Sunday 8 August

Although we’ve now officially entered the ‘silly season’ regarding news, there’s plenty of it and, more insidiously, ‘living with Covid’ seems to have been conflated with normalising the damning statistics (92 Covid deaths on Friday and 31,808 new cases), not to mention the terrible health, financial and societal side-effects. Our Prime Minister continues to shame this country, first refusing to accept Nicola Sturgeon’s invitation to meet on his visit to Scotland, his ‘crass’ joke about Margaret Thatcher giving a “big early start” to green energy by closing coalmines, and by demonstrating yet again what’s now trending on Twitter – #oneruleforthem. He has refused to self-isolate after having been in close contact with a staffer who tested positive, although Downing Street denied this, of course. Anneliese Dodds, Labour party chair, said it was clear Boris Johnson ‘hasn’t learned anything from what happened last time he tried to cook up a reason to be above the rules everyone else has to follow…Senior Conservatives are really taking the public for fools. This is yet another example of one rule for them and another for everyone else’. It’s not surprising, then, that we hear Johnson’s approval rating has dropped to its lowest level since October 2020, now -16, according to the Observer poll Opinium.

While the Prime Minister is at Chequers again for the weekend, COP26 supremo Alok Sharma has attracted flak for jetting around the world in his diplomatic mission to get a global climate deal agreed, although this has been defended by some experts and campaigners. The timing is important as Monday a ‘landmark report’ will be published by the Intergovernmental Panel on Climate Change. ‘Details are still under wraps, but the Guardian has confirmed that the warning from the IPCC will reinforce how vital it is to try to prevent temperatures from reaching more than 1.5C above pre-industrial levels. Beyond that threshold, scientists will warn, the consequences of extreme weather will be devastating. The world must act urgently: if greenhouse gas emissions are not halved in this decade, 1.5C of heating will be inevitable and probably irreversible’. This does raise an interesting debate, though: to what extent should high-level activity of this nature be allowed to release those involved from obligations they’re desperately trying to get the rest of us to wake up to?

Meanwhile, much in the news again this week is what some describe as the ‘obsession with foreign holidays’, as the government’s ‘traffic light’ system comes into further disrepute, thought to be driven more by politics (eg regarding the withdrawal of quarantine requirement for those coming from France) than science. Ministers have not released data on which their decisions are based and the latest change to get people up in arms is Mexico moving to the red list. If those tourists don’t make it back to the UK before the deadline, they face large bills for the required stays in quarantine hotels.

The ‘amber watch list’ was also abandoned after it emerged a top adviser had left. In yet another scenario you couldn’t make up, it seems Transport Minister Shapps was the author of the scheme he later turned against. His colleagues were reportedly ‘furious’ as he initially briefed for it, then against, then tried to blame the Prime Minister. You have to love the way Boris Johnson said that he wanted ‘a simple traffic-light system for international travel’ – right. The current hokey-cokey can hardly be described in such terms. Citing the two week delay before putting India on the red list in April, Labour’s Ben Bradshaw said decisions about the traffic light system were an ‘absolute scandal’ and had ‘nothing to do with public health and everything to do with politics…The government has repeatedly failed to publish the detailed data on which its decisions are made…Every other country in Europe does this, so the public and business can plan. Air passenger numbers in Europe have already recovered to about 60% of pre-Covid levels, while the UK figure is 16%’.

But what seems increasingly clear is that ‘staycations’ aren’t always the answer. The BBC showed packed beaches in Cornwall (lifeguards estimated 14,000 on Perranporth beach at one point last week), local services including the NHS under severe pressure, long queues for everything and some people complaining about empty shelves in shops, staff shortages in restaurants and inflated accommodation prices. This is surely another example of a serious issue not being thought out by the Westminster government – they would have known long ago that Covid measures would put much more pressure on the UK’s seaside resorts but what help did those local authorities get when most are already suffering from significant cuts in their budgets?

And this is only if you can afford a holiday in the first place – for many low-paid workers it’s proving impossible. ‘Ministers have urged Britons to holiday at home but big rises in the cost of accommodation and limited availability have made that impossible for many. Inevitably, it is the people who have been most stretched during the pandemic, poorly paid frontline workers, who are in greatest need of a break and least able to afford one’. Another Observer Opinium poll registered findings which aren’t surprising, eg people in higher social and economic groups were much more likely to have taken a holiday abroad, but this is a stark finding: ‘almost two-thirds (64%) of the poorer group said they had not taken and had not booked a holiday this year; that figure was 52% for the wealthier group’. What a shame this is: those frontline workers really need a break yet one NHS worker quoted said she was now only looking to 2023 for a holiday.

The forever jaunty Grant Shapps came in for a second dose of opprobrium last week. When interviewed on Thursday’s Radio 4’s Today programme and asked about the secret ‘advisory board’ of rich Tory donors and their potential influence on government policy, he described them, in an outrageous example of disingenuous gaslighting, as people ‘who love their country and want to see it prosper’. For ‘prosper’ read changing policy to support crony profitmaking.

Three other ministers have also been in the news and not for positive reasons. Prominent Brexiteer Steve Baker has now called Brexit ‘a fiasco’, Foreign Secretary Dominic Raab failed to quarantine on returning from France and, maskless, met Princess Anne only days later, and health minister Lord Bethell continues to be under pressure for appearing to take steps to avoid scrutiny regarding the award of crony contracts and use of private messaging rather than official email. He claimed to have broken and replaced his mobile phone, thereby rendering inaccessible the WhatsApp exchanges which could otherwise incriminate him. At issue is the controversial award of £85 million in contracts to Abingdon Health last year, for Covid testing kits, following a private meeting which Bethell did not declare.

We shouldn’t have to depend on private organisations taking the lead on this but again, the Good Law Project is leading the way. During an interview with James O’Brien on LBC, director Jolyon Maugham said: ‘These [contracts] involve epic amounts of public money so we need to be sure that they’re not doing what Dominic Cummings admits he’s done twice, which is giving contracts to his friends. You have a duty to account to those who give you that public money through our taxes and explain how it is that you came to award these weird and wonderful contracts to your friends or Tory donors…If you deliberately destroy evidence or break your phone… it’s very possible that you’re committing the criminal offence of perverting the course of justice. Once we receive the answers to the questions that we put to the lawyers acting for the Department for Health, we will be taking a close look at whether a criminal offence has been committed’.

Last week we heard that the NHS had gone down from 1 to 4 in a list of 11 countries’ health systems compiled by an American think tank, the Commonwealth Fund. Numbers 1-3 are now Norway, the Netherlands and Australia. Siva Anandaciva, chief analyst at leading UK health think tank the King’s Fund said: ‘According to this report, our previously world-beating health service is at risk of moving to the middle of the pack, largely due to growing delays across the system in people’s ability to access care quickly’. It’s hardly a surprise, because of this government’s longstanding underinvestment in the NHS, and this analyst makes clear the situation can’t be attributed solely to Covid. ‘We can’t brush this under the carpet as being solely a consequence of the impact of the pandemic on patients, staff and services. Even before Covid, waiting lists for treatment were already sizeable after a decade of stalling funding and a growing workforce crisis. As Covid put the NHS under unprecedented pressure, the waiting list for routine NHS care has ballooned to levels not seen since the early 2000s. Whilst the NHS is doing its best to keep services running, increasing demand for hospital, mental health and GP services means the whole health and care system is now facing a capacity crunch’.

This article is interesting, if depressing, on the criteria used for ranking countries. The UK’s rating declined on three important criteria: access to care; care processes, which look at the co-ordination of treatment and how well patients are involved; and equity, or the ability to obtain healthcare regardless of income. The UK was described as ‘a remarkably lean spender among high income countries’. Apparently ‘nearly 60% of adults in the UK found it somewhat or very difficult to obtain after-hours care, one of the highest rates among the countries surveyed’, and as we well know, mental health services have been inadequate. ‘Just 33% of patients said that they got counselling or treatment for mental health problems when they sought help from a specialist in psychological or psychiatric illness – a new indicator that the think tank had not previously analysed. The NHS was the second worst performer of the 11 countries on that criterion, just ahead of France’. This doesn’t surprise me at all – there are long waiting lists for most IAPT (Improving Access to Psychological Therapies) services and often poor choice of treatment, Cognitive Behaviour Therapy being privileged when what many actually need and want is relational therapy.

We hear, not surprisingly, that with the NHS on its knees, funding will be a stand-off between Health Secretary Sajid Javid and ‘hard-nosed’ Chancellor Rishi Sunak. While GPs report having to deal with many more patients in pain because of long-delayed procedures, the crisis overall is attributed to a convergence of ‘Covid issues, the emergence of health problems hidden during the pandemic, soaring waiting lists, an exhausted workforce and the continued pressures on capacity caused by increased infection control’. In turn, NHS Providers chief executive Chris Hopson attributes the funding crisis to an insufficient settlement in the first place, expensive new manifesto commitments, a social care crisis, a massive care backlog and ongoing Covid costs. ‘Any one of those by themselves would be a major pressure. The problem is the combination of all five of them at once…. “There’s real danger of a very large gap between the Treasury and the NHS, the Treasury insisting that they have to regain control of the public finances and get back to the May settlement as quickly as possible – the NHS saying that the demands on the service have changed dramatically and they can’t provide the right quality of patient care in a world of Covid-19 unless those pressures are recognised. It’s difficult to see how those two views get reconciled’.

It was shocking enough hearing recently that the NHS waiting list was about 5 million – it’s now predicted it could rise to 13 million before it starts to fall. Two key factors add to the conundrum’s mix – the new NHS Chief Executive, Amanda Pritchard, and Javid himself, who, as former Chancellor, had a reputation as a ‘fiscal hawk’. But the Prime Minister will also be involved, the King’s Fund said. ‘There won’t just be wrangling between the Department of Health and Social Care and the Treasury. No 10 always has a strong hand in NHS funding decisions and will have a keen interest in showing the electorate that a Conservative government can be trusted on the NHS’. Unfortunately, we’ve seen plenty of signs suggesting that the Conservatives cannot be trusted with the NHS but some commentators think that the 2024 election on the horizon might concentrate minds this time around.

There have been a number of reports in recent years on the need for better investment in mental health services and we need these more than ever, as the pandemic has given rise to much higher demand. The latest report is from the Centre for Mental Health (Now or Never) and calls for strategic government spending on mental health and for services in England to radically change to be fit for the future and respond to the aftermath of the pandemic. Crucially, it points out that it’s not only about investment but about addressing longstanding structural problems in the way services are conceived and delivered, including the inappropriate historical divide between physical and mental health services. Staff shortages are significant, but as the British Association for Counselling and Psychotherapy (BACP) has long pointed out, thousands of well qualified and experienced counsellors and therapists are available for recruitment to help resolve this. But unfortunately the NHS has pursued a policy of training up a separate workforce, primarily in CBT (Cognitive Behavioural Therapy), which is not only wasteful but also continues to sideline approaches to therapy which are often found to be much more helpful to patients. The report also highlights the important need for focus on preventative work, less costly in the long run.

BACP makes the good point that health inequalities across England reinforce the need for mental health services to feature in any real ‘levelling up’ agenda. Centre for Mental Health chief economist and report author Nick O’Shea said: ‘Mental health care needs to change if it is to meet the challenges of the twenty-first century. Our Mental Health Act remains a direct descendant of nineteenth-century predecessors. We still see people being placed in long-stay hospitals and nursing homes far from home for mental health treatment’. A review was conducted of the Mental Health Act a while back but it’s unclear what has been planned as a result of the review’s recommendations. Yet another can the government has kicked down the road? Nick O’Shea reckons ‘the NHS is going to need two to three times current capacity to adequately meet and treat the expected increase in mental health problems resulting from the pandemic’. That’s quite some investment.

Worrying yet predictable findings from another report (by Carnegie UK) concern the decline in wellbeing and rise in loneliness in England, which had already been the case pre-pandemic but increased with lockdown. Governments continue to measure success in terms of GDP and the like, but wellbeing and our degree of connection with others are key determinants of quality of life. It’s appalling and it speaks volumes that such data have been so badly delayed – 17 months for Office of National Statistics data on wellbeing compared with 8 months for economic data. 

Within the context of loneliness in adults in England rocketing by 44% during 2020, from 2.6 million to 3.7 million, the charity is proposing a new measure of national progress – Gross Domestic Wellbeing, or GDWe – to measure whether life is getting better or worse. Chief Executive Sarah Davidson makes clear that this isn’t to minimise the importance of economic data: ‘We’re not saying that economic factors are not important, because they are, and the model of wellbeing that we talk about highlights the importance of balancing social, economic, environmental [and] democratic outcomes … In order to properly capture what’s important to people’s lives, you really need to measure all these things…. if we used GDWe instead of GDP growth ‘as the guiding star” for economic policymaking, it would be a major step towards measuring what matters most to people’.

Meanwhile (and the major principle of this blog), trust in government was found to be at an-all time low following a nearly 40% drop from 2018/19 to 2019/20 (from 31% to 19%). There’s a direct relationship between ability to trust our government and our mental wellbeing, this drop leading to the rise in public anxiety.

Following news last week of Boris Johnson’s ‘weird and gimmicky’ crime plan, which involved offenders being made to wear high viz jackets, a ticking off has been delivered in the form of shoe repair firm chief James Timpson’s tweet, which caused a stir: ‘Instead of making offenders wear high viz jackets in chain gangs, how about helping them get a real job instead? In my shops we employ lots of ex-offenders and they wear a shirt and tie. Same people, different approach, a much better outcome’. This is a much more intelligent approach, of course, the Prime Minister’s plan instead appealing to a certain mentality amongst his voters.

‘Since 2008, when he opened a shoe repair workshop in HMP Liverpool (no key-cutting skills were practised), his company has employed more than 1,500 ex-prisoners. Just four have returned to jail. Many of those who turned their backs on crime – including some with drug and alcohol issues – have progressed to senior roles in the company, including a current board member’.

Crucially, he addresses the root causes of crime. As his parents successfully fostered 92 children, many from the care system, he’s well placed to understand how often these children have poor attachment patterns, leading to unmet emotional and educational needs, difficulties trusting others and poor relationships with authority. ‘What are we going to do with people we release from prison? Unless we stop putting offenders down, they will continue to distrust us and carry on down the paths their lives have led them to. Our evidence shows there is another way, which most certainly does not involve showing them up in public’. Quite so, but a problem for governments in addressing this is the polarity we often find between those wanting to prioritise punishment of offenders and those wanting the greater emphasis to be placed on rehabilitation.

Recently the media rightly made an issue of the unprecedentedly high number of drugs deaths in Scotland. What the BBC at least spent less time on was not dissimilar findings for England and Wales. Sky News reported that ‘There were 4,561 deaths related to drug poisoning in England and Wales in 2020, up 3.8% from the previous year and the highest number since records began in 1993….. Two thirds (2,996) deaths were related to drug misuse, while around half (2,263) involved an opiate’. The opioids crisis is another serious issue in this country which has been under-reported in the media. Experts know that the problem has worsened during the pandemic, and while the Office for National Statistics attributes the rise to some concrete causes like people using benzodiazepines besides heroin and morphine, the root causes like despair and poverty can be overlooked.

While the government has set up a new unit to tackle the problem, experts point to the underinvestment and closure of much-needed drug and alcohol services over recent years. Sky quoted Dr Emily Finch, Vice-Chair of the addictions faculty at the Royal College of Psychiatrists: ‘Years of cuts have left addictions services ill-equipped to treat people and prevent these deaths from rising. The government needs to wake up to the fact that cuts to services, disconnecting NHS mental health services from addiction services and shifting the focus away from harm reduction to abstinence-based recovery is destroying lives and fuelling the increase in drug-related deaths’. The perennial question is can government detach itself from short-term sticking plaster measures in order to effectively address this situation?

In case you missed it there was a bit of really life-enhancing tv last week, in the form of actor Richard E Grant’s travels around Italy, referencing books which had demonstrated the country’s impact on the writers. What a great gig to get but well-deserved: Grant comes across as a lovely bloke who has numerous jolly and informative encounters with locals. Two worth watching out for are his experience of the sulphuric lemon drink and his obvious enjoyment of a freshly made Neapolitan pizza, during which his agent reprimanded him on his table manners.

Finally, something else you couldn’t make up… Health Secretary Sajid Javid is one of five and he’s let it be known that his mother always wanted one of her sons to be a doctor. This didn’t happen but now she is apparently delighted that Sajid is finally something ‘in healthcare’! You could say that….

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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