Wednesday 20 May

It seems to me the government could be sleepwalking into another crisis of its own making, one which is fast undermining its authority and thereby its mandate to govern. Up to 1,500 primary schools in England are expected to remain closed on 1 June after a rebellion by at least 18 councils forced the government to say it had no plans to sanction them. This schools reopening controversy is potentially the fulcrum of lack of trust in the government, leading to a slippery slope of emasculated de jure authority, when de facto authority is being assumed by the other three nations and ‘rebel’ councils. It’s humiliating they’ve had to capitulate to these councils and affect a ‘generous’ response in not sanctioning them. Rapidly declining trust in the government is the direct result of lack of transparency or selective transparency: ministers are happy ‘to level with the public’ when it comes to the likelihood of forthcoming austerity but not when it comes to its numerous mistakes, errors of judgement and failure to disclose important findings promptly.

During another widely criticised PM performance today at PMQs, it was shocking to hear the confirmation that 181 NHS staff and 131 care workers have died from COVID19. Surely a high number of these must be due to insufficient or non-existent PPE and lack of consistent testing? A number of observers have been struck by how lost the PM seems without the support of his usual chorus behind him. Journalist Kevin Maguire tweeted: ‘Very noticeable that Johnson looked behind in the hope of finding Tories to roar him on at PMQs as Starmer exposes his evasiveness over terrible care home deaths. The largely empty green benches leave the blusterer defenceless’.

Despite ministers’ and clinicians’ assurances to the contrary, the fear that cancelled surgery and halted cancer treatment could cause more unnecessary deaths is likely to be realised, because of the massive diversion of NHS resources to COVID19. Research by the Institute of Cancer Research (ICR) suggests thousands of cancer patients could die prematurely because so many hospitals have had to suspend their normal schedules. Professor Clare Turnbull (consultant at the Royal Marsden in London) said: “For people with prostate cancer, a delay of a few months won’t make much difference. But bowel cancer and bladder cancer are ones you wouldn’t want to leave. If you delay for three months, 10%-15% of people who would get cured don’t, and if you leave it for six months then it’s 25%-30%.” Modelling of Public Health England data suggested that we could be looking at deaths of 4,755 more people than the usually expected number. Charity Breast Cancer Now also carried out some research which supports the ICR findings. This will obviously be terribly distressing to patients in this situation and their families and friends. It’s all very well NHS England (which dismissed the research) and other NHS officials telling trusts that they must get on with this surgery but what can these hospitals do given their underfunding and reallocated resources?

On the theme discussed in previous posts about the huge need to reconfigure key services like social care, transport, mental health services, etc, NHS commentator Roy Lilley, in his daily blog, has come up with a good formula to begin this now and he’s absolutely right about the trust issue (see above). He says: ‘HMG needs to regain public trust.  Trust is not a mechanical thing, built on graphs and numbers.  It’s an emotional thing’. He then recommends the following measures, at least some of which have been emphasised by Independent SAGE experts:

  • Scrap the 5pm briefings, they’ve lost credibility.  Change the format, make BoJo do them all, like Sturgeon, Macron and the Governor of New York.  Hold his feet to the fire.  
  • Get journalists like Andrew Neil back in the room.  Proper questions from a proper journalist, not TV news celebrities.
  • Focus on the positives.  How many people have survived CV-19, last week?  Dunno…
  • Honesty; we know there are problems, discuss them openly, with the people most affected… us.
  • Stop making announcements and changes and expect people to catch-up and go-along-with-it.  Include them.
  • Start a national conversation about what comes next.  Then shut-up and listen.
  • Admit mistakes, say what went wrong and tell what you’ve learned.  Like buying rubbish from Turkey and calling it procuring PPE.
  • Ask people how they are doing, set up national listening networks.
  • Pass more of the decisions down-the-line to regional and county level.  The only thing R0 is good for is to tell us where we are different.  Let people find local solutions to national imperatives.

‘Real leaders learn, trust is the glue of life.  We are where we are…  where’s that?  Unglued’. Spot on. Roy Lilley also has plenty of ideas as to how the reconfigure the NHS more fundamentally. You can follow him on Twitter at @RoyLilley and sign up for his daily blog at

roy.lilley@nhsmanagers.net.

Also on reconfiguring services and systems, the TUC has issued a report calling for the creation post-pandemic of a national recovery council, which would (crucially, the opposite of current top-down one-way strategy) ‘bring together government, unions and employers to create a greener and fairer economy’. A Better Recovery argues that ‘choosing the wrong approach to recovery now risks embedding low growth, long-term unemployment and all the social ills that go alongside’. It carries 6 major recommendations, such as new ways of doing business (including fair pay and a fair tax system), a real safety net, equality at work, sustainable industry, and (critically) rebuilding public services. TUC General Secretary Frances O’Grady said what the government won’t want to hear, except this crisis has forced them, against their natural conservative inclination, to massively invest in the state: “We’ve got to get that safety net strung again, we’ve got to invest in our public services, which may have to build resilience for a long time to come…Unions are back … but the state is back too.”

https://www.tuc.org.uk/ABetterRecovery

This sounds like essential and sobering viewing on Channel 4 this evening, a documentary featuring how lockdown has been for over 70s in the vulnerable category. It includes the stories of ‘people from all over the nation and filmed on location, conveying the immense challenge of being especially vulnerable in the midst of a pandemic’, and how they’ve been adapting.

https://www.radiotimes.com/tv-programme/e/mbr7bg/old-alone-and-stuck-at-home/

Finally, I’ve been heartened by the giving and receiving of small gifts during lockdown, a lovely community-based activity. Asking around about this has thrown up numerous examples including a U3A member who found an Easter egg on her doorstep, a friend was invited for (suitably distanced) Prosecco by neighbours she’d never met before and another has been distributing little jars of her homemade jam and chutney. Both giver and receiver get a boost as it shows we’re being thought about. What’s your experience been? I’ve been making and distributing banana bread and during the last week I was given (by different people) a pot of marigold seedlings, a cake, a glass of special white wine, a packet of nail files and today a piece of carrot cake and baby redcurrant bush. The nice thing is it’s not a tit for tat exchange – it’s more a case of what goes around comes around. The existence of the Twitter hashtag #lockdowngifts shows this spirit of generosity is alive and kicking, a positive thing indeed in these surreal times.

Published by therapistinlockdown

I'm a psychodynamic therapist in private practice, also doing some voluntary work, and I'm interested in the whole field of mental health, especially how it's faring in this unprecedented crisis we're all going through. I wanted to explore some of the psychological aspects to this crisis which, it seems to me, aren't being dealt with sufficiently by the media or policymakers, for example the mental health burden already in evidence and likely to become more severe as time goes on.

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