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 __________________________________________________________________ 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 __________________________________________________________________ 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 __________________________________________________________________ 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 __________________________________________________________________ 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 __________________________________________________________________ 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 __________________________________________________________________ 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 __________________________________________________________________ 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 __________________________________________________________________ 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 __________________________________________________________________ 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 __________________________________________________________________