Saturday 17 October

With a week like this, during which COVID cases have risen by 50% (now about one in 160 according to the Office for National Statistics) and the government has imposed its much-trailed Three Tier strategy, it could be easy to overlook other important news, such has been the resulting outcry. Under the new rules, nearly a third of the country – more than 17 million people – face localised restrictions. It has seemed that the government is trying to drive a wedge between the northern politicians, some going along with the government’s Tier 3 status for their areas, but Andy Burnham for Greater Manchester still resisting it, without further financial support. It’s now thought the restrictions will be imposed on Greater Manchester regardless. Having largely ignored local politicians and public health experts for months, prioritising hubristic centrist ideology over the nation’s health, ministers are finally, when it suits them, talking about the importance of ‘putting party politics aside’ and ‘working together’. You couldn’t make it up. Regarding Tiers 2 and 3, at one fell swoop the hospitality sector has taken a major hit (likely to prove fatal in numerous cases) and the mental health of single person households (15% of the population) has been put further at risk through the prohibition on separate households meeting inside.

I forecast widespread non-compliance (plenty of evidence already) and the mass purchase by pubs and restaurants of environmentally unfriendly patio heaters, if they have the funds and the space for outside seating. Illogically, you can visit a restaurant alone and therefore be in the same space as many more households, and are cash-strapped venues intending to ask customers whether they’re in the same household? If faith in the PM and his government wasn’t already seriously undermined, it surely would have been with Chief Medical Officer Chris Whitty’s statement at the press conference that he was not confident even this strategy would be sufficient to slow the spread of the virus. Immunologist Professor Sir John Bell has just said the same thing.

It also emerged that SAGE warned weeks ago that more urgent action was needed but the government ignored it. Besides the ‘circuit breaker’, SAGE had recommended advising all who could to work from home; a ban on household mixing in homes, except for those in support bubbles; the closure of all bars, restaurants, cafes, indoor gyms and services such as hairdressers; and all university and college teaching to be online “unless absolutely essential. So, it looks quite possible that even these latest measures will prove insufficient and we will be back to general lockdown within weeks, except, unlike countries like France, Spain and Italy, the UK lacks the resource to police it, leading to a quasi-lockdown.

Many have commented on the no-brainer that what’s really essential in slowing the progress of the virus is an effective test, track and trace system, but we are still no nearer that given the litany of failures it’s been dogged by. And still no sighting of Baroness Dido Harding, who should be out there ‘straining every sinew’ to improve it and defending her record. It’s almost as if ministers have agreed to shield her from scrutiny. It emerged that only around one fifth of those who should be self-isolating were actually doing so but this couldn’t be solely attributed to selfishness, as in many cases people can’t afford it without support. Labour’s Zarah Sultana tweeted: ‘People need a liveable income to be able to self-isolate, but working class people aren’t getting that support. Instead, as the PM made clear to me today, many have to choose between self-isolating in dire poverty, or the risk of a £10,000 fine. Outrageous’. Although yet again the devolved nations seem steps ahead of the Westminster government, the science and experience outside the UK must make us wonder whether lockdowns don’t work, since the minute they’re eased the situation worsens. A Radio 4 listener tweeted: ‘Lockdowns are a blunt instrument – so much points to the lack of an effective track and trace system, which the government isn’t going to fix any time soon, thanks to its disastrous crony outsourcing policy’. Another said: ‘Phew!! It’s official now. UK is following herd immunity strategy. Tiering is just a whitewash’.

Meanwhile, both the government and the media continue to ignore the wisdom of Independent SAGE, which ran another webinar on Friday which anyone could join, demonstrating transparency and inclusiveness the government has rarely shown any grasp of.

Guardian sketch writer John Crace wrote several disembowelling pieces this week, starting with this description of that press conference. ‘Johnson looked knackered before he even started… For a moment it looked as if the narcissist had been confronted with his own sense of futility. A situation that he couldn’t bend to his will, no matter how delusional the thought process. He is cornered by hubris: a man hating every second of his life but condemned to experience its unforgiving horror. Not even the health secretary could be bothered to attend to watch this latest meltdown….Yet all he had really achieved was to remind everyone that he was out of his depth and had no real answers to anything. Like all of us, he was just dancing in the dark. Beam me up, Whitty’. This gets close to the central message of this blog:  the nation’s mental health is severely undermined in an already gruelling situation when its leaders, who we justifiably look to for psychological ‘containment’, are incapable of delivering it, cannot be trusted and have no real authority. A Radio 4 listener tweeted:  ‘Time is of the essence…’ says Boris Johnson, whose whole government has had an irony bypass. Shame he didn’t say so before as so much time has been wasted by his uncoordinated and corrupt CovidUK strategy’.

Crace also slated the PM’s performance at Prime Minister’s Questions, in a piece called ‘Starmer has the intellect, the economics, the science. Johnson has his apathy’ suggesting that Johnson is no longer even pretending to counteract Starmer’s forensic forays, instead falling back on trying to ‘make PMQs look like a meaningless charade, to minimise the beatings’. He was apparently surprised at an entirely predictable question, that is at what point did he ‘decide to abandon the science and cobble together a three-tier regional system with which almost no one was happy?’ ‘Boris looked genuinely bemused. As if he had quite forgotten it was Wednesday and had been hoping for a lie-in. So he did what he always did. He filled dead air with dead words. When he had said he was going to follow the science, he had never intended to imply he would do so faithfully. Rather he was going to pick and choose the bits he liked’. ‘Of course Boris Johnson won’t take Keir Starmer seriously’ said one tweeter at the PMQs hashtag – ‘Sensible policy must be sacrificed on the altar of Tory hubris’.

Speaking of hubris, we can’t ignore the Brexit news this week and clear evidence that the PM’s sabre rattling brinksmanship and setting of unnecessary deadlines is rapidly unravelling. The epitome of fibs must be the regular allusion by politicians to an ‘Australia type deal’ (aka No Deal), a disingenuous way of saving face skilfully demolished on Any Questions last night by former World Trade Organisation DG Pascal Lamy when wheeled out by trade policy minister Greg Hands.

Not content with two PM eviscerations in one week, Crace turned his attention yet again to his other favourite target, Health Secretary Matt Hancock, again painting a worrying picture of cognitive dissonance. In a piece entitled ‘Teetering Matt Hancock ignores head and heart and sticks to PM’s script’ and subtitled ‘Door Matt knows a circuit breaker is the right way to go but he lacks the strength to stand up to Boris’, he describes what he calls a ‘spectacular’ fall from grace. He suggests that at the start of the pandemic Hancock seemed to have a grasp of the situation but one failure and missed target after another soon put paid to that although he could persuade himself he’d stuck to ‘the science’. ‘But even that escape clause for his conscience was snatched away once the prime minister chose to ignore Sage’s recommendation to introduce a circuit breaker in September and then chose not to disclose the evidence until this week’…Now Door Matt finds himself ground down by Boris Johnson’s desperation to please the crowd and he just reads from whatever script is put in front of him. He doesn’t even bother to check the details as he can be fairly certain they are incorrect’…. He apparently wheeled out the cliché ‘Things will get worse before they get better’, as if that was remotely acceptable. ‘He wasn’t kidding. We now have a government masquerading as a piece of self-destructive performance art’.

Following on from last week’s piece about the massive amounts spent by the government on Brexit consultancy, more news emerged this week of colossal sums disappearing down the test, track and trace rabbit hole. Apparently management consultants including the Boston Consulting Group are being paid as much as £6,250 a day to work on the system, amounting to an ‘eye watering’ £12 bn. But the BCG tentacles have reached further than this and we’re told that ‘publicly available data collated by the Spend Network show that they were awarded contracts worth at least £18.3m for work related to the pandemic’. As if this wasn’t jaw dropping enough, it seems that BCG are actually amongst smaller fry in this scenario – ‘BCG’s 40 workers are only a small fraction of the 1,000 consultants employed by Deloitte on the system’. The profoundly worrying thing (amongst others the Good Law Project is trying to plumb the depths of consultancy contracting), is the lack of transparency resulting from the suspension of normal tendering procedures during the pandemic. ‘None of these appointments has been announced publicly, no costings have been published, and there is no information about how the Department of Health and Social Care (DHSC) will secure value for money from the consultants’. Another often overlooked downside is the loss of organisational expertise and infantilisation which increased dependency on consultancy leads to.

Much has been said about the crisis in social care, the can kicked down the road for years by successive governments, but news today should have been a real wake up call. Whereas days ago, looking ahead with more promises, the PM said he was going to fix social care (when?), it was said today that the sector needs urgent funding within the next few days – not weeks or months – as private homes were in danger of going to the wall. The crisis is due to the number of empty beds due to the pandemic, deaths and new residents unable to move in, but also the funding model often based on private equity. Closures would leave thousands without a home or a job and be simply unacceptable anywhere, let alone a developed country.

A Department of Health and Social Care spokesperson said: ‘We recognise the challenges facing the social care sector and we are doing everything we can to support it’. Nowhere near enough, many have argued. The National Care Association said: ‘The statistics are alarming and provide a stark warning as we anticipate a second wave. Social Care provision has been fragile and ignored for too long’. Nevertheless, some policymakers don’t advocate an entirely national service. This article on the King’s Fund view makes clear the appeal this may have but points up key differences, eg social care has eligibility criteria and NHS doesn’t. ‘Who is eligible for publicly-funded care, who manages and commissions it, who provides it, who regulates it and how it is funded are distinct issues that don’t all have to sit in the same place and may not be best carried out at a national level….. a nationalised service would be hugely expensive, legally difficult and time-consuming to implement, without necessarily delivering the benefits its proponents expect’. The King’s Fund recommends a mix of providers – public, private and voluntary, locally commissioned and those organisations ‘embedded in the community’. This in itself is problematic as it takes time to achieve this engagement and embedding, but the real sticking point is that all this ‘requires local authorities to pay providers a fair price for good quality care, which in turn requires national government to fund councils adequately’.

It seems to me a big mistake to have allowed private equity anywhere near the care home sector – sensing decent gains in the wake of government austerity and losses in other PE areas, these companies ‘piled in’, only later to reap the overlooked complexities and mounting debt. But, as so often, short-termism prevailed and PE may have felt welcome at a time when central government was making severe cuts to council budgets.

As the importance of nature moves further up the public agenda in terms of maintaining mental health and tackling climate change, it’s puzzling that adherents of ‘wild swimming’ must be regularly ignoring notices warning that this activity is prohibited in many waters and that only one in seven of English rivers are considered ‘ecologically healthy’. The Week tells us that the Environment Agency set a target for 75% of English rivers and lakes to meet the ‘good’ standard by 2027 (that’s quite some way ahead) but predicts that it won’t be achieved. The main barriers are said to be raw sewage discharged from storm overflows and agricultural run-off but there’s also the danger of swimmers contracting Weil’s disease from water contaminated by affected animals such as rats. The situation in Scotland sounds better (64% of rivers rated as healthy) but the average across Europe is only 40%. This is interesting as not long ago there was an interesting article about how the main rivers in some European capitals were being geared up for swimmers. It sounds a great idea as long as health and safety measures were in place but what about all the river traffic?

One development excellent for both physical and mental health which sounds far more promising is that of mapping Britain’s intercity footpaths via a ‘slow map’. A BBC piece about this interviewed one woman who had never walked to the next village just a few miles away. The assumption of car use and more inactivity mean this won’t be a surprise to many, but a major disincentive is the lack of known routes away from main roads, where the pavement soon disappears and heavy traffic makes the experience unpleasant. ‘Geographer Daniel Raven-Ellison is offering a solution; a new map created by volunteers during lockdown to show the best walking routes between all of Britain’s main towns. All that is needed now is 10,000 keen walkers to test out the routes on his ‘slow’ map’. Interestingly, the article carries a photograph of a walkway looking remarkably like one near here in North London. It also makes clear just how important this development is. ‘Coronavirus is changing life in many unexpected ways and those who think more walking should be part of our lives now have a new tool. Maps do not just describe the world, they can often help change it’.

Finally, the Radio 4 series of profile programmes is typically bang on topical with tonight’s subject of Liverpool mayor Steve Rotherham. A former bricklayer, it’s cheering to hear of politicians who’ve had ‘a proper job’.

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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