Not eclipsed by the news about POTUS, another eventful week, to put it mildly, and perhaps we should no longer be surprised that both our PM and skills minister Gillian Keegan on Tuesday couldn’t answer questions on the detail of local lockdown restrictions, which of course makes them less enforceable. It’s been very telling that there was such a backbench rebellion and Speaker condemnation about Parliament not being consulted on COVID legislation. Boris Johnson seems to have quelled this for now, but it was noticeable that Parliament was only promised consultation ‘as far as possible’, keeping the government’s door open for unilateral imposition. And local government is still not being properly involved in local lockdown decision making and in crucial data sharing. This time it was the turn of Secretary of State for Business, Energy and Industrial Strategy, Alok Sharma, to defend the indefensible. In a car crash interview on Radio 4’s Today programme, he was very defensive and kept repeating that people should consult the government website to check the regulations for their areas. Quite apart from the fact that all ministers should be abreast of the changing regulations, there’s the issue of the digitally excluded, who would not be consulting the government website any time soon.
In one of his habitual eviscerations, Guardian sketch writer John Crace dissected the PM’s poor performance at Prime Minister’s Questions and even poorer one at the later press briefing. ‘We will fight and beat the disease, Boris said, as if every other country had just given up on the idea. ‘We will not throw in the sponge’…. Though, in truth, it rather looked as if Boris had done precisely that. He looked dreadful, his eyes puffy and bloodshot and his complexion pasty, as he repeated the measures he was taking that were clearly not really working that well. He sounded like a man waiting on a miracle’. I can’t have been the only one half expecting Boris to follow the ‘sponge’ comment with a reiteration of the previous week’s proverb, ‘a stitch in time saves nine’, although, manifestly, there have been no ‘stitches’, or the wrong ones, that failed to keep the knitting together.
On the subject of performances, surely one of the most disgraceful for some time, (astonishingly, not picked up by the Speaker) was when Slough MP Tanmanjeet Singh Dhesi asked when the Slough test centre would be back up and running, some locals having been forced to go to the Isle of Wight for a test. Instead of answering the question, Matt Hancock said how hard work test centre staff had been working and ‘I simply won’t have it, this divisive language’. This is a shocking example of misrepresenting legitimate concern and scrutiny.
As COVID cases continue to rapidly rise and fears of another general lockdown increase, a poignant article in the Guardian highlighted the existence of a frailty scale (endorsed by NICE, the National Institute for Health and Care Excellence, which determines NHS policy and treatment). This is said to effectively ration treatment for older and disabled people who become COVID patients. Of course we’ve heard statements on this issue before, but this is the first time I’ve heard of a firmly documented scale. The Clinical Frailty Scale is described as ‘a worldwide tool used to swiftly identify frailty in older patients to improve acute care’, but the article’s author doesn’t see it as a tool to ‘improve’ care. ‘Rather than aiming to improve care, it seems the CFS – a fitness-to-frailty sheet using scores from one to nine – was used to work out which patients should be denied acute care. NICE’s guidelines advised NHS trusts to “sensitively discuss a possible ‘do not attempt cardiopulmonary resuscitation’ decision with all adults with capacity and an assessment suggestive of increased frailty”. Chilling stuff: it’s not hard to imagine the fear this would strike into the hearts of vulnerable patients. The NICE statement is worded diplomatically (some may say euphemistically) but we have to wonder whether a properly resourced NHS would have to resort to such a thing. ‘The human race has progressed to an era where diversity and inclusion enriches us all, but a deplorable NICE Covid 19 policy has instead regressed 100 years to the darkest era of social Darwinism where medical care could be denied to those of us who are less fit and healthy’.
Radio 4 recently serialised ‘Dear Life: a Doctor’s Story of Love, Loss and Consolation’ by palliative care doctor Rachel Clarke, aka ‘doctor_oxford on Twitter, where she often takes Matt Hancock to task for misleading statements and the like. Described by the blurb as ‘a thoughtful and uplifting meditation on mortality and end of life care’, it’s another reminder of the difficulty much of society still has around death. You may have heard an excellent series a while back, presented by the inimitable Dame Joan Bakewell – We Need to Talk About Death. The pandemic has increased awareness of this need to talk about it and not to push it under the carpet in the stigmatised way it used to be. The blurb is right to use the word ‘uplifting’: despite the subject matter it’s not at all gloomy and the part about her father’s illness, decline and death is almost unbearably moving.
A number of articles have recently focused on how well Italy has managed the pandemic overall, when it might have been thought at the start that the exuberant Italians wouldn’t have been prepared to comply with rules. As one Italian author puts it: ‘My native land is usually depicted as a beautiful place whose abundance of natural and cultural treasures is entrusted, alas, to its disorganised, corrupt, unruly inhabitants… Now, an article on the US website Foreign Policy presents Italy in almost mystical tones, as the country that “snatched health from the jaws of death”… Is this global surprise at our collective behaviour flattering or patronising? Most of all, our national pride is sobered by the understanding that things are far from over’. No hubris here.
What follows is a useful analysis of the contrasting approaches of Italy and Sweden, at the same time being very clear that we’re not ‘out of the woods’, cases are rising again and that it’s too early to say which country will be shown to have had the best strategy. She believes the main issue is the contrast between governments which are ‘taking full responsibility for their actions and those that leave their citizens in a haze of uncertainty, and have unaccountable leadership’. Which ones could she possibly be talking about? She finally suggests a new understanding of the nature of democracy: ‘Accountability and transparency no longer look like the outer frame of democracy into which the more relevant policy details are placed. We now see them clearly as democracy’s very fabric. Something without which everything else – health, society, peace, life itself – is in grave danger’.
An article in Psychology Today (How COVID 19 hijacks a psychological vulnerability) focuses on the still-neglected area of the pandemic’s effects on mental health, inter alia puncturing the myth that ‘the virus doesn’t discriminate’. The intertwined relationship between our physical and mental health has been known for some time, yet it still doesn’t filter through to common understanding or what we experience from GPs, who often continue to treat only the physical symptoms. ‘Our psychological states, especially the experience of chronic stress, may present a major vulnerability for severe COVID-19 complications. Even more worrisome, COVID-19 may be worsening the very mental patterns that are contributing to our current predicament’.
Evidence now shows that the virus does ‘discriminate’, for example by disproportionately affecting older people, black and Asian people, the obese and those with underlying conditions such as heart disease and cancer, these very conditions strongly correlated with increased stress. ‘Scientific research also sheds light on the strong tethers between chronic stress and immune dysfunction. This is a central focus of the growing field of psychoneuroimmunology’. The article then describes the important links between these health conditions, stress, inflammation and compromised immune systems and makes a case for the role of stress in COVID 19 to be more generally acknowledged and addressed. A key point it doesn’t mention is that stress and anxiety are greatly exacerbated when we cannot trust our leaders to devise and implement an effective pandemic management strategy.
Still on mental health, it’s good to hear that, following earlier work this year on the importance of touch, which invited us to participate in a survey, psychologist Claudia Hammond will next week be presenting a series of short programmes (Anatomy of Touch), focusing on the effects of COVID 19. There had already been a decline of touch in society but overnight it plummeted, given social distancing requirements, and the effects of this are rarely openly discussed. The programme blurb’s allusion to ‘touch hunger’ made me think this was the kind of concept there’s often a long, compound German noun for. I’ll be checking with a few Germans. A social media source had a discussion about this, some saying there wasn’t a word for it, but one suggestion was Nähebedürftigkeit (craving closeness).
Some positive news this week was that in the smart Surrey town of Walton-on-Thames, a letting agency has opened in a prime site, one designed for homeless people, thought to be the first of its kind in the UK. RentStart has been operating for a few years but perhaps in a less prominent and upmarket location. CEO Helen Watson pointed up the levels of deprivation in that area despite its initial impression, saying ‘I thought ‘why don’t we seize the high street back for us? And why don’t we make our clients have the best experience? We’re making a stand about it, saying ‘come in’, removing the stigma and being proud of who we are’.
Exemplifying the level of hidden housing need, about 450 contact RentStart every year, 150 finding accommodation with the 30 private landlords who work with RentStart to offer accommodation to low income people. Good for these landlords but it’s reassuring for them that they’re given a written guarantee that any unpaid rent will be covered and one month’s rent will be paid in advance. Even more positive is that the charity offers more besides accommodation, helping clients with skills training, such as budgeting, CV writing, or setting up meetings with potential employers. It also runs and runs a matched-savings scheme to help people start saving, so enabling them to put into practice some of this skills training.
What a great example of meeting need, in contrast with the longstanding chaos of the housing market. Ms Watson wants to see similar organisations all over the country and ‘is interested in helping others replicate what it does’. She believes that the pandemic has made people see more clearly that ‘personal circumstances can change in a nanosecond and that homelessness can affect anyone, even in leafy towns and villages’.
Finally, you might be interested to see this lovely little film, made during lockdown by a local film director about a community café many of us visit around here. A great example of community engagement, even more important during these surreal times, it’s the story of the café and its owner, a French-speaking Algerian brought up in Normandy, what the café means to him and also to locals, several of whom (including me, looking too serious) feature in it.