Sunday 12 September

The 20th anniversary of 9/11 will be concentrating minds even further on Afghanistan and the west’s legacy there. As accounts of Afghans’ distress and persecution continue to emerge, the only guard of the Kabul UK embassy to have made it to the UK with his wife and baby was interviewed on Radio 5 Live last night. He has been pleading for his family in Afghanistan to be rescued and it’s not surprising that when asked whether he thought the UK government didn’t care about the Afghans, he diplomatically said he couldn’t answer because he didn’t know this country or its rules. Naturally, more views have emerged as to the West’s mistakes and lack of political vision, including one citing the hopelessness of the mission given previous abortive British invasions in 1839, 1878 and 1919. Key factors are thought to be the Afghans being easy to conquer but hard to rule, that they’re ‘mosaic of competing tribes’ which make sure no central authority can work there and that liberal democracy is a system of government alien to them. In Newsweek Rod Dreher said that ‘twenty years and $2trn later, our nation building folly has ended in catastrophe, with the Taliban back and the US humiliated’. Another side-effect is the rise of terrorism here – the Director General of MI5, Ken McCallum, has said the threat is ‘real and enduring’ and that more than six Islamic terrorist plots had been foiled during the last year (29 late-stage attack plots disrupted over the last four years). 

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In Financial Express Muhammad Mahmood pointed out western lack of attention to Afghan losses: over the 20 years ‘at least 164,000 people were killed – by reaper drones and B-52 bombers and by the CIA-controlled militias, who controlled countless atrocities under the guise of rooting out the Taliban’. He also suggests that the West exaggerates its achievements but these are ‘somewhat illusory….only 2% of women, mainly from the Western-backed elite, had access to further education; 84% are still illiterate…. the Taliban may be brutally repressive but to many in a weary embittered nation it offered stability……’. A former diplomat wrote to the Times to challenge government spin about this being the biggest air evacuation since the Berlin blockade (1948-9) when other examples are more relevant, for example one in Kabul in 1928-9, much more challenging because of far less airpower and technology. ‘Politicians ought to do more historical research’. A sceptic tweeted: ‘The neo-cons did *not* want to impose democracy on the world, they wanted to open up new markets & make loadsadosh, mainly by disaster capitalism’.

Meanwhile, the Taliban have strengthened their position politically and symbolically, having claimed to have defeated the rebels in the Panjshir Valley, having raised their flag (a white banner bearing a Quranic verse) over the presidential palace on the 20th anniversary of 9/11 and having finalised their all-male governance structure (different from what was thought a week ago). Three key positions are: Amrullah Saleh, ‘legitimate acting president of Afghanistan’ and leader of forces resisting the Taliban in Panjshir; Mullah Mohammad Hassan Akhund is prime minister; and Ahmadullah Muttaqi is multimedia branch chief of the Taliban’s cultural commission.

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Meanwhile, there appear to be two different universes where Covid is concerned due to government mixed messaging, some seeming to believe that it’s all over (‘things are opening up again’, encouraging facemask refuseniks) and others noting with dismay, even alarm, that on Friday there were 147 deaths (compared with 45 in Germany), cases are rising dramatically and the government has denied (aka it will happen but we’re pretending it won’t) plans for a half-term ‘firebreak’. ‘At the top of the Tory party, meanwhile, the political optimism ignited by vaccines is still alive, and there remains a hope that ministers might somehow slip free of the Covid crisis and begin to leave the whole mess behind’. If it wasn’t so dangerous it would be quite touching that the government has so much faith in the vaccination programme – Vaccines Minister Nadhim Zahawi said the booster programme will ‘protect the most vulnerable’ and enable the virus to transition ‘from pandemic to endemic status’ next year. It’s still being treated as a silver bullet, which is manifestly not the case and which the government seems to believe will exonerate them from mandating other important measures.  

 In another important change, Zahawi was on the Andrew Marr programme last Sunday talking up the commitment to vaccine passports, but now, only a week later, Health Secretary Sajid Javid has announced yet another government U-turn, again pathetically demonstrating that this government is in hock to its vociferous backbenchers. Another interesting development is the decision by the chief medical officers to override the JCVI’s recent advice against vaccinating 12-15 year olds. The vaccination is expected to start around 22 September. Whatever the wisdom of this decision, it could surely undermine the authority of JCVI (Joint Committee on Vaccination and Immunisation).

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Another polarity is the one between those who believe we should go ahead with a booster programme here (eg ministers) and those of the view that none of us are protected until every country is, therefore donate doses to needy countries. Culture Secretary Oliver Dowden defended the number of doses Britain had donated to other countries and pointed to the fact that Israel had begun giving third doses to its citizens.

We now hear that the Prime Minister is expected to address both parliament and a news conference on Tuesday about the government’s plan for managing Covid through the autumn and winter, prompting a wag to tweet: ‘The government has a plan?!’ No wonder, as we repeatedly witness this government’s reactive and poorly thought out approaches to key issues, followed by a strategy, if it can be graced with that description, which goes off at half cock and only partially addresses the problems. Good examples are the policies adopted on schools and on social care reform. The Covid plan is thought to include repealing some parts of the Coronavirus Act but retaining some elements, including giving sick pay to those isolating from day one rather than day seven, directing schools to remain open if they close against government guidance, and helping the NHS to get the emergency resources it needs.

Gabriel Scally, Visiting Professor of Public Health at Bristol University and a member of the independent Sage group of scientists, has usefully revealed the holes in this plan besides its cynical narrative. He criticised the government for ‘inadequate’ public messaging and not mandating measures like better ventilation and better quality face masks. ‘The government and its senior officials claim that Covid should be regarded as similar to influenza and that we have to ‘learn to live with it’. This worryingly persistent and flawed approach ignores the hazardous and evolving nature of the virus. Buildings need to be modified to improve ventilation, he says, and the public should be encouraged to wear properly designed masks that may protect them as well as others. All too often, messaging has been aimed at transferring responsibility to individuals. Pointing the finger at people who are obese, are reluctant to be vaccinated, or are unlucky enough to have severe underlying conditions and telling them to be ‘cautious’ is no substitute for what has been missing all along – an effective strategy for getting the virus under control’. Exactly.

It’s no surprise to learn that Boris Johnson has fallen to his lowest approval rating since becoming Prime Minister, a net score of -17. Approve: 32% (-3) Neither approve or disapprove: 19% (NC) Disapprove: 49% (+4). But as usual this is likely to be water off the duck’s back.

The debate over social care reform has also dominated the news, some Tories having threatened to vote against the government because of their attachment to the Conservative ideology of a ‘low tax economy’. It seems astonishing that these Tories would prioritise this selfish and doctrinaire approach over the glaring need for this crisis to be resolved, especially when an ‘oven ready deal’ had been promised two years ago. It was a sizeable opposition in the Commons, MPs voting 319 to 248 to back the measures, which include a 1.25% rise in National Insurance paid by employees and employers. I’ve long thought it strange that those over 60 were not required to pay though many could afford to do so. A major problem is that the amount this is predicted to raise, £36bn over three years, will mostly go towards clearing the NHS backlog, with only £5.4bn going to social care.  

Although the PM has radically quadrupled the means test threshold for social care recipients to £100,000, social care experts believe the deal falls far short of what is needed. ‘But in supporting documents published by the government was the reality of the deal Johnson was so far offering: £1.8bn a year extra for social care instead of the more than £6bn extra that the Health Foundation think tank calculates will be needed by the end of this decade just to keep up with demand. Improving services in the often threadbare social care sector could cost an extra £14bn a year’. Is this an example of ‘all fur coat and no knickers’, big claims to progress but with little substance beneath?

A sceptic outed the elephant in the room which is a wealth tax: ‘Sajid Javid: the Nastiz have kept their promise not to raise tax. The sub-text: Albeit it’s their less-familiar promise; by hiking NICs not IC, the Tories have kept the one promise they value, their promise not to tax the super-rich and wealthy more’. The NI increase is thought to unfairly penalise young employees and the whole approach does nothing to resolve intractable problems like staff shortages, low wages and postcode lotteries regarding service provision. Boris Johnson also failed to give an answer to Keir Starmer’s question about a guarantee that no one would have to sell their home to pay for care. Selling one’s home seems to have long been considered the last bastion of social care provision.  I’ve personally seen nothing amiss about homes being sold to pay for care – although it’s true young people have it hard these days the common expectation of an inheritance seems entitled and socially divisive since many will have no opportunity of getting one.

More worryingly and further proof of the ‘half cock’ general approach, the proposals are thought likely to only help a tenth of older people in need. ‘After it comes into effect in 2023, the new policy will directly help about 150,000 more people at any one time, according to government documents. But already about 850,000 older people who receive care have at least some of the cost paid by local authorities. Age UK estimates that a further 1.5 million older people need care but are ineligible for support – up from about a million in 2014. Some pay for it themselves, some get help from their families and some go without any care at all. But while the prime minister’s £36bn national insurance tax rise focused on how care will be paid for after 2023, he made no provision to ensure that the sector survives the crisis engulfing it now’. Experts also point to the likely rise in council tax these proposals will result in. ‘Unless more generous funding for councils is announced at the upcoming spending review, we can still expect significant council tax rises in the coming years, if rising needs and the myriad of pressures facing other council services are to be met’. An unpopular measure indeed.

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Not least because of the campaign by Peter Stefanovic, whose video about the Prime Minister’s lying has had 34m views but still no coverage on the BBC, there’s more awareness of this ongoing mendacity. The Guardian’s John Crace shows how the social care reform debate has illustrated this. ‘There can be benefits to being a serial liar. While politicians with a reputation for honesty can find their careers ended by one broken promise, those, like Boris Johnson, for whom the truth is by and large an unknown country, can skate by unscathed. Simply because no one expects him to keep his word. His relationships with family, friends and voters are entirely transactional. They get to hear what they want: he gets to bend reality to whatever serves him best at any given time. One of the great illusions is that so many mistake his constant shape-shifting as a sign of self-confidence. It isn’t. It’s a sign of someone with no self-worth’. Despite some powerful opposition from his own side on the social care vote, the Prime Minister was sure of getting it through, almost as if this justified breaking promises. ‘Another broken promise had paid off. In the short term at least. Whether it would cost him the next election when Tory voters had felt the impact of the tax hike was something he would worry about later. Like most pathological liars, Johnson really only lived for the day’.

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Meanwhile, the strained and understaffed NHS soldiers on, a relevant expression in view of news that the Unite union in Scotland has said the army should be drafted in and “pop-up wards” erected at Accident and Emergency departments where patients are waiting hours to be admitted, for example at Aberdeen Royal Infirmary and the Queen Elizabeth University Hospital in Glasgow. The head of the ambulance service has apologised for long waits, but Unite says waiting times of up to three hours puts patients’ lives at risk.

At the same time it’s no surprise that Minister for Care Helen Whately deflected from the longstanding NHS underfunding by warning NHS trusts about some senior managers’ salaries being too high, eg £270k and more. This tendency towards disproportionate salaries has indeed occurred across the entire public sector in recent years but in this case the intention of her intervention comes across as somewhat cynical.

https://bbc.in/3lfYRUO

Still on NHS issues, pressure continues to mount regarding the difficulty of getting GP appointments and the rise in virtual rather than in-person consultations. This definitely contributes to people’s anxiety and symptoms could become worse if people are disincentivised from contacting the GP. A GP writing to the Daily Telegraph reinforced the need for the system to change: ‘Ideally we would have many more GPs and a system funded to allow walk-in open surgeries with no barriers’. He attributes the current access problems to the falling number of full-time GPs coupled with the rising complexity of this role. A writer and economist spells it out even more clearly: in The Times James Kirkup, director of the Social Market Foundation think tank, says the main problem is the way GPs are paid. ‘Their financial incentives are at odds with the interests of their patients. GPs now earn so much that fewer feel the need to work full-time….in many cases doctors quit because their pension pot has hit the £1m cap beyond which higher taxes kick in’. He also cites as a major problem a formula (Carr-Hill) intended to get GPs to work in areas of particular need, but this formula doesn’t sufficiently recognise deprivation, leading to GPs opting for easier options in ‘leafy suburbs’. So much for ‘the doctor will see you now’.

The longstanding underfunding of mental health services in this country has now shown itself in a different form – inquest judgements. In a useful piece of work, the Observer identified 56 mental health-related deaths in England and Wales from the start of 2015 to the end of 2020 where coroners identified a lack of staffing or service provision as a ‘matter of concern’, meaning they believed ‘there is a risk that future deaths could occur unless action is taken’. Examples include the case of a woman whose referral to psychotherapy was still outstanding when she died 11 months later, and another individual had waited 7 months for a psychological assessment.

These aren’t unusual. It all begs the question of whether ministers and policymakers are even aware of coroners’ Reports to Prevent Future Deaths (PFD), which register when they believe action should be taken to prevent deaths occurring in future, and which are then sent to relevant individuals or organisations for them to respond. Do Clinical Commissioning Groups ask NHS trusts to submit details of these reports and to what extent they have addressed them? These trusts could well say the circumstances are beyond their control because of insufficient funding and psychiatric beds. Many of the cases are suicides, which are increasingly flagged up by coroners when they didn’t used to be. Dr Rosena Allin-Khan, Labour’s shadow minister for mental health, said: ‘The Conservatives have cut a quarter of mental health beds since 2010. This has put the NHS at breaking point, with devastating consequences for people’s lives’.

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Having stuck so rigidly and for so long to an avoidance strategy, Prince Andrew once again has tried to evade the arm of the United States law regarding the sexual assault allegations, this time by fleeing to Balmoral in a story which could run and run. We learned this week that following one failed attempt to serve civil suit papers on the Prince, these papers were actually served. How pathetic it seems, then, that because of Andrew’s refusal to cooperate (despite earlier assurances that he would) a US court will hold a pre-trial conference on tomorrow to determine if the papers were properly served before the case can progress. ‘The prince has repeatedly denied the allegations in the lawsuit brought by Giuffre, 38, a longtime accuser of the late convicted sex offender Jeffrey Epstein. When the suit was filed last month, legal experts suggested it left Andrew with no good options as he seeks to repair his image and return to public life. If the prince tries to ignore the lawsuit, he runs the risk that the court could find him in default and order him to pay damages. If he decides to fight, Andrew faces years of sordid headlines as the case winds its way through court’. So Prince Andrew is between a rock and a hard place, but as long as this saga continues, with the Queen continuing to protect him, the more reputational damage it could inflict on the royals. Surely, whatever the outcome, it will be difficult, if not impossible, for Prince Andrew ever to return to public life.

https://bit.ly/2X5OOcp

Finally, some good news for those who detest the mess on our pavements caused by discarded chewing gum. Following government threats to impose a gum tax, manufacturers headed this off by agreeing to pay up to £2m a year for gum removal. We’re told that pilot projects to both remove gum and to encourage people to bin it rather than drop it reduced the problem by 64% but the plan does beg several questions. About 87% of England’s streets are thought to be ‘blighted’ by gum, but how would it be decided which streets benefited and if the money was donated to councils how would it be guaranteed it would be used for this purpose rather than being absorbed into general expenditure? Answers on a postcard…….

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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