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    Today the Welsh  First Minister, Mark Drakeford, said that all care workers in Wales will received a £500 payment which will provide recognition for an often “under-valued and overlooked” workforce.The payment will be available to some 64,600 care home workers and domiciliary care workers throughout Wales.

    It comes after the Welsh Government has provided an initial £40m extra funding for adult social care services to help meet the extra costs associated with responding to the coronavirus pandemic. This extra funding was, in the first instance, intended to meet the extra costs to providers for responding to the care needs of their clients but it can now also be used to address a number of the business pressures the sector faces.

    To date the Welsh Government had provided PPE to the residential care sector from its own stocks through twice weekly deliveries and the First Minister confirmed that testing should continue in care homes where   Covid-19  might be present.

    First Minister Mark Drakeford said:
    Tens of thousands of people work in social care in Wales, looking after some of the most vulnerable people in our communities and are doing so with great dedication in often challenging circumstances.
    They are undertaking tasks, which involve a high level of intimate personal care, often accepting a greater degree of risk and responsibility. Many of our social care workers are juggling their own personal caring responsibilities with their professional ones.
    I want our social care workforce know their hard work is both appreciated and recognised. This payment is designed to provide some further recognition of the value we attach to everything they are doing to – it recognises this group of people are providing the invisible scaffolding of services, which support both our NHS and our wider society.
    Further details about the extra payment will be announced shortly. The Welsh Government is working with local authorities, who commission social care services in Wales, and with trade unions and Care Forum Wales, to finalise details.
    The First Minister has called on the UK Government not to tax the extra payment, enabling social care workers to keep the full amount. The Welsh Government is also working with the Department for Work and Pensions to make sure it does not impact on people’s benefit entitlements.

    The First Minister added:
    We are urging the UK Government and the HMRC to make an exception in these truly exceptional circumstances.
    Today’s announcement follows the announcement of the death in service payment for the families of all NHS and social care staff made by Health and Social Services Minister Vaughan Gething on Tuesday.
    This scheme will provide eligible beneficiaries with a one-off sum of £60,000 and will apply to those working in frontline roles and locations where personal care is provided to individuals who may have contracted coronavirus.

    The Welsh Government is also increasing the amount of funding for the Discretionary Assistance Fund (DAF) so it can support the calls for financial help from people across Wales.As the stay-at-home restrictions continue, families have been turning to the fund for additional support to help them with some of the financial pressures and challenges they are facing.


    The Welsh Government’s Minister for Housing and Local Government, Julie James, has called on the UK Government to make urgent changes to Discretionary Housing Payments (DHP) to help protect more people in hardship and provide faster help to those who need it. It says that the Coronavirus is having a dramatic impact on people’s and family finances with claims for Universal Credit and calls on the DAF at a record high. These are some of the most vulnerable people in our society, who, through no fault of their own, find themselves facing a significant change of circumstances. It’s only right that we do all we can to protect them from extreme financial pressure. This additional funding will help the Welsh Government support as many people as we can through this period of financial hardship.

    The DAF provides grant funding to support people experiencing extreme hardship. Many of people will be the most vulnerable in society due to issues relating to poverty, physical and mental health issues and are therefore at greater risk from the impacts of coronavirus. The Welsh Government has written to the UK Government urging it to change Discretionary Housing Payments. These are available to people in receipt of Housing Benefit and Universal Credit, but they have to wait at least five weeks to receive it. People who are not entitled to either of those two benefits, but are on reduced incomes due to coronavirus, have no entitlement to the payments.  


    It says that the UK Government should make a permanent change to give all Universal Credit claimants entitlement to DHP from the date of their claim, rather than waiting for five weeks. The Welsh Government also proposes a temporary change to give those people who are not in receipt of these benefits but are facing difficulties meeting housing-related costs as a result of coronavirus access to DHP.

    1 Comment

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

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

    1. Social Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    1. Evidence of unpreparedness

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

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

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

    1. Getting out of lockdown

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

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

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

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

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

    20th April 2020

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

    2 Comments

    BUYING BEDS FROM PRIVATE HEALTHCARE PROVIDERS

    Can the minister explain why the Government has chosen to buy beds from private healthcare providers rather than requisitioning private hospitals and staff as the Spanish Government has done?

    The Centre for Health and Public Information (CHPI) has demonstrated that the government’s deal to purchase their entire capacity in return for covering their “operating costs, overheads, use of assets, rent and interest” is in effect a bailout for private hospitals. https://chpi.org.uk/blog/who-benefits-from-the-nhss-bailout-of-private-hospitals/

    Based on the accounts (2017 or 2018) of their operating companies, four of the largest private hospital providers (Spire, BMI, Nuffield, Ramsay) have an average gearing (total debt / equity) of over 300%. This means that they are heavily reliant on debt to finance their businesses, and are therefore potentially vulnerable to a prolonged period of low or non-existent demand.

    Without the deal, private healthcare providers would face the same fate as other industries who are experiencing a significant drop off in demand due to the virus. Crucially it also represents a bailout for the landlords and lenders of the private hospitals whose investments would also be at risk if the hospitals were unable to honour their payments.

    Why is the Government acting to protect private healthcare providers, and the profits of their investors, rather than taking the alternative approach of requisitioning private hospitals and their staff to support the NHS?


    What payments will the government have to make for requisitioned private health care capacity?


    Can the government provide assurances that the contracts signed for ventilators from known Tory backers like Dysons and JHB are of the required standard to enable gradual re-establishment of breathing?

    CARE AND NURSING HOME RESIDENTS

    Are you confident that all care and nursing home residents who are symptomatic are being tested for COVID-19?


    Why there is a difference in priority for the NHS and Care sector?

    Please supply any figures of death rates and infection rates as incidence and prevalence.  It should surely be easy for every care home retirement village and other institutions to collect daily stats and report regionally.

    How can you ensure that Trusts, NHS charities and local authorities work together to provide a system coordinated response?


    PUBLIC HEALTH ADVICE

    Why does the Government advise 7 days isolation for those who are symptomatic for COVID-19 while the WHO advice, followed in most of Europe is to isolate for 14 days?

    CONTACT TESTING, TRACING AND NUMBERS

    • What is the best estimate of the proportion of the population who have had Covid-19?
    • What is this estimate based on?
    • Is there any community surveillance for Covid-19 taking place? If so what are the details? What are the results?
    • How much contact tracing is done for patients who have been diagnosed as having Covid-19?
    • What role will contact tracing play in managing the easing of the current public health measures?
    •  What steps is the government taking to have a robust tracing capacity in place as we emerge from the current public health measures?
    • What criteria will be government use in terms of R0, new cases, patient deaths, herd immunity, contact tracing capacity etc to inform any decision to ease current public health measures?
    • How many of the NHS and care staff who have died in this epidemic are from overseas?

    The figures now emerging for the deaths of those working in the NHS cover the very substantial numbers of outsourced workers, a cohort that the public just don’t know about. Aside from being cheaper and allowing corporates to cream off a profit, these workers are treated as second class employees, with worse conditions, oppressive supervision, abysmal support and non-existent occupational health. Aside from low pay and the insecurity of zero hours contracts there are countless ways in which they are coerced to “just get on with it”, risking serious harm.

    The DHSC is undercounting numbers of health workers infected, can the government give assurances that they will provide accurate figures and include out sourced agency and locum staff?

    Hospitals have been asset-stripped for years by outsourcers, PFI partners and management and IT consultants, and Lansley’s Health and Social Care Act has undermined the structural coherence of the NHS. The malign results of this we now see with hospitals struggling against collapse with the untold sacrifices of heroic staff. And even here, the government (Matt Hancock) has consistently under stated the numbers of deaths of NHS staff: on Friday he said the number was 19 when it was 31 and he repeated the 19 figure on Saturday when it was in the 40s and in the public domain. Can we be assured that Mr Hancock will provide accurate figures and strive to remain on top of his brief?

    We know the numbers of front line workers losing their lives to Covid is now in excess of 40  – why has the government not acknowledged this nor yet apologised for their gross mishandling of PPE supplies.


    The finger-prick antibody tests that Hancock has ordered are widely regarded as unreliable with low sensitivity and specificity. Can we be assured that this is not the case?


    With respect to testing – why has the government wasted millions on a test which quickly proved not to be reliable. Who sanctioned this?


    What are the step changes to increase current testing capacity to 100,000 by the end of the month?  When will each new site come on stream and how much capacity will be added – and then say what actually happened – on a weekly basis?

    What really is the approach to testing front line staff? Pretending to test all front line staff is pointless as someone who is negative today could be positive tomorrow – so this would mean testing everyone everyday which would need significantly more capacity than planned. Are they testing staff who are currently self isolating and not at work and those who become symptomatic?

    What is their approach to testing care home residences and staff? Initially this should focus on those home with assumed cases and needs to be done in a consistent way

    FUTURE FUNDING

    We are pleased to hear of the Prime Minister’s recovery, and noting his praise for the dedication and commitment of NHS staff, will he now reinstate the NHS as the preferred provider when work is commissioned?

    Given the inability of local Public Health teams to provide an adequate local response to the epidemic given recent cuts and reorganisation, will be now ensure the reinstatement of Public Health powers and budgets?


    Public support for the NHS has never been higher, arguably because the population understands better than this and the previous Tory government how vital it is to national life. Will the government undertake to reinstate the NHS on its former footing as a National health service, and undertake to spend the same proportion of GDP on it as comparable countries?

    COMMUNITY SERVICES

    There is likely to be a wave of people being discharged from hospitals who remain very ill. Given the shortfall in GP and District Nurse numbers, how does the SoS expect that these patients will be adequately supported?

    Is now the time to commit to a significant increase in District Nurse numbers with upskilling to enable more people to remain at home post-Covid with GP support?

    PPE

    PHE has continually prevaricated about the spec – and in comparison to other countries still falls short, yet even that is still proving impossible to obtain for too main frontline workers, both in hospitals and in the community. We know the supply chain in England in particular is flawed because the Cabinet Office brought in an a ‘middle man’ without any experience of handling PPE or the manufacturing industry. Cabinet Office must be told they should be stood down with immediate effect from their role in England and allow industry to liaise directly with hospital Trusts, primary care bodies and care organisations for fast track targeted purchasing to unblock this ASAP.

    Why has the government persisted in shipping PPE/ventilators equipment from abroad  –  some of it substandard or out of date  – when we have received skilled offers from such as GTech in Worcester offering 30k ventilators ( not CPAPs) and the British textiles manufacturing industry being continually blocked from their significant capacity to provide PPE  – some of which is now going abroad in frustration?

    Tough Questions

    1 Comment

    31/03/2020 cllralanhall BlogPress Leave a comment

    Personal Protective Equipment, known as PPE is in demand. There are reports that there is a shortage in hospitals and care facilities.

    The Daily Mirror reports that hospitals listed as having shortages include Rotherham General Hospital, Bristol Children’s Hospital, Hillingdon Hospital in Uxbridge, Royal Devon and Exeter Hospital and at St Thomas, Lewisham and two other unnamed hospitals in London.

    “The correct PPE must be made available at every site that might require it. This is vital in order to protect our patients but also to protect the lives of the life-savers.”
    DAUK’s Dr Natalie Ashburner in 

    @DailyMirror @nashburner#COVID19 #testNHSstaffhttps://t.co/Mhd2UISZeF

    — The Doctors’ Association UK (@TheDA_UK) March 19, 2020

    The view from the NHS frontline is explained here:

    https://youtu.be/WphmagWsCUI

    Dr Samantha Batt-Rawden, an intensive care doctor and president of the Doctors’ Association UK, told Nick Ferrari that more doctors will die unless they get proper equipment.

    In a further twist, healthcare workers who raise their concerns are facing being “gagged”. Helen O’Connor, GMB says in The Guardian “It is scandalous that hospital staff speaking out publicly face being sacked by ruthless NHS bosses

    who do not want failings in their leadership to be exposed. Suppression of information is not just a matter of democracy, it is now a major public health issue.”

    The Local Government Association has sent a letter to the Secretary of State for Health, Matt Hancock MP. It says that there is an urgent need for Government to move faster in making PPE available for the adult social care sector. Sufficient supplies that are of acceptable quality are needed immediately. Councils and their provider partners also need concrete assurances about ongoing supplies for the days and weeks ahead.

    Councillor Alan Hall has written to the Director of Public Health for Lewisham seeking reassurances for both hospital and social care staff locally. The full letter is below:

    Catherine Mbema
    Director of Public Health – Lewisham

    Dear Catherine,

    I have been informed that the lack of Personal Protective Equipment for cleaning staff at Lewisham Hospital is a real concern. Trade Unions say that there is a shortage of supply and that staff are very worried. It has been described as “a total nightmare”.

    As the Public Health Lead across Lewisham, I would be very grateful if you could raise the shortage of supply with the NHS and the Hospital and reassure us that PPE will be available.

    Whilst I write, personal carers have reported shortages and inadequacies nationally. Can an assurance that all Lewisham Council and NHS staff have been provided with effective PPE?

    May I take this opportunity to thank you and your team for all the incredible work that has been placed upon you. I have always campaigned against Public Health cuts and the short sightedness of this is surely been borne out now.

    Kind regards,

    Alan

    Cllr Alan Hall

    In an article on the United Nation’s website, there is a chilling message:

    “COVID-19 will not be the last dangerous microbe we see. The heroism, dedication and selflessness of medical staff allow the rest of us a degree of reassurance that we will overcome this virus.

    We must give these health workers all the support they need to do their jobs, be safe and stay alive. We will need them when the next pandemic strikes.”

    Please help: NHS Staff need adequate PPE now https://t.co/XLsLDNaz5g via @socialisthealth

    — Alan Hall (@alan_ha11) April 1, 2020

    Comments Off on PROTECT ALL FRONTLINE HEALTHCARE WORKERS

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

    1. A global crisis

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

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

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

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

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

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

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

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

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

     

    1. 2. The NHS and Social Care

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

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

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

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

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

     

    1. Jobs and income

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

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

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

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

     

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

    2 Comments

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

    1. Global crisis

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

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

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

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

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

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

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

    1. The public health system

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

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

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

    1. Local government and social care

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

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

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

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

    1. The NHS

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

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

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

    1. Maintaining people’s standard of living

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

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

    1. Conclusion

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

    24th March 2020

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    COVID-19 Pandemic

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

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

     

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

     

    1. A global crisis

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

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

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

     

    1. The public health system

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

     

    1. The NHS, Local Government and Social Care

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

     

    1. Funding for staff and facilities.

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

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

     

    1. Staff training, welfare and support

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

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

     

    1. Vulnerable populations.

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

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

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

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

     

    1. Assuring universal basic income.

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

     

    1. Conclusion

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

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

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

    On behalf of officers and vice chairs

    Comments Off on SHA COVID-19 Blog 1

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

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

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

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

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

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

     

    On behalf of the Officers and Vice Chairs

    1 Comment

    The Conference on Retroviruses and Opportunistic Infections (CROI) in Boston is the most important yearly scientific meeting for HIV doctors and the global community of people living with HIV.

    However, this year – and at the very last minute because of the new coronavirus outbreak – the organisers replaced it with a ‘virtual’ conference.

    HIV i-Base, the London-based HIV Treatment Information charity, regularly attends this conference. Simon Collins and Polly Clayden at i-Base always report on the latest scientific research, including on new drugs for both treatment and prevention of HIV.

    But importantly his year, CROI have given open access to a special session on COVID-19 and SARS-CoV-2.

    Here is Simon Collins’ report for i-Base. This includes a link to the special session which contains up-to-date information about the outbreak that can be of interest to all, and not just to people who are HIV positive:

    The special session on coronavirus at CROI yesterday is posted for open-access on the CROI website. [1]

    The 75-minute overview includes four talks and a Q&A at the end.

    A few selected key points include:

    • The highest risk of more serious illness and outcomes (risk of dying) are older age (80>70>60 years old), and having other health conditions (heart, lung/breathing, diabetes, cancer). The risk of the most serious outcomes is 5 to 30 times higher than with seasonal influenza (‘flu’).
    • Implications for people living with HIV are not currently known, other than as for the general population. One speaker included low CD4 as a possible caution. [Note: Due to lack of evidence so far a low CD4 count has not been included as a risk in the recent UK (BHIVA) statement]. [2]
    • Transmission is largely from microdroplets in air from someone during the infectious period (generally from 1 day before symptoms to average 5 days, but up to 14 days after). These can remain infectious on hard surfaces for an unknown time (possibly hours) which is why hand-washing and not touching your face is important.
    • Best ways to minimise risk of infection include washing your hands more carefully and frequently and not touching your face.
    • Soap and water is better than hand sanitisers (and more readily available).
    • Best candidate treatment (so far) is remdesivir (a Gilead compound). This has good activity against a range of viruses in in-vitro studies and is already in at least four large randomised studies.
    • Studies with candidate vaccines are expected shortly – within two months of the virus being isolated – fastest time for vaccine development.
    • The response in China after the first cases were reported was probably much faster than it would have been in the UK. This included:
      –  Within four days of the first reported cases, the suspect source was identified and closed (a seafood market).
      –  Within a week, the new virus was identified (SARS-CoV-2).
      –  The viral sequence was then shared with WHO and on databases in the public domain for other global scientists to use.
      –  Within three weeks of the first confirmed cases, Wuhan and 15 other large cities in China were shut down as part of containment measures.
    • One of the questions after the main talks asked whether SARS was now extinct. The answer explained that SARS is a bat virus, and only 50 out of about 1300 species of bats have been studied so far. So SARS is very likely still around.

    COMMENT

    Currently, the most important things for people living with HIV are:

    1. To make sure people have enough medications – including at least one month spare. If travelling where there might be a risk of quarantine, to take additional meds with you to cover this.

    2. As recommended by BHIVA, sensible hygiene precautions (hand washing and not touching your face etc). [2]

    3. Avoid or delay any non-essential or non-urgent hospital visits.

    4. Special caution for those who are older or who have multimorbidities – which are prevalent in HIV.

    References

    1. Special session on COVID-19. CROI 2020, 8–11 March 2020.
      https://special.croi.capitalreach.com
    2. BHIVA. Comment on COVID-19 from the British HIV Association. 27 February 2020.
      https://www.bhiva.org/comment-on-COVID-19-from-BHIVA
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    One on International Trade dispute settlements and the other on Social Care.

    These are not official SHA policy.

    Issues for the NHS during UK Trade deal Negotiations

    As socialists we have an almost irreconcilable set of principles

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

    Video 1: the current state of social care.

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

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

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

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

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

    3 Comments

    Boris Johnson’s Queen’s speech includes this statement:

    “New laws will be taken forward to help implement the National Health Service’s Long Term Plan in England.”


    A Camden New Journal article ‘Beware false prophets’ published last month, reports:

    “The most alarming feature of the Long Term Plan, however, is that it completely locks in the contracts on offer through the adoption of Integrated Care Partnerships (ICPs).

    “These ICPs are the planned outcome of NHS England’s Sustainability Transformation Plans and Accountable Care Organisations, and are non-state organisations with a single management structure. Included within them are hospitals as well as primary and commun­ity care services – and possibly social care too.

    “These giant five to 10 year multi-million-pound commercial contracts will be open to bidding, and they will not be subject to public scrutiny (information is routinely withheld on grounds of commercial confidentiality). This will open the way to bids from giant international health corporations that already run similar de-skilling of healthcare in the US and elsewhere.”

     

    Jeremy Corbyn’s Labour speech in Northampton is clear:

    “For a decade our NHS has been run down, carved up, and prepared for privatisation. A Labour government will reverse this. We’ll repeal the Tory-Lib Dem privatisation Act of 2012. We’ll give our NHS the resources, equipment and staff it needs. That means more GPs and nurses and reduced waiting times. And under Labour prescriptions in England will be free.

    “And we’ll make life-saving medicines available to all by ensuring Big Pharma can no longer hold our NHS to ransom. The prices pharmaceutical companies demand don’t reflect the costs of the drugs they make. They simply charge as much as they can get away with.

    “We’ll use compulsory licensing to secure generic versions of patented medicines and create a publicly-owned generic drugs manufacturer to supply cheaper medicines to our NHS, saving our health service money and saving lives.

    “Only Labour can be trusted with the future of our NHS.”


    Please see Mariana Mazzucato’s The Value of Everything, especially Chapter 7 “Extracting Value through the Innovation Economy”. It explains value extraction by Big Pharma.

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