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COVID-19: Response from Doctors in Unite

The threat posed by COVID-19 demands a united national response across the UK. As well as protecting individual and public health, the burden of maintaining public resilience must be shared equally, on a pooled basis across society.

In response to COVID-19, Doctors in Unite urges the government to:

  • Extend day-one sick pay to those on zero hours contracts, in the ‘gig-economy’ and to the self-employed.
  • Ensure that workers are not under pressure to attend work while they are unwell and may inadvertently pass on the disease, both financially and in regards to staffing.
  • Allow the NHS to requisite private health care facilities to accommodate effective COVID-19 treatment and quarantine provision if needed.

Trades Union Congress General Secretary Frances O’Grady has said:

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

The government issued a statement on 4th March, explaining that statutory sick pay (SSP) would be available from day one, and that “there is a range of support in place for those who do not receive Statutory Sick Pay, including Universal Credit and contributory Employment and Support Allowance (ESA).”

This solution is not sufficient for the three million people in the UK on self-employment contracts plus the two million workers who do not earn enough (£94.25 per week) to claim SSP. In order to claim, these workers would need to enrol for Universal Credit which can take up to five weeks for payment. The alternative is ESA which requires claimants to have built up two to three years of National Insurance contributions.

Doctors in Unite endorses the position adopted by the Socialist Health Association which strongly supports the TUC, and urges that this scheme is extended to those workers who currently do not qualify for SSP.

Employers should make up SSP to the average pay of workers to ensure they are under absolutely no financial pressure to attend work while they are unwell and may inadvertently pass on the disease. This must apply not only when patients are ill but also when people are laid off work for public health reasons, even if they themselves are not actually unwell. 

This is an area where the government must step in, as many sectors (e.g. retail, hospitality, or care providers) which interact most with the public may not have the financial resilience to weather the storm created by COVID-19.

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

Our NHS must be in a position to requisition private health care facilities where it will increase local health capacity or facilitate quarantine provision.

As the trade union for medical doctors, Doctors in Unite congratulates our colleague trade unions and Labour leaders for engaging with the government and employers, to ensure that these steps are taken as a matter of urgency in the national interest.

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Coronavirus: how will an overstretched NHS cope?

Wuhan Novel Coronavirus (CoVid-19) has claimed over 1,300 lives and infected 60,000 worldwide so far, with no sign of slowing down. The NHS has become an increasingly fragmented service supplied by multiple providers, which is at risk of failing to deliver the co-ordinated, effective response that Coronavirus requires.

The last potential pandemic the NHS responded to was swine flu in 2009. Since then, the NHS has altered significantly – although privatisation was well under way, there were some notable differences that meant it was in a better position to respond to pandemic flu.

At the time there was a clear hierarchy from the top table decision makers: the Chief Medical Officer, Department of Health and the Health Secretary, down to the Primary Care Trusts and GPs. The Strategic Health Authorities operating above the PCTs had power to realign funding priorities between PCTs as needed.

An excellent report from the Centre for Health and Public Interest in 2014 reviewed the response in 2009 and found this hierarchy had a “clear line of sight,” allowing the co-ordinated response that swine flu required. There were flaws, such as a lack of evidence base for the widespread delivery, and the unnecessary stockpiling of anti-influenza medication, but in terms of interdepartmental communication and a joined up response, things worked well.

None of the organisations that existed then remain today, due to the top-down reorganisation that followed the Health and Social Care Act in 2012. We are now undergoing another costly reorganisation with the creation of Sustainability and Transformation Plans and Accountable Care Organisations. £79.9 billion of the NHS budget is controlled by Clinical Commissioning Groups, who purchase services from local providers. There is a fragmented landscape of different providers and disparate service provision across different regions. According to NHS England there are 150 independent providers of health services in England on top of the 233 NHS providers.

The Secretary of State for Health retains emergency powers to demand co-ordinated action, but these are yet to be exercised. It remains to be seen how these disparate services, with different contracts and arrangements, can be centrally directed to deal with a possible pandemic. We have lost the organisational memory that the swine flu response developed. With so many different providers with varying contractual arrangements offering widely differing health care services, an effective response to Coronavirus may be far more challenging.

Monitoring of the contracts with private providers is often poorly done, so it is conceivable that these arrangements might not be conducive to scaling up service provision in the event of a global health emergency. The chaotic healthcare architecture is exacerbated by the continuing cuts to local government public health services, as much as 8% from 2013 to 2018, and by our already overwhelmed emergency departments.

Coronavirus may well spread in large numbers. The neglect and fragmentation of our health service by the last 10 years of Conservative government could make a difficult situation catastrophically worse.

Dr Sammy Luney is a junior doctor and member of Doctors in Unite. A longer version of this article can be found on his Medium page.