COVID-19 update 7 September 2020 – still stumbling along

A review of where the UK is in its response to the Covid-19 pandemic

1. Policy failure

Richard Horton, editor of the prestigious medical journal ‘The Lancet’, described the management of COVID-19 as the “greatest science policy failure for a generation” in his book on the pandemic. Currently the numbers of newly diagnosed patients are steeply rising with many wondering if the government has completely lost its grip. So – four months after Johnson showed his remarkable grasp of the scientific narrative by declaring: “If this virus were a physical assailant, an unexpected and invisible mugger (which I can tell you from personal experience it is), then this is the moment when we have begun together to wrestle it to the floor” –  where do things stand?   

2. Increasing number of positive test results

In July, the lowest number of daily new positive tests recorded was 574; by 6th September 2020, this had risen alarmingly to nearly 3000 on each of two successive days, showing a sudden increase of around 50% just as schools were reopening and more workers being coaxed back into workplaces. Over the preceding few weeks, European countries such as France, Germany, Spain and the Netherlands had all seen a sharp rise in new cases, with 40% being in the younger age group. In the UK, the change in new diagnoses from predominantly elderly people to the young was even more apparent, with two thirds being in this demographic, including the steepest increase seen in 10 – 19 year olds accused of not observing social distancing.

3. Disillusionment

Meanwhile those with symptoms were often being told they will have to drive long distances, sometimes over a hundred miles, just to get a test. For many, this is simply not feasible, while for those who do make such a journey there is the risk of spreading infection further. At the same time statisticians have started to model the effects of NHS winter pressure combined with a second peak of coronavirus and predict that more than 100 acute hospital trusts will be operating at or above full capacity. A survey by the Doctors’ Association UK found that over 1,000 doctors were planning to quit the NHS through disillusion with the government’s management of the pandemic and frustration over pay. Recent national demonstrations calling for pay rises suggest many other NHS staff share these concerns and are prepared to take action.

4. Coronavirus endemic in some cities

A new public health report leaked to the press highlighted that COVID-19 was entrenched in some northern cities, and that case numbers had never really fallen to low levels during initial lockdown. This situation was strongly associated with deprivation, poor and overcrowded accommodation and ethnicity. New cases diagnosed per 100,000 population/week varied widely round the country at 98 in Bolton (topping the league), 37 in Manchester, 29 in Leeds, and only 3 in Southampton. The implication was that local lockdown measures were not likely to be any more effective in suppressing new infections and that there was an urgent need for a new strategy including better and locally tailored responses. These should include effective ‘find, test, trace, isolate and support’ (FTTIS) systems under the control of local authorities, many of which are in despair over their poor funding, and the hopeless performance of national ‘test and trace’.  Given over at huge cost to the private companies Serco and Sitel, these are still only successfully contacting 50% of contacts of known cases, a figure that, according to the official Scientific Advisory Group for Emergencies, should be at least 80%, with all these contacts then going into isolation.  

5. Broader lessons

Other lessons to be learned relate to financial support for workers and isolation of those living in overcrowded housing. It is simply no good (i.e. it is ineffective as an infection control measure) to expect low paid workers often with little or no financial reserves to self isolate for two weeks with either no pay or derisory statutory sick pay – full pay must be given by employer or government. In addition, people in densely packed housing cannot effectively self isolate, and as in some other countries, need to be temporarily housed in suitable alternative accommodation. This might be reopened hotels, or the almost unused Nightingale hospitals for those with mild symptoms.

6. is london different

One question of interest is why figures have not jumped up in London where the number of new cases in different areas is between 6 and 18/100,000/week. Possible explanations are that London was initially hit very hard by COVID-19 and as a result people have remained more cautious. For example, many Londoners who are able to work from home have decided not to heed government advice to return to office buildings. Geographical disparities in numbers of cases probably also reflect the fact that in northern cities such as Bradford, Oldham, and Rochdale, there is a relatively higher proportion of the workforce in more public facing roles such as the National Health Service, taxi services, take away restaurants, etc. Antibody testing (carried out regularly on samples of the population) also indicates that something like 17.5% of Londoners have been infected compared with 5-7% in the rest of the country. Although this is far from ‘herd immunity’ (which would require about 70% of the population to have been infected) it may mean that rapid increases in numbers of infection is at least initially delayed.

7. Airborne spread

There is now considerable support for the idea that an infected person can spread the virus over long distances through the atmosphere, although at the early stage of the pandemic this notion was rejected (hence the 2 meter social distancing advocated as being safe). There is an increasing body of evidence  confirming aerosol spread of virus, and this is well illustrated in food processing plants. Detailed investigation of the huge German meat factory outbreak showed spread of virus came from a single worker in the factory, with infection transmitted over 8 meters and more, and did not represent community acquired infection being brought in simultaneously by a large number of employees. The implication is that environmental conditions and effective ventilation are crucial to preventing spread of COVID-19, but unfortunately government guidelines as yet do not acknowledge this issue or provide appropriate guidance – a clear example of following far behind the science.

8. Treatments

Government strategy is reliant on the development of effective treatments and a vaccine; this in part explains the half-hearted approach to contact tracing. Lessons learned in the pandemic have reduced the numbers of patients that die once admitted to hospital, and this relates to use of oxygen delivery via a tube in the nose rather than one in the windpipe requiring the patient to be paralysed with drugs and breathing performed by a ventilator machine. Studies have also shown that giving a powerful anti-inflammatory steroid drug improves survival. As the number of patients has fallen considerably, less pressured staff also have more time to give better quality care. There is no basis for the suggestion that coronavirus has become less virulent; if it were to mutate, there is also the possibility it may become more rather than less harmful. The most likely explanation for rising case numbers overall with little change in hospital admissions and deaths is the fact that new cases are now predominantly in younger, fit people, who are much less likely to develop severe disease.

9. Vaccine

A vaccine is being presented as a ‘silver bullet’ that is just around the corner, however this is not the right message to give. There are estimated to be 170 research teams working on developing a vaccine, and nine products have reached large scale trials. To frame vaccine development as some kind of race increases the risk that a vaccine which is not very effective or has serious side effects will be rushed into use and public trust destroyed as a consequence. This would be hugely damaging and illustrates the importance of good public health messaging and the imperative of not compromising on safety through political pressure to deliver or the thirst for company profit. More important to bear in mind, there has never been an effective vaccine against a coronavirus just as there has never been an effective vaccine developed against HIV.

10. Fairy tales and reality checks

The Westminster government continues to choose to stumble on through the pandemic in the hope that a vaccine or effective treatment will arrive like a knight in shining armour, effect a rescue and bring us back to what was once normality. There is precious little reason to think that this is a sound strategy. Its cavalier approach to managing this unprecedented health emergency has included closing down Public Health England on spurious grounds – likened to taking the wings off a malfunctioning  aeroplane in mid-flight in order to ensure a safe landing. Basic demands from the public must continue to be for an effective FTTIS system, nationally coordinated but locally delivered and aimed at complete disease suppression; much improved testing, including local testing units and rapid turn around of results; investment in NHS infrastructure and ending the obsession with inefficient and expensive private contracts; honesty and transparency to win public trust and unite the young and old in a common purpose. Sadly, a conservative government characterised by antagonism to public services and one that prioritises business interests over public health is unlikely to be either self critical and learn from experience or to implement positive changes such as those outlined above. The price for wearing such ideological blinkers will be more suffering and more economic damage as COVID-19 once again inevitably spreads like wildfire through our communities. Perhaps it is only a massively increased death toll that will make it change course.

Peers Inquiry into Public Service Lessons from Coronavirus: Full Report

Below is the Doctors in Unite repose to the Peers Inquiry which has asked for an open consultation from the public and professionals in the wake of the coronavirus pandemic.

We welcome the opportunity to feed into the Peers Inquiry into Public Service Lessons from Coronavirus.

We are Doctors in Unite, the doctor’s branch of Unite the Union. Our members are from all branches of practice and public health across the UK. Our website can be accessed at https://doctorsinunite.com.  We have written extensively during the Covid19 pandemic. Our articles can be found on our website.

We believe that the end of the Lockdown is only the end of phase 1. We must act quickly, learning lessons from other countries’ experience, to prevent a second wave or surge and we need to be preparing for next winter when we can expect the return of seasonal flu and the usual winter bed crisis. These in combination with unfettered COVID 19 would be catastrophic

The Committee is seeking input on the following questions:

General

  1. What have been the main areas of public service success and failure during the Covid-19 outbreak?

Health and social care staff have embraced the challenges and worked flat out to care for the public. They have done this despite lack of adequate personal protective equipment (PPE), we will never know how many have lost their lives as a direct result of this.

The massive decrease in air and road traffic and hence in air pollution is also something to be celebrated along with the decrease in mortality from respiratory illnesses (excluding COVID). Many people report enjoying the reduced levels of noise and being able to hear bird song. 

The implementation of free transport on London’s buses will have encouraged some people not to drive, further diminishing emission of pollutants, but we must not forget that this was driven by the unacceptably high mortality from COVID of London’s bus drivers. They should not have had to die, they should have been issued with adequate PPE. We believe that free bus travel should continue as a fitting legacy to them and as one tool in the fight to combat climate change.

The decrease in traffic and the reluctance of people to use crowded public transport has led to a significant increase in cycling. It is welcome that the Mayor of London, Sadiq Khan, has chosen to capitalise on this and improve cycling infrastructure in the capital. The health and environmental benefits from the increase of active transport must not be squandered.

The level of failure has been legion. 

The Westminster Government responded extremely slowly to the approach of the virus. They squandered weeks, when it was obvious that COVID was heading our way. Time when they should have been making preparations including sourcing appropriate PPE and setting up test, trace, isolate and support systems. We believe that these delays can only be explained by ideological dogma overcoming sound public health advice and established good practice.

It is increasingly widely held that if lockdown had happened a week earlier that thousands of lives could have been saved.

https://www.bbc.co.uk/news/health-52995064

There should also have been a plan, under the aegis of Directors of Public Health, to reduce transmission in care homes and a plan for treatment within homes where necessary. This could have included the provision of oxygen and outreach medical and nursing teams.

Massive cuts in the Public Health budget during the last decade of austerity have severely curtailed the ability of local teams to respond to the pandemic and set up time honoured infectious disease control processes of test, trace, isolate and support. Countries that have adopted these methods have had far fewer deaths per head of population from COVID 19 than the UK which is in the ignominious position of having one of the highest death tolls in the world. We regard the premature abandonment of contract tracing along with the failure to curtail mass public events as major strategic errors. The Governments promise to set up a national test, track and trace programme by the beginning of June has been beset with problems and the official start date has been repeatedly postponed. It is now unlikely to be ready by the end of June, if then, yet local councils are holding back on developing local schemes putting their faith in the national one. Independent SAGE are clear that locally based test, trace, isolate and support is the way forward

  1. How have public attitudes to public services changed as a result of the Covid-19 outbreak?

The public have behaved extremely well. They have understood the seriousness of COVID 19 for some people and the pressures on the NHS and Social Care. During the peak of the pandemic attendances for non COVID related illnesses were much lower than expected. This however brings its own problems in that mortality and morbidity from non COVID conditions will be higher than usual leaving a massive legacy of unmet need. Lessons must be learned from this. Health and social care capacity must be invested in so that this backlog can be quickly addressed. Investment must be maintained so that we are never in the situation again that we found ourselves in with COVID 19 where there was no slack in the system to enable us to cope.

COVID has shown that the public are willing to accept huge changes if there is an existential threat. Government should acknowledge this and be much bolder in their attempts to tackle climate chang

Resource, efficiency and workforce

  1. Did resource problems or capacity issues limit the ability of public services to respond to the crisis? Are there lessons to be learnt from the pandemic on how resources can be better allocated and public service resilience improved?

The NHS has been decimated by cuts and privatisation over the last two decades but there is still some semblance of central coordination of a still largely, though shrinking, publicly provided service. This has enabled some level of planning. Social Care, on the other hand is nearly all privately provided and as a result so fragmented that there is little if any central planning of that sector. The tragic catastrophe of the thousands of deaths in care homes where low paid staff, many of whom work on precarious contracts through agencies is a damning indictment of the policy of privatisation of this sector which, lacking resilience, has become heavily dependent on the public sector for survival. In this context we note the Welsh Government intervened early on and arranged for regular PPE supplies to its care sector.

Social Care should be brought back into public ownership and the NHS should be restored to the comprehensive, publicly funded, publicly provided service, free at the point of delivery that it was in 1948. The NHS was founded to give everyone equal access to health and social care, doing away with the need for the funds to pay for it or the reliance on charity. There must be no return to workhouse mentality, charity and privatisation has no place in the provision of health and social care.

Despite Operation Cygnus finding in 2016 that “The UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors,” the then Health Secretary Jeremy Hunt refused to implement its’ recommendations.

 We believe that the COVID 19 pandemic has highlighted how essential it is to have a comprehensive NHS which is publicly funded from general taxation, publicly provided and free to all at the point of delivery. Public Health and Social Care should be included in this because to provide effective health care the three must work together.

https://www.theguardian.com/world/2020/apr/19/government-under-fire-failing-pandemic-recommendations

https://www.theguardian.com/world/2020/may/07/revealed-the-secret-report-that-gave-ministers-warning-of-care-home-coronavirus-crisis

Pandemics usually lead to increases in morbidity and mortality from other non pandemic conditions. A decade of austerity, where the NHS has been forced to work at full capacity so that there is no slack in the system has made this worse. The shocking drop in the number of GP referrals for cancer treatment – down 60 percent from last year, and GP referrals to specialist care – down three quarters from last year, is incredibly concerning. Hospital bed occupancy of 85% is the upper limited that is deemed safe, but for years many hospital trusts have run at levels well above 90% leaving no room to respond to emergencies such as COVID 19.

https://nhsproviders.org/news-blogs/news/winter-bed-occupancy-rates-threaten-patient-safety

https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/bed-occupancy-in-the-nhs

https://www.nhsconfed.org/news/2020/06/performance-figures-reveal-unseen-impact-of-coronavirus

https://www.bma.org.uk/news-and-opinion/nhs-stats-highlight-brutal-impact-of-covid-19-on-healthcare-services-and-patient-care-says-bma

  1. Did workforce pressures preceding the crisis, such as difficulties in the recruitment or retention of workers, limit the ability of public services to meet people’s needs during the lockdown? How effectively, if at all, have these issues been addressed during the Covid-19 outbreak? Do public services require a new approach to staff wellbeing?

Please see answer to (3) above. The effect of cuts in the NHS and Social Care has seriously damaged the capacity to respond to the pandemic.

We welcome the Government’s decision to remove the NHS tariff for overseas health and social care staff (though we note there are delays in its implementation) but we regard it as reprehensible that the UK Government still treats many health and social care staff as being low skill and that they will be subject to strict migration restrictions.

  1. Why have some public services been able to achieve goals within a much shorter timeframe than typically would have been expected before the Covid-19 outbreak – for example, the increase in NHS capacity? What lessons can be learnt?

This is mainly due to the dedication of public sector staff who have worked flat out to protect and care for the public.

Technology, data and innovation

  1. Has the delivery of public services changed as a result of coronavirus? For example, have any services adopted new methods of meeting people’s needs in response to the outbreak? What lessons can be learnt from innovation during coronavirus?

Health services, especially General Practice have embraced remote working and largely consult through telephone or video in order to keep patients safe by minimising exposure to Covid 19. However this is not a panacea and care must be taken before this becomes the new norm. Many people, especially in deprived areas, do not have reliable access to the internet. There is a considerable amount of digital poverty. This must not be allowed to become an additional barrier to the vulnerable accessing care. Nor is it necessarily a better and more efficient way to deliver care. There is no evidence that on line consulting is quicker and it robs the clinician of valuable cues from the patient that are only available in face to face settings.

  1. How effectively have different public services shared data during the outbreak?

Others will be better qualified to comment on this question than we are.

  1. Did public services have the digital skills and technology necessary to respond to the crisis? Can you provide examples of services that were able to innovate with digital technology during lockdown? How can these changes be integrated in the future?

See answer to question 6.

Inequalities 

  1. Have public services been effective in identifying and meeting the needs of vulnerable groups during the Covid-19 outbreak? For example, were services able to identify vulnerable children during lockdown to ensure that they were attending school or receiving support from statutory services? How have adults with complex needs been supported?

Lockdown has led to an increase in domestic violence, this is yet another sector that has suffered huge cuts in the last ten years so that support services are unable to cope with demand.

https://www.theguardian.com/society/2020/apr/24/charges-and-cautions-for-domestic-violence-rise-by-24-in-london

https://www.independent.co.uk/news/uk/home-news/domestic-abuse-refuges-government-funding-announcement-a9166691.html

  1. Were groups with protected characteristics (for example BAME groups and the Gypsy, Roma and Traveller community), or people living in areas of deprivation, less able to access the services that they needed during lockdown? Have inequalities worsened as a result of the lockdown? If so, what new pressures will this place on public services?

The Governments hostile environment has been a deterrent to overseas migrants seeking the health care that they need. Many Overseas migrants are not eligible for routine NHS secondary care, though COVID, along with other conditions is exempt from charging. This policy causes overseas migrants to fear that seeking health care will either lead to destitution due to bills that they cannot pay, or deportation if their status is undocumented and seeking health care flags them to the home office. The policy is complex and many do not understand that some conditions are exempt, leading them to fail to seek any sort of health care. This is inhumane and the policy should be scrapped, but in addition it adds to the level of circulating virus in the community that is present to infect others.

https://www.independent.co.uk/news/uk/home-news/coronavirus-undocumented-migrants-deaths-cases-nhs-matt-hancock-a9470581.html

Another effect of the Government’s hostile environment is that many undocumented migrants work in low paid roles in the care sector and lack employment rights. They are financially compelled to work even when unwell and if out of work they have no recourse to benefits.

  1. Are there lessons to be learnt for reducing inequalities from the new approaches adopted by services during the Covid-19 outbreak?

We note the high level of death and illness that afflicted health and social care staff, predominantly affected those from a BAME background.

COVID 19 has laid bare the inequalities in UK society. Mortality has disproportionately affected the poor and vulnerable, particularly the BAME community. The PHE report  into disparities in outcome for COVID has been widely criticised for giving no recommendations for action.

During normal times the life expectancy and the healthy life expectancy of the richest in society is years greater than for the poorest. Poverty, poor nutrition and lack of control over one’s life lead to the poor health outcomes and disproportionate incidence of chronic long term conditions amongst the poorest in society. COVID 19 disproportionately kills off those with chronic long term conditions. This is not news, the Black Report in the 1980s and more recently Sir Michael Marmot’s reports of 2010 and this year’s ten years on, clearly show the problems and identify solutions. That their recommendations have not been acted on has meant that the poorest in society have disproportionately died.

http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf

https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on

Despite these inequalities having been well documented for decades the public policy response over the last decade has been to move in an opposite direction. We have seen recent governments pursue policies to reduce the role of the state even though it is the major instrument to redistribute services and opportunity in modern British society. Within the public sector resources have been dramatically moved away from local authorities and other public bodies serving communities and groups with the greatest social need.  With this loss of publicly funded support and resilience it is not surprising that these communities have suffered the most in the present Covid-19 crisis. The words of the UN Special Rapporteur are a damning indictment of these policies.

https://www.bbc.co.uk/news/uk-48354692

Integration of services

  1. A criticism often levelled at service delivery is that public services operate in silos – collaboration is said to be disincentivised by narrow targets from central Government departments, distinct funding and commissioning systems, and service-specific regulatory intervention. Would you agree, and if so, did such a framework limit the ability of public services to respond to people’s needs during the Covid-19 outbreak?

We fully support that health and social care should work seamlessly. We are concerned however that in many instances patients were transferred to care homes without their Covid-19 status being firmly established. This is not acceptable and leaves a vulnerable section of the population exposed to a virulent infection.

For the future there needs to be proper transitional and quarantine provision in place between the NHS and Social Care and within Social Care itself.

We note the proportion of care homes that became affected by Covid-19 varied considerably – almost 60% of Scottish homes had Covid-19 compared to 40% in England and 25% in Wales. This variation should be examined to see if there are any lessons to be learned.

https://www.theguardian.com/world/2020/jun/02/covid-19-spilling-out-of-hospitals-and-care-homes/says-uk-expert

  1. Were some local areas, where services were well integrated before the crisis, better able to respond to the outbreak than areas where integration was less developed? Can you provide examples?

The three devolved administrations, who largely embraced a public services response, seemed to provide a more coherent and integrated response than the fragmented, cocktail approach in England which was over-dependent on out-sourcing and ad-hoc arrangements with private companies. These experiences also highlighted the desirability for more local responses – and in the English context the London-centric leadership did not allow a more tailored response to the local need across the country.

We also commend the Welsh Government’s decision to provide front line care staff with a bonus of £500 in recognition of loyal and dedicated service. It is a pity that the Treasury has not seen fit to exempt this sum from tax and national insurance liabilities.

  1. Are there any examples of services collaborating in new and effective ways as a result of Covid-19? Are there lessons to be learnt for central Government and national regulators in supporting the integration of services?

See response to question 3. Years of privatisation, fragmentation and cuts, with the added difficulty of enshrining competition into the NHS with the 2012 Health and Social Care Act have severely undermined the ability to provide integrated services across the system. Removing these barriers and facilitating sensible system wide planning around the needs of those who need to be cared for rather than the constant push for “efficiency savings” in a sector that has been subjected to an unprecedented financial squeeze during the last decade of austerity would help enormously.

https://www.kingsfund.org.uk/projects/positions/nhs-funding

https://www.england.nhs.uk/2019/04/staff-praised-as-nhs-productivity-grows/

  1. What does the experience of public services during the outbreak tell us about services’ ability to collaborate to provide “person-centred care”?

See answers to previous questions, cuts, privatisation and consequent fragmentation with competitive procurement processes have severely undermined the ability of public services to collaborate and provide person centred care. Any good practice is down to the willingness and dedication of health and social care staff to go above and beyond the call of duty.

The relationship between central Government and local government, and national and local services

  1. How well did central and local government, and national and local services, work together to coordinate public services during the outbreak? For example, how effectively have national and local agencies shared data?

While we agree that there should be a “Four Nation” response to the pandemic across the UK, each devolved administration should retain the ability and capacity to respond to its own needs where necessary.

If a “Four Nation” response is to work more effectively it requires Westminster to engage in a regular and consistent dialogue with the devolved administrations. Pandemics do not need permission to cross borders.  This has not always the case during Covid-19 to date.  There are opportunities for shared procurement practices across the UK but we are concerned to hear that some supply contracts agreed with devolved administrations were “gazumped” by Westminster. There is also a need to revisit how professional advice is secured and commissioned. Bodies such as SAGE are predominately under the wing of Whitehall and the UK Government with devolved governments having a very secondary role. This can mean that crucial strategic decisions are made at a “Whitehall pace” rather than that which might be more appropriate to the devolved parts of the UK.

Community contact tracing is an area which should be locally driven to provide the best outcomes. However the Westminster Government have insisted on a nationally driven programme, which has been beset with problems and has been described by ISAGE as being unfit for purpose. This insistence on a national solution has hindered the setting up of local test, trace, isolate and support systems which have been proven to be effective in disease control. See also answer to question 18.

  1. How effectively were public services coordinated across the borders of the devolved administrations? Did people living close to the border experience difficulties in accessing services?

See answer to question 13.

  1. Can you provide any examples of how public services worked effectively with a local community to meet the unique needs of the people in the area (i.e. taking a “place-based approach” to delivering services) during the Covid-19 outbreak?

Places where community test, trace, isolate and support have been piloted have given insights into how they can be made to work. Ceredigion, Sheffield and Northern Ireland, for example, have successfully instituted local schemes.

https://www.walesonline.co.uk/news/wales-news/area-wales-missed-coronavirus-simple-18348215

https://www.theguardian.com/world/2020/may/21/uk-first-coronavirus-contact-tracing-group-warns-of-difficulties

Lack of properly coordinated local schemes will lead to avoidable deaths as lockdown is eased and people begin to move around more freely. The app promised by Hancock is clearly beset with major problems

https://apple.news/AnQsy9rXJSrajZJtKjLUW6A

https://www.newscientist.com/article/2241041-there-are-many-reasons-why-covid-19-contact-tracing-apps-may-not-work/https://www.wired.co.uk/article/contact-tracing-app-isle-of-wight-trial

  1. Would local communities benefit from public services focusing on prevention, as opposed to prioritising harm mitigation? Were some local areas able to reduce harm during coronavirus by having prevention-focused public health strategies in place, for example on obesity, substance abuse or mental health?

The rise in foodbank usage shows how desperately close to poverty are so many in our population. This situation could, and should, be prevented in future by an adequate benefits system, or universal minimum income, and a significant rise in statutory sick pay to at least the minimum living wage. This support is vital in view of the particular vulnerability of disadvantaged and marginalised communities.

Role of the private sector, charities, volunteers and community groups

  1. What lessons might be learnt about the role of charities, volunteers and the community sector from the crisis? Can you provide examples of public services collaborating in new ways with the voluntary sector during lockdown? How could the sectors be better integrated into local systems going forward?

Mutual Aid groups were quickly set up across the country and people undertook their social responsibility to forgo freedoms in order to protect others and save lives. This is potentially an important future asset and we urge both national and local government to explore ways of supporting this important reservoir of social solidarity and community cohesion.

It is a scandal that care home workers needed to access charities to be able to afford to eat if they were sick or needed to self isolate. (see also answer to 19 above).

  1. How effectively has the Government worked with the private sector to ensure services have continued to operate during the Covid-19 outbreak?

The involvement of the private sector has led to an only too familiar string of unfortunate events.

Unipart did not have the workforce to distribute the PPE that was available. https://www.hsj.co.uk/finance-and-efficiency/system-failure-on-personal-protective-equipment/7027207.article

https://unitetheunion.org/news-events/news/2020/april/government-cuts-to-nhs-supply-chain-causing-hospital-ppe-delays-and-must-be-reversed/

Serco had a serious data breach where they revealed the email addresses of hundreds of contact tracing call handlers to each other.

https://www.theguardian.com/business/2020/may/20/serco-accidentally-shares-contact-tracers-email-addresses-covid-19

Capita took weeks to process the applications of retired GPs and other staff who were willing to return to work to help with pandemic management.

http://www.pulsetoday.co.uk/clinical/clinical-specialties/respiratory-/gps-giving-up-on-month-long-process-to-join-covid-assessment-phone-line/20040776.article

Privately run testing centres, such as those of Deloittes, are difficult to access, results have gone missing and have not been communicated to GPs.

https://www.theguardian.com/world/2020/apr/23/hospitals-sound-alarm-over-privately-run-test-centre-in-surrey

Virus testing occurs in ‘super labs’ bypassing existing NHS facilities which have much quicker turnaround times and good links to the local General Practices that they serve. Testing in NHS labs would have kept GPs in the loop, vital for community contact tracing.

https://lowdownnhs.info/comment/why-bypass-nhs-labs-for-mass-testing-concerns-over-new-super-labs/

Private hospitals were thrown a life line when the Government struck a deal to pay them £2,400,000 per day to rent 800 beds, without this these hospitals would have struggled for business. Few of the beds were used, but the private hospitals were paid the money anyway.

https://lowdownnhs.info/news/nhs-englands-deal-a-life-saver-even-for-private-hospitals/

It is our view that private capacity should have been requisitioned, not rented out. £2,400,000 per day would have been far better spent on the NHS and Social Care provision.

CONCLUSION

In conclusion we would like to reiterate that we believe that the COVID 19 pandemic has highlighted that it is essential to have a comprehensive NHS which is publicly funded from general taxation, publicly provided and free to all at the point of delivery. Public Health and Social Care should be included in this because to provide effective health care the three must work together for the needs of the patient and not for profit.

Private providers must serve the public interest

In the middle of March 2020, it was clear that the NHS would not have the capacity to deal with the increased demands of the Covid-19 epidemic. This lack of spare capacity is clear evidence of continuing government failure to invest in the NHS to provide the required flexibility to meet unplanned needs.  As a necessary but panic measure to deal with the threat of COVID 19, Johnson’s Government struck a deal with the private hospital sector to rent beds from them at a cost of £2,400,000 per day.

By the end of June, after approximately one hundred days this will already have cost the NHS a quarter of a billion pounds. It is clear that the Government can find funds when they are needed and that their default position is to throw money at the private sector despite the shocking record of commercial organisations in providing health and social care.

This is a disgrace which has thrown a lifeline to the private health providers who would have not been able to operate normally during the pandemic and would have lost huge quantities of money but for this.

NHS hospitals have largely coped with the first wave of the COVID 19 pandemic by ceasing all other activity and by the public co-operating with a country-wide lockdown. The extra capacity has been mostly unused. Effectively the private hospitals have received tens of millions of pounds of public money, and rising, to do nothing.

As the NHS begins to deal with the huge backlog of non COVID care these private hospitals must be obliged to make their facilities available to help with the catch up in care and they must do so taking into account the windfall they have obtained to date.

There must be no profiteering from Covid-19.

We demand:

  • Private hospitals must provide value for the money already paid to them and make their facilities available to help clear the backlog of NHS care for no extra charge.
  • There must be full scrutiny and open book accounting to ensure that taxpayers can see that they are getting value for money.
  • Commercial organisations must not be permitted to cherry pick their way to bigger profits at a time of great national emergency.

https://www.independent.co.uk/news/health/coronavirus-nhs-waiting-times-surgery-privatisation-a9550831.html?amp

Doctors in Unite statement 28/06/20

COVID-19: the lack of safe PPE will be this government’s legacy

As the number of cases of COVID-19 in the UK continues to rise it has become increasingly clear that there is a dire shortage of appropriate PPE for health and social care workers.

There have been repeated assurances from the government that there is plenty of appropriate PPE. However it is widely reported from the front line that PPE is in very short supply, and that what is available does not adequately protect from infection. Deliveries do not arrive and hotlines that have been set up do not work. 

In desperation many health and social care workers have taken it upon themselves to source their own equipment from DIY stores, and some have made agreements with local secondary schools to make visors on 3D printers. This situation is wholly unacceptable.

Doctors in Unite de­mands transparency from the government about the real state of affairs with respect to the current reserves, on-going production and distribution of PPE. Health and social care workers are working long hours in stressful conditions in response to the COVID-19 pandemic. The government owe it to us to be honest, and acknowledge our very real and widespread experience with shortage of appropriate PPE and explain to us why it is lacking.

It is the duty of the employer to ensure that the working environment is safe for employees. As a trade union we contend that the current situation in health and social care with respect to COVID-19 and PPE is not safe for either patients or workers. We believe that health and social care workers should not work without appropriate PPE, as to do so endangers the worker and the patient. We do not believe that health and social care workers, including porters and cleaners, should inadvertently carry infection from one patient to another through lack of disposable equipment.

Research has shown that while approximately one in five will suffer severe symptoms, and approximately one in twenty may die, the vast majority of the population will suffer a mild illness – some so mild that they are unaware they are infectious.

We must therefore assume that everyone is infectious and protect ourselves accordingly. Failure to do this will result in health and social care workers becoming infected en masse, and unavailable for work in large numbers. This will put greater strain on the NHS and social care than already exists. It will result in patients becoming infected by health and social care workers. Consequently, and disgracefully, some patients and workers will needlessly die.

We demand that industry is immediately repurposed to produce appropriate PPE in adequate quantities to properly protect staff. At the very least this should be long sleeved gowns to cover all clothes, gloves, plastic overshoes, a mask (preferably FFP3, since coughs and sneezes are also aerosol generating events) and eye and face protection for all workers in the community. Critical care workers would need considerably greater protection. 

We demand to know where this equipment is being produced, in what quantities, and when and how it will be delivered to the front line. 

If the government will not give us this information we can only assume that the PPE is not available. Given that at the time of writing we are still to feel the full force of the pandemic in the UK, this would demonstrate a total abdication of the government’s responsibility to keep the population safe.

We reject any accusation that we are engaging in political point scoring. We believe that it is the duty of the trade union movement to draw attention to the harmful effects of government policy and to demand that the population (workers and patients) receive proper care. 

Failure to draw attention to damaging government policy now will only lead to far worse consequences in later months, when the full force of COVID-19 has hit, when people have seen their relatives refused critical care because there are not enough ventilators for everyone, and there is not sufficient staff to look after them. People will quite rightly ask why the trade unions and professional organisations did not speak out.

It has been recently reported1 that in 2016 then Secretary of State for Health Jeremy Hunt, now chair of the Health Select Committee rejected stockpiling of PPE for health and social care workers on the ground of cost. It is clear that the health of the nation has been put firmly behind the strength of the economy in terms of government priority.

Dr Jackie Applebee 

Chair, Doctors in Unite

Dr Rinesh Parmar

Chair, Doctors’ Association UK

Dr Gary Marlowe 

Chair, BMA London Regional Council (signing in a personal capacity)

Michael Forster 

Chair, Health Campaigns Together

John Puntis and Tony O’Sullivan 

Chairs, Keep Our NHS Public

Professor Wendy Savage 

  1. https://www.theguardian.com/world/2020/mar/27/advice-on-protective-gear-for-nhs-staff-was-rejected-owing-to-cost