Saturday 10 October

I seem to be saying this most weeks but it has indeed been another eventful week, some developments proving quite shocking when we thought it couldn’t get any worse. Leaving aside the drama across the Atlantic, the main one here must be being the loss under the aegis of Public Health England and the discredited Serco Track and Trace of 16,000 tests, meaning so many details weren’t entered into the system until a week later. Their contacts were therefore not traced, leading to possibly thousands of potential people remaining uninformed and at risk of spreading the virus. IT experts and others were shocked on learning that what ministers tried to dampen down by calling a ‘glitch’ was largely due to trying to send data via an outdated version of Excel, spreadsheet software not designed for mass data transmission, rather than a recognised database platform.

The wider context of the ‘glitch’ is a system which simply isn’t working, despite Health Secretary’s protestations to the contrary. Matt Hancock was lambasted in the House after it was revealed that just 33% of in-person test results were returned within 24 hours, months after the PM said he wanted all test results delivered within a day. As cases are rapidly rising, prompt testing is needed more than ever, but supply problems persist, many being forced to isolate at home because they can’t obtain a test or get to a centre. And more is emerging about the prevalence of asymptomatic cases: in a national survey more than 80% of people who tested positive had none of the core symptoms of the disease the day they took the test. Matt Hancock seems to have adopted a defensive strategy which consists of no longer attempting a response to critics but simply rudely dismissing them or coming out with a non-sequitur statement, as he did with Labour’s Dawn Butler last week.

Hot on the heels of the testing debacle came news, not surprising, of further restrictions in the North of England and elsewhere, and a leaked plan for a three-tier approach to restrictions and lockdowns. More and more areas are being subjected to lockdowns, possibly a cynical ploy to increase the numbers of locked down areas, approaching a general lockdown in all but name. Meanwhile, north of England mayors and public health experts are up in arms about the lack of consultation, despite business minister Nadhim Zawahi emphatically declaring that they had been consulted. I’d be more inclined the believe the angry Greater Manchester mayor Andy Burnham, who described on Question Time and other programmes a discussion with ministers where agreement appeared to be reached, but it actually hadn’t, and the first the mayors knew about imposition of further restrictions like households not mixing was seeing it in the papers. The government seems to have no idea how contemptuous this would feel to the northern politicians and how difficult it would be for them to deal with the fallout. Besides the need for proper consultation, Burnham’s key demand was no further restrictions without support: the thousands of staff working in the bars and restaurants shut down overnight had no source of income.

One of Guardian sketch writer’s Boris Johnson eviscerations this week naturally focused on his appalling conference speech, where he sounded like a parody of himself, talking bullishly about COVID19 being ‘the trigger for major social and economic change. Try to think of the virus as an opportunity rather than a disaster’ etc. ‘But up until now, he’s got away with it (being a ‘conman’) – in his public life at least – because the country has been happy to collude with him. It wanted someone who could tell a few gags and promise that everything would be OK in the end. The narcissistic fantasist as national saviour. But the last eight months have changed all that. The country has grown up in the time of coronavirus’. Felt to be a profoundly misjudged speech, in which Boris alluded to people being ‘fed up’ with the virus and how he was working to get things back to normal…. ‘There was nothing on the toll the last eight months had taken. No apologies for government inaction, failure and incompetence that has seen the UK leap to near the top of the global COVID mortality scale’. A fantasy land speech including the promise to fix social care (a can kicked down the road so often it must be severely dented by now) where the PM failed to even convince himself, let alone party members and viewers.

The second John Crace evisceration focused on Boris Johnson’s increasingly poor and bizarre performance at Prime Minister’s Questions. Resorting defensively to questioning the Labour leader when he’s the one supposed to answer questions, his defeated demeanour apparently contradicted his assertion the night before that he had rediscovered his ‘mojo’. ‘None of this is what Boris had ever wanted or planned. He had signed up for the glory and the applause. Not to see the country through its biggest health crisis in 100 years. Six months in and he’s all but out of ideas. He knows that. And more importantly his own backbenchers know that. Even though the whips have tried to get MPs to sound more enthusiastic, no one is fooled.’ The Labour leader kept hammering home the severity of the missing cases and contacts, getting deflections and non-answers in response. One of the embarrassments for the government is the cases have actually risen in 19 of 20 lockdown areas, proving the strategy isn’t working. ‘Boris chuntered on, but by now no one was listening. Rather there was a general feeling of futility on both sides of the house. The Tories despair of a leader who gets weaker with each outing and no longer appears to really want the job’.

What must be puncturing the PM’s increasingly effortful joie de vivre even more is that normally loyal right wing newpapers are beginning to challenge him, the Telegraph and the Mail leading the charge. Both papers criticise the lockdown strategy for curtailing freedom but also question the effectiveness of the measures introduced. While a no 10 spokesman said: ‘We live in a liberal democracy and you would fully expect open debate on these matters’, it could prove unsettling for the government as the winter approaches if more papers go the same way.

It stands to reason that in order to ‘beat the virus’ (in gung-ho government parlance) or even live with it, we need to operate within the context of decent public services. Unfortunately, these have been decimated in recent years and in the Guardian Richard Vize describes a disconnect with the Build Back Better slogan. ‘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…. Tens of thousands of deaths from disrupted healthcare could follow’. Apart from the longstanding crisis in social care, nearly every part of the public sector is short-staffed – this needs rectifying and the ‘excessive dependence on consultants’ needs to end. Vize effectively suggests a reconfiguration of government, enabling public health to be ‘brought out of the shadows and put at the heart of public services’, and it must be brought into overarching policy rather than left in a silo. ‘The pandemic has shown how public health permeates everything from industrial production to transport. It needs to be integral to public policy’.

Talking of consultants, Brexit preparations have apparently involved the government spending amounts rising by 45% to more than £450m in three years. Eight top management consultancy firms were cited, the top of the heap being Deloitte, which pocketed £147m in 2019/20 alone. ‘While 1% of civil servants are paid more than £80,000 a year, day rates for management consultants working in the public sector range from about £1,000 for junior consultants to about £3,500 for partners’. It’s rather shocking to see the table detailing what each government department spent on consultancy over the last three years. Just imagine what could have been done with that in the NHS or social care. Yes, there will be a need for some consultancy, but this level is simply off the Richter Scale and begs the question, where is Whitehall’s own expertise? While Deloitte said ‘We are confident that our work adds significant value to the public sector organisations we work with’, a government spokesman said they didn’t recognise some of the figures quoted and ‘We continue to take considerable steps to reduce unnecessary spending and protect taxpayers’ money’.

Keep a look-out for the green lapel ribbons today and wear your own if possible – it’s World Mental Health Day (the theme of mental health for all is set by the World Federation for Mental Health and led in the UK by the Mental Health Foundation). Various pieces of research are underway, including MHF’s own work on resilience (or not) across the UK during the pandemic. One finding was that ‘most people (64%) say they are coping well with the stress of the pandemic. However, many are struggling with the current crisis’.  The Resilience Research Centre defines it this way: ‘In the context of exposure to significant adversity, resilience is both the capacity of individuals to navigate their way to psychological, social, cultural and physical resources that sustain their wellbeing and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways’. ‘Resilience’ has become a controversial concept in the mental health field because it’s felt in some quarters to put disproportionate responsibility onto the individual to resolve their difficulties, to justify offering fewer services on the NHS, and to ignore the underlying systemic issues such as poverty and poor housing which contribute to mental ill-health in the first place. On the other hand, it is a necessary personal quality to cultivate, so the term needs treating with some caution.

At the same time is the not surprising news that, based on research carried out for the Royal College of Psychiatrists, one in four are waiting more than three months for mental health treatment – this is putting it mildly. We hear of much longer waiting lists, longer than a year in some places. ‘The delays are leading to patients ending up in A&E, seeing their mental health decline and experiencing problems with their work, finances or relationship. RCP warned that the big increase in mental health problems caused by the Covid-19 pandemic could result in even longer waits for care’. We already know there’s a ‘mental health pandemic’ and this research reinforces earlier findings. A Department of Health and Social Care spokesman acknowledged the pandemic-related need and said: ‘We are committed to increasing the mental health workforce. Mental health services will expand further and faster thanks to a minimum £2.3bn of extra investment a year by 2023/24 as part of the NHS Long Term Plan.’ The problem is that this ‘expansion’ has been left vague and the amount is insufficient to even plug earlier gaps in services: professional bodies like the BACP (British Association for Counselling and Psychotherapy) are regularly pressing the government on what this boosted workforce will look like, when the desperate need is for more qualified and experienced professionals to offer psychological therapies of choice (not restricted to CBT, which many find doesn’t touch the sides).

This year the Queen’s Birthday Honours have especially recognised people’s contributions during the pandemic –  two high profile ones being fitness guru Joe Wicks, the ‘nation’s PE teacher’ and footballer Marcus Rashford, who forced the government to U-turn over free school meals. Both get MBEs. Yet again, though, it does prompt the wider question of the uses and abuses of the honours system, which too often, especially in the recent Prime Minister’s Honours, is seen as a route to bribing or acknowledging cronies.

You might be interested in the new series on Radio 4 of the Moral Maze, which involves a panel of public figures interviewing a series of ‘witnesses’ on a key topic, this week being the role of lived experience in policymaking. How much of a role should it have? Is it essential or does it cloud judgement? This is a key theme in discussions on mental health policy but I don’t think this episode focused on that, interestingly.

Finally, fans of the Sicilian detective Salvo Montalbano will be delighted that he’s back on BBC4 tonight, and yes, it’s new, not a repeat, with actor Luca Zingaretti credited as co-director for the first time. Even if you don’t care for Montalbano, it’s worth tuning in for the ‘gorgeous Sicilian backdrops’ and the opening sequence of that inimitable theme music accompanying the swooping camera shots panning the mountains and bays of South-east Sicily.

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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