Government mistakes risk second wave 26 June 2020 Local communities – not the NHS – are the frontline in the battle against Covid-19. Each hospital admission means the virus has already broken through. The health secretary, Matt Hancock, has promised the NHS will have everything it needs to tackle coronavirus, but what it really needs is an effective public health response to keep it at bay. By failing to face up to its failures, the government risks unleashing a second wave. The experiences of countries with an impressive record in controlling the pandemic, such as Germany, New Zealand and South Korea, show that even the best prepared systems can experience major flare-ups that are difficult to control. But still the UK government has not put in place the systems to identify local outbreaks quickly and come down on them hard. A joint statement in the British Medical Journal (BMJ) signed by healthcare leaders including the presidents of 11 royal colleges and the Faculty of Public Health articulates widespread concern that England simply isn’t ready. Areas of weakness it identifies include coordination of national, regional and local bodies – such as councils and Public Health England’s regional health protection teams, the bedrock of any communicable disease response. Read the full article at Guardian Society __________________________________________________ Test and trace: slow and fatally flawed 11 June 2020 “I don’t believe the virus is under control, and I don’t believe that the system of surveillance we have at the present time is sufficient,” says Gabriel Scally, former regional public health director and a member of the Independent SAGE group of scientific advisers. As lockdown restrictions are eased and businesses reopen, he is one of several public health experts worried that England’s ability to contain outbreaks of covid-19 is seriously compromised by weaknesses in the planning and operation of the government’s much anticipated “test and trace” programme. Launched on 28 May, test and trace is now at the front line of efforts to prevent further outbreaks. But new infections are still high (an estimated 39 000 a week in private households in England from 26 April to 30 May 2020, in survey data released by the Office for National Statistics on 5 June), testing procedures are slow, and the tracing system is flawed, public health experts tell The BMJ. They also raise concerns about how test and trace could widen health inequalities in populations most affected by the pandemic. Scally says, “I think the situation is extraordinarily dangerous, and I don’t see any sign of the systematic, thorough, well resourced, and expert approach that is needed.” Read the full article at BMJ __________________________________________________ Hancock’s hospital obsession costs lives 29 May 2020 Matt Hancock’s at it again. The health and social care secretary’s appearance at the 5pm briefing on Wednesday to finally announce the test and trace system in England showcased the flaws that have undermined the effectiveness of the entire coronavirus response: seeing everything through the lens of the NHS, marginalising and ignoring local government, and throwing money at private companies to fill the gaps left by public sector cuts. Hancock knows all about shielding the vulnerable. He has been using the NHS as his personal human shield from the start The “NHS track and trace system” largely consists of thousands of people working in Serco call centres, for which the training has been so haphazard that the company’s chief executive has issued a video apology. Painting NHS lipstick on it is supposed to give people confidence it will work. Unheralded, much of the work will fall to local government public health teams. And yet again Hancock delivered a calculated snub to councils, refusing to acknowledge their contribution in a thank-you lis that included businesses. Hancock knows all about shielding the vulnerable: he has been using the NHS as his personal human shield from the start. Read the full article at Guardian Society __________________________________________________ Public health cuts hit Covid-19 response 21 May 2020 The covid-19 pandemic has laid bare the impact of years of spending cuts and muddled structural reforms on the effectiveness of England’s public health services. It has also shown that their current position within local government is the best place for them but that they need clearer national leadership. Under the reforms implemented in 2013 by the then health secretary, Andrew Lansley, in the Health and Social Care Act 2012, public health in England moved back into local government, where it had been until 1974. Directors of public health became the strategic leaders tasked with a remit to tackle local health inequalities, as well as commissioning services including sexual health, smoking cessation, drug and alcohol services, and early years support for children, such as through school nursing and health visitors. Public Health England was created to oversee emergency preparedness, health protection such as communicable disease control, and public health campaigns, as well as supporting local systems with data and evidence. It was an executive agency of the Department of Health, not an independent body.1 However, the NHS retained some aspects of public health—notably, vaccinations and immunisation, and the chief medical officer remained the lead advocate for public health throughout government and leader of the public health profession. Read the full article at BMJ __________________________________________________ How Covid-19 is reshaping public policy 18 May 2020 A decade after the implementation of austerity, government is again shaping its economic response to a global crisis, with profound implications for public services. Once again, ministers are faced with stark choices over taxation and spending, which will have repercussions for many years. Two years after the global financial crash, the Labour and Conservative parties both went into the 2010 election promising some form of austerity. There was a broad consensus that spending restraint would be needed, because annual spending as a fraction of national income had shot up – partly because income had fallen. The austerity programme unveiled in the June 2010 Budget by George Osborne, chancellor in the Conservative/LibDem coalition, set two goals – eliminating the structural budget deficit and reducing national debt as a percentage of GDP. Professor Tony Travers of the department of government at the London School of Economics says: “It was decided to get the deficit down from around £110bn a year to nought in five years. It was a quick cold bath approach rather than a prolonged, tepid shower.” CIPFA chief executive Rob Whiteman says the Tory response to the crisis was ideological: “The financial crash tapped into a sense that the state had grown too big and that the state, through its well-meaning interventions, had made people too dependent upon it.” Read the full article at Public Finance __________________________________________________ Central grip will throttle the recovery 15 May 2020 England’s overcentralised state has already undermined the country’s ability to respond to the spread of Covid-19. Now it looks set to undermine the economic recovery too. As the country takes its first tentative steps towards getting back to work, all the key decisions are being taken by the same ministers who have overseen the disastrous response to the initial pandemic. Faced with an economic contraction unprecedented in its speed and depth, every business from a large factory to a small shop that can reopen safely helps our chances of stopping the recession becoming a depression. Meanwhile, different parts of the country are grappling with widely varying rates of hospital admissions for Covid-19. While admissions per 100,000 population in London were by far the worst in England a month ago, now it is the north-west which has a rate markedly higher than the rest of the country. But in the south-west, the admission rate has remained low. Yet the new rules governing our lives announced by Boris Johnson on Sunday apply equally to a Cornish village and Manchester city centre. The relentless march of centralisation has meant that every substantial problem in this unfolding health and economic catastrophe ends up on a minister’s desk for resolution. Read the full article at Guardian Society __________________________________________________ Virus exposes limits of central control 3 April 2020 NHS and care workers have gripped public attention as the country responds to the Covid-19 pandemic. But the one million people who work in local government have also been working flat-out – work that will continue well past the present crisis, that has been made much harder by 10 years of austerity, and that is not being helped by some parts of Whitehall trying to micromanage the local response. As councils cope with a huge wave of demand on every front, from social care to refuse collection, they are taking daily instructions from ministers and officials across Whitehall, themselves under pressure and struggling to keep pace with directions from Downing Street. Ironically perhaps after years of cuts, the tensions aren’t about money, but about communication and coordination. There have been delays, confusion and aborted work, such as changes of policy about whether central or local government is managing the assembly and distribution of food parcels, and local preparations for additional mortuary capacity being put on hold in favour of a national response. While some difficulties are inevitable, the fundamental problem is ministers persisting in the fantasy that everything works best when it is run from the centre. Read the full article at Guardian Society __________________________________________________