Public Policy Media
Richard Vize
LATEST ARTICLES
NHS begins 2021 facing
perpetual crisis
18 December 2020
Think 2020 has been awful for the NHS? Next year is shaping
up to be far worse – and most of the huge hole it’s in was dug
long before Covid. The virus has merely finished off the job.
The health service does not have the beds, staff or equipment
to recover the ground it lost during the first two waves of the
coronavirus pandemic, but the government is blocking
desperately needed improvements, and another round of
organisational upheaval is on its way.
Roughly one in 11 clinical posts are vacant, and it would
hardly be a surprise to see many staff rush for the retirement
door once the worst of the pandemic is behind us. The NHS
can’t solve the problem without long-term certainty over
funding for staff.
Around 140,000 patients in England have been waiting more
than a year for surgeries such as a hip replacements, up a
hundredfold from a year ago. With the whole system beset by
delays long before we had even heard of coronavirus, the lack
of spare capacity means it will take years to help many
patients.
Unprecedented interruptions and delays to cancer tests and
treatments have been exacerbated by the pitiful state of
diagnostic equipment.
Read the full article at Guardian Society
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Sunak’s spending review will cost
lives
27 November 2020
Rishi Sunak’s spending review will cost lives and cause yet
more cuts in local services. But he still found the cash for a
red wall bung.
If there were any lessons about spending priorities during the
pandemic it is that investing in public health services saves
lives, but Sunak offered nothing. The core public health grant
– this year at £2.4bn – has been slashed by a fifth in five years.
The hollowing out of this vital public service has been a
central factor in the UK having a Covid-related death rate
worse than the US and Brazil and five times that of Germany.
Covid-19 suppression and preparing for future pandemics will
remain a core task, and the failure to give councils the
resources to do the job will drive up the death toll. When
billions can be found for the NHS it almost feels like a
calculated insult. No wonder a despairing Jeanelle de Gruchy,
president of the Association of Directors of Public Health,
described Sunak’s refusal to increase the public health grant
as “completely incomprehensible”.
Read the full article at Guardian Society
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Life and death of Public Health
England
20 November 2020
Public Health England was born from the most controversial
reforms in NHS history—and it’s been killed off just seven
years later, the first casualty of a blame game over tens of
thousands of deaths from covid-19.
Under the Health and Social Care Act 2012 as championed by
the then health secretary Andrew Lansley, Public Health
England (PHE) was established as an executive agency of the
Department of Health, meaning that it had operational
independence but took instructions from ministers. In
contrast, the Health Protection Agency, which PHE replaced,
had had independence as a non-departmental public agency.
This lack of autonomy would undermine PHE’s relations with
parliament, would stoke criticism from public health
specialists, and would eventually prevent it from defending its
reputation when the covid pandemic took hold.
As well as taking up the Health Protection Agency’s role of
protecting the public from infectious diseases and
environmental hazards, PHE absorbed numerous other
organisations including the National Treatment Agency for
Substance Misuse, the public health observatories, cancer
registries, and national screening programmes. The Rare and
Imported Pathogens Laboratory, at the government science
facility in Porton Down, also came with the Health Protection
Agency.
Read the full article at BMJ
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Rotten culture permeates
government
13 November 2020
There is something rotten in the government’s culture. Less
than a year after Boris Johnson led his party to an 80-seat
majority, ethical standards are routinely compromised and
the principle of transparency is under attack.
The mishandling by the communities secretary, Robert Jenrick,
of the £3.6bn towns fund typifies this casual abuse of power –
a shoddy piece of work that barely pays lip service to basic
principles of openness and objectivity. Established in July 2019
to support the economies of struggling towns, the fund
selected 101 places, 40 based on need and the other 61
chosen by ministers. Tory seats and targets were the big
beneficiaries, leading to Labour concerns that the money was
used to win votes.
An excoriating report by the cross-party Commons public
accounts select committee accuses the Ministry of Housing,
Communities and Local Government of dishing out billions
based on vague justifications, scant evidence and sweeping
assumptions. One town, Cheadle in Greater Manchester
(Conservative, majority 2,336), was given cash despite being
ranked by officials as the 535th priority out of 541 towns.
The department refused to disclose its reasons for selecting or
excluding towns, offering risible excuses that have fuelled
accusations of political bias and that has, according to the
report, risked the civil service’s reputation for integrity and
impartiality.
Read the full article at Guardian Society
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Building back starts with public
services
2 October 2020
Boris Johnson has promised to “build back better” after the
pandemic. But to stand any chance of improving public
services, the government has to understand the significance
of the wreckage around us.
Covid-19 has laid bare the destruction caused by a decade of
austerity. Everywhere there is a lack of capacity, from too few
respirators to threadbare public health teams in local
authorities. Every part of the system was running hot, so when
the virus hit, one of the wealthiest countries on Earth was
quickly tipped into crisis. Tens of thousands of deaths from
disrupted healthcare could follow.
With local government reduced to little more than a skeleton
operation, towns and cities were entirely dependent on
government handouts to cope. The folly of running our social
care system on minimum wages and zero-hours contracts was
cruelly exposed as underpaid staff moved between homes to
make ends meet, unwittingly taking the infection with them.
Meanwhile, decades of underinvestment in social housing
ensured the virus ripped through our most deprived
communities, with overcrowded homes and shared facilities
providing the perfect breeding ground for the infection.
Read the full article at Guardian Society
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Prison collapse typifies age of
austerity
18 September 2020
The slow-motion collapse of England and Wales’ prison system
is a textbook example of the government’s repeated public
service failures in the age of austerity.
The mismanagement of the prison estate, exposed in a
scathing report from the Commons public accounts
committee, is a carbon copy of ministers’ numerous other
foul-ups over the past decade. There are starring roles for
inadequate funding and disastrous use of private contractors,
with supporting parts for squandering money by aiming for
unachievable savings, raiding capital budgets to prop up
running costs, making big promises with no credible delivery
plan, and failing to join up policy. Inevitably, it is all followed
by yet more delusional promises of future delivery and the
piecemeal populism of ever-longer sentences.
Prisons are the responsibility of HM Prison & Probation
Service, an executive agency of the Ministry of Justice (MoJ). Its
declared aim is to ensure they are decent, safe and productive
places to live and work.
But the last annual report from HM Chief Inspector of Prisons
for England and Wales said living conditions for most
prisoners were inadequate and some were squalid, including
cramped, bloodstained, flooded and filthy cells, rat, flea and
cockroach infestations, and broken windows.
Read the full article at Guardian Society
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Hancock never stops to count
the cost
21 August 2020
Borne on the tidal wave of his self-confidence, Matt Hancock
crashes from one unforced error to the next, never troubling
himself to pause to count the financial and human cost. His
latest masterstroke is to abolish the country’s public health
agency in the middle of a pandemic.
The National Institute for Health Protection announced by the
health and social care secretary this week brings together the
health protection parts of Public Health England (PHE) with
NHS test and trace and the Joint Biosecurity Centre. It will
focus on external health threats, especially pandemics.
Everyone who works in the UK public sector knows that
endlessly demolishing and rebuilding its structures
undermines morale, wastes time and money, haemorrhages
expertise and experience, and rarely solves problems.
Establishing this new organisation piles risk upon risk as we
head into a dangerous winter. It bolts together a privatised,
poorly performing test and trace system, a biosecurity centre
that barely exists, and PHE staff cut adrift with no clear idea of
their future, all under a temporary leadership. But none of
this troubles Hancock.
Read the full article at Guardian Society
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Failed ministers want even more
control
24 July 2020
As the UK begins to pick through the economic, social and
personal wreckage of our failed response to coronavirus, two
competing visions for the future are emerging: centralise,
control and privatise, or localise and disperse.
Both Downing Street and the health and social care secretary,
Matt Hancock, with an eye on the forthcoming public inquiry,
have convinced themselves that the weaknesses exposed by
our pandemic response were the result of too little power at
the centre.
Hancock expresses frustration that when he pulled on the
Public Health England lever there wasn’t much attached to it,
while both he and Boris Johnson are railing against their lack
of direct control over NHS England and its chief executive,
Simon Stevens. Ever the shrewd political operator, Stevens has
extracted huge amounts of additional funding from the
Treasury while keeping a low media profile.
But Hancock was the fundamental cause of the poor public
health response. Ignoring desperate pleas from local
government public health directors to be given a leading role
in tackling the pandemic, particularly around testing and
contact tracing, the government has instead used the private
sector to build new infrastructure such as the testing centres
and lighthouse labs from scratch, disconnected from councils
and the NHS.
Read the full article at Guardian Society
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Men’s attitudes caused mesh
scandal
10 July 2020
Julia Cumberlege’s report into avoidable harm inflicted by the
healthcare system exposes an institutional inability to listen to
patients in general and women in particular.
Her investigation into decades of failure batters the reputation
of the NHS, professional bodies, regulators, manufacturers,
private providers and policymakers.
Established by the then health secretary, Jeremy Hunt, in 2018
to examine how the healthcare system in England responds to
reports about harmful side-effects for medicines and medical
devices, it examined three notorious cases of treatments
taken by women: hormone pregnancy tests associated with
birth defects and finally withdrawn in the 1970s; the anti-
epileptic drug sodium valproate, which can harm children
during pregnancy; and vaginal mesh implants, a cause of
crippling, life-changing complications and unbearable pain.
The review only came about because of decades of relentless
campaigning by patient groups.
The story Lady Cumberlege uncovers is not of rogue actors or
localised problems but systemic, endemic failure to listen to,
or respond to the needs of, patients. After speaking to
hundreds of women, a pattern emerged of not being
empowered to make informed choices, not being heard, not
being believed by arrogant, intimidating doctors, a lack of
understanding of women’s health and feeling abandoned.
Read the full article at Guardian Society
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What is the Joint Biosecurity
Centre?
2 July 2020
What is it?
The Joint Biosecurity Centre brings together data analysis and
epidemiological expertise to ensure covid-19 outbreaks are
detected and brought under control quickly.
What will it do?
It will provide independent, real time national and local
analysis of infections, and will advise the government on how
to respond to infection spikes, such as by closing workplaces.
It will also look for clusters associated with particular parts of
the economy, such as pubs.
It will build on the UK’s public health infrastructure and
surveillance network—including the NHS Test and Trace
programme, Public Health England, the devolved public health
agencies, and researchers—to understand the covid-19 threat
at any given time. It is primarily for England; its relationship
with the devolved administrations has not been agreed.
It is modelled on the Joint Terrorism Analysis Centre,
established in 2003, which advises the government on the
appropriate terrorism threat level. A key role of the Joint
Biosecurity Centre will be advising the chief medical officers
across the UK on the appropriate covid-19 alert level.
Read the full article at BMJ
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