Tens of Thousands of Avoidable Deaths Due to The Government’s Callous Indifference to the effects of Covid 19

June 1 2020 heralded the official start of the easing of the lockdown that has been in place since 23rd March to try to contain the spread of Covid 19.

The current reality is that due to the Westminster Government’s repeatedly vague and confusing messaging, compounded by their unwavering support of the Prime Minister’s rule breaking Chief Advisor, Dominic Cummings, people are already relaxing social distancing.

We have now known about the threat from Covid 19 since January this year, and through the lens of the media watched it heading our way via Iran, Italy and other countries. The UK had more time than most to prepare, however this opportunity was squandered by the Westminster Government.

Instead of learning from the experience of other countries and making sure that key workers had sufficient personal protective equipment and that time honoured locally coordinated test, trace, isolate and support programmes were in place to contain the spread of the virus, Boris Johnson glibly announced that the UK’s strategy would be one of developing herd immunity (a form of indirect protection from disease that occurs when a large percentage of the population has become immune) and that we should prepare ourselves for our loved ones to die.

Soon after, Imperial College published modelling which showed the NHS would be overwhelmed by Covid cases if more stringent measures were not put in place.

The Government publicly abandoned their herd immunity strategy and the UK went into lockdown. Over two months later, following a shockingly high peak in early April, the daily death rate and reporting of new cases has declined significantly, but not enough to suppress the virus to a level that makes it safe to start to open up schools and businesses.

The much heralded national contact tracing scheme is beset with problems and unlikely to be up and running (let alone working well) before the end of June at the earliest. Meanwhile, local projects are being held back, starved of resources and undermined.

We must ask ourselves why our Government have careered from one position to another during the Covid 19 crisis, seemingly out of control and always on the back foot. They, like anyone else, can be forgiven for the odd mistake, but this has had the appearance of a complete shambles.  They have the more conservative of the best scientific minds at their disposal and experience from other countries which were beset by the virus before the UK to draw on.

So why has their response been so seemingly incompetent and why are they now insisting that it is safe to ease lockdown when the evidence suggests that this will trigger another viral surge? Could this be construed as akin to corporate manslaughter?

We believe that the Westminster Government has been forced by events to address the health of the public in this crisis but has done so through gritted teeth because it is at odds with their ideological programme of dismantling the welfare state. For them the crisis is also an opportunity to expose more public services to privatisation.  This is why they have so vigorously prevented NHS laboratories and local public health teams from expanding their services appropriately to meet the demands of the pandemic, instead choosing to  contract with Tory-contributing, multinational, outsourcing agencies like SERCO despite the fact that these companies’ incompetence and corruption in providing health care are well known.

Easing lockdown may “stimulate” the economy, but in the process thousands, if not tens of thousands of lives, especially those of the elderly, will be sacrificed as the virus surges again.

This is disgraceful and callous. Lives are far more important than profit.

We have said before that lockdown should not be eased until

  • Proper locally coordinated test, track, isolate and support systems are in place and shown to be working
  • There is financial support so workers do not lose income if they need to isolate
  •  There is adequate ongoing supply of appropriate PPE for all key workers

None of these things are yet adequately in place.

History shows that pandemics have lethal subsequent waves.

We believe that to end lockdown in the current circumstances will lead to huge numbers of avoidable deaths as the virus surges again. When these deaths occur the question must inevitably arise – ‘was this corporate manslaughter?’

There is no rationale to the behaviour of the Westminster Government other than to put profit before people – we demand a change in strategy to put the health of the people first.

Doctors in Unite 7 June 2020.

References:

  1. https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea68b5
  2. https://www.theguardian.com/world/2020/mar/12/uk-moves-to-delay-phase-of-coronavirus-plan
  3. Britain Drops Its Go-It-Alone Approach to Coronavirus – Own Matthews, Foreign Policy 17/03/20
  4. https://www.theguardian.com/commentisfree/2020/may/28/coronavirus-infection-rate-too-high-second-wave
  5. https://www.bbc.co.uk/news/health-52473523
  6. https://www.theguardian.com/commentisfree/2020/may/28/ppe-testing-contact-tracing-shambles-outsourcing-coronavirus
  7. https://www.bbc.co.uk/news/health-52284281
  8. https://doctorsinunite.com/2020/05/25/isolate-trace-and-support-is-the-only-safe-way-out-of-lockdown/
  9. https://doctorsinunite.com/2020/05/18/testing-times-require-radical-solutions/
  10. https://www.history.com/news/spanish-flu-second-wave-resurgence
  11. https://www.theguardian.com/world/2020/may/31/did-a-coronavirus-cause-the-pandemic-that-killed-queen-victorias-heir

Thoughtlessly placed DNARs do harm to patients and doctors

Doctors in Unite reiterate our opposition to any scoring system being used as a blanket cut-off to people accessing hospital care. We understand that conversations with patients about their wishes with regard to treatment and end of life care can be very helpful to ensure dignity in dying, but these must be undertaken with the utmost sensitivity, and with the best interests of the patient and their loved ones at its core.  These conversations must never be a means of rationing care or of ticking a box in a care plan.

We are increasingly concerned to hear of incidents across the country during the COVID-19 pandemic, where patients who score above a threshold on various frailty indices have had conversations with health care workers in which the patient felt pressurised to agree to a DNAR and to give up the right to be admitted to hospital. Health care workers often feel that they are responding to official guidance and that they have no choice but to comply. This is fundamentally wrong. Health care workers must always place the interests of their patients as their main obligation and duty.

Of course not everyone will benefit from intensive procedures such as ventilation, but even the most frail may benefit from less interventionist treatment such as specialist assessment, symptom control, antibiotics or oxygen. It has been reported that the bed occupancy in some NHS facilities is lower than usual. Despite this thousands of people are dying in care homes, some of whom may have benefitted from hospital admission.

We restate our conviction that every life is of equal value. There must be no arbitrary thresholds above which treatment is withheld, and no one must feel coerced into forgoing treatment which is their right out of guilt that there are not enough NHS services to go around, especially when there is reported to be capacity in NHS hospitals.

Dr Jackie Applebee is the chair of Doctors in Unite

Government ineptitude has undoubtedly led to many unnecessary deaths – they must be held to account

Richard Horton, respected editor of the medical journal ‘the Lancet’, aptly summed up the current pandemic in the following words: “Coronavirus is the greatest global science policy failure in a generation. Austerity blunted the ambition and commitment of government to protect its people. The objective was to diminish the size and role of the state. The result was to leave the country fatally weakened”. China implemented a lockdown in Hubei province on 23rd January in response to a new and severe respiratory infection. One week later the World Health Organisation declared a global emergency in recognition of what had become a worldwide pandemic. It then took nearly two months for the UK government to grasp the seriousness of the problem and to implement social distancing and isolation. This delay has led to many unnecessary deaths.

Despite there being core public health principles of “test, isolate and contact trace” in response to an epidemic, this process has not been implemented in the UK. There was talk of ‘herd immunity’ as an alternative strategy, but scientists then pointed out this could mean hundreds of thousands of deaths before the infection was under control. A panicked government decided to abandon its irrational belief in ‘British exceptionalism’ and on 23rd March instituted a lock down of sorts, with people encouraged to stay at home, and most businesses closed down. News footage still showed London underground packed with people and construction workers as key workers were expected to turn up for work as usual.

Unrecognised dangers included the risk to the elderly living in care homes together with their carers, the risk to bus drivers and other key workers with public-facing roles in the community.  The fact that many workers on zero hours contracts and those outsourced from the NHS and not entitled to sick pay would be forced to continue to go to work even if ill. Sick and elderly patients were discharged to care homes only to spread infection without having been tested for the virus, and outrageously, ‘do not attempt cardio-pulmonary resuscitation’ orders proliferated for pensioners and those with learning difficulties or disabilities often without discussion. The official death toll has gone up to above 20,000 – but these are confirmed deaths in hospital and there may be at least as many again in the community without a definitive diagnosis.

In the meantime, countries like Singapore, South Korea, New Zealand and Germany, which rapidly instituted widespread testing and contact tracing were demonstrating a much lower number of cases and deaths. While the UK government kept promising more testing, numbers grew painfully slowly. Centres specially created to test key staff were set up by the accountancy firm Deloitte, given the contract without it going out to tender under obscure legislation passed in 2015. As usual, reports of problems with lost samples and mis-communication of results followed, just as the privatisation of NHS logistics caused problems with distribution of personal protective equipment (PPE). Despite repeated reassurance from government ministers that stocks of PPE were available, this turned out not to be the case as week after week front line staff complained of being sent to war without the necessary armour. Around 132 NHS and care staff have now died from the disease and will be remembered along with many others on International Workers’ Memorial Day.

Worse still for government credibility were details of the unpublished Cygnus report from a 2016 pandemic planning exercise, and more from the 2019 National Security Risk Assessment, both showing that the government knew full well of the major risk posed by the likelihood of a new pandemic, and the need to stockpile PPE and equipment such as ventilators for intensive care, yet did nothing. As one commentator remarked: “We have been paying for a third-party fire and theft policy for a pandemic, not a comprehensive one. We have been caught out”.

Things which have assisted the pandemic response include the fact that we still have a ‘national’ health service and brilliant staff with a public service ethos. Things that have hindered the response include government reforms over recent years promoting marketisation, fragmentation, privatisation and outsourcing. NHS England has rightly taken over commissioning functions from Clinical Commissioning Groups, and government has wiped away the £14 billion hospital overspend to let Trusts focus attention on doing what was necessary to fight the infection. The small private sector capacity was harnessed to assist the NHS. However, the huge PFI debt millstones remain in place, and private hospitals are only too happy to be subsidised to the tune of £2.3 million/day through block contracts- one of the businesses that will not now go under in the coming recession.

The hostile environment aimed at those migrants with uncertain immigration status not only meant the end to universal health care under the NHS, but now fear of being reported to the home office or financially charged will undermines planned contact tracing. This charging needs to be abolished now, as does the yearly surcharge of £625 for members of NHS staff coming from abroad, and each of their family members.

Government policies left the NHS in a weak starting position, with over 100,000 staff vacancies, cuts in bed numbers of 17,000 since 2010, and near the bottom of the European league table in relation to intensive care beds (half as many as Italy and around one fifth of those in Germany). The government will be constructing a narrative portraying themselves as victims of a natural disaster, doing their best in impossible circumstances and leading us all to victory in the war against Covid-19; in this they will be aided by large sections of the media.

Trade unionists must make sure that ministerial incompetence, arrogance and callous disregard for human life are not forgotten and there is a holding to account. When the pandemic is over, we cannot go back to how things were before. We need to take the public with us in demanding a return to NHS founding principles, a publicly funded, managed and delivered health service with democratic control, linked to a national social care service. Renationalisation of the NHS; proper funding; an end to PFI, the Health and Social Care Act and the Long-Term Plan for the NHS; and an end to outsourcing and privatisation. We are witnessing a tragedy unfold and a government scandal of momentous incompetence. The right lessons must be learned.

Dr John Puntis is co-chair of the campaign group Keep Our NHS Public.