The debate about whether or not schools should reopen on 1 June (and now the British Medical Association is firmly supporting the unions) highlights an important issue about how we treat risk. Too much risk adversity makes for existing in a comfort zone rather than living, but although life does involve risk every day, in this situation it’s crucial that safety measures are observed. Not surprisingly, mistrust of government comes to the fore again, as many suspect the urge to reopen schools is driven more by the needs of businesses to get their employees back to work. How unfortunate that Education Secretary Gavin Williamson resorts to emotional blackmail, writing in the Daily Mail that teachers should be ready to “do their duty” and cooperate with the government’s efforts. A Radio 4 listener tweeted: ‘Let’s hope the ‘protective bubble around groups of children’ would be more effective than Matt Hancock’s ‘protective ring around our care homes’.
With fine weather forecast this weekend, the first since the new Stay Alert strategy, police and locals fear beauty spots being inundated and restrictions flouted. When interviewed police and politicians keep saying that the public has generally understood and abided by the guidance but the evidence contests this: 14,000 fines have been issued for lockdown breaches since it started. That’s quite a number and it would be interesting to know how many fines had actually been paid. Meanwhile, here’s a novel idea from writer Matt Haig: ‘I hope when this is all over we will be able to opt into individual lockdowns voluntarily to get us out of social events we don’t want to go to’.
Within the last 48 hours there have been more examples of ministers still misrepresenting aspects of crisis management, when the facts and chronology are now well established, eg Stephen Barclay (Chief Secretary to the Treasury) on Question Time alluding to 120,000 tests having been carried out that day. Perhaps BBC journalists, often supine, are becoming more incisive now, as it took Fiona Bruce three efforts to get him to concede that this equated to only 71,600 people tested. On the Today programme yesterday Brandon Lewis, robustly challenged by Justin Webb, refused to accept that the care homes advice had been wrong despite more scientists now saying it was, and alluded to Keir Starmer ‘playing politics’ (aka holding the government to account) and ‘quoting out of context’ at PMQs on Wednesday. And on Any Questions last night Social Care minister Helen Whaley floundered frequently at the end of Chris Mason’s rod. Yet the disingenuous narrative from ministers continues. In response to Matt Hancock’s assertion that right from the start they tried to ‘throw a protective ring around our care homes’, palliative care doctor Rachel Clarke tweeted: ‘This is categorically untrue. Care homes were left without testing. Without contract tracing. Without PPE. Without support. You can deny it all you like, Matt Hancock, but we were witnesses – we ARE witnesses – and believe me you will be held to account’.
New figures show that 12,526 care home residents died due to COVID19 in England and Wales during the four months to May. The number is much higher than those previously reported as it includes both deaths from the virus within care homes and residents who died after being taken to hospital with the virus, who accounted for a quarter of deaths. The Guardian reports on ‘isolated care home residents ‘fading away’ – capturing what’s really going on in these sequestered places. Residents, many with dementia, are confined to their rooms so don’t meet others, activities were stopped and they receive no visitors, so their mental health is suffering considerably. One anonymous carer told the Care Inspectorate in Scotland: ‘The virus won’t be the killer of these people, it’s the distress and fear of not seeing family that is doing it. Residents who were giggling, happy and active before the crisis now just lie in their beds or sit alone in their rooms with their doors closed. Many now barely respond when you speak to them. Some shout for their friends and family. Others have given up entirely and are fading away.”
This is such a sad ending for these elderly people, who have been so shockingly overlooked by government strategy, and distressing for their families having to cope with their relative’s demise in these circumstances. In many cases this is likely to result in a complicated grief reaction (complex, prolonged and unresolved) because they won’t have been able to say goodbye or properly acknowledge that passing. Although the measures to protect residents are crucial, some could have been avoided with sufficient planning and testing at the start.
There seems a division of opinion on the timing for a public inquiry into the government’s performance, ministers and others saying ‘the time will come when all this is over’ (aka kicking the can down the road?) and those, like the Hospital Consultants and Specialists Association, making the case for setting it in motion now. Apparently it can take months to set up an inquiry so all the more reason to start sooner than later, key issues being how quickly Downing Street reacted to the threat, whether lockdown came early enough and why the testing and tracing attempt has been ‘inadequate’.
Rather shocking but not surprising, because of continuing austerity and the lack of effective and consistent mental health support, is the increase in suicides in England and Wales over the last year. Figures for 2019 indicate 4,620 deaths from suicide, an 11% increase on 2018. This represents one in five deaths heard in coroners’ courts, according to the Ministry of Justice. It will be interesting and sobering to see what the figures will be for 2020, given the mental health burden building up during COVID19. Setting that in context, it’s been known for some time but now the Royal College of Psychiatrists has confirmed that people with no history of mental illness are developing serious problems for the first time as a result of the lockdown, due to stresses over isolation, job insecurity, relationship breakdown and bereavement.
Frontline NHS staff particularly are regarded as being at risk of PTSD (Post Traumatic Stress Disorder), because of their onerous and stressful roles in caring for desperately ill and dying patients, the huge unknown quantity that COVID19 is, difficulty of obtaining PPE, seeing their colleagues become ill and losing some, fears for their own families’ health and the prohibition by many trusts on speaking to the media about these conditions. Professor Neil Greenberg, trauma expert at King’s College London, has said staff may need months or even years of “active monitoring” of their mental health after things return to some semblance of normality. But what help are they getting?
NHS England is said to be providing crisis support to its staff, its mental health director alluding to individual trusts’ support and ‘online resources’ etc and NHS charities’ money was supposed to be used in part for talking therapies. But NHSE hasn’t produced a formal long-term plan to offer extra psychological services in the aftermath of the pandemic, BBC News tells us. Surely this is a major omission. Dr Michael Bloomfield, a psychiatrist at University College London (UCL) and Camden and Islington NHS Foundation Trust’s traumatic stress clinic, said ‘there is an urgent need to work out how staff calling new NHS mental health hotlines can be referred on to specialist services’. Greater demand for more structured mental health support could come much later, when the urgency of the current crisis has abated.
Clinical psychologist Julie Highfield said: “What’s really needed long-term is an 18-month to two-year recovery period,” with access to counselling and trauma-focused therapy’. Support is currently ‘patchy’ and concern has been expressed about some new charities set up to coordinate this work using insufficiently qualified and experienced practitioners. This further highlights the problem of counselling and psychotherapy not being statutorily regulated in this country. Professor Greenberg said some voluntary schemes are really good, but the quality varies: “Some follow evidence-based guidelines, but some are, to be fair very well-intentioned, but often not very well put together. It would be quite dangerous to allow a proliferation of well-meaning charities, which might distract or detract people from going and getting the right care.”
It’s absurd that several professional bodies including BACP (British Association for Counselling and Psychotherapy) operate accredited registers of suitably qualified and experienced counsellors and therapists. There’s a wasteful duplication of effort because too often, as in primary care, the NHS chooses to look elsewhere or train its own, usually in the biomedical and non-relational Cognitive Behavioural Therapy, whereas what many clients need relational therapies and a choice of them.
You might be interested in two consecutive programmes later on Radio 4 – Loose Ends (a medley of conversation, music and comedy) has the inimitable Grayson Perry amongst its guests and the weekly Profile features Labour MP Dr Rosena Allin-Khan, who recently challenged Matt Hancock in the House of Commons and got told to ‘watch her tone’. Let’s hope the Health Secretary tunes in!