Sunday 12 July

As the COVID19 death toll reaches 44,798, it’s been another very busy news week, starting with widespread criticism of the PM for appearing to blame care homes for not taking sufficient precautions in the early stages of the pandemic, leading to over 20,000 care home deaths. It was then left yet again to hapless ministers to try to explain what the PM ‘had actually meant’. It must be difficult constantly being called upon to defend the indefensible, with the added burden of constantly having to ‘explain’ (never apologise) for their boss’s ‘misspeaking’. Since it’s emerged how many care home residents, especially those with dementia, have gone into decline during lockdown because of lack of contact from family and others, I wonder how many more deaths there will be if such decline proves irreversible. The horrifying scale of these deaths has made imperative the urgent need for social care reform, one of the main challenges being the fragmentation of the sector (85% of the UK’s 22,000 are homes privately owned).

There’s already proof that rather than the mad rush to restaurants and pubs the government would like to see, especially given its ‘Eat out to help out’ mantra, there’s quite a bit of caution for obvious reasons, such as the continuing lack of a functioning test and trace system. A few weeks ago someone wrote anonymously about their experience in one of these call centres, not getting any proper training or even work. Now another recruit has written a similar piece, again citing tech not working and being paid to refresh their screen every 15 minutes: ‘…. NHS test and trace has been sold as ‘a world-beating system’ but everything that could go wrong has. I hope that when this is all over, there will be a massive public and independent inquiry to find out how the UK got it so wrong’. The government continues to insist that it makes decisions according to the science. A sceptic tweeted: ‘When the government says it’s ‘acting on best scientific advice’  read…. whatever scientific advice we can find that best suits our agenda’.

Cancer is another area where deaths are going under the radar (though perhaps less so now following this week’s Panorama coverage), due to delayed or interrupted treatment or undiagnosed symptoms due to patients not feeling safe going to hospital or trying relieve pressure on the NHS. The Health Care Research Hub (HDR UK) for Cancer estimated that as many as two million routine appointments, including breast, bowel and cervical cancer screenings, may have been missed throughout the crisis. Urgent referrals fell by around 60% during the peak and a worst-case scenario estimate could see 35,000 more people dying of cancer by this time next year.

Having long lamented the lack of help for the culture and heritage industries, some were very relieved this week at the announcement of a £1.5 billion rescue package, but others believe it’s too little, too late, far less than other countries are making available. Some arts organisations are already close to being forced into administration. It was striking how many commentators quite rightly said ‘the devil’s in the detail’, and alarming to hear that the details of how to apply for funding will apparently will be posted on the DCMS website ‘within the next few weeks’. This doesn’t exactly convey a sense of urgency. The Guardian arts critic, Michael Billington, wrote an acerbic article in the form of a letter to the Culture Secretary, describing the ‘roadmap’ as ‘worse than useless’, showing no awareness of how the arts actually work. ‘So far the most practical plan for the theatre has come from Sam Mendes, who has made numerous recommendations: increasing the theatre’s tax-relief scheme from 20% to 50%, inviting the government to become theatrical “angels” by investing in productions, challenging the streaming services to put money into an industry from which they directly benefit. Have you spoken to Sir Sam about his ideas? Have you co-opted him onto the cultural renewal taskforce you have set up? Or are you simply fiddle-faddling while Rome burns?’

In a coup de grace, he said: ‘It’s time, Mr Dowden, you faced up to a simple truth: artists know much more about the arts than politicians…..I’ve never met you and I’m ready to believe you are well-intentioned. But I wonder if you have even begun to grasp the scale of the crisis facing the performing arts… Unless you come up soon with a detailed, precise, properly financed plan of action you will go down in history as the politician who presided over the dissolution of the arts in Britain. The only thing one can say for sure is that the show definitely won’t go on’.

The Culture Secretary, who presided over Thursday’s press conference, also came in for some mockery at the hands of the Guardian’s parliamentary sketch writer, John Crace, who described him as having ‘the air of a trainee sales assistant on the luxury goods floor of a department store – posh, well-meaning, but not particularly bright’. He was thought to have struggled with journalists’ questions about the science behind the mass reopening of various venues: ‘….by now Oliver was a beaten man. All he could offer was that he was sure the prime minister would never have sanctioned anything that put the public at risk. Er, hello? Have you met Boris?’

An exasperated reader left this comment: ‘Why do they keep lying to us? Every serious epidemiologist acknowledges this is likely a two year (in the best case) – if not four/five year pandemic and there’s a real risk on top of that that Covid becomes endemic and circles the world forever. They’re pedalling false hope, afraid of turning to the country and saying the truth – namely things will not ‘get back to normal’. We need innovation, not a re-hash of the Tories’ 2019 election manifesto…’

Described as a ‘mini-budget’ or ‘summer statement’, when some commentators thought we needed a full Budget, Chancellor Rishi Sunak made a midweek splash, with large sums promised for job creation, job retention, retraining, green recovery, stamp duty cut, VAT cut for the hospitality industry, discounts for eating out and unspecified infrastructure projects. The economic plan to deal with the aftermath of the coronavirus crisis appeared generous at first sight, including funds for employers taking back furloughed workers, a pledge to provide 30,000 new traineeships to get young people in England into work amid fears of mounting unemployment, but there was widespread criticism and some heartrending stories in the media about the thousands of self-employed sole traders, who got nothing. The Guardian has a useful breakdown of how the package amounting to ‘up to £30 billion’ will be allocated. The effect of Sunak’s ‘eat out to help out’ measure was slightly dented by his smiling appearance in a pub as a ‘waiter’ not wearing a mask and taking plates of food to the wrong customers, plus the restriction of this discount to £10 per head and availability Monday-Wednesday only. Owners of more upmarket establishments and those running craft ale pubs have been angered by the clear favouring of large pub chains.

In a development which will please followers of the #NotmovingontillDomisgone Twitter hashtag, we hear of moves to get the Metropolitan Police to investigate, following the decision of Durham Police to take no action against Dominic Cummings for his lockdown breaches. Nazir Afzal, the former chief prosecutor for north-west England, has been spearheading efforts to get the issues properly investigated, having lost his brother to coronavirus in April. Afzal’s lawyers have pointed out that the Durham Police investigation only focused on Cummings’ movements in County Durham and not on why he left London when his wife was suffering coronavirus symptoms and a day before he fell ill himself. It will be interesting to see what, if anything, emerges from this attempt to initiate a wider exploration, especially given the political sensitivity involved. One thing’s for sure – Afzal won’t give up in a hurry.

Radio 4’s File on 4 this week focused on the widely predicted mental health ‘pandemic’ to come, affecting both those who’ve long experienced mental ill-health and those experiencing it for the first time. The programme explored whether the stress and anxiety of lockdown and of the uncertain future could lead to a national mental health crisis. No doubt about it, I’d say, and not only the UK – most, if not all, countries affected. Looking at mental health services during the crisis, the reporters heard stories of early release from mental health wards and of sudden shifts in how help is provided. A while ago a mental health worker writing anonymously in the Guardian revealed how psychiatric ward staff felt like sitting ducks, with a lack of PPE and with patients who, understandably, were highly anxious and didn’t have the capacity to understand the need for distancing. Crucially, reporters asked the key question as to whether services ‘already stretched to breaking point’ will be able to cope. These services were inadequate before the pandemic and are likely to deteriorate further, unless substantial changes are made to the way mental health services are funded, structured and delivered. The same NHS people are regularly wheeled out for such programmes, always managing to portray a fairly positive view of services which simply isn’t borne out by reality. The first thing that needs to happen, in my view, is the reconfiguration of primary care services, the IAPT (Increasing Access to Psychological Therapies): this is characterised by long waiting lists and the privileging of Cognitive Behavioural Therapy, which is short-term and doesn’t go beyond symptom control, when what most people need is relational therapy. Primary care is so important because many will first seek help from their GP, not all of whom are clued up about mental health. For relational therapy they will often need to seek private help, which should be a choice, not a necessity because of poor choice of treatment on the NHS.

On the same theme, one of the most alarming things of the last 24 hours is the announcement of the government’s desire and intention for a top-down reorganisation of the NHS, catalysed by the Health Secretary’s ‘frustration’ that too much power lay in the hands of NHS England head Sir Simon Stevens. The government has apparently been exasperated at NHS trusts still not being able to balance their budgets despite ‘record funding’ and the need to get Sir Simon to agree to courses of action rather than being able to initiate it. The description of what’s intended sounds profoundly undemocratic, another example of the centralisation of power of the kind seen in dictatorships. We’re told ‘the prime minister has set up a taskforce to devise plans for how ministers can regain much of the direct control over the NHS they lost in 2012 under a controversial shake-up masterminded by Andrew Lansley, the then coalition government health secretary’. Over the summer this taskforce will present the PM with a set of options to achieve the key goal of reducing NHS operational independence, to be followed by a parliamentary bill. Influential think tank the King’s Fund said: ‘Any large-scale reorganisation of the NHS comes at a high price as they distract and disrupt the service and risk paralysing the system. The last major reorganisation came in the 2012 Lansley reforms. These proved hugely controversial for the coalition government but perhaps worse, they have not stood the test of time’. It’s frustrating and worrying that although some good things are included, such as more integration of services, the disruption mainly seems to be politically motivated and is unlikely to address the shortcomings evident in the area of mental health, to mention just one.

Coinciding with Keir Starmer’s first 100 days as Labour Party Leader, an Opinium poll in the Observer shows that 52% of voters now say they could imagine Starmer inside No 10. Two weeks ago, Opinium found more people cited Starmer as their preferred choice as prime minister (37%) than Boris Johnson (35%). But people seem to be sticking to the view that the government displays more economic competence (42% compared with 26% for Labour). The Guardian points out what a marked change all this is from March, Labour now only four points behind the Tories overall, (Tories on 42%, Labour on 38%) when back then it had been 54% and 28%. This must be due in large part to the dogged, forensic yet polite approach the Labour leader has used with the PM in the Commons, especially at PMQs.

These days we’re hearing more and more about how enjoying nature is good for our mental health, and besides high profile projects like the National Trust’s to reclaim farmland on the White Cliffs of Dover, restoring it to meadowland, there are many local efforts with small patches of land, often based on cooperation between councils and volunteers. This is important work given the context, that in the UK, 97% of wildflower-rich land – seven million hectares – have been lost to modern agricultural and out-of-town developments since the 1940s.Now, there’s a larger scale project, run by conservation charity Bugbear, to restore ‘B-lines’ all over England. Bugbear hopes to help restore and create at least 150,000 hectares of wildflower pathways with the launch this week of its B-lines network for England. B-Lines are defined as ‘a strategically mapped network of existing and potential wildflower habitats that criss-cross the country. The 3km-wide corridors stretch from the coast to the countryside and towns and cities, covering in total some 48,000 sq km of England’. The name is a reference to bees and their importance as pollinators, and the threat to various species including the long-horned bee.

It seems our over-centralising government could learn something from the charity’s approach: since Bugbear started this work 6 years ago, supported by DEFRA (Department for Environment, Food and Rural Affairs), it’s worked with various different partners, statutory and voluntary and private, including councils, wildlife trusts, landowners and highways agencies. The result has been ‘450 hectares of wildflower pathways as stepping stones between fragmented sites’. So a model for success could be what’s displayed here: cooperation, consultation, multi-partner working and preparedness to go local, coupled with the centralised overview enabled by DEFRA.

Finally, you might enjoy this witty ditty from Fascinating Aida member Dilly Keane, about Dominic Cummings – perhaps humour is one of the few ways we can cope with the continued attempts to bury this saga.

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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