Our exit from lockdown must be safe and sustainable

The UK has been in lockdown since March 23rd 2020 in an attempt to slow down the spread of COVID-19. Six weeks on the number of new cases per day has begun to decrease and the government and businesses are clamouring to restart the UK economy. We believe that people’s health should come before profit and that there should be no return to work until it is safe to do so.

The UK has the highest death toll from COVID-19 in Europe. Data does not support that it is yet safe to relax physical distancing.

We may have reached the peak, but there were still nearly five thousand new cases diagnosed on May 3rd. As access to testing has been so poor it is impossible to know how many other people in the community are infectious.

We cannot undertake any meaningful planning for an exit strategy from the current lockdown without an understanding of COVID-19’s prevalence and our current levels of immunity.

On April 2nd Health Secretary Matt Hancock promised to test 100,000 people daily by the end of the month. The government claims to have reached their target though there are allegations that the tally was artificially boosted.

Testing must be safe, freely available and reliable and must be accompanied by rigorous contact tracing.

True prevalence is proving hard to predict. Where one study suggests 75% of people infected may be asymptomatic, another reports a very low rate of current infection – less than 1% of the tested population.

The only way out of this is to gather data and learn the truth.

Epidemiological studies of appropriately sized, randomised cohorts repeated every few weeks would chart the progress of the disease.

Cuts to public health have made it virtually impossible to mount coordinated local responses to COVID-19 with testing, isolating and contact tracing. Restoring and updating local communicable disease control is an integral part of properly funded, publicly provided health and social care.

The lack of appropriate PPE is an ongoing problem in public facing jobs and this will only be exacerbated as more people return to work. Industry must be immediately repurposed to produce appropriate PPE in sufficient quantities.

If people are to return to work it must be safe for them to do so, including during their commute.  

Each workplace should undergo appropriate risk assessment to prevent unnecessary transmission of the virus. We do not believe that the government can be trusted to do this. Trade unions must have oversight. For example, it should be up to the education trade unions to determine whether it is safe to open schools and the criteria that will need to be met. Schools must not be seen by the government and businesses as convenient childcare to enable a kick-start to the economy. We support the NEU’s demands that schools should only be opened when it is safe to do so.

COVID-19 has highlighted the importance of a nationally coordinated, publicly provided health and social care service. The NHS has excelled itself in coping with the crisis whereas the largely privatised, for profit care home sector, which has no central coordination, has been tragically unable to prevent COVID-19 from taking a huge toll on its residents.

It is well known that there is a spike in morbidity and mortality from all causes when a pandemic hits and services focus on the crisis in hand. 

The private health sector must not be allowed to profit from this. The private sector should be requisitioned if they are needed to help to clear the backlog. Matt Hancock, Secretary of State for Health and Social Care promised that “we’ll give the NHS whatever it needs and we’ll do whatever it takes”. 

The NHS needs investment to deal in-house with the waiting lists inevitably generated by the crisis, and investment must be ongoing to preserve NHS resilience. One of the lessons from COVID-19, and most winter flu epidemics, is that the NHS cannot be run flat out all year round without headroom and spare capacity to cope with peaks in demand.

New infrastructure, such as software for arranging work rotas, is increasingly outsourced to the private sector. This is unnecessary and could easily be managed within the NHS.

Neither must health care be rationed to cope with the backlog. We reject the blanket use of the term ‘Procedures of Limited Clinical Value’. Patient care must be decided individually on clinical need and not restricted due to financial pressures.

Deprived populations have very high death rates. Society’s response to COVID-19 has disproportionately affected those from BAME communities, the poor and vulnerable.

The UK is one of the most unequal societies in the world. While the more affluent are able to isolate in comfortable homes with plenty of outside space the poorest often have to share beds and go without food – for them physical distancing is impossible. Many epidemiologists, including Sir Michael Marmot, have demonstrated that the more unequal a society is the less healthy it is for everyone, including the richest. Health Equity in England: The Marmot Review 10 Years On, published only two months ago by The Health Foundation, is a damning indictment of Government policy. 

Many other commentators suggest ways to redress the imbalance, but successive Tory governments have largely ignored them. If these measures had been introduced it would have been much easier to contain COVID 19. We demand that Marmot’s original recommendations to be fully implemented.

We believe that people’s health must not be sacrificed in the interests of profits. There should be no return to work until it is safe to do so. Ordinary people must not be made to pay for the crisis – there must be no return to austerity. The UK is a rich country and there is plenty of money in society to ensure that everyone’s needs are met. If the banks could be bailed out in 2008 the people can be supported properly now. A Green New Deal would help to provide a more sustainable economy and a Universal Basic Income would help orientate us towards a fairer society based on need not profit.

Before lock down ends there must be:

  • Freely available testing with contact tracing which is rigorously followed up, and the restoration and updating of local communicable disease control.
  • Frequent epidemiological studies of appropriately sized, randomised community cohorts to determine the prevalence of COVID-19. 
  • Sufficient supplies of appropriate PPE for all public facing workers.
  • Trade union oversight on the safety of return to a particular workplace, and trade union control of the safety aspects such as physical distancing.

Longer term there must be:

  • A sustainable, green economy based on need not profit, with no return to austerity.
  • No exploitation of the backlog in care by the private sector to boost their profits.
  • A comprehensive national health and social care service, publicly funded, publicly provided and free at the point of delivery for all in the UK with adequate investment and an end to outsourcing, privatisation and fragmentation.

International Workers’ Memorial Day

IWMD this year is unique in falling in the middle of the UK lockdown due to the COVID-19 pandemic. Lack of appropriate PPE has thrown millions of public facing workers into harms way as they do not have the right tools to protect themselves from infection.

In this environment it is vital that IWMD is observed. We intend to do this safely, with social distancing, and by asking for people to take a moment’s silence in their homes or workplaces.

Representatives from the trade union movement will leave a memorial banner and floral tributes at the Royal London Hospital at 10:45am on Tuesday 28th April, to mark the memory of those workers who have died during the pandemic. Similar memorials are taking place in other UK cities including Sheffield and Leeds.

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

Demands in response to COVID-19


The challenge of coronavirus requires a radical response. We will overcome this virus, but current legislation falls short – much more must be done. We demand:

Full PPE

This must include FFP3 masks, visors/protective spectacles, fluid resistant gowns with sleeves and gloves for all health and social care workers dealing with patients and service users who have or are suspected to be infected with COVID-19. This is vital to prevent staff going off sick en-masse leaving no one to care for patients.

Widespread testing

Whole population testing for COVID-19 is essential, with particular attention paid to health and social care workers. Isolation and follow up of identified cases with rigorous contact tracing is crucial.

Laboratories in hospitals

Full pathology laboratories should return to hospitals. Cuts and privatisation of labs have reduced the capacity for testing so that when they are needed the system cannot cope.

Public control of private hospitals

Private health care facilities must be taken under public control and made available to assist the NHS in caring for ill patients.

Public control of industry

Key industries must be taken under public control and repurposed to manufacture equipment that is essential to deal with the outbreak of COVID-19, such as PPE, ventilators and antibiotics. 

An end to needless competition

The protection of intellectual property rights for key equipment such as ventilators must end, so that companies can collaborate to produce them. There is no place for the pursuit of profit and competition between companies during a national crisis. 

Support for staff to work remotely 

Guidance on confidentiality and data security should be rapidly produced. Investment in IT should take place to enable all those who need to work from home to do so. 

Protection and recompense for retired workers returning to work

Retired workers returning to the NHS deserve the proper provision of PPE and COVID-19 testing. Older people are more vulnerable to the virus, and will need thorough protection. 

Full pay when self-isolating

All UK workers who are off sick or self isolating due to COVID-19 should be paid as if they were in work. No one should be under financial pressure to work when government advice is that they should be at home. Previous record of days off sick should not be an impediment to this principle.

Universal basic income

Universal basic income must be made available for all in line with the living wage for the period of the crisis. This would be in place of all other benefits, universal credits or employment support.

Retraining for the newly unemployed

Those who have lost their jobs should be offered free retraining in roles that support our society and infrastructure during the pandemic. This could include medication delivery, care work, and supporting the socially isolated.

Universal access to essential services

Everyone should to be able to access the essentials that they need, including food and shelter. The homeless should be accommodated in empty hotels and houses. Supermarket stocks should be centrally managed and provisions distributed so that everyone can have what they need. 

Proportionate, time limited emergency laws subject to regular review

While being clear that everyone must be able to access what they need, there is a fine balance between ensuring equity of distribution and infringements of people’s reasonable rights and liberties. All new legislation that curtails civil rights must be limited in scope, be regularly reviewed, and should include a sunset clause.

Comprehensive support for vulnerable health groups

Services for the homeless and those who suffer from substance misuse must be maintained. These are vulnerable groups who are at high risk of complications from COVID-19 infection. They are often hard to reach and should be provided with phones so that key workers can maintain contact while working remotely.

Comprehensive social care

Disabled people are vulnerable and their needs must be properly met. They are at particular risk if their carers become unwell. Those who have accepted personal budgets are particularly at risk. Services must continue for them in all circumstances. 

An end to overseas charging

NHS eligibility checks for migrants leads to them not accessing healthcare as frequently. It is vital that during a pandemic, everyone gets the care they need. Charging overseas visitors for NHS care must be stopped and the legislation that allows this abolished.

Extended rent and mortgage payment holidays

Suspend rent and mortgage payments for all NHS and social care staff. No health or social care worker should be anxious about living costs. Many are at risk of losing household income if their partner loses their job. The current three month mortgage holiday should be extended to at least six months.

Psychological support for health and social care workers

Psychological support services should be provided at no cost for NHS and social care staff caring for patients during the period of the pandemic crisis.


We the undersigned support these demands and urge their adoption by the government as quickly as possible:

COVID-19: A GP’s Perspective

As I write we are at the beginning of the pandemic in the UK. We still have relatively small numbers of cases but they are steadily increasing along with, tragically, associated deaths.

There is a very fine line between not fuelling mass panic, which is unhelpful, but also in taking sensible precautions.

Public health messages such as thorough hand washing and minimising touching our faces and each other are very important. This will have some effect in slowing the spread of the virus. However, we only have to look across to Italy to see how it has quickly overwhelmed their health care system, even when they have twice the number of critical care beds per person than we do in the UK.

In my view, our responsibility is to try to slow the spread of the virus, to minimise the pressure on critical care (though of course the pressure is still likely to be huge), and also to demand that the government increases the number of critical care beds as a matter of urgency by requisitioning private hospitals, upgrading existing beds in NHS hospitals and if necessary setting up field hospitals.

This will also require immediate training of NHS staff to look after critically ill patients as there are not enough at present. The last 10 years of systematic underfunding and dismantling of our NHS, along with massive cuts to social care, is now having devastating consequences.

Primary care is where 90% of NHS encounters take place, so it seems obvious that most cases of COVID-19 will be dealt with here. It is important that health workers remain well as far as possible and so are able to continue to treat patients. Unfortunately, personal protection equipment (PPE) that has been issued to GP practices is more or less useless – simple paper surgical masks which do not stop infection.

Many GP surgeries are moving towards a system called Doctor First, where patients are not allowed access to the premises without first speaking to a doctor over the phone. This is to protect staff and other patients from people who may be infectious with COVID-19.

Patients are being advised by the government to self-isolate and sweat it out at home if they become unwell, and to contact NHS 111 if they cannot manage self-isolation. NHS 111 has rapidly become overwhelmed, and there are reports of 12 hour waits for a response.

Understandably patients are not all going to meekly wait at home. Some will either come to our surgeries and demand to be seen or go to A&E, spreading the virus.

There is a debate about self-isolation, closing schools and universities and whether these are the correct strategies. I think it is not possible to say with any certainty yet whether we should or should not adopt these measures. If we do, are we just pushing another peak further down the road? What happens to, for example, children who live in poverty and rely on free school meals, or families where parents have to work to pay their rent? Will such strategies push the burden of childcare for school age children to vulnerable grandparents?

What we can say with certainty is that years of austerity have decimated our NHS, and that despite this NHS staff are, as always, rising to a very difficult challenge. While we wait for a vaccine and more critical care beds, we need to try to slow the spread down.

We should demand:

Immediate requisitioning of private hospitals to increase the pool of critical care beds.

Immediate training of NHS staff who are willing, to help look after critical care patients.

Adequate supplies of proper PPE for all staff on the front line.

Suspension of all non-essential work, for example CQC inspections, appraisals and enforcement of key performance indicators such as QOF and enhanced services. No practice should be financially penalised for dealing with this unprecedented crisis.

Adequate IT and internet connectivity to cope with the rise in remote working.

That sick pay is paid from day one. Staff should not suffer economic hardship for self-isolating or being off sick. Anyone who comes to work who is potentially infected is a danger to everyone else.

Sick pay be extended to those on regressive employment contracts, such as zero hours contracts.

No penalty for those people missing DWP assessments as result of self-isolation.

Provision of centralised primary care type services in each borough for those patients who are too sick just to sweat it out at home, but not ill enough to go to hospital.

Much more testing. We can learn from South Korea, where mass testing is being performed via drive through test stations.

Dr Jackie Applebee is a GP and the chair of Doctors in Unite.