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    Public meeting Wednesday June 3 – Get your ticket!

    We would like to invite you to our first virtual Zoom public meeting

    Internationalism in the Post Covid-19 World

    Wednesday 3rd June, 6pm to 8.30pm

    Speakers are: Harsev Bains, Baroness Christine Blower, Dr Kailash Chand, Jeremy Corbyn MP, Jacqui McKenzie, Murad Qureshi AM.

    Please register for this event at liberation.org.uk/event  And pass it on to friends and colleagues!

    Joint event by The Socialist Health Association and Liberation.

    Please contact Jean Hardiman Smith at admin@sochealth.co.uk for more information.

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    The SHA has been publishing its COVID-19 Blogs weekly since the 15th March. A number of themes have cropped up consistently throughout as actual events have occurred.

    Too slow to act

    The slow and dithering response by the government has been one such theme. This has been exposed with embarrassing clarity by media investigative teams which this weekend include the Insight team. Their detailed report on the dither and delay leading up to lockdown showed that when Italy and Spain locked down on the 10th and 13th March respectively each had over a million estimated infections in their countries. In the UK we had looked aghast at the footage from Lombardy and Madrid as their health and care system was visibly overwhelmed but the government failed to heed their strictly enforced lockdown policies in the 2 weeks warning we had. During this time from the 8th March the Johnson administration allowed the Five Nations rugby matches to go ahead in Twickenham and Edinburgh, the Cheltenham races, the Liverpool/Atletico Madrid football match on the 11th March and two Stereophonics pop concerts in Cardiff held on the 14th and 15th March. All this was apparently following the science…..

    France locked down on the 16th March with an estimated 800,000 infections and Germany locked down on the 21st March with only 270,000. The Johnson government had resisted calls to lockdown at the same time as France on the 16th March. They waited until the 23rd March by which time the estimated number of infections in the community had almost doubled to 1.5m. This dither and delay lies at the heart of our comparatively poor outcome with the COVID-19 confirmed deaths of 37,000 (an underestimate of all excess deaths). This list includes at least 300 NHS and care workers.

    Protect the NHS

    Germany’s earlier decision has reaped benefits alongside their border closure, effective test, trace and isolate (TTI) policies, with sufficient testing capacity, and led by regional public health organisations. They also have sufficient ITU/hospital bed capacity without the need to build new Nightingale Hospitals. Our government did not close borders or introduce quarantining on entry, and turned out not to have used February to build our testing capacity either.

    The strategic attention in the UK has been to ‘Protect the NHS’ but not in the same way Care Homes. Because of the shortage of testing capacity we had to stop the community based test, track and isolate (TTI) programme. The NHS has stood up well through the dedication of its staff and demonstrated the superiority of a nationalised health system. However from a public health policy perspective the COBR meetings should have been thinking about the whole population and what populations were at high risk such as those in residential and care homes.

    The data in Wuhan had been published quickly and had shown that it was older people who are most at risk of disease and death. We knew all this, the Chinese data has been replicated in Europe but the Government failed to follow through.

    The Privately owned Social Care sector

    Unlike the NHS hospital sector, the care sector, of residential and nursing homes,  are a patchwork of large ‘private for profit’ owners, smaller privately owned and run homes and the charitable sector. There is a registration system and some quality assurance through the Care Quality Commission (CQC). The fact that we do not have a National Care Service along the lines of the NHS has led to operational problems during the pandemic between commissioners, regulators, owners and the staff who run the homes. As privately run establishments there were varied expectations about procuring PPE for the staff in the early phase of the pandemic response. There was also a lack of clarity about whether satisfactory infection prevention and control procedures were in place and able to deal with COVID-19. How had residential and care homes undertaken risk assessments, working out how to cohort residents with symptoms and manage their care? What about staffing problems, agency staff and policies for symptomatic staff to self isolate? It was important early on to consider in what respect COVID-19 is the same as or different from influenza or a norovirus outbreak,

    It seems that the Secretary of State for Health and his staff have been too slow in aligning Public Health England (PHE), GPs and primary care infection control nurses alongside the homes to provide more expert advice and support on infection prevention and control.  It seems also that some nursing homes took patients discharged from the NHS who were still infected with COVID-19, when on the 19th March the Department of Health announced that 15,000 people should be discharged to free up NHS beds. There was no mandatory testing or period of quarantining before these patients were discharged. In this way hospital based infections were transferred to nursing homes.

    The scarcity of PPE (caused by the Government’s failure to heed the results of Exercise Cygnus) meant that professionals felt nervous about entering homes to assess sick residents and sadly to be able to certify death and certificate the cause of death. Rationing of PPE in this sector has contributed to the risk of infection in care staff, which would cause transmission in the care home. Most homes had to lockdown too, stopping visiting and in some cases having staff move into the home themselves at personal risk and disruption to their lives. It became clear that transmission from the community to care home residents was occurring through staff. This has been very hard on these undervalued and low paid staff, who began to realise that they were transmitting infection between residents or from themselves.

    Some of the stories of care staff’s heroism and dedication to their residents is extraordinary. It is reminiscent of Camus’s book The Plague, which recounts heroism undertaken by ordinary people doing extraordinary things. Tellingly Camus also suggests that the hardest part of a crisis is not working out the right thing to do, but rather having the guts to get on and do it. Many care home managers and staff had to do just that.

    Follow the money

    A recent report looked at HC-One, which is Britain’s largest care home group with 328 homes, 17,000 residents and so far 700 COVID related deaths. The operating profits of the company are of the order of £57m but, through the financial arrangements with off shore related companies, the profits “disappear” in £50m ‘interest payments’. While global interest rates have been at historically low levels HC-One have apparently been paying 9% interest on a Cayman island loan of £11.4m and 15-18% interest on another Cayman company for a £89m loan. Apparently HC-One paid only £1m in tax to the HMRC last year (Private Eye 22nd May) through this transaction with off shore interests off-setting their profit. This is not however inhibiting them from seeking government support at this time. A better future would be to rescue social care by nationalising the social care sector, bring the staff into more secure terms and conditions of service and sort out the property compensation over time through transparent district valuations.

    Test, trace and isolate (TTI)

    At long last the government has signalled that it wishes to reactivate the community based test, trace and isolate programme that it stood down over 10 weeks ago. Of course, once the virus had been allowed to spread widely within communities, the TTI programme would have had to modify their objectives from the outbreak control of the early stages. However they could have continued to build the local surveillance picture within their communities, help PHE to control residential and nursing home outbreaks with their community based contacts and prepare for the next phase of continuing control measures during the recovery phase.

    They seem to have at last realised the potential of local Directors of Public Health (DsPH) who are embedded in local government and who, after all, lead Local Resilience Fora as part of the framework of a national emergency plan. The DsPH have links to the Environmental Health Officers (EHOs) who survived the austerity cuts. EHOs are experienced contact tracers well able to recruit and train new staff locally to do the job. This is in sharp contrast to the inexperienced staff now being recruited and used by the private sector.

    The local public health teams also work closely with PHE and NHS partners and so can fulfil the complex multiagency leadership required in such a public health emergency. Building on these strengths is far better than drawing on private sector consultants such as Deloittes, or companies such as SERCO, Sodexo, Compass or Mitie. All these private sector groups have an interest in hiving off parts of the public sector. In addition, unsurprisingly, they have close ties to the government and Conservative Party. Baroness Harding, who has been brought in to Chair the TTI programme, is a Tory peer married to a Tory MP who was CEO of Talk Talk. She was in charge at the time of the 2015 data breach leading to 4m customers having their bank and account details hacked. No surprises, then, that she is asked to undertake this role as a safe pair of hands in much the same way that Tory peer Lord Deighton has been asked to lead the PPE work.

    Game changers – and what is the game?

    In last week’s Blog we mentioned that Government Ministers seem to be fixated on game changers whether novel tests, treatments, vaccines or digital apps. We mentioned last week that treatments like Chloroquine need proper evaluation to see if they are safe and effective. A report in the Lancet on the 22nd May found that there was no benefit. Indeed the study found that the treatments reduced in-hospital survival and an increase in heart arrhythmias was observed when used for treating COVID-19

    Vaccines need to be researched, as they may well be important in the future but remember that a 2013 review from the Netherlands found that they take – on average – 10.71 years to develop, and had a 6% success rate from start to finish.

    The mobile apps trial in the Isle of Wight seems not to have delivered a reliable platform, and of course the Government has probably ignored the apps working splendidly in South Korea and Singapore. Meanwhile Microsoft, Google, Facebook, Faculty and Amazon stand ready to move in. There are major risks with getting into bed with some of these players including the data mining company Palantir.

    Palantir

    This company was initially funded by the CIA but has secured lucrative public sector contracts in the USA covering predictive policing, migrant surveillance and battlefield software. These IT and data companies have been drawn into the UK COVID-19 ‘data store’. While working alongside NHSX and its digital transformation unit wanting to assess and predict demand there are concerns over data privacy, accountability and the possible impact on the NHS.

    Palantir has been of interest to Dominic Cummings (DC) since 2015, according to the New Statesman, when he reportedly told the Cambridge Analytica whistleblower, that he wanted to build the ‘Palantir of politics’. The other company Faculty had close ties too with the Vote leave campaign. Cummings is said to want to remould the state in the image of Silicon Valley.

    Conclusion

    So in the turmoil of the COVID-19 response the government has looked to multiple game changers while ignoring straightforward tried and tested communicable disease control measures. It has succeeded in ‘Protecting the NHS’ (though not against the incursion of the private sector) but allowed the residential and care home sector to be exposed to infection. We welcome the belated return to supporting DsPH and local public health leadership, which has been left out for too long. Let us hope – and demand – that there is also more investment in public health services and not allow Government spokespeople to start to blame organisations such as PHE.

    We worry that they are not being alert to safeguard public services by inviting some dubious partners to the top table. On the contrary they are VERY alert – to the opportunity of inserting private capital (and profit) in the NHS and other public sector organisations. One such company new to many of us is the data mining company Palantir – a company named after an all-seeing crystal ball in JRR Tolkien’s The Lord of the Rings. Lurking in the background is of course the Prime Minister’s senior political adviser DC.

    24th May 2020

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

    2 Comments

    Vested interest alert – yes I’m claiming that word back – I come from a family of school staff, teachers, TAs, school governors. The dedication and hard work of all school staff, caretakers, cleaners, cooks, governors have shown for the safety, education, well-being, in many instances feeding, their pupils throughout this crisis has been extraordinary.

    I am totally dismayed at any criticism. Staff have the well being and safety of their pupils at their very heart. Their views on the total opening of schools and the views of their representatives have to be totally respected. The issue is complex. In Liverpool, the elected City Mayor has chosen not to open schools on June 1st as a safe-guarding issue as this wonderful city is still reeling from a high rate of infection. Questions are being asked as to why Mayor Joe Anderson has taken this stance when schools in Denmark, led by our sister party, are opening. Joe has never said Liverpool can’t open its schools, he has said when it’s safe to do so and only then. Each local authority has its own characteristics, not only in terms of levels of this dreadful pandemic, but the physical nature and age of its school buildings, levels of deprivation, staffing, the amount of public funding available and not available, the differing needs of its pupils. Country by country comparison is far too simplistic. This is an educational, health and societal issue.

    We all want all our children back in school and we are most worried about our most vulnerable, where home-schooling in a cramped flat with no outdoor space is stretching our children’s educational and physical and mental health well-being. I have family members with differing views – what I do know is that they are taking decisions based on local circumstances and always with the education and health of their pupils and staff foremost in their thinking. What is clear is that our health and education services, so starved of resources in this dangerous and false economy of austerity, especially in cities like Liverpool, have to be funded properly based on demographic need. I sincerely hope this Government remembers that but I fear not. Is it safe to open schools to children other than those of key workers or classed as vulnerable? There will always be risk – the question is how to reduce it. We must now learn from other countries – transmission from children to adults, children returning to schools in Italy presenting with multisystem inflammatory syndrome weeks after exposure.

    The UK did not have community testing, contact tracing and isolation early. Surely the question is are schools safe enough to open? Which means we need information and monitoring at a local level, the amount of new cases locally and rates of transmission. Local data should be driving policy and assuming a date for the entire country is ideologically rather than data driven. We need to get children back into education, but a locally managed data driven approach has to be the only way. Prioritising testing over a date. Listening to our teaching staff and our unions.

    For Liverpool in present circumstances – I’m with Joe.

    Theresa Griffin Labour MEP North West 2014-2020

    Member SHA

    1 Comment

    The crises in health and social care are rightly at the forefront of people’s anger about the government’s lack of preparation for an inevitable pandemic, as we now face with Covid-19. People are dying unnecessarily. An integral element, simmering under the surface, is the fragmentation of public health nutrition services that should provide food security within our communities so vulnerable people are kept in good nutritional status. Yet even before this crisis there was an estimated 3 million malnourished people, with an aging population this will increase, and 8 million people in food insecurity. As lockdowns began, research from the Food Foundation estimated 3 million households were already experiencing hunger. Inequalities underpin the right to life in this crisis: mortality rates for people living in deprived areas are double that for those in less deprived areas, and interlocks with ethnicity. Some highlight ‘obesity’ but is not the problem food and health inequalities? Poverty underpins people’s lack of access to foods of good nutritional quality. Rising poverty levels are driven by erosion of welfare state and neoliberal restructuring of our economy through deregulation, precarity and low pay. Child poverty has increased by 100, 000 over the past year with around 30% of all children living in poverty. Food poverty is increasing and requires structural change not short term solutions. To protect child health and meaningfully tackle poverty a host of fiscal steps are urgently required to enable families to buy food, such as basic living income and immediate action to increase welfare. This does not remove the need for a food security system that ensures a basic level of socially acceptable nutrition is available for all; that includes universal free school meals and hot meals for older people. Public health nutrition is more than just food. It’s about ‘social’ nutrition: the infrastructure of community resources that enable people to eat together and to collectively care.

    The networks of care within our communities have broken down as the infrastructure providing services and civil spaces have closed. There is little research that documents how the spending cuts and restructuring within public health has impacted public health nutrition. However, research is underway that aims to inform the inevitable public enquiry on Covid-19. As socialists, we need to go further and give a call to action to stop further privatisation and charitisation of PHN. Fundamentally, the interests of private industry and charity conflict with the welfare state. Despite the altruism of many involved, these organisations cannot meet current or future needs which will increase in the looming economic depression. They cannot enable the voices of those who are suffering in our communities.

    Privatisation of PHN began under New Labour as food companies were brought into public health policy. From the 2000s non-NHS providers entered PHN. Local government spending cuts and austerity hit prevention budgets including nutrition-based, child weight management and life style interventions. Cuts to nutrition-related services are broadly felt because nutritional health is cross-departmental involving education, community engagement, adult and children and young people’s services and a range of professions including health visiting. Nutrition was embedded in the Sure Start programme. Since 2010, 1000 children centres have closed as £1 billion has been cut from budgets. The number of community centres, lunch clubs and meals on wheels for the elderly has been decimated. In this crisis, the role of schools in feeding children has shown their centrality in community life. Yet there are barriers due to privatisation that limit a strategic approach. For example, in most neighbourhoods, schools have the only industrial kitchens capable of preparing and distributing foods to large numbers of people. Yet access to these is mostly controlled by private food companies, including multinationals, that hold the catering contracts. So, in many ways communities are isolated, disconnected from power and the resources to enable local solutions. Social theorists argue that ‘austerity localism’ brought cuts, disempowered local communities creating distrust and disconnect with local government. Community involvement is further limited by democratic deficits that are created by material constraints and lack of structural mechanisms. All this suggests that it will be harder for public health to connect with communities and understand the scale of their need. While not supporting the authoritarian Chinese State, community engagement was integral to the Chinese response.

    Responsibility for public health nutrition lies with local government who have enlisted third sector organisations (TSOs), social entrepreneurs, and food industry to construct the state’s food aid response in this emergency. From a dietetic standpoint, it is concerning that food banks can distribute foods that may unintentionally cause harm. For example, food banks only need warn of potential allergens, if they are set up as a business.  Food banks can distribute infant formula. This is risky  for example, for vulnerable families with complex needs and should not be the responsibility of food banks. It suggests a lack of a cross-departmental strategic approach that links with professionals such as nutritionists and health visiting teams.  Providing food at the general level of need is also problematic. The voluntary sector has strategic limitations in its ability to scale up according to need. In London, developing a strategic approach has been spearheaded by NGOs at City level, and boroughs through food action alliances. The food alliances are networks of non-state and non-industry providers, involving a range of activities such as food banks, food growers, community kitchens – supermarkets- fridges. They connect with local government through their public health departments. As crisis hit, they quickly turned their energies to organising emergency food aid. Phenomenal efforts are being made to scale up to meet increased demands. However, they face barriers. For example, many TSOs are involved in competitive processes to win and maintain local government contracts. Funding is often short term; a precarious situation for TSOs. In this crisis they need to collect evidence for ‘sustainability’, that is, to secure future funding.

    Despite the existence of resilience structures at regional and borough levels, strategies to meet increased food needs were not apparent. Indeed, there was little national food strategy (Lang, 2020). In London, as the crisis unfolded new charitable funding streams emerged. Four weeks into the crisis, the owner of London’s free newspaper, Evening Standard, and son of Russian oligarch intervened to feed ‘vulnerable’ Londoners through a new charitable alliance. This centralises food surplus supplies and distribution across boroughs. This role of charities is legitimised by London’s Mayor, albeit likely unintentionally. This upscaling of charities to deliver such large-scale logistical challenges raises concerns about the future direction for PHN.

    Altruism continues with the emergence of new food banks, food project social entrepreneurs and the Mutual Aids. With roots in 19th Century social welfare based on fraternalism not paternalism, these are today on the one hand wonderful, inspiring acts of solidarity but what will they become? There are many questions to consider: Do they adopt a public health perspective that considers inequalities including class and ethnicity or are these individual acts of charity and kindness? What is the class composition of the Mutual Aids? Will there be unintended consequences? Within communities, will they bridge or increase class divides and inequalities? Do they provide uniform and equitable support?  Do they contribute to food democracy within our communities? How are they accountable?

    These and other new solidarity networks enter into the terrain of unevenly shared and disjointed public health resources. Across London, a postcode lottery in public health nutrition pre-dates this Covid crisis. For example, eligibility for free school meals depends on the political priorities of local councils as well as government policy. Universal free school meals (UFSM) for all primary age children are provided in only 4 of the 33 boroughs. This includes children in families with no recourse to public funds (NRPF). Their temporary access to FSM during this crisis will be withdrawn as schools reopen. A cruel, intentional political act belonging to the ideology of hostile environment; socially divisive among young children teaching them that ‘others’ are undeserving and go hungry. What will Labour councils do when the onus for feeding children with NRPF returns to them?

    The differences between and within boroughs is seen at the level of schools. Schools take different approaches with some providing food for all children in-need and others based on FSM eligibility. Seven weeks since its introduction, the government’s voucher scheme that replaced FSM continues to be problematic, adding to the suffering of families; some schools are bypassing with their own voucher systems. Schools are filling the gaps but cannot do so as a cross-borough strategic approach due to privatisation. In contrast to London, New York took a pan-city approach with 400 public schools providing food for all adults and children in-need.

    Despite incredible efforts, TSOs, have made it clear they cannot fulfil the function to feed ALL in need:    ‘There is not enough free food or volunteer capacity to feed all economically vulnerable people through local authority and charitable means’. Instead they argue that central government should provide the financial means to enable everyone to buy food that meets their nutritional and cultural needs. From an ethical view it is irresponsible that central government assigns responsibility to local authorities and TSOs without giving the resources to carry out responsibility. It is well established that emergency food aid systems need to be nationally co-ordinated strategies. The UK government’s use of the armed forces for food distribution to the 1.5 million shielded clinically extremely vulnerable people, is recognition of the level of strategic organisation that is needed. It shows that only central government has the resources and therefore responsibility to feed ALL people in-need, across all vulnerabilities. It is not possible for this to be a function of TSOs. How do TSOs and local government decide ‘vulnerability’ without interlocking socially divisive ideas of ‘deserving’ and ‘undeserving’ poor? These are political decisions. Solving hunger takes political will (Caraher and Furey, 2018).

     

    The politics of privatisation and charitisation are felt most strongly on the frontline by the community food activists some engaged for decades in fighting to hold their communities together. One such leading activist and mother, Maya in South London, said

    I’m tired of fighting, fighting, fighting”. Yet she remains on the frontline running the local food bank/social supermarket. She says: diets will slump in areas like this … people use social supermarket but can’t get the foods children want … fresh fruits and vegetables have short shelf life ..we have to respond to new issues that come along …the hidden people that now come out who are in extreme poverty. While caring for her community she comments on new oppression by powerful borough groups and lack of accountability: people are going crazy with this food thing … there’s a lot of money around food …all they want to do is help the ‘poor’ people … they’re doing deliveries, taking selfies and putting it on twitter …  some people are stepping on our heads… others are cashing in on it.” On a part-time London living wage, she finds her own living standards are slipping backwards.

    What will emerge from this crisis? Local authorities will soon be planning their recovery processes. With depleted and finite funds will we see a redefining of ‘vulnerable’; a new means testing for referrals to emergency food aid? We are facing a long recession/depression with increased food poverty, malnutrition and hunger. This is potentially on an unprecedented scale. How will the increased charitisation together with ongoing cuts impact the public health infrastructure and jobs? Who will be providing food for public health? These are important questions for all of us in PHN whether Director of Public Health or unpaid community food bank worker. How we tackle feeding EVERYONE in-need is not just a practical question but a basic ethical one concerning food rights and health equity that requires reconnecting with our communities and schools for grassroots participation in decision-making. Enabling participation requires tackling the material conditions, of work and physical food environments, that underpin health inequalities.

    A weak public health nutrition infrastructure, including diminished community services, contributes to undernutrition, reduced immunity, more illness, more hospital visits. Pre-Covid estimates showed  £200 million could be saved in health and social care spend if greater attention is paid to caring for the nutritional status of vulnerable adults. This would contribute to the inequality seen in the distribution of Covid-19 death rates. Our right to nutritious food is essential to enable our rights to good health and longevity free from illness. To make this a reality, for all, will require fiscal measures that guarantee universal basic living income, that integrates food costs, as well as massive investment in communities and public health nutrition. One among many lessons for how we plan for food and health resilience in times of crisis, is to meaningfully, democratically involve our communities and workforces on the ground.

    Sharon Noonan-Gunning, Registered Dietitian, PhD in Food Policy.

    Caraher M., Furey, S. (2018) The Economics of Emergency Food Aid Provision: A Financial, Social and Cultural Perspective. Palgrave Macmillan. London.

    Lang, T (2020) Feeding Britain: Our Food Problems and How to Fix Them. Pelican Books.

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    Introduction

    This is the tenth SHA weekly blog on the COVID-19 pandemic. We are at an interesting phase of the pandemic when we are moving from Response to Recovery and uncertain how to navigate the tricky waters without the charts and the data dashboard to guide us.

    We have a government that was ill prepared for the pandemic and has been playing catch up from the early days of denial, then delay and a too early departure from building local systems of community testing, tracing and isolating. We are beginning to hear of possible COVID-19 cases in the UK and neighbouring European countries emerging before Xmas so the virus could have been around longer than we have thought. Even so we wasted precious weeks in February and then had the damaging delay between the 10th March to the 20th March, when lockdown proper started during which time the viral spread had been exponential. We now note that England has one of the highest rates of excess deaths of the 24 European countries analysed by Euromomo.

    Game changers

    The government have, in the turmoil, grasped at ‘game changers’ such as the so called home based antibody blood spot test which was scientifically unproven and nevertheless succeeded in getting the Government to buy 3.5m on ‘spec’. We need to know how much Taxpayers money was wasted on that contract and demand a greater scrutiny on such wild contracts without basic safeguards.

    The next ‘game changers’ were the treatments such as chloroquine, which Trump was allegedly pushing on the NHS to treat Prime Minister Johnson. Again these drugs have been shown to be ineffective and potentially harmful treatments. The US Federal Drug Administration (FDA) issued a caution against its use in COVID-19 on the 30th April! There are other drugs being trialled such as remdesivir and favipiravir and some show promise but need properly conducted clinical trials and not be pushed out too soon by politicians anxious to grab a game changer. Remember the risk of Thalidomide, which was used in early pregnancies with disastrous consequences. We have seen with HIV/AIDS that therapies can be successful in controlling a viral disease but the process takes time and effectiveness trials and safety are paramount.

    The other ‘game changer’ is the vaccine which has always been a long shot because there have never been vaccines developed for Coronaviruses such as SARS or MERS. Other viruses such as HIV have also proved impossible to develop a vaccine for and remember each year the Influenza virus ‘flu jab’ immunisation contains three variants which experts assess are the most likely to be circulating during the coming winter months. The effectiveness of the Influenza vaccine is much less than others such as measles in the highly effective MMR vaccine. Furthermore while there are hopeful signs of successful vaccines being developed and some moving into human trials very early on there needs to be clarity about the time these trials take and the manufacturing process as well as mounting an effective vaccination programme. It is not part of the immediate pandemic control measures and with preventive vaccines you need to be very sure of safety as well as effectiveness. We know how the anti vaxxers mislead the public about risks of vaccination and do not want to damage the high uptake of vaccines across world populations.

    Matt Hancock has during his time as SoS for Health and Social Care promoted digital solutions to many NHS issues including promoting companies who in effect were competing as privateers with NHS primary care (Babylon Health). His latest ‘game changer’ application will be the apps being trialled in the Isle of Wight and others elsewhere to assist in contact tracing.  Big players Apple/Google stand ready with their apps to step in! Of course countries like South Korea, Taiwan and Singapore have been using such apps for months and have shown the benefit they confer in the process of Test, Trace and Isolate which the UK government abandoned on March 12th.

    It does seem unbelievable that South Korea has not been subject to lockdown and using testing, tracing and isolation has only had 262 deaths from COVID-19 by the 17th May with a population of 51m people. Their epidemic started several weeks before us and it is not clear what attempts the UK government has made to properly understand their system and learn from it.

    Local Authorities and Public Health

    Local Authority public health capacity has been reduced over the 10 years of Tory austerity and the public health grants reduced in the period leading up to the pandemic. While the Directors of Public Health, through their national body the Association of Directors of Public Health (ADsPH), have been involved with the CMO’s office and Public Health England (PHE) they have not been placed at the centre of the Test, Track and Isolate planning. Again the Government’s default position is to ask their consultancy mates to help design a system from scratch which we have seen with the national testing centres and the Lighthouse laboratories by Deloittes. This is a top down approach rather than a collaborative bottom up development.

    Further work now under a Joint Biosecurity Centre (JBC) is again focused on the digital app and how the information provided can be analysed and communicated. This has all the tenor of a security service GCHQ venture rather than a public health pandemic response! If the testing roll out is anything to go by there will be major glitches in communications with organisations at the heart of it not receiving information and the people themselves left waiting.

    It seems to us that local public health teams under the DPH leadership should have been involved from the beginning working with Public Health England/Wales/Scotland,  and Environmental Health departments to help facilitate test, track and isolate policies locally. They have not been closely involved since containment was abandoned prematurely across the UK despite wide variations in the spread of the virus at that time.

    The government announced that 18,000 staff will be taken on to work on the national test, trace and track initiative run by SERCO but Local PH departments were not asked to build local teams as part of the local response but prepare to help implement the national response. Primary care has also not been part of the model which is another wasted opportunity of bottom up work using local knowledge effectively. The GP surveillance system has shown its worth over many years with respiratory viruses like Influenza and patients know their GP practice as a trusted point of contact.

    We have seen that COVID-19 has spread across the UK unevenly and a UK wide response designed in Westminster has not been appropriate elsewhere where case numbers may have been very low with risks quite different from metropolitan London, Birmingham and Manchester. Of course there needs to be national leadership in the design and procurement of such an app and Public Health England with their counterparts in the devolved nations be part of the design team. However for it to be an effective system there needs to be local leadership and engagement which builds links between partners and particularly with local primary care teams to use test results and develop the capability of mapping clusters and initiating further local investigations within national case definitions to ensure testing is done, contacts traced and people are isolated swiftly as there is a risk that the virus will persist for weeks to come. There are signs that devolved governments such as in Wales may be approaching this in a more joined up way.

    Social Care

    In earlier blogs we have talked about the vital role that the social care sector plays, how their staff often work in difficult conditions on low pay. The impact of the pandemic now has shifted to this sector, which has 17,000 homes and look after 400,000 elderly or disabled people in need of care. This sector is where many of the excess deaths have been occurring and thanks to statisticians outside government who have signposted the excess deaths measure we know that they have accounted for 20,000 deaths so far. Weekly deaths in care homes have tripled in the past month. In Scotland recently it is estimated that 57% of deaths from COVID now come from deaths in nursing or residential homes.

    We have heard case after case of social care providers not having the PPE they require, having to accept hospital discharges who may have been infectious, not being supported in the way you might expect from external agencies. They have had to introduce infection control policies, which seem inhumane when considering the resident’s end of life experience and the memories of their survivor families. We should have a quick look at the risk assessments/processes to allow named next of kin to visit their relatives and be there at the end of life. It does feel that this is the time to grasp the nettle and create a new National Care Service which is publicly run and which does not require rental payments to ‘off shore’ bodies, who have invested in the land and properties rather than the commitment to care. Not all care homes are owned and run by business interests of course but all suffer from chronic underfunding, staff shortages and service gaps between the NHS and their own provision. The CQC is unable to bridge the gap.

    Moving out of Lockdown

    We are all getting tired of having our lives constrained by lockdown while at the same time pleased at the social solidarity shown by most of the population. The trade unions are quite right to ensure that the workforce is not endangered by a hasty return to work without rounded risk assessments.

    Take the school debate for example. It is relatively easy to look at children themselves and declare that they as an age group have been relatively spared the harms of COVID-19. However we know that they do seem to get the infection and harbour the virus in their noses and throats too. We don’t know how contagious they are but there is obviously a risk and scientific studies are understandably scarce. European countries such as Norway and Denmark have had far less cases and deaths than the UK and have got down to very low levels. For example Norway has had 8,244 cases with 232 deaths and Denmark 10,927 cases with 547 deaths. Their schools have had to implement big changes in the way they mix outdoors and indoors classes and have had to physically distance children in classrooms and for school meals. Halving class sizes seems the likely way we would need to go in the UK which might mean two day sessions which would have huge implications for schools.

    But its not just children! Teachers and school staff are at risk and there needs to be proper occupational health assessments to assess individual risks in the staff. Then there are parents and grandparents who may be involved in bringing children to school and mingling with others at drop off. Children may in turn bring back the virus to the home where there may be vulnerable others living there. So rather than the hurried declaration made to reopen fully on the 1st June there needs to be proper discussion and agreement with trade unions and parents and staff/school Governors on the risk assessment and plans. Remember too that schools have been open during this time for children of essential workers and vulnerable children many of whom have not attended. Oh, by the way, Eton pupils will return to school in September and they already have small class sizes!

    Scrutiny of Public Expenditure

    It is estimated that the Government has now built up £300 billion national debt through its Pandemic investments. The furloughing scheme has been widely welcomed, as has the cancellation of NHS (England) historic debt. However there have been some decisions made by harried Ministers that have been misplaced (such as the home based antibody test) as well as some of the spend on ventilators and Nightingale hospitals when it was already apparent that the NHS was coping somehow with the huge demand on ITU capacity. The decisions to contract out some of the tasks on testing, track and trace have been questionable and the investments in the pharmaceutical industry for vaccine production/drug development need to be scrutinised. Contracts worth more than £1bn have been awarded to 115 private companies dealing with the pandemic, without allowing others to bid for the contract. This has been under fast track rules which suspend normal procedures and include contracts to provide PPE, food parcels, COVId-19 testing and to run operations rooms with civil servants. This latter group includes Deloitte, PWC and Ernst & Young!

    The last thing we want is to be plunged back into austerity at the end of the pandemic. Already we hear of withdrawal from the rough sleepers investment in accommodation before alternative plans are in place and indeed before realistic resurgence in tourism happens. The new normal needs to preserve the advances that have been made. Similarly simple calls for people to drive to work risks the modal shift that is possible towards walking, cycling to work if public transport is deemed too crowded for social distancing. Electric cycles can be promoted for those with further to travel or in hilly areas. The reduction in air pollution while helping the carbon load is still not at levels this year required if we want to meet the goals of the Paris Accord and keep global temperature rise to 1.5 degrees.

    The Chancellor and his advisers will be wondering how to get more money into the Treasury. Now is the time to look at a proper wealth tax and to deal with off shore tax avoidance. Dyson tops the Sunday Times Wealth list and remember Sir James moved his head office out of the UK to Malaysia during the Brexit debates. He is sitting on £16.2 billion wealth. The Duke of Westminster has had 300 years in the top spot of property wealth  (£10.3 billion) built on their portfolio of 300 acres of Mayfair and Belgravia (remember the Monopoly Board!). Others in the top 10 include the Coates family who have accrued £7.17 billion through gambling business such as Bet365 and we know the damage to public health that gambling does. Finally lets call out Richard Branson who sought a government subsidy of £500m for his furloughed staff in Virgin Atlantic with his £3.63 billion. He has apparently not paid any personal tax in the UK for 14 years. These super rich need to be taxed on their annual earnings as well on inheritance transfers, which by using Family Trusts subvert the process.

    Finally

    As we think of US billionaire David Geffen on his $590m yacht, who posted on Instagram that he was isolated in the Grenadines avoiding the virus – lets consider a better fairer future.

    The pandemic can be an opportunity for progressive change to reduce inequalities but we know that there are entrenched and powerful interests. The rich are often supporters of entrenched interests as they benefit from the status quo. In the light of the pandemic they should reflect on how sustainable the status quo really is. We also need to clear set out a new road map for a fairer future.

    17th May 2020

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

    2 Comments

    The UK has been in lockdown since March 23rd 2020 in an attempt to slow down the spread of the Covid 19 virus. Six weeks on the number of new cases per day has begun to decrease and government and business are clamouring to restart the UK economy. We believe that people’s health should come before profit and that there should be no return to work until it is safe to do so.

    The UK has the highest death toll from Covid 19 in Europe and the data does not to support that it is yet safe to relax physical distancing.

    https://www.theguardian.com/world/2020/may/05/uk-coronavirus-death-toll-rises-above-32000-to-highest-in-europe

    https://www.theguardian.com/world/2020/may/02/coronavirus-uk-how-many-confirmed-cases-are-there-in-my-area

    We may have reached the peak but there were still nearly five thousand new cases diagnosed on 3rd May 2020 and because access to testing has been so poor it is impossible to know how many other people in the community are infectious.

    We cannot undertake any meaningful planning for an exit strategy from the current lockdown without an understanding of COVID-19’s prevalence and our current levels of immunity.

    On April 2nd Health Secretary Matt Hancock promised to test 100,000 people daily by the end of the month. The government claim to have reached their target though there are allegations that the tally was artificially boosted.

    https://www.theguardian.com/world/2020/may/01/ministers-accused-of-changing-covid-19-test-tally-to-hit-100000-goal

    Testing must be safe, freely available and reliable and must be accompanied by rigorous contact tracing.

    https://www.theguardian.com/world/2020/apr/29/uk-turned-down-offer-of-10000-coronavirus-tests-a-day-four-weeks-ago

    True prevalence is proving hard to predict. Where one study suggests 75% of people infected may be asymptomatic, another reports a very low rate of current infection – less than 1% of the tested population.

    The only way out of this is to gather data and learn the truth.

    Epidemiological studies of appropriately sized, randomised cohorts repeated every few weeks would chart the progress of the disease.

    Cuts to Public Health have made it virtually impossible to mount coordinated local responses to Covid 19 with testing, isolating and contact tracing. Restoring and updating local communicable disease control is an integral part of properly funded, publicly provided health and social care.

    https://www.theguardian.com/world/2020/apr/26/to-tackle-this-virus-local-public-health-teams-need-to-take-back-control

    The lack of appropriate PPE is an ongoing problem in public facing jobs and this will only be exacerbated as more people return to work. Industry must be immediately repurposed to produce appropriate PPE in sufficient quantities.

    If people are to return to work it must be safe for them to do so, including their commute.

    Each workplace should undergo appropriate risk assessment to prevent unnecessary transmission of the virus. We do not believe that the Government can be trusted to do this. Trade Unions must have oversight. For example it should be up to the education trade unions to determine whether it is safe to open schools and the criteria that will need to be met. Schools must not be seen by Government and business as convenient childcare to enable kickstarting the economy. We support the NEU’s demands that schools should only be opened when it is safe to do so.

    https://actionnetwork.org/forms/open-schools-when-it-is-safe/

    Covid 19 has highlighted the importance of a nationally coordinated, publicly provided health and social care service. The NHS has excelled itself in coping with the crisis whereas the largely privatised, for profit, care home sector, which has no central coordination, has been tragically unable to prevent Covid 19 from taking a huge toll on it’s residents.

    https://www.bmj.com/content/bmj/369/bmj.m1465.full.pdf

    It is well known that there is a spike in morbidity and mortality from all causes when a pandemic hits and services focus on the crisis in hand.

    https://www.bmj.com/content/bmj/369/bmj.m1607.full.pdf

    The private health sector must not be allowed to profit from this. The private sector should be requisitioned if they are needed to help to clear the backlog. Matt Hancock, Secretary of State for Health and Social Care promised “We’ll give the NHS whatever it needs and we’ll do whatever it takes.”

    https://www.parliament.uk/business/news/2020/march/covid-19-statement/

    The NHS needs investment to deal in house with the waiting lists inevitably generated by the crisis, and investment must be ongoing to preserve NHS resilience. One of the lessons from Covid 19, and most winter flu epidemics, is that the NHS cannot be run flat out all year round without headroom and spare capacity to cope with peaks in demand.

    New infrastructure, such as software for arranging work rotas, is increasingly outsourced to the private sector. This is unnecessary and could easily be managed within the NHS.

    Neither must health care be rationed to cope with the back log. We reject the blanket use of the term Procedures of Limited Clinical Value (POLCV). Patients care must be decided individually on clinical need and not restricted due to financial pressures.

    Deprived populations have very high death rates and the effects of societies’ response to Covid 19 disproportionately affects those from BAME communities, the poor and vulnerable.

    https://www.theguardian.com/uk-news/2020/may/01/covid-19-coronavirus-newham-london-uk-worst-affected-area

    The UK is one of the most unequal societies in the world, while the more affluent are able to isolate in comfortable homes with plenty of outside space the poorest often have to share beds and go without food, for them physical distancing is impossible. Many epidemiologists, including Sir Michael Marmot, have demonstrated that the more unequal a society is the less healthy it is for everyone, including the richest. The Health Foundation Report published only two months ago “ The Marmot review ten years on” is a damning indictment of Government policy.

    https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on

    Many other commentators suggest ways to redress the imbalance, they have largely been ignored by the Tory Governments. We contend that if these measures had been introduced it would have been much easier to contain Covid 19. We demand that Marmot’s original recommendations to be fully implemented.

    http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review

    In conclusion we believe that people’s health must not be sacrificed in the interests of profits. There should be no return to work until it is safe to do so and ordinary people must not be made to pay for the crisis, there must be no return to austerity. The UK is a rich country and there is plenty of money in society to ensure that everyone’s needs are met. If the banks could be bailed out in 2008 the people can be supported properly now. A Green New Deal would help to provide a more sustainable economy and a Universal Basic Income would help orientate us towards a fairer society based on need not profit.

    In summary before lock down ends there must be:

    • Testing which is freely available with contact tracing which is rigorously followed up and restoration and updating of local communicable disease control as an integral part of properly funded, publicly provided health and social care.
    • Frequent epidemiological studies of appropriately sized, randomised community cohorts to determine the prevalence of Covid 19.
    • Appropriate PPE for all public facing workers.
    • Repurposing of industry to produce sufficient supply of appropriate PPE.
    • Universal Basic Income and a Green New Deal with an economy based on need not profit.
    • Trade Union oversight on the safety of return to a particular workplace and trade union control of the safety aspects such as physical distancing
    • No exploitation of the backlog in care by the private sector to boost their profits.
    • A comprehensive National Health and Social Care Service, publicly funded, publicly provided and free at the point of delivery for all in the UK with adequate investment and an end to outsourcing, privatisation and fragmentation.

    Posted by Jean Smith on behalf of Doctors in Unite 5.5.20

    2 Comments

    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