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

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

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

    Hunt the manager.

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

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

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

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

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

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

     

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

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

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

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

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

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

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

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

    Dr John Carlisle

    Chair, Yorkshire SHA

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    The Welsh Government is proposing to use its legislative powers to require local authorities and Local Health Boards to  produce a market stability assessment report on the social care sector  in their Regional Partnership Board (RPB) area.

    The legislation will be supplemented by a code of practice on the exercise of relevant functions in relation to market stability reports and statutory guidance on taking a partnership approach to preparing and publishing market stability reports.

    This innovative piece of legislation is welcomed by the Social Health Association Cymru – Wales which has responded to the Welsh Government consultation document.

    ================================================================

    Response to Welsh Government Consultation by Socialist Health Association – Cymru / Wales


    What do we want to know? Welsh Government would welcome comments on the draft regulations, code of practice and statutory guidance from local authorities, local health boards, and other organisations or sectors which are represented on RPBs or have an interest in the provision of care and support to the local population.
    It would also welcome comments from members of the public, including especially individuals who need care and support, and carers who need support. In particular, we would welcome responses to the following questions:


    Question 1 Do you agree that market stability reports should be prepared on a regional basis, by local authorities and local health boards through the regional partnership boards? If not, please give your reasons.

    A.    The Socialist Health Association Cymru believes that the business model underpinning our social care service in Wales is no longer sustainable and we need to be planning for a National Care Service.

    The independent sector continues to express concern about its marginal viability with residential care providers requiring levels of bed occupancy that go against the Welsh Government’s policy of more care in a domestic and homely community environment.

    There is a recruitment and retention crisis which is worse in the independent sector due to poorer pay and conditions, less training and fewer opportunities for career progression.

    Within this context we believe there is an urgent need to undertake regular assessments of the continuing viability of the current model of provision.

    While the consultation document proposes reports on a regional basis, it important that the geographical spread of provision in mapped at a more local level.


    Question 2 Do you agree that market stability reports should be produced on a five yearly cycle alongside the population needs assessments? If not, what alternative arrangements would you propose, and why?

    We note that the proposals recommend that a five year assessment cycle with at least a mid-cycle interim review.

    A.   We believe that the overall fragility of the sector requires a three yearly overall assessment with a yearly review.


    Question 3 Have we specified all the key matters that need to be included in market stability reports? If there are other matters you think should be included, please specify.


    A.   While we are fully aware of the sector’s legacy of being heavily dependent on for-profit providers, we are surprised at the failure of the consultation document to consider what role public bodies might play in service provision. This is only briefly mentioned in the context of a sudden closure of an established private sector provider.

    The omission is all the more surprising as it recommended that the assessments should be linked the to Regional Partnership Board needs assessment.

    The implicit assumption is that local authorities will have no role in the management or shaping of the market beyond its present contract compliance assessments. This means that it will be for others to address gaps in service provision.

    The variation in local authority fees across is Wales in considerable. It is far from clear why this is the case though these fees are at the heart of any assessment of the viability of the sector.

    Question 4 Do you agree that market stability reports should be kept under regular review and revised as necessary, but at least at the mid-way point of the five year cycle? If not, what other monitoring and review arrangements would you propose, and why?

    A.  See reply to Q2


    Question 5 In your opinion, does the draft code of practice strike the right balance between what is required of local authorities and what is left to their discretion? Are there further requirements or guidelines you would like to see added, or other ways in which the document might be improved?

    A.    The document urges “reasonable” efforts for community engagement. This is a rather elastic requirement which could result in a minimum level of engagement. It would be useful to be more specific that efforts should be made to engage with organisations such as the CarersUK, Stroke Association, Alzheimer’s Society, Mind as well as any successor organisation to Community Health Councils.

    There should be a specific reference made to any community councils in the Regional Partnership Board area.

    There only the most fleeting reference to engagement with care staff and other support / partnership professional groups. There should be a clear requirement to engage with local trade unions involved in the Education, Health & Care Sectors e.g. Unison, GMB Unite the Union, RCN, NEU and Local Medical Committee. In some areas, where there may be low levels of trade union membership, the local trades union council ( if it exists) should be consulted.

    Local groups of faith should also be specifically included in any engagement. They provide comfort and support to many of our citizens in times of difficulty and they can have important insights into the needs for particular communities.

    Question 6 In your opinion, does the draft statutory guidance set out clearly the partnership approach that local authorities and local health boards should take in preparing their market stability reports? Are there further requirements or guidelines you would like to see added, or other ways in which the document might be improved?

    A.  See replies already given.
    The document mentions the need to anticipate trends but is rather limited in the scope of the horizon scanning it envisages. This is a vulnerable sector underpinned by a fragile business model. It follows that more vision is required in looking at delivery models of care e.g. more in-house provision by public bodies, the NHS or the Third Sector.

    Question 7 What impacts do you think our proposals will have on the duties of public bodies under the Equality Act 2010, or upon a local authority’s duty under the 2014 Act to have due regard to the United Nations Convention on the Rights of the Child, the United Nations Convention on the Rights of People with Disabilities, or the United Nations Principles for Older People?

    A.   This is a timely document and Welsh Government is to be commended in initiating this legislation. Not withstanding the attitude of the Westminster Government to international agreements the Welsh Government has always used best international standards to drive policy.

    A citizen focused, responsive, stable and caring service needs to be in place to meet international standards. This must include provision that is based on the needs and wishes of its users. The workforce must be well trained and valued.

    None of this will be possible if overall business model of care is not longer fit for purpose for the challenges of the 21 Century.

    Question 8 We would like to know your views on the effects that our proposals with regard to market stability reports would have on the Welsh language, specifically on opportunities for people to use Welsh and on treating the Welsh language no less favourably than English. What effects do you think there would be? How could positive effects be increased, or negative effects be mitigated?

    A.   This is particularly important. Bigger, footloose corporate bodies have a smaller footprint in Wales which is generally a good thing. Smaller, local providers with a local workforce are more likely to be culturally sensitive to their needs of citizens.

    In many parts of Wales the local population will include people who have spent most of their lives in an area and others who have moved in at various stages of their life cycle. Our providers must respond to this diversity.

    Many vulnerable users would wish to engage with services in their first language. The planning and service delivery process must be responsive to this need.

    The Welsh language is an important part of Welsh life. As well, individual communities have other cultural attributes which can provide support and comfort to local service users which should also be factored into a citizen centred service.

    Question 9 Please also explain how you believe the proposed policy around market stability reports could be formulated or changed so as to have positive effects or increased positive effects on opportunities for people to use the Welsh language and on treating the Welsh language no less favourably than the English language, and no adverse effects on opportunities for people to use the Welsh language and on treating the Welsh language no less favourably than the English language.

    A.   See Q8.

    Market stability reports should include a specific section demonstrating how the needs of Welsh speakers and other sensitive cultural dimensions are taken into account.


    Question 10 Under the Well-being of Future Generations (Wales) Act 2015, public bodies have a duty to consider the long-term impact of their decisions. We would like to know to what extent you think our proposals will support the principle of sustainable development set out in that Act. Further information on the Well-being of Future Generations (Wales) Act 2015 may be found here: https://www.futuregenerations.wales/about-us/futuregenerations-act/

    A.   Our health and care service is still too illness and crisis orientated. It needs to be more pro-active and enabling for all our citizens.

    Beyond the immediate pressures of Covid-19 and the longer term legacy we have inherited, the Welsh Government needs actively to promote a policy of prevention and early intervention to create a more equal and socially just society that is at ease with itself.

    This includes providing our young people with the best start in life, providing all citizens with the opportunity to live full and enjoyable lives and providing a healthy ageing strategy including tacking loneliness and social isolation for citizens as they progress through life.

    Question 11 We have asked a number of specific questions. If you have any related issues which we have not specifically addressed, please use this space to report them. Please enter here.

    A.   SHA Cymru welcomes this proposal to assess the inputs into service provision other than in crude quantitative ways. This approach could be extended to other field of policy e.g. to assess the scope and scale of service provision in different communities and localities.

    Our Chief Medical Officer has often pointed out that “one size does not fit all”. Different communities have different needs. If we are to address these varying needs at a community level we need to develop processes which could be informed by the lessons learned from implementing this legislation.

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    I am pleased to circulate the details of the launch of the joint SHA/KONP campaign to reshape social care in England. The launch will be at 1100 – 1300 on 10th October

    Register for the event here

    This is a major national campaign with a wide ranging support. Your support and involvement will be vital.

    More details are attached, including a MOTION that we would like you to discuss at wards and CLPs.

    We look forward to seeing you there.

    Yours,

    Brian and Jean

    A SUMMARY OF THE SOCIAL CARE CAMPAIGN

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    The current business model for social care in Wales, like the rest of the UK, is under extreme pressure. This vulnerability has predated the present Covid-19 pandemic. Care Forum Wales, the main representative body for the private care sector, has claimed that Wales could lose half its care homes within a year unless urgent action is taken. A Care Forum Wales survey also reported that 84% of respondents said low pay made it difficult for the recruitment of staff. Responding to these long standing concerns the Welsh Government commissioned the Welsh Institute for Health and Social Care to study the variation in terms of employment in the social care sector in Wales.

    The study looked at the comparative experience of various social care sectors in Wales including local authorities, independent sector and the NHS. There were (2017) approximately 1350 providers in the independent sector with a workforce of 52,500 and 130 local authority services with a workforce of 11,000. While the study showed variation within sectors there were also important overall differences between the sectors which could account the differing sectoral work experiences.

    The median minimum basic pay for front line independent sector care workers was 18% less that for local authorities (£9.74/hr) and 9% for NHS. The differences for maximum basic pay were 32% less for independent sector workers compared to local authority staff (£11.88) and 18% less for NHS health care support workers. Independent sector care supervisors received 32% less in their median minimum basic pay compared to local authority supervisors (£13.37/hr) and 78% in their median maximum basic pay ( LA supervisors £18.03/hr) . In addition the public sector workers were much more likely to receive pay enhancements for pensions and activities such as weekend shifts, holiday cover and over-time.

    Compared to 55% of independent sector front-line workers about 25% of local authority staff were in permanent full-time employment while 23% in independent sector were permanent part-time posts compared to 51% in public sector. However there were less differences in more senior posts across the sectors. About 20% of front-line care workers across the independent, local authority and NHS had the equivalent of zero hours contracts. There was some evidence that not all staff were unhappy with the relative flexibility these contracts provided.

    The report confirmed that recruitment, retention and staff turnover is a problem for the sector as a whole. While all had concerns about the recruitment and retention of staff this was greatest in the independent sector. These problems were less in more senior staff positions and overall there was a greater problem in recruiting staff compared to retention. While the independent sector felt it was in competition with local authorities for staff, both felt under pressure from the NHS and outside sectors such as retail. As well there were geographical variations with rural areas having less problems that more urban ones.

    While pay was an important factor other issues such as the status of social care, work pressures and responsibilities were felt to barriers to recruitment and retention. On the other hand the caring and pastoral aspects of the work were valued by the staff and contributed to them staying in post in despite the poor levels of pay.

    The Welsh Government has responded to some of the problems in the sector with others more difficult to address due to ongoing austerity policies and the continuing failure of the Westminster Government to live up to its promised on producing a comprehensive set of proposals to deliver a quality, affordable social care service.
    In order to improve the skills and status all all staff care staff will be expected to be registered with Social Care Wales by 2022. Once they have been in employment for more than three months care staff will have the right to choose between a defined hours or “zero hours” contact. And last year (2019) the Welsh Government supported “We Care” a campaign and on-line portal to support social care recruitment.

    In the Covid-19 pandemic care staff were provided with a £500 grant in recognition of their work by the Welsh Government. However despite declaring its commitment to the workers in the sector, the Westminster Government refused to exempt the bonus from stoppages such as taxation and NI contributions.

    It is clear that most of those who work in the sector are committed to their job and value its humanitarian values even above pay. An unemployment fall-out from Covid-19 might provide some easing of recruitment and retention difficulties but this cannot be seen as a sustainable solution. More comprehensive measures are needed.

    For decades social care has been provided on the cheap with the cost, in the first instance, being borne by staff in terms of their pay, work conditions and their opportunities for career progression. This downward pressure was driven by the policies of out-sourcing and tendering and an under-valuing of the public sector. But this policy has more or less come to the end of the road.

    The Welsh Government realises this and has commenced a consultation process on legislation that will require local authorities and health boards to regularly assess the financial sustainability of the care sector in their catchment areas. This should provide important information to inform the future shaping of local social care services.

    But we need to do more. We must start looking for more radical solutions within the overall context of a National Care Service. As a first step domiciliary care services should be brought back into the public service as their contracts lapse. And we then need to see how this option can be extended to all other workers in the sector.

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    This is SHA Scotland Secretary Dave Watson’s contribution to a Jimmy Reid Foundation paper; ‘Reconstructing Scotland after COVID-19: learning further lessons from the pandemic.’

    A Scottish Care Service

    Even before the pandemic, it was clear that the social care system in Scotland was in urgent need of reform. The current system is underfunded, lacks capacity, and has major workforce recruitment and retention problems with fragmented delivery through a discredited commissioning process. When former Conservative ministers are openly talking about the nationalisation of care homes, there is widespread recognition that there is a problem (even if not agreement on what should be done to solve the issue). The system is not just failing those who need social care but is also damaging the NHS with over half a million hospital bed days lost every year because of delayed discharges at the cost of £120m. These problems have been magnified during the pandemic. The lack of Personal Protective Equipment (PPE), inadequate testing, minimal sick pay, and use of agency staff, have all contributed to the tragic deaths in care homes and amongst social care staff. Care at home has also been impacted with care packages reduced or abandoned. Informal carers have all too often been left to pick up the pieces.

    The concept of a (national) Scottish Care Service (SCS) as part of the solution is not a new one. It has been Scottish Labour policy for a number of years, most recently as a 2019 General Election manifesto commitment (see p35 here). My own organisation, the Social Health Association, outlined the idea in its recent social care consultation paper. And, UNISON Scotland has recently published what it describes as a ‘road map’ towards the creation of a national care service. But while there is growing support for the principle of a Scottish Care Service, many in the sector have reasonably asked what it means in practice.

    There seems to be a consensus in favour of a national framework rather than a service delivery organisation or making it part of NHS Scotland, not least to recognise the different models of care. But that leaves open what the SCS would undertake directly and what would be the governance arrangements. A national framework approach must end the current marketisation of social care. It could set consistent standards, contracts and charges for services not covered by free personal care. Most importantly, it would include a statutory workforce forum to set minimum terms and conditions, organise effective workforce planning and put a new focus on training and professionalism.

    On governance, the usual approach would be to create a new Non-Departmental Public Body (NDPB). This would leave the SCS with a similar democratic deficit to NHS Scotland and would undoubtedly be populated with the ‘usual suspects’ by the ministers who make the appointments. As the service will be delivered locally, another approach would be to create a joint board from councils across Scotland. This was a solution UNISON Scotland proposed for police and fire, which had the added advantage of keeping the VAT exemptions. The joint board could have places for relevant stakeholders, including users and worker providers.

    A national service would also need to address regulation. The Care Inspectorate’s ‘light touch’ response to rising complaints has highlighted the need for reform. In fairness, it has been constrained by the Scottish Government’s own ‘Better Regulation’ code, together with inadequate powers and resources. There would also need to be a review of workforce regulation currently administered by the Scottish Social Services Council and UK professional regulatory bodies.

    If the service is going to be delivered locally, this leaves open the question of local governance and ownership. As the Accounts Commission noted in its annual overview, the current system of Integrated Joint Boards (IJBs) has struggled to deliver integration or a shift in spending from hospitals to community care. There have been many attempts to improve integration in Scotland since the joint finance arrangements of the 1970s and all have struggled. It may be that this iteration will eventually deliver, but many will argue that it requires stronger democratic accountability to make difficult decisions, and that means a bigger role for councils. This happens in other parts of Europe, but even here, they have not always shifted resources from hospitals to community services.

    Greater integration does not require staffing integration. Professional barriers have been broken down in recent years, and joint teams have shown that they can work effectively together, particularly when physically working together in community hubs. A huge staffing reorganisation would create stasis, just at the time when we need to free up staff to innovate. When IJBs were created, I – as a UNISON Scotland official – wrote a workforce framework, which would have addressed many of the current problems. Sadly, workforce issues were largely ignored at the time.

    The fragmentation in service delivery is a significant problem that does need to be addressed with more than one thousand care at home providers, and the scandal of care home firms registered in tax havens. In the short-term, the pandemic has highlighted the need for greater coordination on issues like procurement. Abolishing the market, standard contracts and common workforce standards will help shift resources to the front-line. In the medium-term, there should be greater common ownership, particularly in residential care.

    Common ownership does not preclude innovative voluntary sector operators who can meet the new standards as the best in the sector already do. The private sector likes to make a false link between personalised care and marketisation. All care should be personalised, and that requires a range of services, not a range of ownership models. Local delivery should also be about greater innovation in service delivery, trying new models of care that integrate people with care needs into communities.

    Finally, there is the tricky issue of funding. In England, the issue has at least been considered in the Dilnott Report, although it was overly focused on protecting assets. In Scotland, we cannot simply hope for the Barnett consequentials of reform in England to plug the current funding gap, let alone future demographic pressures. It requires a mature conversation with citizens about taxation. If we want to go further and fund care on the same basis as the NHS, then the conversation shifts to proposals like the former health minister Andy Burnham’s care levy, which involved a form of inheritance tax. Calling it and similar plans a ‘death tax’ is not a mature conversation.

    The creation of a Scottish Care Service is an idea which has come of age. Turning it from a concept into a practical solution requires more work and some difficult conversations. If we are to ‘Build Back Better’, as the Tories implore, an integrated health and care service, with national standards and local delivery should be the highest priority.

    Dave Watson, Secretary of the Socialist Health Association Scotland
    www.shascotland.org

    sha_social_care_reform

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    The Local Government Association, on behalf the broad leadership of the social care sector including the Association of Directors of Social Services, has published a set of 7 principles to guide the future of adult social care post Covid. But they show the sector’s leadership continuing to be high on rhetoric, but empty on substance. They are bankrupt of ideas to make the rhetoric a reality.

    The 7 principles talk, for the umpteenth time, of social care needing to be based on ‘what works for people, not what works for systems or structures’. They seek to emulate the person centredness that makes the NHS so valued by the public. People trust that when they present symptoms to an NHS clinician the diagnosis and treatment will be based solely on the clinician’s knowledge of what is wrong and what is possible. It would not even occur to the person that the determination of their diagnosis and decisions about the treatment options will be referred upward to a manager, least of all to a manager whose primary task is to manage the budget.

    But, for reasons set out in my recent blog, this is exactly what happens in social care. At the individual level, while need precedes resources in health care, resource precedes need in social care. It’s an arrangement that serves very well the political expedients of keeping spend precisely to budget while denying the existence of any funding gap. The sector’s leadership, sadly and only too willingly, obliges.

    So sector leaders are left yet again repeating mantras with a long record of failure. The history is lamentable.

    Following the failure of the Community Care strategy of the 1990’s to make social care ‘needs led’, the personalisation strategy was launched in 2008 with personal budgets the centre piece. ‘Up-front’ allocations of money would empower service users to purchase their own support package, the ultimate in person centredness. Bu it quickly became apparent that up-front allocations would not happen. Completely impracticable and ignored by the Care Act ‘up-front’ allocations became ‘indicative’ only and thus tokenistic. In 2012, Think Local Act Personal, the organisation charged by Government with leading implementation of the strategy, issued a series on exhortations to practitioners and councils under the banner Making It Real.

    The irony in the implicit message that personal budgets had completely failed to ‘make it real’ was lost on the sector’s leaders. Inevitably, Making It Real had no impact. TLAP duly issued a second iteration of Making It Real in 2018. It too has had no impact. And so to the present and the 7 principles amount to yet a third exhortation to ‘make it real’.

    Exhortations to practitioners and councils to deliver ‘what works for people’ are hopeless in the face of underlying, powerful systemic forces that ensure the system’s priority is to work to sustain itself.

    What of the future for social care – integration with the NHS?

    It’s hard to imagine anyone taking the analysis and remedies of sector leaders seriously. This is not just because of the self harm in exposing the bankruptcy in their own ideas. Covid’s exposure of the impoverishment of social care invites questions of the leadership Councils have provided over the decades. Is it really just about government under-funding? How soon, if not already, before Councils are seen as a busted flush?

    Signs are pointing to integration with the NHS as the political solution. But with social care in its present state, that would be a disaster for both services and the older and disabled people who rely on them. The NHS is at its best delivering clinical care to deliver best possible health. When it moves beyond that into care, its record is even more lamentable than that of local authorities. The bureaucratic opaqueness and gross inequity of Continuing Health Care bears witness to that. A weak and unreformed social care service risks being reduced to little more than a servant to health objectives. This would sound the death knell of the ambition of social care to be the driver of our older and disabled citizens being supported to lead the fulfilling and dignified lives they are capable of.

     

    Colin Slasberg – former Assistant Director of Social Care and Independent Consultant in Social Care.

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

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

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

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

    Its initial adoption of a “herd immunity” strategy.

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

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

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

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

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

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

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

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

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

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

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

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

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

    These warnings, however, were effectively ignored.

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

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

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

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

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

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

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

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

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

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

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

    Other articles written by Susanna Mitchell and Roy Trevelion are:

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

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

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

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

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

     

    Comments Off on Why the UK failed the pandemic test

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

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

    1. Austerity (2010-2020)

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

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

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

    1. Poor political leadership (PM and SoS Health)

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

    1. Social care

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

    1. Inequalities

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

    1. Privatisation

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

    1. Recovery Planning

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

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

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

    NHS and NIHR

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

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

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

    A wealth tax?

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

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

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

    Populism and COVID

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

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

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

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

    27.7.2020

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

    Comments Off on SHA COVID-19 Blog 20

    At a time of heightened public interest in the future of social care, what would be the way forward guided by the principle of social justice? Some of it is in plain view and takes the form of immediate funding shortfalls. The only issue is the political will to find the money. Important as these issues are, their resolution will do nothing to redress what many believe is the most painful injustice of all. The system used to identify ‘need’ and allocate resources – based on the eligibility ‘needs test’ –  is not only inherently inequitable but works in a way that deprives the individual of the control over their lives essential to us all for our dignity, self worth and wellbeing. The system built around the needs test is obscure to the public and has no public appeal. It need be no surprise that social care cannot muster the political will to address the more obvious funding shortfalls.

    For a truly socially just system the ‘needs test’ must be abolished and replaced with a system that manages the tension between needs and resources very differently. This will not require more money. But it will require political will and the intellectual effort for new thinking.

    The immediate funding issues

    Before considering the needs test, it may be worth reflecting on the immediate funding issues.

    The issue presently uppermost in the public mind is the undervaluing of care staff. With something like 1 million care staff, every pound an hour they are paid will cost about £1.8BN

    Not far behind that in the public mind, and with a political head of steam developing to do something about it, is the means test. It results in the unfairness of the ‘dementia tax’, of people having to sell their houses to pay for care, and of as many people funding their own care or going without as receive state support.

    There are two proposals to reform the means test. One is the idea of the ‘care cap’ – a lifetime limit to how much an individual would have to pay in charges. Introduced by the Dilnot Commission in 2011, it is estimated this would cost in the region of £3BN. The other is to make all ‘personal care’ free as in Scotland. The House of Lords Economic Affairs Committee favours this and costed it at £7BN last year.

    A third would be to simply abolish the means test altogether (or charge only the ‘hotel costs’ of a residential care placement which was the very limited intention when the means test was introduced by the Attlee Government in 1948). The cost would likely to be somewhere nearer to £15BN.

    There would be some good news for the Treasury from a system driven by social justice. It would surely bring an end to public companies raking in excess profits. Research by the Centre of Public Health Information established that some £1.5BN is leaked out of the residential care market in this way. That amounts to some 10% of the value of the residential care sector.

    The gross spend on social care is currently £20BN. Addressing the means test and paying a fair price for care to ensure care workers are properly remunerated could potentially double that. But doing all of this would be leave the fundamental nature and character of the service unchanged.

    The eligibility needs test

    A founding principle of the NHS was that need will precede resource and that the resource would be publicly funded.  This has arguably been the principle that, whatever its faults, has made the NHS an enduring beacon of social justice.

    However, when it came to the care of older and disabled people this principle was reversed. The priority of the Attlee government was to end the grave injustice of the institutionalisation of older and disabled people in workhouses. Poor Law Boards would be abolished and responsibility transferred to Local Authorities. But when asked in Parliament what Local Authorities would actually do, the Minister for Health replied ‘as much as our resources will allow’.

    Surely unintended, this had two devastating consequences. It implicitly put care of older and disabled people at the back of the queue for public resources, leading it to its Cinderella status. Secondly, it reversed the polarity of needs and resources. Instead of need determining resource, resource would determine need.

    The modern manifestation of the principle is the concept of ‘eligibility criteria’. The justifying theory is that there is a body of ‘needs’ for care and support that can be applied to any and all. Application by all councils of the same ‘eligibility criteria’ will ensure fairness and equity. It’s a theory that has superficial appeal. It is unchallenged. All councils claim to be delivering the National Eligibility Criteria (currently established under the Care Act of 2014).

    It is, however, a myth without mitigation. In a system where need must be determined by resource, it’s the local resources that must be the driver. The ‘eligibility’ decision must be localised to local budgets. National criteria are irrelevant.  They are, indeed, written in a way that makes the key decisions meaningless. This is necessary for local discretion.

    Not only is this localism logically the case, the empirical evidence leaves little room for doubt. Councils report annually on how many people they support and the amount they spend in doing so. Dividing one by the other – which government reports do not do – gives the average spend per person. Once adjusted for regional price differences, this surely gives the best measure of equity. The highest spending councils in 2018/19 spent an average of £22.7K and the lowest £12.9K – an astonishing 70% difference.

    This is no random unevenness that can be explained away as the uniqueness of communities served. There is a clear pattern. Deprivation of communities served is the key factor. The means test results in the most affluent communities serving 50% fewer people per head of population than councils serving the most deprived communities. Councils spending the most can spread the jam much more thickly. The highest spending councils serve communities significantly more affluent than the lowest.

    So to the inequity is added injustice.

    The damage does not end there. The eligibility process works by standardising ‘need’. Standardisation cannot be made to fit with the highly individual nature of the lived experience of need. Needs arise from the complex interplay of a host of factors each of which are themselves highly variable. It has become a modern cliché that each person is ‘expert in their own needs’. The cliché is reduced to lip service when delivered in a system which allows the person to express only ‘wishes’ while the council determines their ‘needs’. It’s infantilising. It is inaccurate as a way to identify need and therefore inefficient.

    Failure in delivery of the principle must not be allowed to dim the importance of the principle that individuals are indeed the best experts in their own needs. Their view of their needs should prevail subject only to their view making best use of resources to enable them to have their best level of wellbeing.

    There will be a dividend for the Treasury.  The greater accuracy of the assessment will mean much greater for value for money from the resource made available. The sector itself believes, although wrongly ascribing blame on poor social work practice, that the current eligibility driven system wastes significant levels of resource through poor use of resources.

    Why does the eligibility needs test persist?

    The needs test has survived since 1948 and defeated countless attempts at transformative change of social care. These include the Community Care reforms of the 1990’s and the more recent personalisation strategy.

    Why is it so enduring? Again, the answer is plain. It serves two political expedients. Firstly it keeps spending to budget, no matter the real need. Secondly, it ensures there is never any record of unmet need. This is important because, in contrast to the NHS where growing waiting lists in the NHS creates political pressure, there is no equivalent in social care. Sir Chris Wormald, Permanent Secretary to the Department of Health and Social Care told the Public Accounts Committee, who wanted to know how much funding social care needed, told them that councils had all the money they required to meet their responsibilities under the Care Act. What he didn’t say was that would be true no matter the size of the budget or the level of real need.

    What will it take to abolish the needs test?

    One obvious answer is to guarantee funding will meet all needs to ensure all have the quality of life they can reasonably expect. But the uniqueness of individual needs and the huge variability in the cost of meeting them would mean social care could have to be delivered on an ‘open cheque’ basis. No public service, not even the highly valued NHS, enjoys that. Credibility demands that strategies assume social care will continue to be delivered within a budget not likely to meet all needs. Success is to be measured by the smallness of the gap between needs and resources.

    Can the needs test be abolished in a budgeted system?

    The answer is an unequivocal ‘yes’. ‘Need’ must be identified in the context of securing the quality of life reasonable for each older and disabled person to expect through. The resources must make the best use of resources but without regard to what happens to be available. The United Nations definition of Independent Living provides a ready made standard of wellbeing to adopt. This would put the UK in the forefront internationally. From that point, decisions must be made as to how many each of those needs the council can afford to meet. Spending will be controlled to budget. However, it no longer be through eligibility of need but by affordability of need.

    The law, through the Care Act, has already made this possible. It provides for ‘need’ to be assessed against 9 dimensions of wellbeing. These dimensions are synonymous with Independent Living. The Act also creates the legal conditions to enable councils to say if they can or cannot afford to meet need. None of these provisions are currently being used. They are being ignored by councils as, under the influence of the Government’s Statutory Guidance to the Act, they are perpetuating a localised eligibility process.

    In February the Labour opposition in Barnet put forward a 4 point plan to replace eligibility of need with affordability of need as the means to control spending. This was to ensure the assessment process was able always to put the person and their welllbeing at the heart of their assessment process and to ensure the Council would be aware of any gap in funding between needs and resources. The Conservative administration rejected the proposal. They believed the Council was already delivering the Care Act and its wellbeing principle, that resources never interfere with the assessment of need, and that choice always determines what people received. The Labour group is currently testing the veracity of those claims.

    Will the needs test be abolished?

    The key issue is political will. The gap between needs and resources will be publicly exposed. What waiting times do for the NHS in creating political pressure, unmet need will do for social care. Political leaders will have to leave behind the comfort the eligibility system has provided them. The greater the funding gap given authenticity through deriving from the aggregated lived experience of need, the greater the political discomfort. But it can be expected the public narrative will shift from what ‘social care’ requires to what older and disabled people require. Few people understand or care about the former, but many are likely to about the latter. Currently councils are seen as visionless machines, employing what Tracey Lazard of Inclusion London (a network of disabled peoples’ organisations) describes as ‘dark arts’ to ensure the system’s delivery under cover of misleading public messages. Councils will be on the side of the older and disabled people they serve, free to promote public understanding of the real needs within their communities.

    Insofar as public sentiment drives political will, social care will stand a much improved chance of securing the funding it truly requires.

    Conclusion

    The needs test, and all its attendant ills, is the unintended legacy of what was otherwise a great reforming Labour government. Although understandable in the context of the 1940’s, rectification is long overdue. There is a clear moral argument that it falls to Labour to ensure it happens.

    2 Comments

    Week 18

    In this week’s blog we urge the government to stop dithering and clarify the guidance on face masks; to get on with sharing all test results with local Directors of Public Health; and to stop shifting the blame for our world-beating COVID death rate onto Public Health England (PHE) and the NHS.

    Facemasks

    The important point to note with facemasks, which gets lost in translation, is that face coverings help prevent the wearer from transmitting the virus to others. Remember in the COVID-19 pandemic we have learnt that people without symptoms can pass on the virus to others – by coughing, sneezing, shouting, singing or even talking loudly.  As the prestigious Royal Society report puts it: “My facemask protects you, your facemask protects me”

    The value of the public’s wearing facemasks has been slow to gain scientific support from the World Health Organisation (WHO) as well as within wealthy Western Countries such as the UK and USA. The WHO have, however, changed their tune now and recommend the use of non-medical masks for the public when out and about and where maintaining social distance is difficult. The advice is clear that medical masks are for health care workers as they reduce the risk of the health care worker getting the virus from their patients. It also prevents a healthcare worker who has the virus but doesn’t have symptoms from transmitting the virus.

    For the public there are two groups of people who should wear medical quality masks according to the WHO – people over the age of 60yrs and those with underlying conditions such as diabetes. The point here is that high quality fluid resistant facemasks help protect the wearer from the virus when treating patients and similarly protects older people at risk and those younger people at higher risk due to underlying conditions. This becomes even more important as vulnerable people and those in the shielded groups emerge from their lockdown.

    The rest of the population are advised to wear non medical face coverings that can be homemade and made of cloth. There are plenty of websites (including UK government ones) showing how to make them from old socks, tee shirts, tea towels, coffee strainers and the like. The benefit of this advice is that while there is a worldwide shortage of medical grade masks the use of cloth face coverings does not risk depleting supplies for health care staff.

    Remember: My facemask protects you: Your facemask protects me!

    Mutual benefit is something that socialists have little difficulty understanding and accepting but it does require a high uptake, which is where political leadership comes in. We saw the UK Prime Minister wearing a blue Tory facemask on the 10th July alongside a hint that he is considering making it a requirement to wear them in shops. This has of course already been introduced in Scotland, which is having a comparatively successful campaign to stop the spread of COVID-19 and going for elimination of the virus like New Zealand. Sunday’s BBC News reported that the US President had finally agreed to wear a face mask because someone told him he looked like the Lone Ranger!

    In the middle of June it was made a requirement in England to wear a face covering, if travelling on public transport such as buses and trains, where maintaining a 2m distance was impossible. So the government typically is inching its way towards making a decision – a slow adopter, in the terminology of the Economics of Innovation.

    The UK is starting from a low base with estimates of 25% of the public wearing masks in public places but so too were other countries in Europe like Italy and Spain who now report adherence of up to 80% which is moving them towards the levels achieved in countries which have been successful in containing COVID-19 in East Asia. What it needs is political leadership: for example, politicians like the Chancellor should be wearing a face covering when serving food in Wagamama.

    We know that failed leaders like Trump find it counter to his macho self image to wear a sissy mask but meanwhile thousands of his citizens are going down with the virus. Our PM, who shares many of the Trump traits, has also been slow to show leadership, and he missed the opportunity when they changed the social distancing recommendation from 2m to 1m+. That was the opportunity to require that people going into shops and other enclosed public spaces must wear a face covering.

    As far as the underlying science is concerned there have been research groups in Oxford who have reviewed the literature and state that ‘the evidence is clear that people should wear masks to reduce viral transmission and protect themselves’. On the light blue side of the debate a Cambridge group of disease-modellers have stated that population-wide use of facemasks helps reduce the R rate (the number of people that one infected person can pass the virus on to) to less than 1 and prevents further waves when combined with lockdown. This benefit remained even when wearers ignored best advice, contaminating themselves by touching their faces and adjusting their masks! In answer to critics these researchers have pointed out that there have been no clinical trials of the advice to cough into your elbow, to social distance or to quarantine.

    It comes down to political leadership and we note that Nicola Sturgeon has made the move, successful countries in Europe have too, and London Mayor Sadiq Khan has called on the Government to get on with it. Surely we have learnt enough about COVID-19 being spread before symptoms arise – by the so call silent spreaders?

    Sharing Test Results

    In previous Blogs we have talked about the hugely expensive and unsatisfactory ‘NHS” test and trace initiative. Imagine a Director of Public Health (DPH) within a local patch who has colleagues in Public Health and the local NHS/PH laboratories. Under normal circumstances they have a strong professional relationship and get test results emailed back very fast from the Laboratory with information that is useful for contact tracing – name and address, GP, date of birth and the history leading up to the test being taken. They can act quickly and ensure good liaison with Public Health experts and the local NHS. Logically the government should in England, like they have in Wales, have invested in a greater capacity of local testing. The so-called Pillar 1 tests have been this sort, and results have been supplied to local Directors of Public Health (DsPH) in a timely way.

    Enter stage left Matt Hancock and his buddies. Establish something completely new – the so called NHS Test and Trace initiative– at a great cost and run by an accountancy firm Deloitte and a private contract company SERCO neither with any prior experience. They establish some Lighthouse Laboratories with Big Pharma,  who may be geographically close to the local NHS labs but are contracted privately as a parallel service. They establish contracts with Amazon/Royal Mail/the British Army and others to take the swabs and transport them. Result – a mess where huge numbers of tests are lost, the results delayed and poor quality information is belatedly supplied to bemused DsPH . That is what we have seen in Kirklees, Leicester and now some other districts which have not had the benefit of the so called Pillar 2 tests done by Test and Trace.

    The latest data published by the government shows that there are more than a million tests that were ‘sent out’ but not completed. This all helped Matt Hancock show at the Downing Street press conferences that he had the testing capacity and had posted the swabs out! No wonder that the UK Statistical Authority have been concerned about how the information on testing has been presented!

    One of the excuses offered by the government has been about personal data being shared with DsPH. They forget that this is a PUBLIC HEALTH EMERGENCY and that COVID-19 is a notifiable disease and there is a statutory duty to report on cases.  Again we see dither and delay……

    June 24th PHE starts to share postcode, age and ethnicity with DsPH.

    July 3rd NHS Digital releases Pillar 1 and 2 results.

    July 6th Positive test results reported at below Local Authority level

    July 15th Postcode level dashboard to be supplied including contact tracing at LA level.

    July 16th Test results at smaller population areas (down to a 6000 households level)

    The message here is that the data from NHS Test and Trace is being very slowly shared with local DsPH and their teams who have been charged with managing local outbreaks like the one in Leicester. The key issue is – why did the Government encourage the design of the system from the top down rather than bottom up?

    Don’t blame PHE and the NHS.

    The PM and Matt Hancock have become a bit nervous about the ‘blame game’ as the demand for an urgent and time limited inquiry increases. Their performance has been poor compared to others within the UK like Scotland and across the Irish Sea and the English Channel. So who can they point the finger at?

    The Daily Telegraph is of course the PM’s previous employer and vehicle for his thoughts. It was in this newspaper on the 30th June that we first heard about Public Health England shouldering the blame.  The newspaper headline was ‘Heat on PHE as the Prime Minister admits Coronavirus response was sluggish’.

    The performance of PHE has not been faultless but we know why they were not able to scale up their testing capability when they had the opportunity. During the pandemic they have provided expert public health guidance to the system and supported local Health Protection teams but those teams have been “slimmed down” to anorexic levels during the austerity years, along with Local Authority departments.

    Public Health England was created in 2013 when it replaced the Health Protection Agency. It is an executive agency accountable to Ministers and the Department of Health and Social Care. It has many specialist research laboratories vital to national security – as used when Novichok was used in the attempted assassination of Sergei and Yulia Skripal in Salisbury in 2018. Remember the local DPH leading the local response, and then being supported by Porton Down and Public Health England?

    Public Health England employs 5500 staff with a budget of £287m per annum.

    The infectious diseases element of PHE has a budget of £90m per annum so it surprised everyone to learn that the Government has set aside £10 billion for spending on the NHS Test and Trace system. This money will be going to private firms such as SECO and G4S and dwarfs the entire PHE budget 110 fold because it is paying not just the cost – as it would if it were being done in the public sector – but the cost plus the high profits they demand!

    Remember too that on July10th G4S settled its Serious Fraud Office (SFO) case in which it was accused of overcharging the Ministry of Justice for electronic tagging of offenders. The Serious Fraud Office said that G4S had accepted responsibility for three counts of fraud that were carried out in an effort to ‘dishonestly mislead’ the government, in order to boost its profits.

    As the Guardian reports on the G4S case :“The £44.4m in fines and costs takes the total paid out by outsourcing firms involved in the prisoner tagging scandal to more than £250m. SERCO reached its own £22.9m agreement with the SFO last year, six years after repaying £68m to the Ministry of Justice”.

    So what is our government doing? It is pointing the finger of blame at PHE, which is an executive agency accountable to Ministers, and handing out generous contracts to G4S and SERCO who only recently have been found guilty of fraud.

    The one success in the pandemic has been the way that the NHS coped with the surge of cases – yes: hard to believe, but the PM is also pointing his finger at the NHS, too, and is threatening another round of Tory disorganisation.

    Clap Clap.

    13.7.2020

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

    2 Comments

    In this week’s Blog we will have a look at the lessons learnt so far with the first City lockdown in Leicester and see what this tells us about the UK Government’s handling of the COVID-19 pandemic, raise issues again about their competence, outline why the social determinants of heath matter and assess the risks involved in privatisation of the NHS testing centres and public health functions.

    Local lockdown

    Leicester has been directed by central government (Hancock in the House of Commons on the 30th June) to remain in lockdown this weekend when other parts of England were being urged by the Prime Minister to be brave, to bustle in the High Streets to help ramp up an economy which is waiting to be turbo charged. The government announced in Westminster on June 18th that there was a local outbreak causing concern in Leicester. This news broadcast in the media saw the local Mayor of Leicester and their local Director of Public Health (DPH) in a bemused state. They had been left in the dark because the central government and their privatised drive through/hometesting  service led by Deloittes/SERCO had not shared the so called Pillar 2 data with them. They did not receive Pillar 2 test data for the next 10 days!

    Outbreak plans

    Local Directors of Public Health (DsPH) across England had been required by central government a month earlier to produce Local Outbreak Control Plans by the 30th June. According to the PM they were meant to be in the lead to ‘Whack the Moles’ in his typically colourful and inappropriate language. Whacking moles apparently means manage local outbreaks of COVID-19. Anybody who has actually tried to Whack a Mole on their lawn or at a seaside arcade will know that this is almost impossible and usually the mole hole appears again nearby the following day.

    Local DsPH have been receiving from Public Health England (PHE) regular daily data about local NHS hospital laboratory testing from the Pillar 1 sources. In Leicester this was no cause for concern as there had been a decline since the peak in positive cases in April.  That explains why the Mayor and DPH were bemused. Each week there are now summary bundles of data incorporating both sources sent by PHE but not in a way that local teams can analyse for information of interest such as workplace/occupation/household information. Belatedly, postcode data is now shared which had been hidden before! One of the first requirements in outbreak management is to collect information about possible and confirmed cases with an infection in time, place and person. This information needs to include demographic information such as age and gender, address, GP practice and other data pertinent to the outbreak such as place of work/occupation and travel history. Lack of workplace data has made identifying meat packing plants in outbreaks such as near Kirklees more difficult and another example where the local DPH and the Local Authority were wrong footed by the Minister.

    Public Health England review

    On the 29th June PHE published a review  ‘COVID-19: exceedances in Leicester’. This excellent review showed that the cumulative number of tests in Leicester from Pillar 1 was 1028 tests whereas the number of Pillar 2 was 2188 which is twice as many! The rate per 10,000 people in the Pillar 1 samples was a relatively low rate of 29 while Pillar 2 showed a rate of 62/10,000. The combined positive rate of 90/10,000 is more than twice the rate in the East Midlands and England as a whole. It was on the basis of this Pillar 2 data that the government became alarmed.

    It is just incredible that the government have contracted Deloittes/SERCO to undertake something that they had no prior experience in and to allow a situation to develop when the test results from home testing and drive through centres was not being shared with those charged with controlling local outbreaks.

    The political incompetence was manifest to an extraordinary level when Nadine Dorries, Minister for Mental Health, confirmed to a Parliamentary enquiry that “the contract with Deloittes does not require the company to report positive cases to Public Health England and Local Authorities’.

    It seems as if the point of counting numbers of tests undertaken each day was to simply verify that home tests had been posted and swabs had been taken in the drive-through sites so that Matt Hancock could boast at the Downing Street briefings that the number of tests was increasing.. But we are trying to control COVID-19 and Save Lives. Sharing test results with those charged with controlling local outbreaks must be a fundamental requirement.

    Deprivation and health

    In earlier BLOGs we have highlighted that COVID-19 has disproportionately affected those who live in more deprived areasand additionally has impacted even more on BAME people. Studies have shown that relative poverty, poor and cramped housing, multigenerational households and homes with multi-occupants are all at higher risk of getting the infection and being severely ill. Other factors have been occupation – people on zero hours contracts, low pay and in jobs where you are unable to work from home and indeed need to travel to work on public transport. Many of these essential but low paid jobs are public- or client-facing which confers a higher risk of acquiring the infection.

    All these factors seem to be in play in Leicester. The wards with the highest number of cases have a high % of BAME residents (70% in some wards). One local cultural group are Gujeratis with English as a second language. Another factor that is emerging is the small-scale garment producing factories. It is estimated that up to 80% of the city’s garment output goes to internet suppliers such as Boohoo.

    The garment industry

    Two years ago a Financial Times reporter, Sarah O’Connor, investigated Leicester’s clothing industry. She described a bizarre micro-economy where £4-£4.50 an hour was the going rate for sewing machinists and £3 an hour for packers. These tiny sweatshops are crammed into crumbling old buildings and undercut the legally compliant factories using more expensive machines and paying fairer wages. As she points out (Financial Times 5th July) this Victorian sector is embedded into the 21st century economy and the workforce is largely un-unionised. The big buyers are the online ‘fast fashion’ retailers, which have thrived thanks to the speed and adaptability of their UK suppliers.  Boohoo sources 40% of its clothing in the UK and has prospered during lockdown by switching to leisurewear for the housebound while rivals have shipments left in containers.

    Mahmud Kamani with Kane founded Boohoo in 2006 and it has made him a billionaire. It is said that other competitors such as Missguided and Asos have been put off by concerns about some of Leicester’s factories – including claims over conditions of modern slavery, illegally low wages, VAT fraud and inadequate safety measures. A researcher went into the garment factories earlier this year and is quoted as saying

    I’ve been inside garment factories in Bangladesh, China and Sri Lanka and I can honestly say that what I saw in the middle of the UK was worse than anything I’ve witnessed overseas’.

    Occupational risks, overcrowded housing and poverty have been shown to be risks to contract the virus and become severely ill with it. BAME communities have additional risks over and above these as we have discussed before in relation to the Fenton Disparities report, which was blocked by Ministers who were not keen on the findings of racism in our society and institutions.

    Health and Safety

    In Leicester the Health and Safety Executive has contacted 17 textile businesses, is actively investigating three and taking legal enforcement action against one. In business terms the UK’s low paid sector are an estimated 30% less productive on average than the same sectors in Europe. As unemployment rises in the months ahead it will be vital to focus on jobs as the Labour leadership have stated. However quality should be paramount and the government apparently wants ‘to close the yawning gap between the best and the rest’.

    The Prime Minister has recently promised ‘a government that is powerful and determined and that puts its arms around people’. These arms did not do much for care homes during the first wave of COVID-19 and looking to the future of jobs and economic development the fate of Leicester’s clothing workers will be another test of whether he and his government meant it.

    Incompetent government.

    The pandemic has exposed the UK but particularly people in England to staggering levels of government incompetence. There are other countries too that have this burden and Trump in the USA and Bolsonaro in Brazil spring to mind. They seem confident that the virus won’t hit their citizens and it certainly won’t hit the chosen ones.

    Psychologists say that people like this appear confident because as leaders they know nothing about the complexity of governing. They refer to this as the Dunning-Kruger effect:

    incompetent people don’t realise their incompetence’.

    5.7.2020

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

    1 Comment

    So here we are in Week 16 of our SHA Blog about how the Johnson government is mishandling and mismanaging – except where it comes to the interests of the profit-making private sector – the COVID-19 pandemic; and why the UK is “world beating” – in terms of the highest death rate from COVID in Europe!

    Test and Trace

    The “teething problems” with the centrally designed, and privately contracted, NHS Test and Trace scheme, continues. It is a privatised system organised through the likes of Deloitte, (Deloitte is one of the Big Four accounting organisations in the world, whose business is in financial consultancy.) These private firms put the NHS logo in their own “branding” to try to build public belief, and confidence, that what they are doing is part of the NHS, and in the public’s interest, when it is a private system making lots of money for private investors: in the way that suits them best, rather than the most efficient way it could be done.  .

    It has had a huge investment of taxpayers’ money to employ 20,000 under-used telephone operators who are poorly trained in the complex field of contact tracing.  The Independent SAGE group reports that one contact tracer told them that ‘out of 200 tracers at my agency we have only had 4 contacts to call over the past 4 weeks’. Speaking to worried people and trying to elicit information about their contacts within a system which has not been able to build trust is a genuine challenge. The familiar GP practice or the local hospital and local authority – in which people really do have confidence – have in this “NHS Test and Trace scheme” had to take a back seat. (Readers will recall from previous blogs that the Independent SAGE group was set up in May to provide scientific advice independent of political pressure, after it was reported that Johnson’s “special advisor” Dominic Cummings had attended, and was believed to have influenced, the Government’s “official” Scientific Advisory Group on Emergencies. )

    Early problems have been identified in the initial design of diagnostic testing. No NHS number for instance, no occupation or place of work recorded, no ethnicity data and test results not being shared with the GP. The Lighthouse labs set up in Milton Keynes, Alderley Park Cheshire, Cambridge and Glasgow are collaborations between pharmaceutical industries (GlaxoSmithKline (GSK) and AstraZeneca), Universities in Cambridge and Glasgow, Boots, Amazon and the Royal Mail alongside the Wellcome Trust. (AstraZeneca owns Alderley Park).

    They were set up to meet the escalating government targets to get testing up to 100K (Hancock) and then to 200K (Johnson) without Ministers being clear about the strategy for testing and ensuring that results got back quickly to people and local players such as GPs and the local Public Health teams who could act. If the objective was just to get tests sent out in the mail or undertaken by Army squaddies in car parks across the country, in order to get the numbers up for the Downing Street briefings, then there was no need to worry about useful information about workplace/occupation? It is not the consortium of laboratories’ fault, as they are contributing to a national emergency, but the political leadership, which has not taken enough notice of public health professionals who have provided laboratory services and integrated themselves with NHS and local public health teams over decades. Public Health England are faced with the nightmare of quality assuring data sent to them from these laboratories.

    Workplaces

    One reason to worry is that incomplete information can lead to a delay in identifying a workplace outbreak. Returning the test result information started at Local Authority level which is not enough information on which to act. After some pressure the local teams have started to get postcode data. However noting a rise in individual cases scattered across West Yorkshire did not help public health officials pin down the common link: which was that they all worked at the Kober Meat Factory in Cleckheaton! These public health systems need to be designed by people who know about public health surveillance, outbreak management and contact tracing. It works best if the tests are undertaken locally, results go back to GPs and local Public Health teams with sufficient information to associate cases with industries, schools, places of worship, community events or food/drink outlets. This is the level of data that would help the public health team in Leicester who are under scrutiny with ‘knowledgeable’ politicians such as Home Secretary Priti Patel declaring the need for a local lockdown in the city. Speed is of the essence, too, as we know that COVID-19 is being transmitted when people do not have symptoms and is most contagious in the first few days of the illness.

    We have known from international data that meat-processing plants are high risk environments for transmission. This is clearly something to do with the damp, cool working environment, which is noisy and so workers have to shout to each other and are often in close proximity. Toilet facilities and rest areas are likely to be cramped and how often they are being cleaned an issue. Furthermore – as we have learnt from Hospital and Care Home outbreaks – how staff get to work will be important to know, too: for example, if they are bussed in together or car sharing, both of those involve being with other people in enclosed spaces.

    As in abattoirs here in the UK and in other parts of the world, jobs like this are usually undertaken by migrant workers. These workers usually live in cramped dormitory type multi-occupation residences. Low paid often migrant workers, who are poorly unionised, are particularly vulnerable to the COVID-19 contagion whether they work in US meat packing factories or in Germany or indeed in Anglesey (Wales). The 2 Sisters plant in Llangefni for instance has had over 200 workers with positive test results.

    The Tonnies meat processing factory in Germany has had more than 1500 of its workers infected and 7000 people have had to be quarantined as a result of the outbreak. This has had a ripple out effect with schools and kindergartens, which had only recently reopened, having to close again. Unsurprisingly there are stories of the factory being reluctant to share details of the staff, many of whom are Romanian or Bulgarian and speak little German.

    Contact tracing

    The importance of testing and rapid reporting of cases to local agencies was highlighted in a recent South Korean example, where a previously well -controlled situation was threatened by the finding that a series of nightclubs had been linked through one very energetic person. Tracers had to follow up 1700 contacts and be able to control the on-going chain of transmission! While South Korea, unlike the UK, has had a mobile phone app to assist contact tracing, they still depend on the local tracers to use shoe leather rather than computer software to really understand the local patch and the complex community relationships.

    The Independent SAGE group is producing useful analyses and information for us all and has been promulgating the WHO Five elements to test and trace, namely:

    FTTIS – Find, Test, Trace, Isolate and Support.

    All of these are important and the recent example in Beijing shows again how a rapid local lockdown response was used to implement FTTIS and they appear to have managed to contain the outbreak to one part of this megacity of over 20m people.

    Social distancing

    The Independent SAGE has also recently taken a line critical of the government position on social distancing. They say that the risk of transmission in the UK remains too high to reduce the social distancing guidance. They oppose the move from a 2m guidance to 1m plus and say that it risks multiple local outbreaks, or in the worse case a second wave. The pattern of continuing waves of infection has been seen in the USA, where social distancing has been poorly enforced, and in other countries where a significant second wave has occurred such as Iran.

    The Government is rightly worried about the economic impact of the lockdown and pandemic, but they are sending out mixed messages on social distancing which has led to chaotic scenes on Bournemouth beach, urban celebrations in Liverpool and street parties in many cities. In the USA it has identified the 20-44 year olds as being a group who are testing positive more frequently and we need to send the message out loud and clear that although they may not die from COVID-19 at the rate older people and those with underlying conditions, they are at risk of long term damage to their health and will transmit the virus to other more at-risk people in their families or local communities.

    The Prime Minister always wants to be communicating good news, and needs to beware that the call for more ‘bustle’ on the high streets and ramping up/turbo charging the economy carries big risks of new local outbreaks that will ensure that the Sombrero curve of infection is not flattened, but that we are condemned to live with on-going flare ups across the country.

    Ex Chancellor Kenneth Clarke tweeted recently, in the light of the situation in the UK and the flip flopping on air travel restrictions, that:

    The UK government’s public health policy now seems to be ‘go abroad on holiday, you’ll be safer there!”

    29.6.2020

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

    Comments Off on SHA COVID-19 Blog 16