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

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

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

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

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

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

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

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

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

     

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

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

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

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

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

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

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

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    Issue: 98

    17 May 2020

    The UK Now Has the 4th Highest Covid-19 Death Rate in the World

    Deaths/Million of Population

    UK: 495

    Some countries which are much more densely populated than the UK have much lower Covid-19 deaths/million rates. These include Bangladesh (2), South Korea (5), India (2) and Israel (31). (Source Worldometer, 14 May 2020).

    Why has this happened? Who is responsible? Is new leadership now required in the UK?

    Covid-19 Care Commissioning/Purchasing/Supply Chaos

    Clinical Commissioning Groups, NHS Trusts, NHS England, Local Authorities, care homes and now DHSC/eBay are all purchasing Covid-19 supplies including PPE.

    Where is the control? Where is the order? Where is the leadership?

    On 1 May 2020, somewhat belatedly, The Department of Health and Social Care (DHSC) apparently wrote to all NHS Trusts stopping them from purchasing supplies. This includes PPE. I’m sure NHS Trusts are not intentionally stupid. They have been buying PPE themselves because the DHSC/NHS England/CCGs were not commissioning/purchasing/supplying PPE!

    The latest supply channel is a joint venture between DHSC and the shopping and auction site eBay. The venture is very new and according to ’Health Service Journal – on 6 May 2020 had supplied just 400,000 PPE items to only 1,400 of the 58,000 UK care service suppliers.

    Ealing Council Leader Julian Bell is alleged to have announced in a Unite Zoom meeting on 12 May 2020 that Ealing Council had been successful in purchasing PPE for four West London Councils’ ‘local care services’. Following recognition of this, Councillor Bell said the Council would soon be the purchaser of all PPE for all London Councils’ local care services. All this seems quite odd when one considers that the vast proportion of care/nursing homes are privately owned. Shouldn’t the owners of the homes be expected to provide PPE for their staff? Surely the same logic applies to the vast proportion of domiciliary care staff who are employed by private companies – their employers should surely provide them with PPE, not Local Authorities.

    On 15 May 2020 ‘The Guardian’ reported on the shambles at the Government’s outsourced PPE depot run by Movianto. Apparently PPE equipment was being stored in a smoke damaged Merseyside warehouse found to contain asbestos. In late March 2020 the Government ordered Movianto to begin distribution of the £500 million PPE stock. However, because of poor management and staff sickness progress was slow, errors were made and as demand grew apparently it became chaotic. The army was called in to sort it out. It didn’t help that during this period the American parent company sold Movianto to a French company. Questions are being asked as to why DHL lost the contract in 2018 and why Movianto, a loss making company for every year since 2010, had managed to win the £10.5 million/year contract.

    Local Resilience Forums (LRFs) Claim Government’s Approach to Them for Covid-19 Has Been ‘Top-down, Uncommunicative and Controlling’

    There are apparently 42 LRF’s in England and Wales. They have been tasked by Government to respond to Covid-19. A review by Whitehall, revealed in ‘Municipal Journal’, is very critical of the Government. The leaked report cited withholding vital data and intelligence on the progress of Covid-19. Research was carried out by Nottingham Trent University for the C-19 Foresight Working Group – a cross-party Government committee.

    Local Resilience Forums – which most people have probably never heard of – were introduced in 2004 in the Civil Contingency Act to provide the means to those involved in preparedness to collaborate at a local level. There is just one LRF in London (serving 9 million residents!) and it’s based at the London Fire Brigade, London SE1.

    Will the Government Mishandle Covid-19 Local Testing/Contact Tracing/Isolation/Quarantining?

    Sadly this is likely.

    Public Health Professor Allyson Pollock at Newcastle University and a member of the King Independent SAGE team has on numerous occasions emphasised that the Covid-19 national epidemic is not homogeneous. It is in fact hundreds or thousands of local Covid-19 outbreaks that are active in this country – all at different stages of ‘diffusion’.

    The key to contact-tracing is local knowledge and meticulous research on the ground. This suggests using Local Authority resources, GPs and the myriad of volunteer groups which already exist in all towns and villages throughout England.

    Allegedly Government outsourcer Serco has assembled/is assembling 15,000 tracers (Call Centre staff?) and 3,000 clinical support staff (recent NHS retirees?). ‘Health Service Journal’ reported on 13 May 2020 that much of the national test centre data/results were not being shared with GPs and Local Authorities. Will Deloitte who run these national test centres hand this test data to Serco?

    Yet another ex-McKinsey & Co employee is joining the fray and in a top position too. Baroness Dido Harding has been appointed leader of the Government’s Covid-19 Test and Trace Taskforce.  Her stint at McKinseys was in the 1980s. However she became notorious for her performance when CEO of TalkTalk for seven years. Her handling of a cyber attack resulted in losses of £60 million, four million customer accounts allegedly hacked, and a loss of 95,000 customers.  Baroness Harding also seems to have kept her role as Chair of NHS Improvement. Maybe with the merger of NHS England and NHS Improvement (NHSI), the NHSI Chair’s role is effectively redundant.

    The Government’s (as yet unnamed) contact-tracing App is still on trial on the Isle of Wight. If it ‘fails’ – on ethical or technical grounds – the Apple/Google App, being used in Europe, is waiting in the wings. And, according to ‘The Times’ of 14 May 2020, there are 43 Covid-19 contact tracing Apps in use worldwide.

    National Audit Office (NAO) Describes £8.1 Billion NHS IT/Digital Transition Spending as Inadequate and Confused

    • 54% of NHS Trusts reported that their staff could not rely on digital records.

    • NAO recommends spending 5% of the total annual NHS budget on IT/digital transformation. NHS is spending 2%.

    • Interoperability between new and legacy systems, especially with repeated changes in national strategies has created a fragmented environment.

    • NHS management of digital transformation at a national level is confused.

    A New Post Covid-19 Healthcare Plan Being Hatched for London

    ‘Urgent Action: System Plans for London’ is the title of a 29 April 2020 leaked memo to the five London Integrated Care System (ICS) Chairs and Senior Responsible Officers (SROs). The author is Sir David Sloman, NHS London Regional Director.

    The memo asked all these bosses to rapidly review their ICS plans in terms of new Cocid-19 challenges and future care strategies. It also asks them to report against 12 expectations contained in a ‘Journey to a New NHS‘ paper along with a set of slides. They had to reply by 11 May 2020. Why the rush one wonders?

    The backdrop to all this is multifarious. Firstly in terms of previous plans we have at least the October 2019 ‘London Vision’, the January 2019 national ‘Long Term Plan’, and the November 2017 ‘London Care Devolution’, and the five London regional October 2016 ‘Sustainability & Transformation’ Plans. In terms of statutory significance the ICSs have no legitimacy at all. In fact in at least one London region (NHS North West London) its ICS will not be formally born until 1 April 2021. (In NHS NWL for example, the only statutory legitimacy lies with the eight CCGs. Ealing’s CCG is strangely quiet at the moment. The last we heard from the Collaboration of the 8 CCGS was that all but Hillingdon CCG were ‘partnering’ with other CCGs. No doubt they are all trying to reduce their combined 2018/19 annual ‘employee benefits’ of some £10 million).

    A bit more NHS NWL flavour here is also relevant. In May 2019 NHS NWL outlined there would be 8 ‘Place Teams’, 8 ‘Local Committees’ and 8 Integrated Care Parnerships (ICPs). One year on, one wonders what’s happened to plans for them? Or is planning and strategy a London-wide only approach now?

    It really does seem an age away in 2013 when NHS bosses were preaching about local commissioning, by local GPs with local knowledge. Their bible then was the 2012 Health & Social Care Act – which ominously is the existing legislation that is being blatantly ignored in spirit and possibly in actuality.   

    Now to the content of the memo. A quick glance at the 12 expectations:

    1. How are you going to deal with non-Covid-19 acute elective and non-elective work? In other words how are NHS Trusts going to carry out the jobs they are paid to do?
    2. A consolidation and strengthening of specialist services. Cancer, paediatrics, renal, cardiac and neurosurgery listed. Does this suggest mergers and closures?
    3. Increase web, telephone and video triage. Never mind the quality – it’s cheaper than actually having to travel from home and meet a patient in a clinical ’setting’.
    4. How will you separate emergency Covid-19 from emergency ‘other’. (Given that some emergency other patients are locked into the ‘stay at home’ paradigm and think NHS UCCs and A&E units are awash with the Covid-19 virus).
    5. Develop virtual by default Primary Care and Outpatients. See 3.
    6. Minimise inpatient length of stay and faster Delayed Transfer of Care. See NHS NWL ‘Shaping a Healthier Future’ case study – seven years and £1.3 billion spend made little progress on this minimalisation.
    7. Address health inequalities – see similar unmet aspirations like Climate Emergency and clean drinking water for all the 7.7 billion inhabitants in our world.
    8. Same expectation as in 2.
    9. Merge corporate support services and clinical support services. Cost savings here.
    10. A workforce plan. Good luck with that one. Too few doctors, nurses, consultants, mental health staff at all levels, and too few support staff. Too many commissioners.
    11. A plan to ‘join together’ NHS institutions and Local Authorities. With different business models, goals, budgets, culture, politics and a shared desire not to open up financial books to each other – little progress on this front visible over the last seven years. No mention of ‘Integrated Care Partnerships’.
    12. Public engagement including ‘deliberate’ forums (e.g. NHS NWL 4,000 EPIC hand-picked sounding board – which is an attempt at regularly polling a representative sample of the 2.4 million NWL patients).

    Revenue and capital cost estimates were asked for. A three phase implementation over 18 months was proposed. But the NHS never meets its timescale projections. A new bit of jargon emerged – ‘London Vision the Touchstone’…….

    The 32 London boroughs commission all London’s social care. However it’s clear from comments heard from the London Borough’s of Ealing and Hammersmith that they have not been asked to comment on these NHS ‘Systems Plans for London’. Yet another painful example of the long running disconnect between healthcare and social care.

    A final postscript on NHS London supremo Sir David Sloman. Google can’t find anything about his life prior to 2009. In 2017 he was admonished by the Government’s data protection agency for illegally giving details on 1.6 million patients to Google Deep Mind.

    Is the Care/Nursing Home Business Model Broken Beyond Repair?

    Most care/nursing homes in England are privately owned. There are 17,000 nursing and residential care homes in England housing 400,000 people (NHS England, 2019). A lot of homes are part of care groups both small (e.g. Abbey Healthcare) and large (e.g. Four Seasons). Some are run by charities (e.g. St David’s, Castlebar Hill, W5). Care is commissioned by Local Authorities (LAs). The homes are regulated by the Care Quality Commission (CQC). Each home has a contract with a local GP practice. Many GP practices are commissioned by NHS England (NHSE). Some GP practices (e.g. the 75 in Ealing) are commissioned by the local Clinical Commissioning Group (CCG). Where local CCGs have been replaced by regional Integrated Care Systems (ICSs) could it be that the succeeding ICS is the commissioner? For over two years now the Department of Health has had social care responsibilities – so the DHSC has overall responsibilities for care/nursing homes. The care/nursing home acronym soup or tangled spaghetti looks like LAs, CQC, GPs, NHSE, CCG, ICS, DHSC.

    ‘Reuter’s’ data analysis up to 1 May 2020 shows at least 20,000 excess deaths in care homes in England and Wales during the pandemic. Is it any wonder then that when the Covid-19 history books are written one of the most painful chapters will be on unnecessary care/nursing home deaths.

    Eric Leach

    Silver Voices

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    Introduction

    The SHA has produced a weekly Blog on the Covid-19 pandemic for the past 2 months. In these Blogs we have looked at many issues but the overriding finding is that the UK Government has been much too slow in responding to the pandemic, which has cost lives, stressed the NHS and severely damaged the economy. We are now one of the countries in Western Europe with the worst outcome in terms of reported deaths and deaths/million population.

    This is a scandal, and as we have learned more about the background to the response we learnt about the emergency scenario planning exercise in 2016 Operation Cygnus (Swan flu). This exercise, which involved the devolved nations and over 900 participants, made recommendations on the need for more PPE to be stored, more ITU ventilators to be procured for an enhanced ITU provision and robust planning for the social care sector which was at risk of being overwhelmed. The recommendations seem to have been largely ignored by the Tory government during its declared policy of disinvesting in the public sector and the policies of economic austerity. At that time Boris Johnson was a senior Cabinet Minister as Foreign Secretary and Jeremy Hunt, now Chair of the Health Select Committee, was Secretary of State for Health and Social Care. Who will take responsibility for not acting on the advice?

    The other issue that has become even more obvious is that public services such as the NHS have been starved of resources over the 10 years of austerity and while the service has made an extraordinary response to the pandemic it is against the background of poor capital investment and major staffing pressures such as medical and nurse staff vacancy levels. Similarly the Local Government sector has been pared down during the Tory years with massive disinvestment, floating State Education to unaccountable Academies and Free Schools, and running down many of its former functions including environmental health and trading standards. Local Authorities who have been driven to cut services and their budgets year on year are now being asked to stand up and take responsibility in an emergency while also trying to cope with the social care scandal. It sticks in the throat to hear government Ministers speak appreciatively about public sector workers, often in low paid jobs, who they have in the past criticised as a burden on the taxpayer.

    In this week’s blog we want to raise the issues about re-building the public health system so it can run the test, trace and isolate campaign from neighbourhood, local authority population, region, nation and central government. We are also concerned about the evidence of further privatisation using the Covid Trojan Horses and the excellent examples from other countries about how they have handled the pandemic successfully and published coherent plans to get out of their lockdowns.

    Test, track and trace, and isolate

    Since the beginning of the pandemic we have been calling for Covid-19 to be contained by using tried and tested public health measures of communicable disease control. Even without access to swab testing of suspected cases local public health workers would be able to establish whether someone was a suspected or probable case from taking the history of their illness. With swab testing this would convert the suspected/probable case to become a confirmed case and the local public health team would build their information base and start to map out the spread of the infection in their locality. Notifiable disease works in this way and at the start of the pandemic this could have been done in all areas. Contact tracing and recording demographic details as well as presenting symptoms would have built up a local picture of the manifestations of the infection, the demographic details and travel histories involved.

    A history of fever and continuous dry cough would have been sufficient to be a suspected case. It was a serious error to not start contact tracing and local notification in all areas to build up the knowledge and skills of local PH teams. Obviously when community spread became overwhelming such detailed work on contact tracing might reduce but a local record of test positive cases should have continued to be built us. Laboratory test results are still collected but this should have fed into the local teams databases. The variation in new cases and deaths across the UK has been very marked and in some areas this task would have been comparatively easy to sustain and in the process train new people under the watchful eye of experienced Environmental Health Officers (EHOs) supported by their Local Authority based public health colleagues.  Expert advice obtained from Laboratories and Public Health England would support the local teams under the leadership of Directors of Public Health (DsPH). Similar networks exist in Wales, Scotland and Northern Ireland.

    The reason for spelling this out at this stage of the pandemic is that at long last the government have rumbled that testing, tracing and isolating is part of the strategy to get out of the blunt tool of total societal lockdown. South Korea’s success was wholly dependent onrigorous testing including basic approaches being supplemented by mobile phone data and other digital systems. They have shown how they can monitor community infections and step in quickly to contain new cases as they arise. They did not have to resort to society lockdown and their economy has continued to function – as well as coping with voting in a general election during this time.

    To get testing scaled-up from its hospital base, the government has defaulted to their prior preferences and have turned to their friends in the private sector: Deloittes, Serco, G4S and Sodexo.  Rather than building local public health teams in Local Government and enhancing PHE reach from their regional organisations, we now have a mix of inexperienced private contractors. So rather than start the process of using the pandemic to re-establish public health capacity locally and regionally we see short-term contracts with the private sector. These private contractors are advertising for contact tracers at £8.72/hr. Sodexo, which is running many of the Covid-19 drive-through testing centres with minimal staff with clinical experience, are paying testers £13.50 /hr and trainers £17.50 /hr and all jobs are offered on a casual basis.

    These political decisions have already led to communication problems with poor reporting back to primary care and PHE, and who knows how, or whether, the data will be integrated into the system in a consistent and reliable way? To everyone’s astonishment, pop-up testing pods appear in local areas without anyone knowing that they were planned, and samples then have to be sent to the USA (yes the USA) to be tested when really results should be back quickly, and within 2 days to be useful. This is a huge lost opportunity to try and re-establish public sector public health services from local to regional levels and so build system resilience and independence rather than inexperienced private sector for profit organisations.

    Privatisation – the Trojan Horses

    The privatisation of the testing services is also being matched by the opening up of NHS data and information systems. NHS England and NHS Improvement (NHSE & I) (now merged in practice, though without the necessary legislation) is creating a data store to bring multiple data sources together including data from NHS111 calls, NHS digital and Covid-19 test results, and NHS and Social Care data. We are told that NHS data will remain under NHS England and NHS Improvement’s control!

    This data is very operational looks at occupancy levels in hospitals, capacity in A&E departments and statistics about length of stay of Covid-19 patients. The dashboard will provide a public health overview and supply operational data across the NHS. The partners in this include private sector multinationals  Microsoft, Palantir Technologies UK, Amazon Web Services (AWS), Faculty (an AI company), and Google. We are told that data and information governance will be strictly controlled.

    Apart from the private sector “entrism” into NHS data and information, we have seen KPMG being commissioned to build the Nightingale warehouse hospitals, which are having to be redesigned or mothballed. The NHS was only able to stand up to the extreme pressure through the dedication, commitment of health workers and their administrative and management staff embued with public service ethos. Another private sector stablemate, Deloittes, was handed the contract to provide PPE and to commission vaccine development. All this without the need for tendering.

    The risk that derives from the 2012 Lansley Act, the 2015 NHS guidance in England and the more recent Coronavirus Act, is that it eases privatisation of our NHS. And privatisation with even more stealth than that recommended by Nicholas Ridley’s Tory Research Dept proposals  to Margaret Thatcher in 1977, before she even became Prime Minister. Much commissioning of NHS services now takes place at national levels with very little if any scrutiny from publicly accountable local Boards. All these changes, brought in by the Tory Government before the pandemic, are now being used to privatise services and potentially set up the NHS for deeper intrusions into its role as a publicly funded and delivered health service.

    Exit out of lockdown

    Although some countries such as Korea and Sweden have avoided lockdown, many others  have had to use this blunt but too often necessary strategy. We are now seeing that countries that acted early and fast with containment measures, are planning the steps needed to safely reduce the constraints on everyday life and the economy.

    We have seen an excellent visual map of the five stages to be taken between May-August in the Irish Republic, which has so far been doing extraordinarily well in containing the infection with relatively few cases or deaths. New Zealand, which has been a beacon to other countries, seems to have succeeded with their policy of eliminating the virus. Under the excellent leadership of Jacinda Ardern, they too have set out their plan for freeing up movement of people and the economy. Neighbouring Australia have also done well with their policy on restricting air travel and quarantining arrivals, closing State borders and undertaking lockdown. They have only had 92 recorded deaths in their 25 million population and now have their staged plan published. No doubt we will be able to watch international sporting contests between NZ and Australia inside their Anzac bubble!

    On the European mainland Italy and Spain are taking their first cautious steps out of lockdown, which in their cases have pulled back the out-of-control spread. France has colour coded their regions and the red areas will remain under tougher conditions, but the South and West will see greater relaxation of controls. All these countries have published clear plans with criteria in easily understood diagrams of each phase and steps clearly laid out.

    The UK government has so far failed to set out the plan clearly and is at risk of confusing people by changing the message from “Stay at Home” to “Stay Alert”! They risk division across the devolved nations of the UK and misunderstandings about any new freedoms. Workers will need proper risk assessments of their workplaces before returning safely to work and this must include considerations about their journey to work, canteen and welfare facilities in the workplace, and that they that meet the standards of social/physical distancing and PPE provision where required. This will take time and many partners such as Trade Unions will need to be involved in aspects of the risk assessment in the workplace as well as facilitating transport to work.

    Conclusion

    We are at a critical point in the pandemic where we are still suffering from a comparatively high level of new cases being identified, with the social care sector suffering from particularly serious epidemic spread, risking the lives of thousands of very vulnerable residents. The government has rather belatedly recognised the WHO advice to test, test, test, and has successfully increased testing capacity but has failed to invest either in rebuilding the capacity of local public health teams in Local Government or in more local Public Health England teams.  In its struggle to get on with the response it is choosing to invest in private companies who have over the past decade already profited from NHS contracts in support services and laboratories, but now seem to have been also given access to NHS data. There is a serious risk of even further and deeper privatisation of NHS provision while publicly extolling the virtues of the NHS. And possibly the opportunity of using the data to try and sell private health insurance directly to individuals , or advertise private services in many more areas currently covered by the NHS. Finally, exiting lockdown will not be easy to achieve, as the epidemic has not declined in a persuasive manner, with the first wave suppressed and therefore prolonged. What people need is a clear staged plan for the steps to be taken and the data that will monitor progress rather than a statement of intent.

    As cardiologist Dr Banerjee notes in the Observer: “We were not humble enough to look at other countries and learn a lesson from them and lock down quickly – it is as simple as that. We were arrogant and thought that we had nothing to learn from other countries and thought that we were an exceptional case. In fact we had a lot to learn but didn’t take the opportunity”

    11.5.2020

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

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    The United Kingdom has overtaken Italy with the highest official death toll from the coronavirus, Covid-19 in Europe. New figures released on Tuesday, 5th May 2020 show that this is the trend, we ask, what does this mean for London and Inner London Local Councils?

    London is a vast geographical area and has a complex demography. The inner London boroughs are more diverse, in general and the outer London boroughs are more suburban.

    The incidents of coronavirus in the capital have been measured by the Office for National Statistics.

    The ONS reports that overall, London had 85.7 Covid-19 deaths per 100,000 population, almost double the rate of the next worst-affected region which is the West Midlands at 43.2 deaths per 100,000.

    Nick Stripe, head of health analysis and life events at the ONS, said: “By mid-April, the region with the highest proportion of deaths involving Covid-19 was London, with the virus being involved in more than 4 in 10 deaths since the start of March.”

    The figures for the top ten London Boroughs are:

    Borough SMR
    Newham 144.3
    Brent 141.5
    Hackney 127.4
    Tower Hamlets 123
    Haringey 119
    Harrow 115
    Southwark 108
    Lewisham 106
    Lambeth 104
    Ealing 103

    If we look even closer within each London borough, we can see the how each Super Output Area is affected. Super Output Areas are a small area statistical geography covering England and Wales. Each area has a similarly sized population and remains stable over time. You can take a look at the ONS interactive map here: 

    The Index of Multiple Deprivation (IMD) is an overall measure of deprivation based on factors such as income, employment, health, education, crime, the living environment and access to housing within an area. [NB There are differences between England & Wales]

    Age-standardised mortality rates, all deaths and deaths involving COVID-19, Index of Multiple Deprivation, England, deaths occurring between 1 March and 17 April 2020

    Looking at deaths involving the coronavirus (COVID-19), the rate for the least deprived area was 25.3 deaths per 100,000 population and the rate in the most deprived area was 55.1 deaths per 100,000 population; this is 118% higher than the least deprived area.

    In the least deprived area (decile 10), the age-standardised mortality rate for all deaths was 122.1 deaths per 100,000 population. In the most deprived area (decile one), the age-standardised mortality rate for all deaths was 88% higher than that of the least deprived, at 229.2 deaths per 100,000 population.

    The bar chart shows how much higher each decile is compared with the least deprived decile for all deaths and deaths involving COVID-19.

    For deciles 4 to 9, the percentage increase in age-standardised mortality rate of deaths involving COVID-19 is similar to that of overall deaths.

    The rate of deaths involving COVID-19 is more than twice as high in the most deprived areas compared with the least deprived

    Local responses will involve contact tracing. This graphic from Public Health England gives a brief description of the process.

    contact tracing is part of a public health approach

    Professor Allyson Pollock of Public Health at Newcastle University has been campaigning to raise the profile of a more localised approach, in a letter she has said that a massive increase in testing and tracing should be the next phase, but decades of cuts and reorganisations have whittled away the necessary regional expertise.

    In the letter the dynamic nature of the pandemic across the country is aptly described as “not homogenous. It is made up of hundreds, if not thousands, of outbreaks around the country, each at a different stage.”

    Her approach champions “classic public health measures for controlling communicable diseases such as contact tracing and testing, case finding, isolation and quarantine. They require local teams on the ground, meticulously tracking cases and contacts to eliminate the reservoirs of infection. This approach is recommended by the WHO at all stages of the epidemic.”

    The history of public health is important including the recent changes in the Health & Social Care Act 2012. This abolished local area health bodies, created Public Health England to fulfil the Government’s duty to protect the public from disease and charged local authorities with improving public health.

    As public health returned to local government, with a sleight of hand, the Government introduced the current programme of public health funding cuts. In 2019/20, the London’s share of the Public Health Grant had fallen to £630 million, representing a per head funding reduction from £80.75 in 2015 to £68.61 in 2019, a fall of 15% and the biggest regional reduction in England.

    “Investing in public health is also hard for governments because the benefits accrue to their successors and there is little to show for spending at the end of the five-year election cycle.”

    “Cutting public health funding would be an act of self-mutilation. If controlling spiralling demand is the priority, for goodness sake don’t cut public health.”

    Luke Allen
    Researcher, Global Health Policy, University of Oxford in the conversation

    A localised response requires political will, expertise and attention to detail.

    Public Health funding and status needs to be revitalised and restored. It is a matter of life and death.

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    THE GOVERNMENT’S DUTY TO KEEP THE PUBLIC SAFE OUTSOURCED TO THE PRIVATE SECTOR

    HANCOCK INCREASES PRIVATISATION BY STEALTH

    On Monday, the news broke that contact tracking and tracing (the next stage in managing the pandemic) will be outsourced to the private sector in the form of at least two private call-centre operators, one of which is Serco. They are providing 15,000 or more staff who, after one day of training, will be given a script to follow in conversations with people who have been in contact with confirmed cases of Covid-19.

    Ministers have been using the pandemic as an excuse to by-pass “normal” procedures for awarding Government contracts which involve invitations to tender and have been awarding contracts to a string of private companies and management consultants with no open competition.

    Even these “normal procedures” are a way the Tories privatise the NHS – the way they first began to do it – by insisting services which had previously been provided in-house by NHS employees, be “put out to tender”. Which is how firms like Carillion which went bust in Jan 2018 leaving debts of £7 billion, G4S, ISS, Sodexo, Bouygues and others came to be the employers of hospital porters, cleaners and catering services. A privatisation process dating back to 1979 and the Thatcher government and including more recently the Private Finance Initiative supported by the Labour Government of Tony Blair, but accepted as a disastrous debt-generator by subsequent Labour leaders.

    The Government has proved itself totally inept at managing the health crisis caused by the Coronavirus. It ignored the findings of Exercise Cygnus in 2016 which forecast the need – in the event of a pandemic – for ventilators, PPE and all the equipment which the NHS now faces a dangerous shortage of. The Government did not want to spend the money. In fact it has been cutting the NHS to the bone instead.

    Worse than cutting the funding, it has also been cherry-picking lucrative bits of the NHS and offering them to private investors for private gain at the expense of service to patients.

    When Johnson said “The NHS saved my life”, voters may have concluded “the NHS is safe in his hands. The Government understands how important it is now.” They do, but ten years of deconstructing the national service, outsourcing and privatising have gathered momentum and still retain their ideological grip on this government with its zero experience of worry about where the rent is coming from, or the next meal. The NHS has been viewed by the Tories as a potential cash cow for private investors and their already-rich Tory-supporting friends and it still is as these contracts for testing and tracing illustrate.

    At the beginning of the Covid Crisis, the SHA said, as did most of the medical profession and its journals, a range of statisticians, forecasters, epidemiologists and other scientists, that the dismissive and over-confident decisions of Johnson and Trump were seriously ill-founded; that pursuing the idea of “Herd Immunity” would mean that the NHS would be overwhelmed, and that the Government should accept the hand of friendship from the EU and other countries which offered to share sourcing of needed equipment (despite the “we can do better on our own” series of snubs to the rest of Europe, emanating from the UK Tory Government since 2016).

    These commentators urged the adoption of effective measures.

    1. To slow down the spread so the emergency services could cope, hence the lockdown, though the UK Government was slow to introduce it compared to other countries.

     

    1. To test for the virus and trace the contacts of those infected, so the lockdown could be relaxed without a second wave of the epidemic. Again the UK Government was slow to implement this. SHA President and Prof. of Public Health, Allyson Pollock said that tasks including testing, contact tracing and purchasing should be handled through regional authorities rather than central government.

    This was delayed while a private sector plan was cobbled together presumably to pre-empt the NHS, local authorities and other public sector bodies being asked to do the same, though they have a greater range of contacts, experience and expertise in spite of the relentless down-grading of the public health infrastructure and the budgetary strangulation of local councils.

    1. This would give time for a longer-term solution, and the development of a vaccine to reduce the numbers likely to get Covid-19 again, or reduce its severity.

    Firms such as Serco, Mitie, Boots, Deloitte, KPMG, and a US “data-mining” group called Palantir, have already acquired the rights to manage Covid-19 drive-in test centres, the building of the Nightingale Hospitals, and the purchasing of PPE. Deloitte, for example, is a multinational “professional services network” and one of the largest accounting organisations in the world, managed to acquire a contract to advise the Government on PPE purchases a few weeks ago. It thus took more decision-making authority from the NHS and local authorities, and shifted more power from the frontline. “It’s a power grab”, said Rosie Cooper MP, and we must protest in the strongest possible terms.

    Deloitte has had a poor track record in delivering PPE to the front line since the pandemic began, and taking more decision-making from NHS managers and local authorities shifts power further from the frontline and money for services into private pockets  The tax-payer pays for declining service.

    The Guardian said that NHS Trusts have now been instructed by the DHSC to stop buying their own PPE and ventilators or high value equipment for more general use in hospitals such as mobile X-ray machines, CT scanners and ultrasound machines.

    The system of tracking and tracing will be enabled by an NHS app on smart phones that alerts people that they have been near someone known to have the virus, or if they come into contact with an infected person in the future. Calling it an “NHS app” is no doubt intended to reassure people who might not want to use a Serco or Deloitte app for fear of what might happen to data on where they have been and to whom they might have been close. However, most of the contact tracing work will be contracted out to Serco and at least one other private-sector firm.

    The app goes on trial on the Isle of Wight this week. Supporters of the SHA on the Island (currently busy in a cooperative project of people with sewing machines, recycling donated duvet covers and sheets into scrubs for the frontline) tell us that it went live yesterday with NHS and Council staff, and will reach the rest of the Island by Thursday.

    The Isle of Wight was chosen as an area relatively cut off from the rest of the country during the lockdown, so a good place to study the spread of a virus. Currently there are limited ferry services for lorries transporting food and medicine and for ambulances to transfer serious medical cases to Southampton or Portsmouth. In addition the population is older than the UK average and fewer people have smart phones, so if it works reasonably well in those circumstances it should work even better nationally, says Hancock.

    South Korea did not go into lockdown. It adopted a strategy of widespread tracing and mass testing. Take-up would have to be very extensive for this to work here. There will be resistance to detailed personal data being collected by a multinational company. David Blunkett tried to get us to all have ID cards after 9/11 and met strong opposition from civil rights lawyers, trade unions and, indeed, Tories.

    The government is using the pandemic to transfer key public health activities from the NHS and other state bodies to the private sector. In 1977, Nicholas Ridley wrote a pre-Thatcher plan for the Tory Research Department in which he outlined a strategy of “privatisation of the NHS by stealth”.  “Managing” Covid 19 presents a good opportunity for taking this  further, building on the destructive intent of the 2012 Health & Social Care Act enabling a Tory government to give even more taxpayers money to the private sector.

    Testing and tracing is to be given to the public limited company Serco and others as yet undisclosed, but likely to include the security services firm G4S. Serco became infamous   for having tagged thousands of criminals who either did not exist or were dead and “other botched government contracts”, reported The Financial Times in 2015. The chief executive is Rupert Soames, appointed to turn around the business (whose shares had dropped 50%) who in turn recruited Sir Roy Gardner as Chair and replaced almost the entire board.

    Now, Serco has been appointed by the Johnson Administration to perform public health tasks in England for which it has little experience and little credibility with the general public. This tells you all you need to know about the current Government. Forget all the PR post Covid survival thanks to the NHS and the protestations of undying love for it.

    The real values of the Government are revealed in this move to spread public largesse to its own, although it will rely on public support for the NHS to get people to allow data on their every movement to be collected by a spy on their phone

    The reason why the NHS gets such massive support is because the general public use it, see it first-hand, recognise its skill and, crucially, know – in some imprecise way – that it is “theirs”.  It exists to look after all who come to it for its skills, whether Prime Ministers,  homeless veterans, newly born babies, or those beyond cure but never beyond care. And free at the point of use.

    In contrast, however well run Serco might be, and however well it learns in three weeks what it has taken local government and the NHS decades to absorb, its first duty is to its share holders and the need to pay a dividend.   In this century it will never get the trust that the NHS acquired in the last. Trust and values matter, especially where using personal information and getting the co-operation of millions of the public is concerned. The Times  reported Grant Shapps, the Transport Secretary, as saying the Government would have to make downloading the app “a duty to the NHS”.

    Further, at a time when it is abundantly clear that the NHS, local government, and bits of the already part privatised social care system cannot continue with the pre-Covid-19 settlement, the Serco option is as old fashioned as it is unwise.

    This is one part of the Government’s plan that Labour has to expose and oppose. Now!

    Vivien Walsh & Tony Beddow

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    This is now the 8th weekly Blog published by the Socialist Health Association (SHA) commenting on how the Coronavirus pandemic is progressing both locally and globally. The lens we use is a socialist worldview where we aspire to One World and Planetary Health and are as concerned to reduce global as well as local health inequalities. The Covid-19 pandemic has shone a light on local inequalities within the UK as well as stark global inequalities where people find themselves exposed and unable to follow the advice we receive in the UK and other rich countries to social distance and pursue rigorous hand hygiene.

    Health inequalities in the UK

    Last week the Office of National Statistics (ONS) published a report on Covid-19 deaths by local area and by socioeconomic deprivation (www.ons.gov.uk). This covered the period from the 1st March to the 17th April. During this period there were 90,232 deaths in E&W and of these deaths 20,283 involved Covid-19.

    Unsurprisingly London had the highest age-standardised mortality rate with 85.7 deaths/100,000 people involving Covid-19. This is significantly higher than any other region and almost double the next highest rate. In these SHA Blogs, one of our observations has been that London was the early hotspot and should have been shutdown much sooner and been our ‘Wuhan’. Remember all the press reports of bars and restaurants remaining open and people packed into London underground trains and buses?

    In London Covid-19 deaths were 4,950 amounting to 42% of deaths since the beginning of March compared to 1,051 deaths in the South West region of England, which was only 13% of total deaths there. The eleven Local Authorities with the highest mortality rates were all London boroughs with Newham, Brent and Hackney suffering the highest rates. Outside London rates are high in Liverpool, Birmingham and Manchester.

    Newham has the highest age standardised death rate with 144.3 deaths /100,000 population followed by Brent with 141.5 and Hackney with 127.4. In Newham 78% of its population are in BAME groups and 48% live in poverty after rent and household income are taken account of. The three London boroughs are in the most deprived group and across England the most deprived areas have a death rate of 55.1/100,000 compared with 25.3 in the least deprived (118% difference).

    The Index of Multiple Deprivation (IMD) is an overall measure based on income, employment, health, education, crime, the living environment and access to housing within an area. Each area of England is grouped into one of ten deciles and the most deprived is in d1 and least deprived in d10. As we know from work over the last 40 years since the Black report in 1980 – there is a social gradient for mortality and many other indicators of health and wellbeing.  Covid-19 has magnified the difference especially for those in the three most deprived deciles which shows a stark difference between Covid-19 deaths and all deaths. In the least deprived decile the mortality rate for all deaths was 122 deaths/100,000 population, whereas in the most deprived it was 229. The difference between all deaths (classic social gradient) was 88% whereas between Covid-19 deaths the difference was 118%, which is 30% higher.

    A similar picture emerges in Wales where they present the data as differently. The most deprived fifth of areas have a rate of 44.6 deaths per 100,000 involving Covid-19; this was almost twice as high as the least deprived area with 23.2 deaths/100,000.

    The other key finding from the ONS report was on urban versus rural areas. Major urban conurbations had a death rate of 64.3/100,000, which is statistically significantly higher than other categories including urban minor conurbations. The lowest rates unsurprisingly are in rural settings with rates as low as 9/100,000 population. There is a category ONS use called ‘major towns and cities’ in E&W which are built up areas excluding London. Of the 111 major towns and cities the highest mortality rate was in Salford with a rate of 112.6 deaths compared to Norwich with 4.9/100,00. One interesting prosperous market town that was hard hit is Cheltenham with a death rate of 49/100,00, which is significantly higher than the English average!

    Austerity and the slow burning injustice

    In his 2020 report of ‘Health Equity in England: the Marmot Review 10 years on’ Marmot found that the improvement of life expectancy which had been a consistent finding since the turn of the 19th century stalled in 2010 and years spent in ill health increased. He also showed that the social gradient in health became steeper and regional differences increased.

    The two features of Tory government policy during this period was to roll back the State – public expenditure went from 45% of GDP in 2010 to 35% in 2018 – and to be regressive. This meant that the poorer you were the more likely you would be to be disadvantaged by these changes.

    The excuse for the policies enacted from 2010 was the 2008 global financial crisis, which led to a decline in the global economy of 0.1% in 2009. The IMF  has predicted that the global economy will decline by 3% in 2020 on account of the pandemic. Already we have seen Universal Credit claims in the UK rise from 150,000 before the pandemic to 1.4m by the 13th April and rising daily. Marmot points out the risk that it would be a calamity if we face a new era of austerity after the pandemic. We need on the contrary to argue for a better society with less inequality and built by reducing child poverty, improving child health and education, improved working conditions ensuring that everyone has the minimum income to lead a healthy life and creating a sustainable environment in which to live and work creating the conditions for people to pursue healthy living.

    Places affected by conflict and humanitarian crises

    Inequalities are manifest globally as well as locally in the UK. For instance many of the estimated 70m forcibly displaced people worldwide live in insanitary and inhospitable conditions sometimes up to six families living in one tent in a 3sqm area. In these camps people share few latrines and washing facilities and have to queue for food each day. The Covid-19 mantra has been hand washing, social distancing and lockdown. People in conflict zones or refugee camps simply cannot follow this guidance and also have access to very rudimentary healthcare facilities.

    There is an urgent need to put international pressure on warring parties in Syria and Yemen to end restrictions on access to health care and humanitarian assistance. Public health support is needed to provide the conditions that do not allow the virus to spread and substantial financial support to overhaul the present conditions. This is more important and practical than supplying ventilators. The Covid-19 pandemic requires a global response for the most vulnerable populations globally as well as locally in the UK (David Nott Lancet 1st May 2020)

    Another globally vulnerable group are prisoners. In all countries including the UK prisons are a risk being closed communities with people living in crowded and in some countries squalid conditions. Conditions are worse in countries led by leaders like Duterte and Bolsonaro. In the Philippines for example there are an estimated 215,000 prisoners in prisons built for a capacity of 40,000 and in Brazil 773,000 prisoners are crammed into prisons built for 461,000.

    Whether it’s parts of the world with conflict and humanitarian crises or populations suffering from repressive governments there is an urgent need for rich countries to invest in international organisations such as the UN, WHO, UNHCR, UNICEF and AID organisations to try to mitigate the risks that Covid-19 poses on top of already stressed social conditions. It is possible to act locally on health inequalities as well as show solidarity globally.

    So what?

    In our earlier blogs we have been critical of some aspects of the pandemic response in the UK. It is sad to note that the UK is heading to have the worst outcome in Europe with us starting our epidemic behind Italy, Spain and France when Covid-19 hit Europe. The Government have been too slow to take measures such as locking down London and the South East rapidly and should have continued testing, tracking and isolating across the country – especially where the number of cases has been low and well within the capacity of local resources. This would have built practical experience and we would have learnt valuable lessons.

    Now that we have more testing capacity we need to build the programme from the bottom up. Local public health teams in Local Government stand ready to provide local leadership teaming up with professional Environmental Health Officers (EHOs) who have the skills and local knowledge to provide local leadership. Resources need to be targeted at areas of greatest need as we have illustrated through the excellent ONS report. Certainly smart apps will play a part as well as national leadership from COBR on the key features of the test, trace and isolate programme. However there has arguably been too centralised and London based approach to pandemic management. The time is ripe to allow local authority public health, supported by specialist PH resources to work with their Local Resilience Forum (LRF) using their local skills and knowledge to try to bring the pandemic to heel using classic communicable disease control methods of epidemic controls. This will help eliminate the virus, protect the NHS allowing it to reopen for normal business and enable the economy to start up again as soon as practicable.

    Pandemics kill in three ways says Jonathan Quick of the Rockefeller Foundation:

    The Disease kills,

    Disruption of the health service kills

    and the

    Disruption to the economy kills”.

    3.5.2020

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

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    From Vivien Walsh in Manchester

    Right at the beginning of the lockdown, several of my friends said how concerned they were about the likely impact of enforced social isolation on those who are suffering from domestic abuse. On Monday, the (cross party) Home Affairs Committee of MPs, chaired by Yvette Cooper, reported on this, demanding “that the Government makes domestic violence and abuse a central pillar of the broader strategy to combat the Covid-19 epidemic.”

    Calls to domestic violence helplines, such as Refuge and Women’s Aid, were nearly 50% higher in the week 6-12 April than the average before the pandemic began. Visits to the website of Refuge were three times as high in March 2020 as they were in March 2019. The Home Affairs Committee called for this domestic violence strategy to combine “awareness, prevention, victim support, housing and a criminal justice response, backed by dedicated funding and ministerial leadership”.

    It also made a point of the need for specialist services for different ethnic communities, and for legal aid as an automatic right for women applying for Domestic Violence Protection Orders (DVPOs). An extension of the current time limit for reporting offences is also necessary, since many abused women will be unable to report the abuse they have suffered until after lockdown ends.

    Between March 23 and April 12 there were at least 16 killings of women and children in domestic situations, said the report on Monday. The average number of deaths from domestic violence during lockdown has gone up from 5 per week from a figure of two before. In a year that would be over 250 women killed by the person who is supposed to love them. The Parliamentary Committee had also received evidence that incidents reported were not only more frequent but involved higher levels of violence and coercive control.

    Unless the government takes action to deal effectively with domestic abuse and to properly support the victims of it, we will be facing “devastating consequences for a generation.” Funding is urgently needed to enable a growth in provision of housing for women and children escaping from violence, and to support refuges as temporary accommodation and support. Even before current emergency, England had 30% fewer than the recommended number of beds, and 64% of referrals were turned down in 2018-19.

    There is a National Domestic Violence Helpline (0808 200 247). This is the number to call for  emergency referrals as they are open 24/7. In addition there a variety of services based locally. For example Manchester Women’s Aid (call 0161 660 7999  9:30am-4:30pm Mon-Fri) provides confidential advice and information, safe temporary housing, one to one support for those living in their own homes, access to legal advice and civil orders, specialist workshops for young women 15-25, language workers and access to interpreters, specialist support for women with poor mental health and drug and alcohol misuse. The full list of services in England and Wales is at the end of the article.

    The lockdown is in place to keep people safe from the virus: but it is also providing cover for abusers. Escape from being locked in with an abuser is a matter of life and death. A decade of austerity has not only undermined our NHS, on which we are now so dependent, but has also decimated support for survivors of domestic violence. The Government must increase funding as a matter of urgency – and there will be just as much need for services as abused women and children try to return to “normal” life when the lockdown is over. And Children’s services also need a big increase in funding to make sure children as risk, not only from the mental and physical impact of domestic violence, have access to help and support.

    Amna Abdullatif (whose day job is Women’s Aid lead for Children and Young People, and who is also a Manchester City Councillor) added the following information for the SHA in this blog: “78% of survivors experiencing domestic abuse told us that Covid-19 has made it harder for them to leave their abuser. If you’re feeling trapped, we’re here for you.”

    “Our Live Chat is now open from 10am – 2pm with expert support workers just one click away. You can be reassured that our Live Chat is completely confidential. To access support and advice go to: https://bit.ly/2y7ab0Q

    “If you, or someone you know, is experiencing abuse please read our Covid-19 safety advice for survivors, family, friends and community members https://bit.ly/2yNzqoW

    There are also local services for ethnic groups, such as Saheli Asian Women’s Project in Manchester, which provides advice, information and support services to Asian women and their children fleeing domestic abuse and/or forced marriages.

    The full list of services from the Womens Aid web site is below:

    National Domestic Abuse Helpline

    The National Domestic Abuse Helpline is run by Refuge and offers free, confidential support 24 hours a day to victims and those who are worried about friends and loved ones.

    Telephone and TypeTalk: 0808 2000 247

    Wales Live Fear Free Helpline

    The Wales Live Fear Free Helpline offers help and advice about violence against women, domestic abuse and sexual violence.

    Telephone: 0808 8010 800

    TypeTalk: 18001 080 8801

    Text: 078600 77 333

    The Men’s Advice Line

    The Men’s Advice Line is a confidential helpline for male victims of domestic abuse and those supporting them.

    Telephone: 0808 801 0327

    Email: info@mensadviceline.org.uk

    Galop – for members of the LGBT+ community

    Galop runs the National LGBT+ domestic abuse helpline.

    Telephone: 0800 999 5428

    TypeTalk: 18001 020 7704 2040

    Email: help@galop.org.uk

    Women’s Aid

    Women’s Aid has a live chat service available Mondays to Fridays between 10am and 12pm as well as an online survivor’s forum. You can also find your local domestic abuse service on their website.

    The Survivor’s Handbook, created by Women’s Aid, provides information on housing, money, helping your children and your legal rights.

    Karma Nirvana

    Karma Nirvana runs a national honour-based abuse and forced marriage helpline. If you are unable to call or email, you can send a message securely on the website.

    Telephone: 0800 5999 247

    Email: support@karmanirvana.org.uk

    Hestia

    Hestia provides a free mobile app, Bright Sky, which provides support and information to anyone who may be in an abusive relationship or those concerned about someone they know.

    Chayn

    Chayn provides online help and resources in a number of languages about identifying manipulative situations and how friends can support those being abused.

    Imkaan

    Imkaan are a women’s organisation addressing violence against black and minority women and girls.

    Southall Black Sisters

    Southall Black Sisters offer advocacy and information to Asian and Afro-Caribbean women suffering abuse.

    Stay Safe East

    Stay Safe East provides advocacy and support services to disabled victims and survivors of abuse.

    Telephone: 020 8519 7241

    Text: 07587 134 122

    Email: enquiries@staysafe-east.org.uk

    SignHealth

    SignHealth provides domestic abuse service support for deaf people in British Sign Language (BSL).

    Telephone: 020 3947 2601

    Text/WhatsApp/Facetime: 07970 350366

    Email: da@signhealth.org.uk

    Shelter

    Shelter provide free confidential information, support and legal advice on all housing and homelessness issues including a webchat service.

    Sexual Assault Referral Centres

    Sexual Assault Referral Centres provide advice and support services to victims and survivors of sexual assault or abuse.

    Get help if you think you may be an abuser

    If you are concerned that you or someone you know may be an abuser, there is support available.

    Respect is an anonymous and confidential helpline for men and women who are harming their partners and families. The helpline also takes calls from partners or ex-partners, friends and relatives who are concerned about perpetrators. A webchat service is available Wednesdays, Thursdays and Fridays from 10am to 11am and from 3pm to 4pm.

    Telephone: 0808 802 4040

    Get help for children and young people

    NSPCC

    The NSPCC helpline is available for advice and support for anyone with concerns about a child.

    The NSPCC has issued guidance for spotting and reporting the signs of abuse.

    Telephone: 0808 800 5000

    Email: help@nspcc.org.uk

    If you are deaf or hard of hearing, you can contact the NSPCC via SignVideo using your webcam. SignVideo, using British Sign Language, is available on PC, Mac, iOS (iPhone/iPad) and Android smartphones (4.2 or above). This service is available Monday to Friday from 8am to 8pm and Saturdays from 8am to 1pm.

    Childline

    Childline provides help and support to children and young people.

    Telephone: 0800 1111

    Barnardo’s

    Barnardo’s provide support to families affected by domestic abuse.

    Family Lives

    Family Lives provide support through online forums.

    Support for employers

    Employers’ Initiative on Domestic Abuse

    The Employers’ Initiative on Domestic Abuse website provides resources to support employers including an employers’ toolkit.

    Support for professionals

    SafeLives provides guidance and support to professionals and those working in the domestic abuse sector, as well as additional advice for those at risk.

    Support a friend if they’re being abused

    If you’re worried a friend is being abused, let them know you’ve noticed something is wrong. Neighbours and community members can be a life-line for those living with domestic abuse. Look out for your neighbours, if someone reaches out to you there is advice on this page about how to respond. They might not be ready to talk, but try to find quiet times when they can talk if they choose to. If someone confides in you that they’re suffering domestic abuse:

    • listen, and take care not to blame them
    • acknowledge it takes strength to talk to someone about experiencing abuse
    • give them time to talk, but don’t push them to talk if they don’t want to
    • acknowledge they’re in a frightening and difficult situation
    • tell them nobody deserves to be threatened or beaten, despite what the abuser has said
    • support them as a friend – encourage them to express their feelings, and allow them to make their own decisions
    • don’t tell them to leave the relationship if they’re not ready – that’s their decision
    • ask if they have suffered physical harm – if so, offer to go with them to a hospital or GP
    • help them report the assault to the police if they choose to
    • be ready to provide information on organisations that offer help for people experiencing domestic abuse

    If you are worried that a friend, neighbour or loved one is a victim of domestic abuse then you can call the National Domestic Abuse Helpline for free and confidential advice, 24 hours a day on 0808 2000 247.

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    From Ekua Bayunu, Member of Greater Manchester Socialist Health Association, and selected candidate for Hulme in the next Manchester City Council elections.

    When I joined SHA a couple of years ago I wanted to focus my energies on action against inequalities in the health systems around race, particularly in mental health. We now have evidence of the toxins that were seeping into us from the right, distracting us from actually building effective socialist action on health issues here in Greater Manchester.

    Skip forward and we are slap bang in the eye of the storm of the Covid 19 pandemic and still searching for some strength in our unity to make a difference to our communities. Many of our members are fully immersed in either working on the frontline, in providing care in our institutions, or in volunteering in mutual aid groups, many doing both and I send love and admiration out to us all.

    We lost my neighbour, an elderly Somalian man, to the virus on the last weekend in March. It felt like the storm that was brewing had just swept in and taken one of ours before we barely knew it was coming. Then the statistics started coming in. We are dying in inexplicably large numbers. We? I’m a woman of African heritage, my community is African, South Asian, Working class.

    My close friend, a street away, is a nurse working at MRI, already stressed by the lack of PPE, worrying about her family, the risk she posed to her 3 daughters and husband at home, when she got ill two weeks ago, together with two colleagues from her ward. They got tested. She doesn’t have access to a car, and the only testing is drive-through. No you can’t walk in. No you can’t get in a taxi! She started talking to us about wills and supporting her daughters and all the worries she has for them. Her eldest also works as a nurse, the youngest is only 10. Her cultural background is Turkish, and she knew she might die.

    She is in recovery, but the statistics get worse and worse. The demand for action grows as do the questions and desire for investigation. I read articles in the silo of my social media accounts and watched as it began to break slowly into mainstream media. At first I thought: they are holding back on the narrative, because it doesn’t suit their agenda to highlight how many were dying in service to us all who were from Diasporan African, Asian and other minority communities. We entered this year with forced deportations built on a narrative that these were the communities of criminals and spongers on the state. Suddenly the NHS workforce were our heroes, they put out ads supporting these workers and most of the workers were white. Did you all notice?

    Then as the statistics leaked into a wider societal consciousness, I became openly worried. Information being fed via the television is so absent of any real analysis that it actually begins to shape a eugenicist narrative, which the Prime Minister does little to distance himself from. Our deaths are not real sacrifices based on years of inequalities in education, health care, housing and employment, but gives out a message of our inherent weakness and inferiority! And whilst we all are shut in, angry, confused, needing to have something or someone to blame, in the place of blaming this government for its lack of care in putting profit over people, it is easy to discern they are creating a diversionary agenda.

    It is becoming increasingly clear BAME people are dying disproportionally, on the wards, driving our buses, cleaning our streets, in our care homes. They are presented as the problem, when they are the heroes and victims of the pandemic. Last week the government finally pulled together a commission with PHE to investigate the causes of BAME people dying disproportionally. Do we all assume that the why will lead to how to stop this? To a solution to help us? I can’t.

    Posted by Jean Hardiman Smith on behalf of Ekua Bayunu, Member of Greater Manchester Socialist Health Association

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    From Mark Ladbrooke, of Oxford SHA branch, and formerly chair of Oxford University Hospitals Foundation Trust (OUHT) Joint Union Committee

    Oscar King, Jr. and Elbert Rico, porters at John Radcliffe Hospital, Oxford, and union activists, died two weeks ago of suspected Covid-19.

    Both of them are married to members of the nursing team at the hospital and Twilight, Oscar’s wife, was admitted to hospital, while their 10-year old daughter is being cared for. Oscar and Rico came from the Philippines and had worked at the hospital since they arrived.
    The Filipino community is extremely important to the NHS – after workers from the UK itself and India they make up the largest proportion of the workforce.

    Patients may not notice the porters as much as they notice doctors and nurses, but their role is just as vital, since they take everyone where they need to go, and move equipment and machinery to where it is required. The Labour Movement has supported junior doctors and nurses in dispute with management (backed by government) at various times – but porters, domestics and catering staff are frequently outsourced and are at the end of the queue.

    As long ago as 1982 the Thatcher government brought in competitive tendering for NHS services such as catering, cleaning, portering and estates maintenance. Oxford University Hospitals Foundation NHS Trust (OUHT), of which the Radcliffe is part, signed up to a Private Finance Initiative (PFI) deal, under which management of the porters, domestics and catering staff was transferred to a private company as the hospital was expanded. PFI was dreamed up when Norman Lamont was Tory Chancellor, but took off under the New Labour Government of Tony Blair after 1997.

    A Unison strike in Dudley in 2000 was the seventh against transfer to the private sector, as part of increasing resistance to PFI. The striking workers won important concessions around secondment, nevertheless management was still transferred to Carillion (which went bust in Jan 2018). The John Radcliffe workers threatened strike action in 2015 around pay cuts.
    Industrial action continues to be taken against PFI and its impact on working conditions, most recently this year in Lewisham (because the outsourcing firm failed to pay cleaners, porters and catering staff the wages that had been agreed) and Paddington. In the latter case, porters, caterers and cleaning staff at St Mary’s, with the support of some of the other staff, including doctors, became employees once again of the NHS.

    We, in the Joint Union Committee and local SHA branch knew Oscar, in particular, as a “brilliant rank and file union leader”. The SHA branch is well connected to the workplace and local unions. They help provide the leadership of the branch. The Chair of the SHA branch, Cllr Nadine Bely-Summers, a nurse, who also represents Oxford City Council on the local Health Overview and Scrutiny Committee (HOSC), demanded answers from Bruno Holtof, chief executive of the OUHT, about the deaths of the two porters:


    – How many staff on site are managed by outsourcing companies or agencies?
    – What personal protective equipment (PPE) was provided by the trust to staff managed by outsourcing companies or agencies?
    – What personal Protective Equipment (PPE) was provided by the trust to staff managed by Bouygues and other outsourcers eg G4S? When was this provided?
    – Are staff being put under pressure to return to work while reporting sick?
    – How are the frontline outsourced staff who are vulnerable being treated?
    – Is the Trust legally liable for Health and Safety breaches on its premises including those by outsourcing companies and agencies?

    In response to her demands the Director of Public Health has promised to investigate further.
    BAME Labour activists working with Oxford City’s Labour Council have raised concerns that this may be part of a worrying national picture of an especially high death toll among black and Asian workers, as reported on various TV channels and in several daily newspapers in the last week.

    The local city council has written to the Chief Executive of the NHS Trust asking for an explanation.
    Nadine said “We must seek assurances from all NHS Trusts that there is day-to-day monitoring carried out to make sure there is not a disproportionate impact of the rates of infection and death on ethnic minority workers, and that adequate PPE are being provided at all times to all staff groups”.

    Stop Press!

    The Chief Executive of the Trust has written back to the council saying, among other things:
    We note, however in the case of reporting incidents in relation to Covid-19, that the HSE have indicated that “[in] a work situation, it will be very difficult, if not impossible, for employers to establish whether or not any infection in an individual was contracted as a result of their work. Therefore, diagnosed cases of Covid 19 are not reportable under RIDDOR ( Reporting of Injuries, Diseases and Dangerous Occurrences Regulations )  unless a very clear work related link is established.”

    We are unable to comment in detail on specific individual cases but are able to note that there is not currently evidence to support such a link in relation to these two staff members. However we can confirm that reporting and investigation will take place in line with HSE guidance where a diagnosis of Covid-19 is directly attributed to an occupational exposure.

    Oxford and District Labour Party Executive has asked Anneliese Dodds (Labour Oxford East) to raise this issue in parliament. She reports that Labour is planning to raise such issues on workers’ memorial day.

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    Firefighters’ Union making demand on International Workers Memorial Day
    Government must issue urgent guidance to employers in public and private sector, FBU says

    The Fire Brigades Union (FBU) is today (Tuesday) demanding that the government issue guidance to employers stating that the death of firefighters and key workers as a result of COVID-19 should be automatically recognised as work-related, allowing for their families to receive compensation.

    In a letter to Prime Minister Boris Johnson and devolved administrations, the FBU says that the guidance must cover all of those officially recognised as key workers by their respective governments as well as those who have been required to continue to work by their employer.

    The Westminster government announced a life assurance scheme for the families of NHS and care staff, but the FBU says thousands of families of firefighters and other key workers are still at risk of financial harm should they die from the virus.

    The FBU says that any compensation scheme should not preclude employees’ families from taking legal action against employers who may have jeopardised the safety of their workers, such as by failing to provide protective equipment.

    As well as the over 100 NHS and care staff that have already succumbed to the illness, dozens of transport workers are thought to have died, along with other workers in both public and private sectors.

    The FBU says that employers need to be given clear and unambiguous instruction to automatically consider all COVID-19 deaths as having been caused by the performance of their employees’ duties.

    The demand comes on International Workers Memorial Day as millions around the country and the world observe a minute’s silence in memory of the front line workers who have died during the crisis.

    Firefighters at risk

    The FBU says firefighters are at increased risk from COVID-19 infection as a result of their regular interaction with the public during emergencies. However, this risk has increased further with fire and rescue services undertaking a number of additional COVID-19 duties.

    Firefighters across the UK are now moving dead bodies, driving ambulances, delivering medicines and food to vulnerable people, and transporting patients to and from Nightingale Hospitals.

    Currently, firefighters can receive compensation from their specific scheme for long-term injury, illness, and death, but, to be eligible, a strict criteria must be satisfied to prove it was sustained as a result of their work. In the fire service and other industries this is often a source of disagreement between unions representing workers or their families and the employer.

    The FBU says that unless a specific COVID-19 compensations determination is forthcoming from the government, demonstrating that the illness came from their role as a firefighter will prove difficult, causing distress for families and potentially financial harm. [Note 1]

    The FBU is now calling for the government to write to all fire and rescue services in the UK and provide guidance stating that those who die from COVID-19 should be automatically assumed to have sustained the illness in the performance of their duties.

    There are currently around 48,000 serving firefighters in the UK who are covered by the firefighters’ compensation scheme.

    Other key workers

    The FBU says that such a compensation determination should also be broadened out to include all key workers who become infected and die from COVID-19.

    It should also cover those who have been instructed to continue working by their employer, but who are not in the official list of key workers.

    The government must, therefore, issue similar guidance to all employers in the public and private sector stating that in the case of any worker who dies or suffers long-term damage from COVID-19, it must be treated as arising from their duties.

    If necessary, the government must underwrite the scheme.

    Matt Wrack, FBU General Secretary, said:

    “Tragically, hundreds of frontline workers have already died from COVID-19, and sadly so will more over the coming days and weeks. Each one of these deaths not only causes heartbreak for loved ones but can also push the families left behind into financial difficulty. The last thing they need is to fight a battle for compensation.

    “For firefighters, their regular work with the public puts them at an increased risk of COVID-19 infection, a risk heightened by the additional work they are doing in the response to the crisis, which now includes the movement of bodies, transporting of infected patients and delivering of vital food and medicines.

    “There is sadly a real chance that firefighters will die, and that’s why we are calling on the government to urgently instruct all fire and rescue services to treat any death from COVID-19 as being caused by their work, making families automatically eligible for a payment under the firefighters’ compensation scheme.

    “This instruction must also be broadened out to include all key workers, both in the public and private sector. Those not deemed key workers, but who have been obliged to continue attending work by their employer, must also be covered. Any compensation arrangements must not prevent families from taking further legal action against employers who have jeopardised the safety of their workers.

    “This crisis has demonstrated clearly who the key workers are in our society. And there can be no doubt that nurses, doctors, refuse collectors, bus drivers, firefighters, carers, and many more, have gone over and above to keep all of us safe – and the country running. The government must now promise to do its bit to keep all of their families safe and secure into the future.”

    Media contacts

    Joe Karp-Sawey, FBU communications officer

    FBU press office
    press@fbu.org,uk

    Notes

    Not all firefighters are in the firefighters’ pension schemes. Firefighters who are not in the firefighters pension scheme do not receive a death in service benefit unless they qualify under the firefighters’ compensation scheme i.e died as a result of a work-related injury/ illness/ disease. By making a clear compensation determination, the government would ensure those not in the pension scheme are also financially supported.

    The letter to the Prime Minister is available here: LETTER TO THE RT HON BORIS JOHNSON MP FROM FBU GENERAL SECRETARY MATT WRACK – 28 APRIL 2020.pdf

    The FBU is aware of 4 firefighter deaths in Italy and 9 firefighter deaths in the United States due to COVID-19

    On Monday 13 April, the FBU criticised the Westminster government for failing to commit to testing firefighters, as services lose around 3,000 staff to coronavirus self-isolation.

    Firefighters can now construct vital protective face shields for NHS and care staff, drive ambulances in parts of the country, will also now begin transferring both COVID-19 and non-COVID-19 patients from Nightingale hospitals, after the latest agreement between the FBU, fire chiefs, and National Employers: https://www.fbu.org.uk/news/2020/04/24/firefighters-make-face-shields-health-and-care-staff-and-transfer-patients-and

    Under previous agreements, firefighters are now permitted to assist ambulance services in some specified activities and drive ambulances; deliver food and medicines to vulnerable people; and, in the case of mass casualties due to COVID-19, move dead bodies. In the West Midlands and parts of the East Midlands, body movement work has now begun.

    Firefighters can also fit face masks and deliver vital PPE and medical supplies to NHS and care staff; take samples for COVID-19 antigen tests; drive ambulances to non-emergency outpatient appointments and to transport those in need of urgent care; and to train non-emergency service personnel to drive ambulances: https://www.fbu.org.uk/news/2020/04/16/coronavirus-firefighters-now-allowed-carry-out-antigen-tests

    The Fire Brigades Union (FBU) is the professional and democratic voice of firefighters and other workers within fire and rescue services across the UK. The general secretary is Matt Wrack

    The FBU is on Twitter: @fbunational and Facebook: facebook.com/FireBrigadesUnion1918

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    This is the 7th week that the SHA has published a Blog tracing the progress of the Coronavirus pandemic globally but more specifically across the UK. Over this time we have drawn attention to the slow response in the UK; the lack of preparedness for PPE supply and distribution; the delay in scaling up the testing capacity and system of contact tracing; a too early move away from trying to control the epidemic and poor anticipation of the needs of the social care sector.

    However we need to start to look at how we can reverse the situation we find ourselves in being one of the worst affected countries in the world. Our deaths in the UK now exceed 20,000 and we have been following Italy and Spain’s trajectory. It is true that while the lockdown came too late – London should have gone first – it has had an impact on suppressing the first wave and the NHS has stood proud and able to cope thanks to the unflagging commitment from all staff. It is good that Parliament has been reconvened so proper scrutiny can be given to government decisions on public health as well as the economy. We look to the new Shadow Team to pursue this energetically.

    It is no surprise that Trump’s USA is a lesson of the damage disinvesting in the Centers for Disease Control and Prevention (CDC) has had. It has led to poor emergency preparation and poor leadership at handling the pandemic at a federal level. From a SHA perspective an example of the superiority too of a nationalised health system as compared with a private health care model in the USA. Compare how it looked in New York City during their peak and the relative calm in London on the 8th April. From his rehabilitation home at Chequers it was concerning that one of the first phone calls PM Boris Johnson allegedly made was to Mr Trump. They share many characteristics but let’s hope that we do not end up second only to the USA in the international table of deaths/100,000 population and tie ourselves too closely with the ‘Make America Great Again’ nationalist neo-conservative movement.

    1. Scientific advice

    One of the characteristics of this pandemic has been the UK Government Ministers repeated claim that they have been making decisions on the best scientific advice. This claim has mystified some commentators who feel that the decisions being made by Ministers has not been in line with WHO advice (test, test, test) and not consistent with comparable EU countries who seem to have managed the pandemic more successfully (Germany and Denmark). We have never said that we cannot compare data published in Germany and Denmark before now!

    Sometimes Governments make bad calls during an emergency and wanting to keep the membership of SAGE secret was one such. There has been mounting concern about the provenance of some of the advice leading to Ministerial decisions. For example the early misunderstandings about ‘herd immunity’ and the fear that the nudge behavioural psychologists were having undue influence leading to the crucial delay in lockdown. Some of these scientists work in government units, which is not good for an independent perspective.

    The mixed messages about the modellers and their estimates of the likely deaths (20,000 to 500,000) which also surfaced before one modeller was allegedly responsible for pushing (thankfully) the belated decision on the lockdown.

    Many public health trained people have begun to wonder who on SAGE had any practical public health experience in communicable disease control? These concerns were prompted by the sudden abandonment of testing and contact tracing, the lack of airport or seaport health regulations used by other countries such as Australia and New Zealand (Australian deaths so far 80 for a population of 25m and NZ 18 for a population of 5m).

    Recently we have also been bemused by the inability to recognise how homemade cloth facemasks might play a part in easing lockdown. While there might be a relative lack of ‘gold standard’ evidence there is ‘face validity’ that a mask will stop most droplets and this will be important as we are finding so many people are infected for days before showing the classic symptoms and signs of fever and cough. Homemade cloth masks would not compete with NHS and Social Care supplies and these do seem to have been part of the strategy that countries that have been more successful at containment than the UK. We suspect that in time the recommendation to wear a cloth mask when going outside your home will become a recommendation!

    After the initial planeload of British nationals from Wuhan, who had been appropriately quarantined, there are no measures in place at all at our airports. The explanation about incubation period does not hold if people are quarantined for 14 days. The precision of temperature measurements should be seen as part of a screening regime, which would include risk assessment of country of origin, symptoms reported on a questionnaire or observed as well as temperature measurement. It is obvious that if a passenger causes concern the less accurate thermal imaging technique can be augmented by other more reliable ways of taking a temperature! It does not seem right that such measures are discounted for the UK and we are one of the worst performers while other countries with competent public health professionals take it seriously. It is estimated that nearly 200,000 people arrived from China to the UK between January and March 2020 with no checks at all apart from general Covid advice. Empty hotels would have been suitable for quarantining people at risk of having the virus. This matters as it is a very contagious virus and can spread before symptoms appear. Such symptoms can also be minimal and hard to detect.

    Now that the membership of SAGE has been leaked we can see that one of the Deputy CMOs is the only person who has had any ‘on the ground’ experience of communicable disease control in communities. This is important when we start to consider how we can get out of lockdown by using the new testing capacity optimally, contact trace effectively and introduce control measures locally. This will require Public Health England (PHE) to begin to strengthen its relationship with local Directors of Public Health (DsPH) located in Local Government. These DsPH can provide local leadership and work with Environmental Health Officers (EHOs) who to date have not been drawn into the pandemic management system.

    The presence of Dom C in SAGE meetings raises concerns. Of course civil servant officials have always attended the meetings to ensure that they are properly organised, agendas circulated and minutes recorded. It is quite a different thing to have an influential Prime Ministerial adviser like Dom C attend the meeting and no doubt interject during discussions and help shape the advice. That should be the Chief Scientific adviser’s (Prof Vallance) job and his role to brief the PM. The trust in SAGE has been damaged by the disclosure of membership, the lack of jobbing public health input as well as the presence and influence of these special advisers (SPADs).

    1. Easing lockdown

    One of the problems in the management of the pandemic in the UK has been the centralised London perspective, which has dominated the options and led to a one-size fits all approach. We have said before in these Blogs that Greater London was our Wuhan (similar population sizes). We should have shut London down much earlier and stopped the nonsense of those crowded tube trains and buses. We have seen from the Ministerial briefings that London has had an almost classic epidemic curve – rising steeply and then levelling off and declining. The devolved nations and English regions have lagged behind. Scotland and Wales got their first cases about 4 weeks after London and the South East. Regions such as the SW region in England, Northern Scotland and the Islands, rural Wales and parts of the North of England have been slow to have cases and even now have had few cases and few deaths. These areas did not need to be locked down at the same time as London and the South East and could have instituted regional testing and contact tracing which would have helped flatten the curve and protect the NHS.  Such a strategy would have built up experience of doing this which we now have realised we need to do to get out of lockdown. However we have an asymmetric situation with the regions showing gradual and flat epidemic curves, which will be prolonged and frustrate a UK alone approach.

    The challenge of easing lockdown will be quite different in metropolitan urban areas with heavily used public transport and metro trains and a more dense housing with fewer green spaces. The picture in more rural areas and small towns is quite different. There is a serious need to engage with local government more appropriately, pull back from central control and set out a framework as has been started in Scotland and Wales which local government partners can start to address via their Local Resilience Fora (LRFs) and emergency control structures.

    There does still need to be a UK wide COBR approach but the strategy needs to be more nuanced to set out the UK framework and allow devolved nations who are a similar size to New Zealand and Denmark and English regions to plan locally sensitive approaches drawing on expert advice from Public Health organisations such as Public Health Wales, Scotland and PHE. Metropolitan areas such as London, Birmingham and Manchester will also want to be able to adapt measures to fit their local complexities. This will be particularly important as we start a system of community testing, contact tracing and control measures. National testing standards and quality will apply and any mobile apps that are developed will need to be agreed at a national level with all the safeguards on privacy and information governance.

    Children have been remarkably resilient to this virus and it seems that back to school is something worth considering as an early venture as long as schoolteacher’s health is safeguarded by not exposing ‘vulnerable’ teachers, and implementing systems to make physical distancing more feasible. It is urgent to look at international best practice and be flexible in our approach.

    Pubs and restaurants will be further down the list as will mass sporting events but widening the retail sector and getting some workplaces back should be planned. Again travel to work should only be necessary for some workplaces and physical distancing, masks and health and safety regulations will need to be updated to suit each work environment before permission to reopen is given. All these steps require enhanced local public health capacity.

    1. Recovery planning

    An important part of emergency planning frameworks is the need immediately an emergency is recognised to begin the ‘recovery planning’. This will depend on the characteristics of each emergency. In the case of Covid-19 we will need to look at the build up of elective care, especially surgical waiting lists. It will also need to urgently review those people with long-term non-Covid conditions who may have had their continuing medical care disrupted. There will also be those casualties of the pandemic who have been traumatised by the pandemic and have mental health issues, burnout, faced economic hardship and PTSD. People who have had Covid-19 and survived a period in ICU and ventilation will also need weeks and sometimes months to recover. So all this adds up to a load for the NHS and associated services to address.

    As we have seen the economy has taken a big hit and many businesses have found themselves having to close down or reduce their workforce/suspend manufacturing output. It is unclear how we measure what has happened to our economic base but we have seen the growth in unemployment, the rise in welfare applications and the stories of those caught out with a sudden loss of employment and income. We know that 12 years after the 2008 financial crash that the legacy remains. This is far bigger so we need to begin to agree how the economy can be rebooted safely while protecting those vulnerable populations and safeguarding the children returning to school or workers to the factory floor. Trade Unions must be key partners of this economic recovery planning challenge.

    The other aspect of a recovery plan is to take advantage of good things we have experienced such as the reduction of air pollution with a reduction of car use and aviation and other transport. The global satellite pictures of Beijing, Delhi and Milan tell the story that life can be better if we reduce our carbon footprint. Working from home, the benefit of fast broadband should all lead to a reappraisal of environmental and other life changes. The growth in cycling and physical activity in green spaces should also be built on.

    Finally the pandemic has once again thrown a light on inequalities with the risks of occupational exposure (bus drivers), risks in hospital environments (porters, receptionists to nurses and doctors) and retail shops (shop assistants/cashiers). Many manual workers have had to go out to work still and in the process through travel and the work environment been at higher risk. Those who live in over crowded households have been at greater risk with fewer opportunities to self-isolate. Many of those in poorer urban housing estates have also been exposed to risk and found safely going to shops, medical centres or exercise much more difficult. We know about the health inequalities gradient and when this pandemic is analysed fully these social economic and environmental determinants will show through. It is pretty clear that BAME communities have been more susceptible to the virus and while this may have some biological features such as cardiovascular/metabolic risks it will also be socioeconomic, cultural and reflect occupational exposure.

    So recovery plans need to be set out to ensure that we do not revert to business as usual but grasp the opportunities that there are to build a better future after the C-19 pandemic. The Beveridge Committee was established relatively early during WW2 and the report was published in 1942 setting out the vision of an NHS and State Education for example. We have an opportunity to push for similar progressive changes after Covid-19.

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

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    • Plans include major cuts to fire engines and staffing levels
    • FBU says it amounts to a ‘betrayal’ of firefighters and the public

    Firefighters have warned of a major threat to public safety as politicians and fire chiefs try to sneak through cuts to the fire and rescue services while firefighters respond to the coronavirus crisis.

    The Fire Brigades Union (FBU) made the comments after a consultation on sweeping fire and rescue cuts was launched mid-pandemic.

    The union has called out the Prime Minister and other government ministers for clapping key workers on a Thursday while turning a blind eye to brutal cuts to a frontline emergency service.

    Firefighters have agreed to take on sweeping new duties to respond to the coronavirus pandemic, including moving dead bodies, driving ambulances, and producing PPE, at the request of the government and the National Fire Chiefs Council (NFCC).

    But East Sussex’s Conservative-controlled fire authority has decided to consult the public on sweeping cuts to the county’s fire service, detailed in an Integrated Risk Management Plan (IRMP) drawn up by Chief Fire Officer Dawn Whittaker and senior managers before the coronavirus outbreak.

    The proposals include major cuts to the number of fire engines, staffing levels, and nighttime fire cover.

    The proposals include

    • Cutting 10 fire engines across the county from Battle, Bexhill, Crowborough, Lewes, Newhaven, Rye, Uckfield, Seaford, Heathfield and Wadhurst stations;
    • Cutting dedicated crews for high-reaching aerial fire appliance
    • Cutting wholetime staffing  levels across the county, particularly at stations in Lewes, Newhaven, Uckfield, Crowborough, Battle and Bexhill stations
    • Reducing night time fire cover at The Ridge fire station

    The FBU has accused fire chiefs and politicians of using the cover of the pandemic to sneak through the plans and has warned the public that this could be the first of many attempts to rush through decisions on cuts to services whilst attention is elsewhere.

    Since 2011, fire and rescue services in the UK have had 11,500 firefighters cut from their staff, and since 2013 have seen real-terms spending on their service slashed by 38%.

    In neighbouring Surrey, the FBU agreed to suspend planned industrial action so that firefighters could help communities through the crisis.

    Matt Wrack, FBU general secretary, said:

    “The Prime Minister and other government ministers are asking people to clap for frontline workers on a Thursday, while their policies continue gutting frontline services. It’s shameless hypocrisy.

    “While firefighters are taking on sweeping new areas of work to keep their communities safe, they have been completely betrayed by fire chiefs and politicians.

    “Frankly, we don’t know what the world will look like on the other side of this pandemic. Across the political spectrum, people are crying out that we cannot go back to normal – and that has to mean an end to brutal cuts to frontline services.

    “We have entered national negotiations in good faith to help communities through this crisis. If politicians and the NFCC want that to continue, they need to step in and stop these cuts.

    “This could be the first of many attempts to sneak through cuts to services while the public focuses on the pandemic. If politicians think they are going to make public services pay for this crisis, then they are sadly mistaken.”

    Simon Herbert, East Sussex firefighter and FBU brigade chair, said:

    “Firefighters are out on the frontline helping our communities through this crisis whilst still responding to fires and other emergencies.

    “Meanwhile, our fire authority has thanked us by beginning the process of decimating our emergency response capabilities and ability to save lives, all from the safety of their living rooms.

    “These proposals are dangerous and will seriously damage the availability of fire crews throughout East Sussex. These proposals deserve proper public scrutiny – not an ill-thought-out consultation process snuck out in the middle of the pandemic.”

    National media contacts

    Joe Karp-Sawey, FBU communications officer

    FBU press office
    press@fbu.org.uk

     

    • On Saturday, Matt Wrack, FBU general secretary, said in an interview with BBC News: “”It’s great that people are going out and clapping on a Thursday night, but the question will be – because clapping is not enough – what are we going to do as a society to redress the balance a bit and give recognition?”: https://www.bbc.co.uk/news/uk-politics-52403609
    • The draft IRMP for East Sussex fire and rescue service 2020-2025, detailing cuts to the service, is available here: https://esfrs.moderngov.co.uk/documents/s1027/200423%20CFA%20IRMP%202020-25%20REPORT.pdf
    • The agenda from the East Sussex fire authority meeting is available here: https://esfrs.moderngov.co.uk/ieListDocuments.aspx?CId=136&MId=333&Ver=4
    • Firefighters can now construct vital protective face shields for NHS and care staff, drive ambulances in parts of the country, will also now begin transferring both COVID-19 and non-COVID-19 patients from Nightingale hospitals, after the latest agreement between the FBU, the NFCC, and National Employers: https://www.fbu.org.uk/news/2020/04/24/firefighters-make-face-shields-health-and-care-staff-and-transfer-patients-and
    • Under previous agreements, firefighters are now permitted to assist ambulance services in some specified activities and drive ambulances; deliver food and medicines to vulnerable people; and, in the case of mass casualties due to COVID-19, move dead bodies. In the West Midlands and parts of the East Midlands, body movement work has now begun.
    • Firefighters can also fit face masks and deliver vital PPE and medical supplies to NHS and care staff; take samples for COVID-19 antigen tests; drive ambulances to non-emergency outpatient appointments and to transport those in need of urgent care; and to train non-emergency service personnel to drive ambulances: https://www.fbu.org.uk/news/2020/04/16/coronavirus-firefighters-now-allowed-carry-out-antigen-tests
    • The Fire Brigades Union (FBU) is the professional and democratic voice of firefighters and other workers within fire and rescue services across the UK. The general secretary is Matt Wrack
    • The FBU is on Twitter: @fbunational and Facebook: facebook.com/FireBrigadesUnion1918
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