Open letter to the Prime Minister about the UK’s Covid-19 strategy from NHS and Social Care workers

Open letter for anyone working in Health and Social care to sign and distribute.

Sign here:

https://docs.google.com/forms/d/e/1FAIpQLSfdk4q_YaJnNrMAGtaz9W32WCYLyWnE1rvLPFR3Y376tydRZg/viewform

Dear Prime Minister,

We are writing to ask you urgently clarify our Covid-19 strategy. Herd immunity was abandoned early on as it became clear hundreds of thousands would die. We entered lockdown in order to “flatten the curve” under the slogan: “Stay at home – Protect the NHS – Save lives”. Despite high levels of ongoing viral transmission, lockdown is now being eased with the injunction: “Stay alert – control the virus – save lives”. Slogans, however, do not constitute a strategy. Given the terrible cost of the pandemic, both in terms of lives lost and lasting damage to the economy, we call on you urgently to set out an explicit strategy in relation to Covid-19. We need an overall strategy for the UK, that is agreed with all the Devolved Nations. It must be flexible to allow for regional differences and decision making with a clear framework for how such decisions will be made.

Colleagues in Ireland, north and south, have set out a very clear vision of what must be done. We face the same choice: either live with the virus under a long-term mitigation / containment strategy waiting (possibly forever) for a vaccine or effective antiviral treatment, or suppress and eliminate new infections. They designate the latter approach “Crush the Curve”. Mitigation means accepting an ongoing toll of illness and lives lost, and living under the constant threat of local surges and possible national waves of infection and deaths. It also means public transport running at minimal capacity, insurmountable challenges for schools, businesses and services to run properly, indefinite restrictions on gatherings and socialising, and an NHS which will collapse under the combined weight of Covid-19 cases and the huge backlog of untreated patients with cancer and chronic conditions.

It appears to us that the Westminster government has chosen the path of mitigation, characterised by the analogy to the arcade game ‘Whac-a-mole’ where infection is expected to keep ‘popping up’ and those in charge do their best to guess where to put limited resources. Once more this is a slogan and not a strategy.

Many countries have successfully chosen to suppress the virus and eliminate infections, including South Korea, New Zealand, Australia, Austria, Greece, China and Iceland. Their people are once again using public transport, returning to school, going out to eat and to shop, with healthcare systems caring for all patients, not only those with Covid-19, and economies already recovering. They demonstrate very clearly that eliminating the infection represents the best strategy in terms of both public health and protecting the economy.

This means having a much more ambitious target of suppressing the number of new cases to zero as soon as possible, and keeping it there. This requires continuing public health measures, such as maintaining social distancing, universal use of face masks in enclosed spaces, sensible travel restrictions, and setting up countrywide community based, efficient and rapid ‘find, test, trace, isolate and support’ infrastructure across the country, including at our borders. If done effectively and comprehensively this would successfully suppress the virus in a matter of weeks, and then keep it there.

We should be prepared to learn from other countries so that our people can also enjoy the considerably greater freedoms and prosperity this will bring. Travel, tourism, and trade with such states would be straightforward and beneficial. Our children will be back at school, vulnerable citizens and precious key workers protected.
The sacrifices made so far have reduced the number of new cases and deaths significantly, but a nadir has been reached with current measures, and we may now even be seeing a rise in infections. The national R value is perilously close to one and it is a question of when, not if, flare ups will occur, or even worse a second wave engulf us once again.

We think it is time for the government to develop and communicate a clear strategy and declare which path all of the UK will follow at this critical juncture.

Yours sincerely…

‘Isolate, trace and support’ is the only safe way out of lockdown

Doctors in Unite believe that comprehensive, publicly coordinated and community based ‘isolate, trace and support’ procedures are vital for control of the COVID-19 pandemic as lockdown is eased.

To keep the frequency of new cases in the community manageable people must be supported to self isolate once they are identified as potentially infectious. To this end it is imperative that there is no loss of income for those who need to self isolate through having been in contact with an index case.

To control the spread of COVID-19 the government must commit to maintaining people’s income so that they are not compelled to work when they should be in isolation. The financial burden should not be directly placed on companies as many of them would simply walk away from the obligation, though of course, companies should contribute properly through corporation tax. 

We call on Unite and the Trade Union movement in general to support our demand and to actively lobby the government to ensure that it is met.

Public Health and Primary Care

In January 2019, Doctors in Unite issued proposals relating to public health and primary care. This document has now been revised.

In the light of COVID-19 the authors believe that if these proposals had been implemented before the pandemic struck then the UK would have been able to respond much more quickly to the need and would have been in a much stronger position to plan and deploy local responses.

The government has allocated significant resources into protecting the front line of the NHS at the level of hospital services, with particular investment in the building of Nightingale hospitals. However, it has put almost no additional resources into primary care or community services to deal with COVID-19.

We believe that strengthening primary care and community services as laid out in our paper would mitigate the effects of COVID-19 for five main reasons:

1. Those working in primary care should look after populations and communities as well as individuals and their families. Dual training and accreditation for GPs and nurses in public health and primary care is essential. Neighbourhood public health leads would co-ordinate appropriate local responses to a pandemic, for example, by supporting people at home with COVID-19, isolating them and contact tracing in ethnically and culturally appropriate ways.

2. Primary Care Networks of GP practices should be funded to provide care home and appropriate domiciliary care during the pandemic. Community organisations should be integrated with primary care, which during theCOVID-19 lockdown could deliver food, medicines and other essential items as well as provide support for isolation, loneliness and respond to mental health issues.

3. We support a social prescribing model, which in normal times encourages patients to go out, meet people, socialise and stay active; during a pandemic this is necessarily amended, and patients are asked to stay in and not meet people, but to still socialise, keep in touch with others and remain active.

4. We develop the idea of local democracy through Neighbourhood Health Committees which would organise appropriate medical, psychological and social care, led by public health leads working seamlessly with directors of public health who have authority and independence which has been devolved from central control.

5. We propose professionally independent public health advocacy so that the people can trust the advice and information they receive.

Read the full paper here

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.

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