for the greatest number of people within their budgets. This will require significant re-skilling of budget holders
    3. Government must require councils to democratise their assessment process. Assessing for eligibility spawns a bureaucratic, obscure and professional-centric process. Such processes must be swept away. New processes will be required that are accessible to all service users to support them to think through and declare their own assessment of their needs and support requirements. The council only has to be concerned that such self-assessments make the best use of resources so the person can have the best quality of life their circumstances allows. The social work role will be to support people to achieve such a self-assessment, working to whatever depth is required. An open, democratised assessment process is key realising the Feeley recommendation that assessments must be ‘co-produced’ and for people to have authentic choice and control over their support.
    4. With the system fundamentally re-purposed, Government will need to ensure there is a workforce development strategy. The social work role will be transformed from the current ‘piggy in the middle’ role to being able to work in authentic partnership with service users. It should come naturally to those whose value base is person-centred and also to social workers who are professionally qualified.

    Re-skilling will also be needed at the most senior levels too. Directors of Social Work will no longer have the task of managing a system that makes ‘need’ fit within whatever resource their political masters give them. Their task will be firstly to get the best from the given resource, and then to inform their political leaders of the shortfall. Their relationships will change. They can truly become the champions of the community.

    1. A transition strategy for existing service users. Resource-led assessments for ‘eligibility’ and person centred assessments are as chalk and cheese. Whilst the former is a negative exchange to see how bad life can be, the latter is a positive one to see how good life can be. However, there will be overlap. Some needs previously deemed ‘eligible’ will continue to be needs within a human rights based approach. There is a clear moral argument that existing service users should not be penalised by the change. All needs previously considered ‘eligible’ that also meet needs within the reformed system should be subject to a guarantee of being met as long as the need remains.

    Conclusions

    For the above reasons, Feeley puts Scotland on the brink of becoming a world leading country in the delivery of social care. It would be one built upon the lived experience of each and every older and disabled person in need of state support. However, in the absence of pressure on Government to deliver the radicalism of the above agenda, the greater fear is that it won’t happen. Feeley’s plea for a system driven by human rights runs the real risk of being reduced to a pre-amble to the Government’s response that will amount to yet another reiteration of warm words and good intentions.

    Implications for England

    Whether or not Scotland does move forward, the lessons England could pick up are clear. England, whilst using different words, operates the same eligibility system as Scotland. England, too, has regional inequity of enormous proportions. Most service user groups will recognise the Feeley report’s description of the assessment and support planning process. It is bureaucratic, damaging and alienating.

    Debates in England are dominated by the funding issue. That takes the form either of focusing on the balance of public and private funding, sources of taxation or funding levels. There is, however, little debate about the vision for social care. Isolated Members of Parliament sometime raise the issue of a vision for social care, but those debates are not entering the mainstream. Yet without vision, how can the service know it is getting the best it can from the resources it has? And without vision, how can the public know what they are being asked to support, and how can political leaders know what they are being asked to fund?

    The issues Feeley is inviting Scotland to grapple with are issues England should grapple with too.

     

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    1. 1. Legislating for Integrated Care Systems: Provider Selection Regime Consultations
      Legislating for Integrated Care Systems: five recommendations to Government and Parliament
      includes the Response to Public Consultation on ICS (See Pages 8-22)

    The consultation findings are attached above (at 2) and it is disturbing to read some of the NHSE/ NHSI conclusions.

    Firstly, the report appears to blur the distinction between what is regarded as an engagement seeking views and a consultation which it was described as on line. It begins by declaring that 5,171 responses from people identifying as members of the public or patients who were concerned with “privatisation” of the NHS in some way, They identified these comments as part of a “national campaign” group ( later named as KONP) which involved speculation about the creation of ICSs! Therefore, they considered them as a single response. So, over 5,000 responses who may or may not have been members/ supporters of KONP, were reduced to one response and treated differently. 5,000 plus responses have been reduced to being described as “speculation” whilst the ” clear opinions” of some of the other 1700 respondents are accepted as having individual validity and are quoted in some detail.

    The distinction being drawn between speculation and a clear opinion is disingenuous, How does someone give an opinion unless you do speculate about what the implications or effects may be of any proposal for change? Furthermore, when the white paper does not actually contain much detail because the government and NHSE say they wish to increase flexibility and move away from prescription, what else can you do but speculate on possible outcomes!

    Not surprisingly, the majority of comments included from groups such as The Kings Fund, NHS Confederation; NHS Clinical Commissioners etc support the NHSE views with a few perfunctory caveats included for the sake of showing some ” balance”. This then feeds into the claim that 79% of respondents agreed or strongly agreed with the proposals ( See Page 3, 1.3; Provider Selection Regime consultation on proposals).

    Of course, this blatantly skewed approach to “consultation” is no surprise, as the Local Foundation Trusts/ CCGs used similar tactics during the consultations over Phase 1 of the Path to Excellence and The Urgent Care Review in Sunderland. It continues a growing trend by the NHS and others of discounting the strength of support for particular campaigns by characterising them as being “protest” groups with no real understanding of the issues. Unfortunately, this seems to be a further indicator of the direction of travel these proposals make in regard to governance of ICSs with moves to marginalise local scrutiny and representation and return control of the NHS to government.

    The NHS says it proposes that ICS bodies should be statutory public bodies but their legislative recommendations to government provide only that they should have a Chair and a CEO with representation from trusts, GPs and a local authority which could literally mean one representative for all local authorities in the ICS footprint ( there are 12 unitary local authorities in the North East and Cumbria ICS). Other unspecified bodies can also be appointed which could include private sector healthcare providers, management consultants or population health experts. But, of course, that’s speculation!

    Developments are now moving on at pace and the NHS has launched another consultation: NHS Provider Selection regime: Consultation on proposals which is due to close on 7th April 2021. This invites responses on developing a bespoke NHS regime to replace the current procurement requirements. You will recall that the White Paper includes the NHSE strategy for bypassing procurement which the MSM heralded as the end of privatisation.

    The first question on this engagement/ consultation is:

    “Should it be possible for decision-making bodies (eg the clinical commissioning group (CCG), or, subject to legislation, statutory ICS) to decide to continue with an existing provider … without having to go through a competitive procurement process?”

    This has obvious advantages in terms of less bureaucracy and administration but if the existing provider is a private health care provider then it does not reduce the privatisation already inherent and makes it more likely that future larger contracts will also go to private companies, particularly if the ICP is able to award one overriding contract. The government and NHS are making great play that this will enable greater flexibility and control locally but without appropriate safeguards being in place it is clear that the way is open for long term commercial contracts of 10-15 years which are already being suggested.

    Please will you look at all this and advise about the next steps.

    Is the Government’s way of dealing with over 5,000 responses legitimate?

    Posted by Jean Smith on behalf of an SHA and KONP member.

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    The following is a major speech from Shadow Health Minister Justin Madders.  In Parliamentary terms it is extremely critical of the government.  Even though the prime minister may have lowered the tone of debate, this is polite, measured, and at  the end, does threaten the PM with his P45.  I work with Justin a lot, and have developed considerable respect for his honesty and integrity over the years.

    Jean Hardiman Smith

     

    As we know, we are now a year into this pandemic. It has been a year unlike any we have experienced before, and it certainly was not the one we would have hoped for. The virus has turned the world as we know it upside down. We have seen the very best of many: our frontline health and social care workers who have selflessly looked after us, our key workers who have kept our vital services running and our country going, and our communities who have come together to support one another, especially those in need. But it has also been the very worst of times for many: families kept apart for months, individuals and businesses left with no support and, of course, the grim milestone of more than 120,000 deaths from coronavirus, which was reached this weekend. We know that each life lost is a tragedy that leaves behind devastated family and friends, and that death toll does need explaining. I will return to that issue later, but I would like to start on a more positive note.

    As the Minister referred to in his opening remarks, more than 17.5 million people in the UK have received their first dose of the covid-19 vaccine. I echo his congratulations to everyone who has been involved in that roll-out. From the scientists to the NHS to the volunteers, it has been nothing short of brilliant, and it is something for us all to celebrate. While we are on the subject, we should also extend our congratulations to Mark Drakeford and the Welsh Government for becoming the first country in the UK to get through the first four priority groups.

    I am sure that all of us have breathed a sigh of relief or even shed a tear when a parent or vulnerable family member or friend has received their first vaccine dose. Yesterday’s news that all adults in the UK will have been offered their first dose by the end of July is very positive indeed, but can more be done? When Simon Stevens says that the NHS could deliver double the number of vaccines it currently is, we will all be asking, why is that not happening? With research showing that some minority groups are well behind the general population in terms of take-up, another question that I am sure Members will want to raise about the roll-out is: what can the Government do to vaccinate more people in hard-to-reach communities?

    I am sure that many Members will have been moved by the story of Jo Whiley and her sister, Frances. She has talked about the anxiety shared by many families across the country. We know that people with learning disabilities are much more likely to die from coronavirus than the general population, with the death rate in England up to six times higher during the first wave of the pandemic, but currently only people with severe learning disabilities have been prioritised for the vaccine. I am sure the Minister is aware that over the weekend, at least one clinical commissioning group announced that it will be offering the vaccine to all patients on the learning disability register as part of priority group 6. I would be grateful if the Minister updated us on whether there are any plans to consider that issue again.

    I have one last question regarding the vaccine. We have asked a number of times for the Government to publish figures on how many health and social care staff have been vaccinated. The Secretary of State said last week that a third of social care staff had still not been vaccinated, so I hope that when the Minister responds to the debate, she will be able to update us on those figures and on what more we can do to improve take-up in that group. It is vital that we look after the people who look after us in social care and the NHS. Our NHS rightly deserves huge congratulations on its impressive and speedy vaccine roll-out, but despite its incredible efforts, it will still take many months before the vaccine offers us widespread protection. With the emergence of new variants, increasing pressures on our health service and continuing high rates of transmission, it is vital that Ministers do everything possible to ensure that frontline health and care workers, who are more exposed to the virus, are fully protected.

    Healthcare staff deaths are now estimated to be approaching 1,000. That is tragic. We know that our frontline workers face higher risk. During the surge in cases last month, the British Medical Association reported that more than 46,000 hospital staff were off sick with covid-19 or self-isolating. A survey conducted by the Nursing Times during the last two weeks of January found that 94% of nurses who work shifts reported that they were short-staffed due to similar absences. We support calls from the BMA and the Royal College of Nursing to urgently review PPE guidance and increase stockpiles of high-grade PPE such as FFP3 masks for all frontline NHS employees. I hope the Minister can update us on what plans the Government have to ensure that health and social care staff are fully protected.

    Finally, we need a plan for staff to address what comes next. Just as the nation needs a recovery plan, the NHS workforce needs one too. We must not forget that we entered this crisis with a record 100,000 vacancies in the NHS. What I hear from staff, who have now been working flat out for a year, is that they desperately need a break, and they need a tangible demonstration that their efforts are truly valued. The NHS rightly has a special place in the hearts of the people of this country, but without the staff, the NHS ceases to exist. That is why we need to recognise that we cannot keep dipping into that well of good will, and that at some point, NHS workers need cherishing as much as the institution itself.

    I cannot mention PPE without briefly addressing last week’s High Court ruling that the Government had acted unlawfully by failing to publish details of covid-related contracts. Why has the Secretary of State not come to Parliament to explain himself? Is breaking the law such a common occurrence in Government nowadays that it does not warrant an explanation from those responsible? The Government’s approach to procurement during the pandemic has been marred by a toxic mix of misspending and cronyism. We all understand that the Department was and is dealing with many pressing issues, but transparency is important, and accountability matters. Of course, we need to remember why there was such a rush to get PPE in the first place—it was because the Government had ignored the warnings and allowed stockpiles to run down. The pandemic has been used too often as an excuse for standards to slip, but it really should not need saying that transparency goes hand in hand with good government.

    Another area where we need greater transparency is the Government’s general response to the pandemic to date. With the highest number of deaths in Europe, those in power now need to answer why that has been the case, because such a grim death toll was not inevitable. If it is the right time to undergo an expensive and disruptive reorganisation of the NHS, it is also the right time to have the inquiry into covid that the Prime Minister promised more than six months ago. The families of the deceased deserve answers, and we all need to know that lessons have been learned and that the same mistakes will not be made again. If we look at what has happened so far, we can see that there has been a tragic failure to learn the right lessons. That is why what we have heard from the Prime Minister today matters, because we are not out of the woods yet. Infection rates, though they are reducing, remain high; there are more people in hospital now than there were at the start of the second lockdown; and there are still more than 1,000 people being admitted to hospital every single day. So, what we do next, when we do it and how we do it remains critical.

    The Opposition have been clear all along about the importance of following the science. We know where not following the science takes us: it leads to the worst death rate and the deepest recession in Europe. It leads to the farce of the Prime Minister refusing to cancel Christmas plans, only to U-turn three days later, and it leads to the shambles of children returning to school for one day, only to find it closed the next. We know that the virus thrives on delay and dither. As we approach a year of life under restrictions, any ambiguity over when, where, why and how the restrictions will be eased in the coming weeks and months is just as big a threat as the virus itself.

    Before I conclude, I just want to say a bit about test and trace. We did not hear anything new from the Prime Minister on that today, but it nevertheless remains a vital part of the pandemic response. We need to remind ourselves that the number of new cases is still above 10,000 each day, and that every day thousands more people are required to self-isolate. For this lockdown truly to be the last, we need to continue to cut transmission chains and the spread of the virus, so this continuing blind spot when it comes to supporting people to self-isolate is as baffling as it is wrong.

    When we first came out of lockdown, the scientific advice repeatedly stated that the easing of restrictions would work only if there was a fully functioning test and trace system in place. That was true last year and it is still true today. We still do not have all test results back within 24 hours, as the Prime Minister promised would happen last June, but perhaps most important are the continued low compliance rates with self-isolation. The Government have known for many months that the lack of financial support to those self-isolating has resulted in extremely low adherence rates. Surveys between March and August last year found that only 11% of people in the UK notified as having been in recent close contact with a confirmed case did not leave their home. That figure has improved a little recently, but it is still well below where it needs to be.

    Around a quarter of employers will only pay statutory sick pay for such an absence. The Secretary of State has previously said that he could not survive on statutory sick pay, so we should not be surprised when others cannot do so either. We also know that seven in 10 applicants are not receiving self-isolation payments from councils, with one in four councils rejecting 90% of applications. They are rejecting them not because there is no need but because the rules have been so tightly drawn that seven out of eight people do not qualify for a payment under Government rules. When Dido Harding herself says that people are not self-isolating because they find it very difficult, a huge question needs to be answered about why the Government have still not acted to rectify this.

    Last month, the Government announced more cash for councils for self-isolation payments, but that was to last until the end of March, and actually the amount handed out was the equivalent to one day’s-worth of people testing positive. That is clearly not enough, and what about after March? We need confirmation of how much support will continue to enable people to self-isolate after that date. Following reports in The Independent late last week that some people working for the NHS through private contractors, such as cleaners, porters and kitchen staff, were being denied full sick pay for covid-related absences because of the removal of supply relief, we need a commitment that this will be investigated urgently and that the direction of travel will be reversed so that everyone in the NHS is properly supported. The Government should be setting an example here, not leading a race to the bottom. On wider financial support, where is the road map for businesses that will still be operating under restrictions for many months to come? We know that the Budget is next week, but they need clarity and support now.

    In conclusion, what the Prime Minister announced today has to be the last time the word “lockdown” passes his lips. There must be no more false dawns and no more boom and bust. With this road map, relaxations should now be clear and notified to the affected parties in advance, but also approved by this place in advance. There should be no more muddle between guidance and laws; no more regulations published minutes before they become law; no more businesses having to throw away thousands of pounds-worth of stock because decisions are reversed at a moment’s notice; no more of the stop-go cycle; and no more hopeless optimism followed by a hasty retreat. This time really has to be the last time. The vaccine has given us hope. It has given us a route out of this. With a year’s experience of the virus and with multiple vaccines on the way, there can be no excuse for failure this time. The Prime Minister has said that he wants the road map to be a one-way ticket. I hope he is right. We all want him to be right, but if he gets it wrong, he should expect nothing less than a one-way ticket to the jobcentre.

     

    3 Comments

    HIV i-Base continue to report on COVID-19 vaccination and treatment. The Q&A service on the i-Base website has been answering many questions about coronavirus vaccinations.

    Please see this new question:

    Are animal products in the COVID vaccines? Are they Halal? https://i-base.info/qa/16668

    Answer:

    The vaccines are safe and recommended if you are Muslim.

    • There are no animal products in the Pfizer, Moderna or Oxford vaccines.
    • There are also no traces of pig products or egg products.
    • These vaccines are all Halal safe.

    The video in the i-Base link above is from Imam Yunus having the vaccine at Newham Hospital in East London.

    As chaplain of St Barts, Imam Yunus talks about how the vaccine is safe, effective and Halal.

    Please note this video is included as an information resource. It is not directly liked to HIV and i-Base was not involved in producing it.

    This is one of more than 45 questions about COVID vaccines. It was produced by and for people living with HIV.
    Q&A on COVID vaccines: are they safe and effective?
    https://i-base.info/qa/16330

    Copying and distribution of i-Base infomation is encouraged – and free – but please credit HIV i-Base as source.

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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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    Watching and reading the arguments Tory MPs put forward for voting against an extension of free school meals over the school holidays, there seems to be a common thread. Nearly all of them use the argument of dependency, that is relying on the state to provide for us rather than supporting ourselves through personal responsibility.

    These arguments are not new, “Booth and Rowntree found the greatest cause of poverty was not, as often believed, feckless shirking by the irresponsible lower classes, but low pay for full-time work, or inability to get regular work despite best efforts”. In other words dependency is invalid as an argument for poverty. The causes of poverty are well known. This research was conducted before 1914.

    What the Tories call dependency, Labour calls decency. Whatever defence the Conservative MPs type, say, shout or even belief is at odds with fundamental human rights. The right to water and food is part of our existence. The Tories commodify them through privatisation, e.g. the English water companies. Now, they are re-defining them – again – as dependency.

    The language of dependency is interesting yet alarming. From 1997 onwards, society was not focussed on this language, but on how to design policy around alleviating poverty. These alleviation measures while not focussing on the eradicating poverty, sadly, but they helped reduce child and pensioner poverty.

    Without the state focussing on alleviation and the eradication of poverty, we will go backwards in time rather forwards. I know, as I grew-up in poverty in the 1980s and received free school meals. I am very proud that Lewisham through the leadership of Damien Egan and Cllr Chris Barnham acted quickly in Lewisham to extend the free school meals entitlement over half-term.

    Finally, I suspect the dependency argument will continue to be spoken by Tory minsters and MPs. If they can use that past descriptor for free school meals then it won’t be long before it is extended to universal, free at the point of need, NHS healthcare. I have no doubt that a significant number of Tory MPs want us to follow the US system of healthcare. Such a system is the number one cause for bankruptcy among the American population.

    https://www.paulbell.org/

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    Today HIV i-Base (where I work part-time) and the UK-CAB (of which I’m a member) joined with more than 70 other organisations sending a joint statement to the Prime Minister, the Secretary of State for Health, and the interim leadership of Public Health England regarding our concerns of the restructuring of public health in England.

    Over 70 health organisations unite to raise serious concerns with Government about plans to reorganise the public health system

    Today over 70 health organisations and alliances have sent a joint statement to the Prime Minister, the Secretary of State for Health, and the interim leadership of Public Health England, raising serious concerns about the reorganisation of public health now underway. This follows recent announcements that PHE will cease to exist by April next year and be replaced by the National Institute of Health Protection.

    The statement is endorsed by a wide range of leading health organisations, including the Association of Directors of Public Health, the Faculty of Public Health, the Royal Society for Public Health, the Academy of Medical Royal Colleges, the BMA, the SPECTRUM public health research collaboration, the Smokefree Action Coalition and the Richmond Group of health and care charities. The statement warns that:

    “Reorganisation risks fragmentation across different risk factors and between health protection and health improvement. Organisational change is difficult and can be damaging at the best of times and these are not the best of times. A seamless transition from the current to the new system is essential.”

    While recognising that there are opportunities:

    “There are opportunities from this re-organisation to improve on current delivery, but only if there is greater investment combined with an emphasis on deepening expertise, improving co-ordination and strengthening accountability.”

    The statement, launched today in a letter to the BMJ from key signatories sets out the principles which all agree must underpin the new health improvement system. This includes the need for renewed investment into public health to address the years of cuts the sector has seen, an interconnected approach with the right infrastructure and expertise to support national, regional and local delivery; and the need to sustain local government system leadership at local level, while strengthening co-ordination with the NHS.

    Dr Nick Hopkinson, a respiratory specialist at Imperial College London, chair of Action on Smoking and Health, speaking on behalf of the Smokefree Action Coalition as a signatory to the letter said:

    “We are in a state of public health emergency because of COVID-19, and system reorganisation at this time brings with it great risks, as well as opportunities. That is why the public health community has come together to set out for Government the principles that we all agree must underpin any reorganisation of the health improvement and wider functions of Public Health England (PHE). If we are to recover from the global pandemic and recession, health improvement is not a ‘nice to have’ but an essential component of a successful response to the challenges we face.”

    Professor Maggie Rae, President of the Faculty of Public Health, signatory to the BMJ letter, said:

    “Reorganisation of Public Health England (PHE) brings with it a real risk that some of the critical functions of PHE will be ignored. The pandemic has shone the light on the health inequalities that exist in the country and it is clear that those with the poorest health have been hit hardest. Scaling up, not down, the health improvement functions of PHE is a prerequisite if the Government is to deliver on its commitments to ‘level up’ society; increase disability-free life years significantly, while reducing inequalities; to improve mental health; increase physical activity; reduce obesity and alcohol harm; and to end smoking. Ensuring there is adequate funding, a robust infrastructure and sufficient public health expertise to deliver at national, regional and local level, is fundamental.”

    Professor Linda Bauld, Chair of Public Health at the University of Edinburgh and Director of public health research consortium SPECTRUM, signatory to the BMJ letter said:

    “While COVID-19 is a pressing emergency, the truth is that chronic non-infectious diseases are still overwhelmingly responsible for preventable death and disease in this country. What’s more those with the poorest existing health have the worst outcomes from COVID-19. A future public health system must be robust enough to protect us from the threats posed by both infectious and non-infectious diseases.”

    Joint statement to the Government on Public Health Reorganisation. Link to statement and list of signatories https://smokefreeaction.org.uk/phehealthimprov/

    Link to BMJ letter: Rapid Response: Joint statement to the Government on Public Health Reorganisation: https://www.bmj.com/content/370/bmj.m3263/rr-1

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    This week the Government is expected to announce that it will scrap the pandemic response function of Public Health England, and merge this with NHS Test and Trace to form an agency “similar to the German Robert Koch Institute”. It is also particularly distressing that the news was leaked to the press before PHE staff could be told.

    The SHA warns the reckless decision to restructure and defund public health services in the midst of a pandemic will result in further avoidable deaths. The public health service, nationally and locally has already been severely starved of funds as a result of austerity.

    The NHS Test and Trace Service (led by Baroness Dido Harding, and run by Deloitte, Serco, Sitel and other private sector outsourcing companies) has received strong criticism for its poor response to the COVID 19 pandemic.

    Dr Brian Fisher, SHA Chair, says “This is yet another example of the Government putting lives at risk by pursuing ideologically driven privatisation in a time of crisis.”

    Socialist Health Association members have told us that “this is another example of this government’s scapegoating, most especially since the man telling us the PHE response has been unacceptable was the man in charge, deliberately ignoring their expert recommendations and favouring sweet manufacturers and other non-expert businesses to deliver a service to the public. Public health has been underfunded, to the point it has required almost superhuman efforts from its staff to maintain a quality of service from the time of the so called Lansley Reforms. For that, our public health experts, like our nurses, are rewarded with a kick in the teeth.”

    SHA calls on the Government to reinvest funds from failing NHS Test and Trace private providers into the public sector pandemic response across the NHS, Public Health England and Local Authorities.

    1 Comment

    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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    On Friday 24 July 2020 HIV i-Base published the sixth COVID-19 supplement to HIV Treatment Bulletin (HTB). Please see this link.

    All i-Base reports are free to copy and i-Base encourages wide distribution. Please credit i-Base when distributing these reports.

    This is a slightly expanded issue of HTB that covers both AIDS 2020 and related virtual meetings plus a fair number of COVID-19 developments that seemed too important to leave out. It is a mixed compilation, but hopefully useful.

    This edition of HTB includes reports from the virtual AIDS 2020 conference and linked satellite meetings on COVID-19.

    The main heading news from AIDS 2020 included continued reductions in the signal concerning dolutegravir and neural tube defects, further results on weight gain from the ADVANCE study, cabotegravir as PrEP in HPTN 083, and an early report of HIV remission.

    As the introduction to these reports shows, interacting with the virtual conference was not always easy. Although we include links to the site in our reports, the site will only be open access (without registration) after 27 July 2020. 

    The difficult website was reflected in overall attendance. Even when watching live events (and many were missed due to technical problems with the site), more than 2000 delegates were rarely online (when more than 20,000 people usually attend).

    Many of the satellite workshops are easier to find and watch, and we include reports from the COVID-19 workshop on HCV drugs to treat COVID-19 and an update on remdesivir. As with the AIDS 2020 website, many of the webcasts and posters are now offline.

    The rest of this extended issue includes both HIV reports and a continued focus on COVID-19.

    For all the hope that coverage of COVID-19 might be less needed, this issue contains another 12 pages about coronavirus. Many important developments come from UK research – including new treatments, immune response, race and ethnicity and vaccines.

    Comments Off on HIV i-Base publish the sixth COVID-19 supplement to HTB

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

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

    1. Austerity (2010-2020)

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

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

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

    1. Poor political leadership (PM and SoS Health)

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

    1. Social care

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

    1. Inequalities

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

    1. Privatisation

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

    1. Recovery Planning

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

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

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

    NHS and NIHR

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

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

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

    A wealth tax?

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

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

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

    Populism and COVID

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

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

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

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

    27.7.2020

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

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    The threat to cut health visitor and community nurse jobs in County Durham, while Covid-19 is still widespread, has been branded as ‘incomprehensible’ by Unite, Britain and Ireland’s largest union, today (Friday 24 July).

    Harrogate and District NHS Foundation Trust (HDFT), which is taking over the County Durham 0-25 family health service contract from 1 September, wants to axe about 37 whole time equivalents (WTEs), while the coronavirus is still widespread across the country.

    Although the HDFT also says it wants to employ 21 WTE new posts, there will be a net loss of 16 WTEs out of a workforce of about 230 WTEs.

    Unite lead officer for health in the north east Chris Daly said: “It is almost incomprehensible that when ‘public health’ is foremost in people’s minds because of coronavirus, Harrogate and District NHS Foundation Trust is swinging the jobs axe.

    “The vast majority of those being earmarked to lose their jobs are health visitors and school nurses – the very professionals at the public health frontline helping families with babies and young children, and children returning to school.

    “Disgracefully, the trust is consulting when staff, have been working flat-out throughout the Covid-19 crisis supporting very stressed families and young people. This flawed exercise is happening before the first wave of the pandemic is over and with the expectation that a second wave will hit this autumn and winter.

    “It is also very wrong that schools and GPs have not been told about the proposed cuts in school nurses. School staff returning in September will be phoning school nurses to come and help with children that they have not seen since March and who may be exhibiting worrying behaviours and dealing with distressing emotions.

    “We believe that already stretched GPs will be expected to pick up the shortfall in keeping babies, children and young people safe. However, there is a real risk that those most at risk may fall through the current safety net that HDFT seems intent on weakening.

    “This is not the time to reduce the health and school nurse provision for children and young people. However, it will be some time before the adverse impact of these cuts are brought into sharp relief.

    “The Durham country council should work with the trust to increase the funding for these essential frontline services. The long-term health of families is never enhanced by reducing the number of healthcare professionals.”

    Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA), will be making strong representations on behalf of its members before the consultation process ends on 31 July.

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