LATEST ARTICLES
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
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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
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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
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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
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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
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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
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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
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Public Policy Media
Richard Vize
April to June 2020