Category Archives: Socialist Health Association

The Socialist Health Association (SHA) published its first two Blogs on the COVID-19 pandemic on the 17th March and 24th March 2020. A lot has happened over the past week and we will address some of these developments from our political perspective.

  1. A global crisis

The pandemic continues to spread around the world and we are seeing that while Europe remains a global hotspot the epicentre is now shifting to North America. It remains to be seen how the Trump administration ‘handles’ the situation but global leadership and best practice will not emanate from the White House and we will need to look to those progressive State and City level leaders in New York City and California for examples of political leadership in a crisis.

The astonishing successes in tackling the pandemic seen in the Far East should still be sources of practical evidence of good practice. Despite the concerns about transparency in the Chinese system it remains an extraordinary achievement to have controlled the spread from the centre of Wuhan (population 11m) to be contained within Hubei Province (population 58m). A bit like London and the rest of the UK! The 1.4bn population of China have so far been exposed to relatively minimal spread. Some of the urban populations in China are huge such as Shanghai’s 24m people and the density and housing would be vulnerable to the spread of C-19. Our government talk of ‘contain’ and ‘delay’ and ‘suppress’ the coronavirus – well there is much to learn from Asia.

Whenever we see TV footage of the Chinese control measures, staff in public places are gowned, have masks and/or goggles and gloves. Clearly there is no shortage of PPE in China! Frequently you see officials challenging people in the streets and checking temperatures with the thermal imaging meters. Of course these screening measures are imprecise and the scientific evidence to support them is thin but we were told in the UK that the two key questions were – have you got a fever or a dry cough? We know that many people are symptomless when they first contract the virus and can be infectious but this does not rule out basic questions such as these delivered by lay workers to protect others in the streets/shops/surgeries/workplaces? People who have symptoms of a cough or fever are referred to diagnostic pods for advice and further testing. This does seem to be good public health control and is also used at airports and seaports, which have been pretty absent in the UK.

Test, test, test was the refrain from WHO leader Dr Tedros A. G. and one of the countries that has shown success in controlling the spread of C-19 is democratic capitalist South Korea where the population of 52m has had 9,583 confirmed cases with only 152 deaths by the 29th March. They have led the world in PCR testing for the presence of the virus with an estimated 316,000 tests done by 20th March. Germany is close behind with 167,000 tests done and the UK trails behind at 64,000 by the 19th March. It is basic communicable disease control methodology to identify probable cases by the history (symptoms/signs) and then have a test to confirm the case. If positive then there is contact tracing and cases are quarantined. It is still not clear why the PCR testing capacity was not scaled up in the UK during the time between the middle of January when the RNA code of COVID-19 was shared worldwide and March when demand for testing and containment accelerated. This is one of the key questions for the enquiry after the pandemic is over.  The relative lack of testing capacity has made the control measures here more difficult. The cases recorded here have, since abandoning the contain phase, been those presenting to hospitals rather than measuring the incidence in the community.

Attention is now moving towards rolling out the second test – the ‘have you had it?’ antibody test. This will not help in the early stages of the illness but will help confirm that people have actually had C-19 and will in most cases have immunity to the virus. This will give more confidence for NHS and Social Care and other essential workers to return confidently to their workplaces. This is in the evaluation stage but should be available soon and hopefully will not be held up. Getting scarce NHS and Social care workers, and other essential workers back to work is extremely important as is protecting them at work from contracting infections.

The pandemic is gradually spreading to India and down the African continent too. This will expose more at risk populations living on the edge economically, often in poor and unsanitary housing. We know that infection control measures will be difficult to undertake and the health services remain relatively weak in LMICs. As ever, social determinants of health and wellbeing will emerge as factors and the mortality will reflect the global inequalities we already know about.

So it was good to learn on the 25th March that the G7 countries have stated their support for the UN and WHO and committed some resources to help tackle the pandemic. The UK has offered £240m which if mirrored by other G7 countries will not get very far towards the WHO target of £71 billion for the immediate public health response and priority research. Lets hope that sufficient resources will flow but sadly the richest country in the world (USA) has had a recent track record of disinvesting from global organisations such as the UN and WHO.

As in the previous Blogs we support the research into novel treatments and the development of a vaccine but not to let that divert us from trying to delay the spread of the virus across our country by enforcing the stay at home and lockdown measures. We should continue to apply basic public health control measures, even within households, of isolating symptomatic people, strengthening hand washing and hygiene measures.

We also welcome the action that has been taken by some Local Authorities to provide accommodation for the homeless and rootless and also providing them with food and places to stay during the day, which reduces spread amongst this very vulnerable population. Lets make some of these initiatives set the pattern for tackling this issue in the post pandemic age.

 

  1. 2. The NHS and Social Care

The NHS has been ramping up their preparedness and we welcome the use of private facilities as part of the national response although we prefer that this is seen as requisitioning and not a favourable commercial contract for the private sector. We also welcome the creation of the emergency Nightingale Hospitals built in Conference centres and sports stadia in London, Birmingham, Manchester, Glasgow, Belfast and Cardiff . These new beds will be purpose built for COVID-19 caseloads but we note that they will need to be staffed by trained nurses and doctors. These new beds must be seen alongside the closure of an estimated 33,000 beds since 2008/9, which has weakened the NHS resilience and made the UK one of the European countries with the lowest beds/1000 population. For example Eurostat data for 2017 identifies ‘curative beds/100K population’ and shows that Germany had 601, France 309, Italy 262, Spain 242 and the UK 211. It is no surprise then that we see intensive care patients being airlifted from Italy and France to Germany. Germany’s testing control measures and its hospital bed capacity is part of the explanation for them appearing more in control of the situation with currently a comparatively low death rate.

We have seen a massive shift in the way that GP services are provided and how GPs and patients are adapting to telephone and videoconferencing. GPs are also playing a vital role in advising and supporting those receiving community care and have long term conditions. These vulnerable patients will be well known to their primary care teams and reliant on being able to get advice. It goes without saying that out of hospital care will be vital during the time when local acute hospitals are stressed with redesigning services to deal with acutely ill COVID-19 patients.

In terms of overall preparedness one does wonder whether the NHS was more prepared for Brexit than a pandemic!

The social and residential care sector in the UK will be a vital player as the pandemic rolls out with its particular risk for older people. The dynamic between social care and the NHS will be important as the NHS struggles and the transfer/admitting/discharge criteria change. Already the NICE guidance on criteria for intensive care has identified frailty explicitly as an issue to assess suitability to admit a patient.

As with other key services social and residential care staffing will be a challenge as recruitment and retention issues increase and staff stay off work to self isolate. The guidance on personal protective equipment (PPE) is being actively reviewed and both NHS and Social Care staff in the Community must be provided with appropriate protective equipment to match the cases that they are assessing in the community or actually caring for. This will become more important for primary care clinicians as well as social care staff asked to look after acute COVID-19 patients or those discharged for hospitals.

 

  1. Jobs and income

Clearly the pandemic has driven a coach and horses through the economy. The Chancellor’s proposals have been helpful and the proposals for the self -employed has moved a long way toward providing some security for this sector. The gig economy however is more difficult and the benefit system has been shown to be inadequate as a place to go for this group of workers. The SHA still feels that there is an opportunity to trial universal basic income as a mechanism to provide all citizens with assurance of having enough income for their health and wellbeing.

There are also concerns that without close Parliamentary scrutiny there are risks that the Tory government will award contracts to their people and the State revenues will be subject to fraudulent claims from off shore companies and global players who have been able over the years to duck paying tax. The SHA has always viewed a progressive tax system to be the route to funding necessary services and that tax dodging should be rooted out.

There may be a case now for a form of  Parliamentary scrutiny so Labour Shadow Ministers have sight of the details around awarding such huge amounts of public money to companies run by the Bransons and Dysons of this world. There is a positive movement underway shown by the selfless work of health and social care services and other essential workers. It is also exhibited by the clapping applause last Thursday and the 750,000 volunteers.

There should be an opportunity as we come out of this crisis to lay the foundations for a different type of society in the same way that after WW2 the incoming Labour party brought in such great reforms as creating the NHS and introducing State Education.

 

On behalf of the Officers and the Vice-Chairs of the SHA.

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

  1. Global crisis

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

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

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

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

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

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

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

  1. The public health system

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

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

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

  1. Local government and social care

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

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

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

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

  1. The NHS

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

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

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

  1. Maintaining people’s standard of living

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

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

  1. Conclusion

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

24th March 2020

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I sent this letter to the Scottish First Minister and health spokesperson with the PQs attached and and copied it to Welsh First Minister and Health spokesperson.

21 March 2020

Dear Nicola and Jean,

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

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

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

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

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

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

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

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

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

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



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

Summary

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

China

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Draft PQs


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

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

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

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

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

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

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

Change.org/NHS4all

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

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

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

 

“Dear ____

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

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

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

Best”

 

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

Good luck and thank you from all the team.

In Solidarity

Tom Griffiths

Keep Our NHS Public

Campaigns Officer

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20/03/2020

 

OPEN LETTER TO THE PRIME MINISTER FROM THE SOCIALIST HEALTH ASSOCIATION

Dear Mr Johnson,

The pandemic has exposed the steady destruction of our public services and welfare state which has happened over the last 10 years.

This is the most unprecedented health challenge in 100 years which is complex and difficult – but as voiced by many experts in the field, we have significant concerns about the way the UK government has hitherto been approaching this national emergency. We hope from now on this will be better co-ordinated. We support frontline staff at this worrying time.

However the public is finally waking up to the fact that, as a result of government austerity and privatisation policies, we are ill-prepared – with too few ICU facilities, NHS beds, healthcare staff and equipment – to offer a safe and effective response to the virus. Those most at risk also have to use a threadbare social care system which is already bending under the strain.

The UK should be in a relatively strong position on public health with a comprehensive service, considered one of the best in the world. However, Tory reforms in England destroyed the health authority structure below national level and has slashed budgets but at least Public Health England has a regional organisation and Local Government have Directors of Public Health. We wish to make some key points:

  1. You are placing staff at risk

There is not enough personal protective equipment (PPE) for clinicians/frontline staff who are now personally at risk every time they go to into work.

There is insufficient testing of staff who, having been put off work with minor illness and then return to the front line, do not know whether they have had the virus or not.

  1. You are placing patients at risk

There are too few beds and too few trained intensive care staff and equipment such as respirators. The government appears to have acted too late. We should be requisitioning beds from the private sector, not paying them £2.4 million a day.

Covid-19 testing has been wholly inadequate. It appears that a combination of inadequate preparation and misguided policy is responsible.

  1. You are placing communities at risk

Undocumented people, for instance migrants and refugees, have long felt unable to use the NHS for fear of being referred to the police or the Home Office. This will increase risk. Legislate on charging and reporting undocumented migrants must at least be suspended.

Those precariously employed, particularly gig economy workers, are still not financially protected and may be compelled to continue working inadvertently spreading infection.

Thousands of excess deaths have occurred in the last few years as a result of the slowdown and reversal in life expectancy. Austerity policies have been a significant cause. It confirms international evidence that cutting the welfare state while at the same time introducing austerity, kills people.

This pandemic is likely to add to that grotesque toll.

  1. You are placing the NHS at risk

Government policy has split hospitals from general practices and from each other. It has created an industrial approach to care where staff and patients are increasingly seen as economic units. The newest redisorganisation has opened up the English NHS planning process to the private sector and to the US, especially if we have a trade deal. In addition, it has the potential to split the English NHS into 44 independent units – exactly what we do not want as we fight a global pandemic. If your government’s Long-Term Plan had already been fully implemented doing exactly that, we would not have been capable of a well-coordinated national response to the Covid-19 crisis.

  1. You are placing Social Care at risk

Too little funding for Local Authorities has put social care on life support. Those most at risk receiving personal or residential care appear to receive the least advice and the least support to combat the virus. Those with Direct Payments, organising their own care with Local Authority funding, appear to be entirely on their own if their carers get ill.

  1. You are placing democracy at risk

The most recent reorganisation of the NHS has made both formal and informal democracy more difficult. Just when we need all communities to collaborate and contribute to responding to this global challenge, NHS organisations have become more distant and poorly responsive.

It has been frustrating and confusing to have changing government advice without any formal presentation of the data and evidence behind it. It was patronising and did not inspire confidence.

 

WE EXPECT YOUR GOVERNMENT TO:

  • Treat us like adults – show us the evidence on which you base your decisions
  • Protect frontline staff right now with clinically appropriate protective gear and systematic testing. Bring testing in line with the WHO recommendations.
  • Protect the population of the UK by permanently increasing NHS staff in hospitals and primary care, increasing hospital beds, increasing respirators.
  • Roll back privatisation and austerity across public services.
  • Seize the opportunity of this pandemic to invest for the long-term in the welfare state, recognising that a thriving society requires a thriving state.
  • Suspend now legislation on the charging and reporting of undocumented migrants.
  • Invest permanently in social care, making it free at the point of use, fully funded through progressive taxation, promoting independence for all and delivered by a workforce with appropriate training, career structure, pay and conditions.
  • Protect those in precarious employment from financial meltdown from the pandemic. All those who should not be at work should have an living income.
  • Ensure that people across the UK have equitable access to the help they need, through their Devolved Administrations
  • Review the Long Term Plan

 

Faced with this international emergency, we need to combine medical expertise – including support from abroad, with technical investment with practical solutions and community engagement along with emergency economic measures to fight this together.

 

Chair SHA

Dr Brian Fisher, London

Vice-chairs SHA

Dr Tony Jewell

Tony Beddow, Swansea

Norma Dudley, London

Mark Ladbrooke, Oxford

Secretary

Jean Hardiman Smith, Ellesmere Port

Treasurer

Irene Leonard, Liverpool

Co-Chair KONP

Dr Tony O’Sullivan, London

 

Co-signatories

Dr John Carlisle, Sheffield.

Terry Day, London

Carol Ackroyd, London

Corrie Louise Lowry, Wirral

Caroline Bedale, Oldham

Hazel Brodie, Dumfries

David Taylor-Gooby, Newcastle

Peter Mayer, Birmingham

Dr Alex Scott-Samuel, Liverpool

Dr Jane Roberts, London

Dr Judith Varley, Birkenhead

Vivien Giladi, London

John Lipetz, London

Jane Jones, Abergavenny

Dr Kathrin Thomas, Llandudno

Dr Louise Irvine, London

Dr Jacky Davis, London

Dr Coral Jones, London

Dr Nick Mann, London

Dr John Puntis, Leeds

Brian Gibbons, Swansea

Anya Cook, Newcastle,

Alison E. Scouller, Cardiff

Punita Goodfellow, Newcastle upon Tyne

Parbinder Kaur, Smethwick

Gurinder Singh Josan CBE,  Sandwell

Jos Bell, London.

Steve Fairfax Chair SHA NE, Newcastle upon Tyne

 

The Socialist Health Association is a policy and campaigning campaigning membership organisation. We promote health and well-being and the eradication of inequalities through the application of socialist principles to society and government. We believe that these objectives can best be achieved through collective rather than individual action.

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COVID-19 Pandemic

The SHA wants to contribute to the tremendous national and international debate about controlling and mitigating the worst effects of the COVID-19 pandemic. We will base these thoughts through the lens of a socialist society, which advocated politically in the 1930s to create the NHS in the UK and for other socialist policies, which see the social determinants of health being as important as the provision of health and social care services as we strive for a healthier and fairer society.

This blog will be the first of a series and will cover

 

  1. A global crisis
  2. The Public Health system
  3. The NHS, Local Government and Social Care
  4. Funding for staff and facilities
  5. Staff training, welfare and support
  6. Vulnerable populations
  7. Assuring Universal Basic Income

 

  1. A global crisis

This COVID-19 pandemic has already been cited as the greatest public health crisis for at least a generation. The HIV/AIDS pandemic starting in the 1980s had a much slower spread between countries and is estimated to have caused an estimated 25-30m excess deaths so far.  The potential scale of this type of respiratory viral infection pandemic with a faster spread means we should probably look back to the 1957 Asian flu pandemic and indeed the 1918 post war ‘Spanish flu’. The 1918 pandemic led to an estimated 40-50m global deaths and was when there was also no effective vaccine or treatment for the new variant of flu. So basic public health hygiene (hand washing), identifying cases and quarantining (self isolation) are still important. We recognise this as a global challenge, which requires global solidarity and the sharing of knowledge/expertise and advice.

The WHO, which is part of the United Nations, needs our support and is performing a very beneficial role.  This will be especially important for those Low Middle Income Countries (LMICs) who often have unstable political environments and weak public health and health systems. Remember the Democratic Republic of the Congo who have only just seen off their Ebola epidemic, war torn Syria and the Yemen.

The USA and other high-income countries should be unambiguous about recognising this as a fundamental global pandemic requiring collaboration between countries along the principles of mutual aid. The UN and WHO need our support and funding and we look to international financial organisations such as the IMF/World Bank to rally around in the way that the world banking system showed they could in their own self inflicted 2008 financial crash. The WHO has recently referred to Europe as the epicentre of the pandemic and we urge the Government to put aside their ideological objections and co-operate fully with the EU and our European partners.

 

  1. The public health system

The UK itself is in a relatively strong position with a national public health service, which has focus at a UK level (CMO/PHE), scientific advisory structures (SAGE), devolved governments, municipalities and local government. The NHS too still has national lines of control from NHSE to the NHS in England and the equivalents in devolved countries. The Tory ‘Lansley’ reforms in England destroyed the health authority structure below national levels (remember the former Strategic and District Health Authorities) but at least PHE has a regional organisation and Local Government have Directors of Public Health. We regret the fact that the 10 years of Tory austerity has depleted the resources in PHE and Local Government through not funding the PHE budget adequately and not honouring the public health grant for local authorities. We hope that the recent budget will mean that the public health service and local government does receive the financial and other resources required to help lead the pandemic response. Pandemics have always been high up in the UK risk register.

 

  1. The NHS, Local Government and Social Care

We are grateful that despite the privatisation of many parts of the NHS in England we still have a recognisable system and a culture of service rather than profit within our one million or so staff and their NHS organisations. We were pleased to hear the open ended funding commitment from the Chancellor at the last budget and urge that leaders within the NHS in England and the devolved countries use this opportunity to try to mitigate the underfunding over the last 10 years and implement the emergency plans that exist and calibrate them to deal most effectively with this particular viral threat. Any debates about further privatisation of the NHS needs to be taken off the agenda and let’s not use the budget money to prop up the private sector but requisition capacity if that is what is needed and compensate usage on an NHS cost basis. We want to protect the NHS from the risk that the NHS Long Term Plan proposals for 44 Integrated Care Schemes opens up the risk of US styled private insurance schemes.

 

  1. Funding for staff and facilities.

It will of course be difficult as a result of the staffing crisis that has been allowed to drift over the past 10 years with shortages of NHS workforce of 100,000 of which 40,000 are nurse vacancies but also includes doctors and other key staff. We and our Labour Party colleagues have been reminding Tory Ministers  that it takes 10 years to train a medical specialist so you cannot whistle them up or poach them from other poorer countries. The government needs to abolish their proposed points based immigration regime and indeed the compulsory NHS insurance of £650 per adult which is a huge disincentive to come here and work in the health and social care system.

Hospitals and other health facilities in the UK take time to plan, build and commission. We can of course learn from Wuhan in China where they built a 1000 bedded hospital in weeks! Our own war preparation in the late 1930s when industry shifted production rapidly from civilian to military supplies is another exemplar. Despite the negative impact of 10 years of Tory austerity we urge the NHS to embrace this opportunity to invest in staff, supplies and facilities needed to manage the effects of the pandemic. Creating strategic regional NHS bodies will ensure that capital and revenue resources committed from the centre are used optimally and equitable to meet population needs in collaboration with local authorities.

 

  1. Staff training, welfare and support

Front line NHS and social care staff will need our support over this time. We must ensure that working practices protect staff as much as possible from the risks in the workplace. Training and provision of Personal Protective Equipment (PPE) is vital and employment practices will need to adapt to the changing situation. Lets not forget social care workers, dentists, optometrists and district nurses who are part of our front line. Staff will need retraining if doctors and nurses are to be diverted to unfamiliar roles as we will need A&E, pandemic pods and intensive care unit capacity to be enhanced. Sadly, we now have a significant workforce who work for private contractors as part of the Tory privatisation of the NHS. We need to ensure that they have the same employment safeguards, minimum pay levels, sick pay and the health and safety entitlements as NHS staff. This is the time to renationalise such services back into the fold.

 Patients with existing long-term conditions remain in need of continuing care as will patients presenting with new life-threatening conditions such as cancers, diabetes and circulatory diseases. NHS managers will need support to organise these different services and decisions to postpone non-urgent elective surgery to free up resources. What also makes sense is testing novel ways of supporting people digitally and by teleconferencing to reduce attendance at NHS premises. This can be rolled out for Out Patient provision as well as GP surgeries. The NHS 111 service, and other online services  and the equivalents in the devolved nations can easily be overwhelmed so pushing out good health information and advice is being done and needs to continue. The public and patient engagement has always been at the heart of our policies and can be rolled out in this emergency utilising the third sector more imaginatively.

 

  1. Vulnerable populations.

In our assessment of what needs to be done we must not bypass the urgent needs of some of our most vulnerable populations. The homeless and rootless populations, many of whom have longstanding mental health conditions and/or substance dependency, are particularly at risk. They need urgent attention working closely with the extensive voluntary sector. Also those populations with long term conditions who will feel at risk if services are withdrawn due to staff redeployment or staff sickness need planning for. Primary care needs to be the service we support to flag up those in need and ensure that their medications and personal care needs continue to be met even if we need to involve volunteers and good neighbours to help out with daily needs such as shopping/providing meals and other tasks.

Undocumented workers such as migrants and refugees are often frightened to use health services for fear of police intrusion. The government needs to make it clear that there will be no barriers to care for this population during this crisis and beyond.

Social care is in need of particular attention. It was virtually ignored in the budget. This sector is at risk in terms of problems with recruiting and retaining staff as well as the needs of the recipients of care and support.. While business continuity plans may be in place there is no question that this sector needs investment and generous support at the time of such an emergency. They will be a vital cog in the wheel alongside home-based carers in supporting the NHS and wider social care system. Those most at risk seem to be the most neglected. Disabled people with care needs have received little advice and no support. Already carers are going off sick and can be replaced only with great difficulty. Those paying for their own care with Direct Payments seem to get no support at all.

With the COVID-19 virus we are seeing that the older population and those with so called ‘underlying conditions’ are at particular risk. We must ensure that this large population do not feel stigmatised and become isolated. Rapid assembly of local support groups should be encouraged which has been referred to as ‘local COBRA groups’. Local government can play a key role in establishing local neighbourhood centres for information and advice on accessing support as we move toward increasing quarantining and isolated households. Again wherever possible the use of IT and telephone connectivity to share information and provide remote support will make this more manageable.

 

  1. Assuring universal basic income.

Finally the SHA recognises that the economy will be damaged by the pandemic, organisations will go to the wall and staff will lose their jobs and income stream. We have always recognised that the fundamental inequalities arise from the lack of income, adequate housing and the means to provide for everyday life. This pandemic will last for months and we think that the Government needs to ensure that we have systems in place to ensure that every citizen has access to an adequate income through this crisis. We pay particular attention to the 2m part time workers and those on zero hours contracts as well as the 5m self-employed. There have been welcome changes in the timely access to the insufficient Statutory Sick Pay but this is not going to be the answer. People will be losing their jobs as different parts of the economy go under as we are already seeing with aviation, the retail sector and café/restaurants. The government needs to reassure those fearful of losing their jobs that they will stand by them during the pandemic. It may be the time to test the Universal Basic Income concept to give all citizens a guarantee that they will have enough income for healthy living. We already have unacceptable health inequalities so we must not allow this to get worse.

 

  1. Conclusion

The SHA stands ready to support the national and international efforts to tackle this pandemic. We assert our belief that a socialist approach sees universal health and social care as an essential part of society. That these systems should be funded by all according to a progressive taxation system and meet peoples needs being free at the point of use.  We believe that a thriving state owned and operated NHS and a complimentary not for profit care sector is essential to achieve a situation where rich and poor, young and old and citizens in towns, cities and in rural areas have equal access to the best care.

We recognise that the social determinants of health underpin our health. We agree with Marmot who reminds us that health and wellbeing is reflected by ‘the conditions that people are born, grow, live, work and age and by the inequities in power, money and resources that influence these conditions’.

The pandemic is global and is a major threat to people’s health and wellbeing. Universal health and public health services offer the best means of meeting this challenge nationally and globally. Populism and inward looking nationalism needs to be challenged as we work to reduce the human suffering that is unfolding and direct resources to meet the needs of the people at this time.

On behalf of officers and vice chairs

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While we welcome the £5bn emergency fund for the NHS and other public services and the open ended commitment made by the Chancellor that the government will provide whatever the NHS needs to meet the challenge of COVID-19; we are concerned to point out three big issues on sustaining an NHS, social care and protecting all workers including those in the gig economy.

The Chancellor re-iterated the discredited election manifesto statements about 50,000 more nurses while we know that there are already 43,000  funded nurse vacancies. He repeated the mantra about 50 million more GP appointments while recruitment of young doctors to become GPs remains poor and it is not clear how this can be achieved in the short term. He reiterated the discredited election slogan about 40 new hospitals. Both staffing promises ignore the fact that it is not only money that is needed – the legacy of austerity cannot be reversed by a cash injection alone – training a GP/medical specialist takes 10 years. Turn the tap off for 10 years and turn it back on expecting accolades is not good enough.

We are very concerned too about the immigration health surcharge, which is being increased to £624 per person. The NHS needs to continue to ethically attract health workers into our country for training and service. The surcharge will apply to EU citizens from January next year. This health surcharge is a serious disincentive and opens another pathway for Tories to introduce insurance charging into the NHS. The cost of collection as with all insurance schemes will be prohibitive.

Social care has been ignored. Everyone involved knows that we should be investing in health and social services and even Jeremy Hunt who presided over NHS austerity is on record as saying that this is a glaring omission in the budget. You need to invest in health and social care and the budget is silent on social care. The budget statement of 8,700 words mentions social care twice only and the manifesto commitment of £1bn/year for 5 years seems to have been lost. Local government leadership role has been ignored such as their role in housing, childcare and social support in communities. The attention given to cars, roads, potholes, red diesel and fuel tax does not signal that the other existential emergency on climate change is being addressed.

Finally we welcome the steps taken to move entitlement to SSP to day one but worry that the 111 service is already over stretched and should not have the burden of certification forced on them. The health and wellbeing of those who are not eligible for SSP, such as the estimated 2m part time and zero hours workers and the 5m self-employed is inadequately protected: the ESA is probably too small a compensation. Many will feel they have to continue to work, putting their own health and that of their families at risk.

The SHA campaigns for health and social services to be free at the point of need and to be funded by general taxation. We know that the 10 years of Tory austerity has damaged the fabric of our NHS and we need to invest in capital and training of staff with confidence in long term growth and sustainability. In a modern society the social care services need to be an integral part of our system and should be planned together with joint investment. This budget has missed an opportunity to make this change.

 

On behalf of the Officers and Vice Chairs

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29th February 2020 the chairman of the Commons Health Committee, and former Tory health secretary, Jeremy Hunt said that we need to consider the ‘social and economic trade-offs’ we are willing to make to contain Covid-19.

TUC General Secretary Frances O’Grady has said:

Employers have a duty of care to support workers affected by coronavirus. No one should have to worry about making ends meet if they have to self-isolate or if they fall ill. They should be able to focus on getting better.

The threat of coronavirus shows why sick pay should be a day one right for everybody. It’s unacceptable that millions of UK workers miss out on this protection. The Government must ensure everyone gets statutory sick pay, however much they earn.

The SHA strongly supports the view of the TUC and urges that this scheme is extended to those on ‘self employment’ contracts – part of the 3 million plus ‘Gig economy’. We would argue further that employers should make up SSP to the average pay of workers to ensure they are under absolutely no financial pressure to attend work while they are unwell and may inadvertently pass on the disease.

Should the coronavirus outbreak spread significantly everyone will be expected to respond putting the interests of the community first. Undoubtedly workers will volunteer long hours and take on exceptional responsibilities. This will increase the risk of errors which will need to be balanced against the risk of failure to treat patients in a mass outbreak. We urge professional bodies to be aware of this.

The SHA congratulates trade union and Labour leaders for engaging with the government and employers and instructs our incoming leadership to move very rapidly to promote this position through forceful lobbying, online petitions and other appropriate means.

During the debate important points were raised regarding:

1.) Enforced quarantine – it should be paid in full.

2.) Government requisition private care facilities if circumstances require it.

3.) Government to consider early releases of prisoners not judged to be a risk to society – because of high COVID-19 spread risk in confined overcrowded prison populations (also note criminalisation of sections of society).

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Introduction

This policy statement is intended to apply to all parts of the UK. The first 1000 days of life (from conception) are crucial for the long term health and wellbeing of families and society in general. The SHA wants adequate NHS, fully funded, woman-centred maternity care, for all women, potential parents, partners and their family/support networks (including all migrant women).  This care is from pre-conception to 6 weeks after birth and beyond.  This is because care needs to focus on long term outcomes as the evidence is that the environment in the uterus and after birth can be detrimental to individuals’ health throughout their lives. It needs to avoid the ‘business’ approach that concentrates on short term targets. To achieve this, the following is necessary:

Overall principles

  1. To address maternal, paternal and child poverty in order to improve outcomes and to relieve stress related damage, good nutrition should be accessible to all, before, during and after pregnancy. To achieve this, public health measures, which make the healthy choice the easier choice, should be developed.
  2. The voices of women, potential parents and their support networks should be heard and listened to at all the stages of planning and evaluation of maternity services.
  3. There should be high quality physical and mental health care appropriate in a diverse society. There should be a proportionate universalist approach to give every child the best start in life. This includes migrant women and their babies.
  4. Pre-pregnancy care must be available to all to achieve the healthiest pregnancy possible. It should cover the very harmful factors in the wider and personal environment, such as tobacco, alcohol and substance misuse, air and industrial pollution, and domestic abuse, which can have devastating consequences on babies from conception and throughout their lives. Improvements are required to ensure the quality and consistency of health and safety in the workplace for pregnant women and potential fathers.
  5. Adequate time and funding for maternity leave, maternity pay, paternity leave and pay and parental leave should be available to all. Partners of pregnant women should have a legal right to take time off in the event of problems developing during the pregnancy.  Pregnant women and new mothers in education at the time of birth, and all those caring for young babies, must be supported to ensure that they are not denied educational opportunities.

Specific stages of care

  1. Antenatal care and education should be accessible to women and potential parents (and their families) from all backgrounds and cultures. Those working should have the right to paid leave to attend. Such education can be provided one to one or within groups.  The groups can be women only or mixed or with special provision for marginalised groups as deemed appropriate in local areas.  Collaboration between midwives and health visitors (and others as appropriate) to facilitate this education is ideal.
  2. All parents should have access to parenting skills support, particularly to prevent and mitigate adverse childhood experiences. The roll out of the Flying Start scheme in Wales is a good development, in contrast with the huge cuts to Sure Start schemes in England.
  3. All care should aim for a safe, respectful and positive birth experience for all women. Women should have a fully resourced, real choice of place of birth (home, midwifery or obstetric unit) having been fully informed about how these will meet their individual medical and personal needs. To achieve this, home birth should be backed up when there is an emergency with adequate pre hospital care (provided by community-based midwives and paramedics specifically educated on maternity care).  Such pre hospital care should enable safe, timely and appropriate transfer to hospital obstetric and neonatal paediatric services.  Midwife–led units should be available to women, and hospital based care should respect and support women’s decisions.
  4. Continuity of care from midwives (and other relevant health care professionals) is crucial. All women should have a named midwife, who works as part of a community-based team of midwives, and who coordinates care with others, such as obstetricians, health visitors, GPs, physiotherapists, and dietitians, as necessary. Ideally there should be continuity of carer throughout the antenatal, intrapartum and postnatal periods. All women should have one to one care during established labour.
  5. Women and their partners, families/support networks should be supported emotionally and physically in the early days after birth. There needs to be adequate and realistic help with breast feeding, including midwifery, health visitor and peer support. Postnatal education and support should be available, via groups or on a one to one basis, ideally continuing educational provision stated during pregnancy.
  6. Community based mental health services need to be available to support women (collaborating with midwives, GPs and health visitors), as well as sufficient mother and baby inpatient psychiatric provision.
  7. There should be full funding of neonatal special and intensive (levels 2 and 3) care.

Staffing

  1. More staff should be recruited to end the use of agency staff. This includes keeping staff from EU countries and making them very welcome. NHS staff should be actively supported and valued in order to relieve work-related stress and burnout and prevent attrition, so that in turn they are able to give the best quality care.  The culture of risk, fear and blame should be resolved.

Research and education

  1. Funding for research into maternity care, preterm birth, still birth, neonatal and perinatal mortality and birth injuries should be increased.
  2. Investment is required in the education of healthcare professional students involved in maternity care. These students should receive non means tested NHS bursaries while being educated. Where appropriate there should be joint education between students such as midwives, paramedics, health visitors and doctors (potential future GPs, obstetricians and paediatricians) both before and after qualification. The latter should not have to be funded by the clinicians themselves.

(References to back up the recommendations of this policy are available on request)

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Ballot executed via Election Buddy and postal voting papers running from 24/01/2020 to 30/01/2020 for the Election Buddy ballot and 22/01/2020 to 04/02/2020 for the postal ballot papers ( to allow time for the papers to be delivered and returned. Postal ballots were sent 2nd class and included a SAE ( 2nd class ).

955 Online voters emails and membership number were entered into the EB ballot.

63 postal papers ( plus another 9 for hard bounced email addresses ) were sent out.

325 votes submitted, 1 spoilt and 28 paper votes returned. ( not all paper ballot returned contain a vote for both the Leader and Deputy Leader. )

The results are as follows.

Ballot for the SHA nomination for the future Leader of The Labour Party.

Name of CandidateEB BallotPaper BallotTotal votes
Keir Starmer149 (45.8%)14163
Rebecca Long-Bailey120 (36.9%)8128
Lisa Nandy45 (13.8%)348
Emily Thornberry11 (3.4% ) 112
Jess Phillips11

Total number of votes tallied      325 

Jess withdrew her candidature after postal ballot papers were sent out.

Ballot for the SHA nomination for the future Deputy Leader of The Labour Party.

Name of CandidateEB ballotPaper ballotTotal votes
Angela Rayner118 (36.3% )10128
Richard Burgon88 (27.1% )795
Rosena Allin-Khan54 (16.6% )155
Ian Murray36 (11.1% )339
Dawn Butler29 (8.9% ) 332

 

Keir Starmer wins and is the SHA nomination for Leader of the Labour Party.

Angela Rayner wins and is the SHA nomination for the Deputy Leader of the Labour Party.

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SHA Scotland Meeting

Further to the notice of the AGM to be held on 23 January, I am writing to notify members of an additional agenda item.

·         Scottish Labour Deputy Leader nomination – There are two validly nominated candidates after the first stage – Jackie Baillie and Matt Kerr. The next stage is CLP/Affiliate nominations and SHA Scotland is entitled to make one nomination.

The UK Party Leader and Deputy Leader nominations are the responsibility of UK SHA and all paid up members should have received a communication from them on this issue.

I look forward to seeing you on Thursday.

Yours fraternally

Dave Watson
Secretary

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2 informative and extremely worrying videos from our Vice Chair, Dr Brian Fisher on the dire state of social care in England.

Video 1: the current state of social care.

This brief video, made for Reclaim Social Care, outlines what social care is and how it operates at the moment in England.

https://photos.app.goo.gl/6kqUa7nbCjg2CEjt9

Video 2: the impact of the cuts to social care:

This brief video, made for Reclaim Social Care, outlines the impact of the cuts to social care. It ends with a plea to avoid voting Tory – sadly, that aspect is redundant now. The Tories have pledged more money for social care and that is likely to make a difference. But not enough to change things significantly on its own. And as the IFS says, austerity is “baked in” to a swathe of Tory plans.

https://photos.app.goo.gl/W2cZz5h7WRbW9v2S8

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