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 __________________________________________________________________ Rough sleepers are dying decades early 6 March 2020 People living on the streets are dying three decades early, but NHS intransigence is undermining attempts to improve services. Official statistics reveal a shocking story of early, avoidable death. In 2018 the average age of people who died while homeless in England and Wales was around 44. In other words, these 726 souls typically died more than three decades too soon, losing 22,000 years of life between them. A third of these deaths were caused by treatable conditions such as respiratory illnesses and HIV. Homeless people are 14 times more likely to die by suicide compared with the general population, 20 times more as a result of drug use and seven times more from falls. Hospital admissions in England relating to homelessness, meanwhile, leapt 130% in the five years to 2018-19. To understand why healthcare is failing people who sleep rough on this industrial scale, the government commissioned independent research from the King’s Fund. The results reveal services are too inflexible to meet their needs, and are so rigid they thwart attempts by committed staff to make improvements. Bearing in mind that even people who work for the NHS often find it difficult to navigate as a patient, it is no surprise that homeless people find multiple barriers getting into and around the health service. Read the full article at Guardian Society __________________________________________________________________ Don’t give planning power to developers 21 February 2020 Boris Johnson’s “smash the system” approach to public policy is about to reach every street, town, village and field in the country. The government is preparing to dynamite development controls and unleash market forces on our physical world, moving power from councils to developers and inflicting great harm on the built and natural environments. While No 10 adviser Dominic Cummings and eugenics aficionado Andrew Sabisky grab the headlines, it is Jack Airey who may well have the more lasting impact on our lives. As Johnson’s new adviser on housing and planning, Airey is leading the charge to strip local councils of meaningful control over local development. Just last month, in his role as head of housing at influential right-wing thinktank Policy Exchange, he published his manifesto, Rethinking the planning system for the 21st century. Airey is undoubtedly right that the planning system is not fit for modern times. Fertile land is being gobbled up for ugly, sprawling, car-dependent, amenity-free housing developments. Poorly planned building is exacerbating the menace of floods. Too few new buildings minimise their carbon footprint. Developers constantly dodge their obligations to build social housing. Read the full article at Guardian Society __________________________________________________________________ Terror medics should not be held back 7 February 2020 The Streatham terrorist attack has again highlighted one of the most difficult decisions the emergency services face – deciding when it is safe to treat wounded people. In the aftermath of the stabbings by Sudesh Amman, a passer- by who helped a man lying on the pavement bleeding claimed ambulance crews took 30 minutes to arrive. The London Ambulance Service (LAS) said the first medics arrived in four minutes, but waited at the assigned rendezvous point until the Metropolitan police confirmed it was safe to move in. Like the perpetrators of the London Bridge attacks in both 2017 and 2019, Amman was wearing a hoax suicide vest. There is a long, brutal history, from Baghdad to the Warrenpoint ambush in 1979 , of using secondary attacks to slay those who rush to terror scenes. The inevitable chaos of a bomb or an attack by several people, such as the 2017 attacks in London Bridge and Borough market, means it can take a long time to be sure all the perpetrators are accounted for. But last summer, the London Bridge inquest heard it took three hours for paramedics to reach some of the wounded. Read the full article at Guardian Society __________________________________________________________________ Ministers threaten our right to know 24 January 2020 Freedom of information and scrutiny of government decisions are under attack. Through obstruction and neglect, ministers and civil servants are choking off our right to know what they are doing and how they spend our money. Meanwhile Boris Johnson and his cabinet are replacing rigorous journalistic questioning with shallow social media stunts, creating a mirage of openness and accountability while hiding away from any real interrogation. The Freedom of Information Act 2000 gave UK citizens the right to request data from public authorities, and obliged them to publish financial and other routine reports. It transformed the relationship between the public and the state, with campaigners and journalists soon pushing its boundaries. Since 2005 the number of Freedom of Information (FoI) requests to government has doubled but, as the Institute for Government revealed this week in its Whitehall Monitor 2020 report, adherence to the act is on the verge of collapse, with departments ignoring their legal duties to supply information. The report points out that in the early years of the act, departments were routinely approving more than half of FoI requests (although the Foreign Office and Cabinet Office have almost always refused 60% or more). Read the full article at Guardian Society __________________________________________________________________ Cummings plan will fail deprived areas 10 January 2020 The obsessive focus of Boris Johnson’s advisers on shaking up Whitehall reinforces the failed belief that all the answers lie in better central government. If they really want the UK to be the most dynamic state in the world and to “level up” the most deprived areas, they need to devolve power away from London. There is good evidence that decentralised countries have stronger growth and better public services – and even the Treasury recognises that the UK is one of the most centralised states in the world. Instead of poking at the problem with a few grudging concessions negotiated through city deals, ministers need to give local government the decision-making and tax-raising powers it needs to make a difference. That would be the fastest route to “levelling up” and beginning to tackle endemic problems such as skills shortages, low productivity and poor public transport. The signals about how Whitehall will be reformed have been mixed. The growing expectation that the cabinet secretary, Sir Mark Sedwill, will be staying for the foreseeable future rather than becoming ambassador to Washington provides experience and continuity at the top. Read the full article at Guardian Society __________________________________________________________________