Saturday 16 May

The debate about whether or not schools should reopen on 1 June (and now the British Medical Association is firmly supporting the unions) highlights an important issue about how we treat risk. Too much risk adversity makes for existing in a comfort zone rather than living, but although life does involve risk every day, in this situation it’s crucial that safety measures are observed. Not surprisingly, mistrust of government comes to the fore again, as many suspect the urge to reopen schools is driven more by the needs of businesses to get their employees back to work. How unfortunate that Education Secretary Gavin Williamson resorts to emotional blackmail, writing in the Daily Mail that teachers should be ready to “do their duty” and cooperate with the government’s efforts. A Radio 4 listener tweeted: ‘Let’s hope the ‘protective bubble around groups of children’ would be more effective than Matt Hancock’s ‘protective ring around our care homes’.

With fine weather forecast this weekend, the first since the new Stay Alert strategy, police and locals fear beauty spots being inundated and restrictions flouted. When interviewed police and politicians keep saying that the public has generally understood and abided by the guidance but the evidence contests this: 14,000 fines have been issued for lockdown breaches since it started. That’s quite a number and it would be interesting to know how many fines had actually been paid. Meanwhile, here’s a novel idea from writer Matt Haig: ‘I hope when this is all over we will be able to opt into individual lockdowns voluntarily to get us out of social events we don’t want to go to’.

Within the last 48 hours there have been more examples of ministers still misrepresenting aspects of crisis management, when the facts and chronology are now well established, eg Stephen Barclay (Chief Secretary to the Treasury) on Question Time alluding to 120,000 tests having been carried out that day. Perhaps BBC journalists, often supine, are becoming more incisive now, as it took Fiona Bruce three efforts to get him to concede that this equated to only 71,600 people tested. On the Today programme yesterday Brandon Lewis, robustly challenged by Justin Webb, refused to accept that the care homes advice had been wrong despite more scientists now saying it was, and alluded to Keir Starmer ‘playing politics’ (aka holding the government to account) and ‘quoting out of context’ at PMQs on Wednesday. And on Any Questions last night Social Care minister Helen Whaley floundered frequently at the end of Chris Mason’s rod. Yet the disingenuous narrative from ministers continues. In response to Matt Hancock’s assertion that right from the start they tried to ‘throw a protective ring around our care homes’, palliative care doctor Rachel Clarke tweeted:  ‘This is categorically untrue. Care homes were left without testing. Without contract tracing. Without PPE. Without support. You can deny it all you like, Matt Hancock, but we were witnesses – we ARE witnesses – and believe me you will be held to account’.

New figures show that 12,526 care home residents died due to COVID19 in England and Wales during the four months to May. The number is much higher than those previously reported as it includes both deaths from the virus within care homes and residents who died after being taken to hospital with the virus, who accounted for a quarter of deaths. The Guardian reports on ‘isolated care home residents ‘fading away’ – capturing what’s really going on in these sequestered places. Residents, many with dementia, are confined to their rooms so don’t meet others, activities were stopped and they receive no visitors, so their mental health is suffering considerably. One anonymous carer told the Care Inspectorate in Scotland: ‘The virus won’t be the killer of these people, it’s the distress and fear of not seeing family that is doing it. Residents who were giggling, happy and active before the crisis now just lie in their beds or sit alone in their rooms with their doors closed. Many now barely respond when you speak to them. Some shout for their friends and family. Others have given up entirely and are fading away.”

This is such a sad ending for these elderly people, who have been so shockingly overlooked by government strategy, and distressing for their families having to cope with their relative’s demise in these circumstances. In many cases this is likely to result in a complicated grief reaction (complex, prolonged and unresolved) because they won’t have been able to say goodbye or properly acknowledge that passing. Although the measures to protect residents are crucial, some could have been avoided with sufficient planning and testing at the start.

There seems a division of opinion on the timing for a public inquiry into the government’s performance, ministers and others saying ‘the time will come when all this is over’ (aka kicking the can down the road?) and those, like the Hospital Consultants and Specialists Association, making the case for setting it in motion now. Apparently it can take months to set up an inquiry so all the more reason to start sooner than later, key issues being how quickly Downing Street reacted to the threat, whether lockdown came early enough and why the testing and tracing attempt has been ‘inadequate’.

Rather shocking but not surprising, because of continuing austerity and the lack of effective and consistent mental health support, is the increase in suicides in England and Wales over the last year. Figures for 2019 indicate 4,620 deaths from suicide, an 11% increase on 2018. This represents one in five deaths heard in coroners’ courts, according to the Ministry of Justice. It will be interesting and sobering to see what the figures will be for 2020, given the mental health burden building up during COVID19. Setting that in context, it’s been known for some time but now the Royal College of Psychiatrists has confirmed that people with no history of mental illness are developing serious problems for the first time as a result of the lockdown, due to stresses over isolation, job insecurity, relationship breakdown and bereavement.

Frontline NHS staff particularly are regarded as being at risk of PTSD (Post Traumatic Stress Disorder), because of their onerous and stressful roles in caring for desperately ill and dying patients, the huge unknown quantity that COVID19 is, difficulty of obtaining PPE, seeing their colleagues become ill and losing some, fears for their own families’ health and the prohibition by many trusts on speaking to the media about these conditions. Professor Neil Greenberg, trauma expert at King’s College London, has said staff may need months or even years of “active monitoring” of their mental health after things return to some semblance of normality. But what help are they getting?

NHS England is said to be providing crisis support to its staff, its mental health director alluding to individual trusts’ support and ‘online resources’ etc and NHS charities’ money was supposed to be used in part for talking therapies. But NHSE hasn’t produced a formal long-term plan to offer extra psychological services in the aftermath of the pandemic, BBC News tells us. Surely this is a major omission. Dr Michael Bloomfield, a psychiatrist at University College London (UCL) and Camden and Islington NHS Foundation Trust’s traumatic stress clinic, said ‘there is an urgent need to work out how staff calling new NHS mental health hotlines can be referred on to specialist services’. Greater demand for more structured mental health support could come much later, when the urgency of the current crisis has abated.

Clinical psychologist Julie Highfield said: “What’s really needed long-term is an 18-month to two-year recovery period,” with access to counselling and trauma-focused therapy’. Support is currently ‘patchy’ and concern has been expressed about some new charities set up to coordinate this work using insufficiently qualified and experienced practitioners. This further highlights the problem of counselling and psychotherapy not being statutorily regulated in this country. Professor Greenberg said some voluntary schemes are really good, but the quality varies: “Some follow evidence-based guidelines, but some are, to be fair very well-intentioned, but often not very well put together. It would be quite dangerous to allow a proliferation of well-meaning charities, which might distract or detract people from going and getting the right care.”

It’s absurd that several professional bodies including BACP (British Association for Counselling and Psychotherapy) operate accredited registers of suitably qualified and experienced counsellors and therapists. There’s a wasteful duplication of effort because too often, as in primary care, the NHS chooses to look elsewhere or train its own, usually in the biomedical and non-relational Cognitive Behavioural Therapy, whereas what many clients need relational therapies and a choice of them.

https://bbc.in/2Z6rKsY

You might be interested in two consecutive programmes later on Radio 4 – Loose Ends (a medley of conversation, music and comedy) has the inimitable Grayson Perry amongst its guests and the weekly Profile features Labour MP Dr Rosena Allin-Khan, who recently challenged Matt Hancock in the House of Commons and got told to ‘watch her tone’. Let’s hope the Health Secretary tunes in!

https://www.bbc.co.uk/programmes/m000j78c

https://www.bbc.co.uk/programmes/m000j7h5

Thursday 14 May

As more and more holes appear in the government’s strategy, despite attempts by ministers to suggest that everything’s gone according to plan, it’s emerged that at least 95,000 people entered the UK from overseas since lockdown imposition, with no attempt to ascertain how many had Covid-19. Keir Starmer’s forensic challenge to the PM yesterday on the policy of discharging untested patients to care homes has had wide coverage, yet this morning health minister Ed Argar still tried to defend it and deny that this had been the policy. A Today listener tweeted: ‘Health minister Ed Argar repeating line of “no evidence of community transmission” to justify lax care homes policy. Why is it so hard for Govt to understand you take action to PREVENT a problem arising? Shameful how they squandered the advance warning we had from Italy’. British exceptionalism again – other countries can’t teach us anything?? What’s astonishing is the revisionist verbal gymnastics performed by ministers in media interviews, aimed at convincing us that there was a plan all along rather than the chaos we’ve seen.

It seems that, despite having received advice over months to this effect from some scientists and experts including Independent Sage members, the government has finally realised it needs a decentralised approach to its test and trace strategy. It’s now appointed Head of NHS Improvement Dido Harding (formerly Talk Talk CEO) as chair, Tom Riordan (CEO of Leeds City Council) to lead on tracing and Sarah-Jane Marsh (Chief Executive of Birmingham Women’s and Children’s Hospital), to lead on testing. The Department of Health and Social Care press release promises a ‘rapid nationwide roll out’ of the programme. It will be interesting to see how this works out.

Another worrying source of inconsistency is the fissure in the four nations infrastructure, because the Scotland, Wales and Northern Ireland governments have been so alarmed by the Stay Alert policy they are going their own way. How will this work out given the five separate (!) taskforces being set up to plan the re-opening of various venues from July? What coordination will there be between them and can we expect different arrangements in the other three nations? We’re told business secretary Alok Sharma will lead on pubs, restaurants and shops, Culture Secretary Oliver Dowden on recreation, Communities Secretary Robert Jenrick on places of worship and Transport Secretary Grant Shapps on aviation.

Revelations about NHS staff being warned, threatened or disciplined for speaking up about unsafe practice or malpractice have been in the news for a while but have become more pronounced during the crisis, because of the lack of PPE and testing for coronavirus and similar worries raised in the care sector. It’s known that whistleblowers often have a very difficult time, but now there’s been a call for a change of attitude towards them, which needs underpinning by legislation to properly protect them. This is the stance of Elizabeth Gardiner, the new chief executive of whistleblowing charity Protect. “What we would like to see is a proactive duty on employers to protect whistleblowers from being victimised,” she says. “That would be the sort of cultural shift that we’re looking for.” Let’s hope this comes to pass. It’s shameful that, on top of their already demanding roles and the risks they take to care for their patients, NHS staff are being silenced by their employers in this way for voicing legitimate concerns about patient safety.

The Spectator (12 May) reports that when this crisis is over, reform of Whitehall will come to the fore again, driven by the Cabinet Office, which has announced ‘an intriguing set of new non-executive directors’. The four are Bernard Hogan-Howe, the former Metropolitan Police commissioner; Henry De Zoete, who worked with Michael Gove and Dominic Cummings at the Department for Education before winning Dragon’s Den and setting up an energy switching service; Gisela Stuart, the former Labour MP and co-chair of Vote Leave; and Simone Finn, a Tory peer who was the coalition’s adviser on trade union matters. All are said to be ‘impatient reformers’. Like the Dido Harding choice for heading up the refocused test and trace programme, it would be interesting to know the thinking behind these appointments, as it’s not always clear. Impatient they may be but changes need to be thought through and planned carefully, also addressing the bullying problem which has dogged the Civil Service for some time.

A recent ‘long read’ in The Week (2 May) discusses how architecture post-pandemic will be different, first referencing how diseases and pandemics throughout history have influenced street planning and building design. It asks whether homes will have to change to accommodate work, pavements have to widen (already planned) to allow distancing and workplaces have to develop alternatives to crowded open-plan working. An innovatory design agency (the Design Research Unit, founded in 1943) was credited with changing the appearance of postwar Britain and is now ‘thinking big’ yet again by reflecting on qualities and characteristics post-pandemic buildings will need. They see workplaces as likely to represent the biggest changes, moving from colleagues closely mingling in open-plan spaces to more partitioning and openable windows. An architect at Foster & Partners, responsible for the innovatory Apple and Bloomberg HQs, foresees wider corridors, more staircases (to prevent people having to cram into lifts), wider desks, safer surface coatings and increasingly functions from opening doors to calling lifts and ordering coffee being controlled by smartphone or sensors in conjunction with facial recognition. Called ‘contactless pathways’, infection control is built in by obviating the need to touch surfaces (‘With 80% of infectious diseases transmitted by touching contaminated surfaces, this hands-free future could well catch on’).

It’s also predicted that high-rise buildings will be more expensive to build and will therefore become less attractive to developers. Population density eg in New York has been placed firmly in the frame for spreading the virus, directing attention to ‘car-centric suburbs’, seen as detrimental for other reasons including being a factor in the climate change and obesity crises. Seeing the pandemic as a catalyst for decentralisation, Professor Wouter Vanstiphout, design as politics academic at Delft University of Technology in the Netherlands said: ‘This is the best time ever to think of a walkable city’, based on smaller units of health and education services being situated in a greater number of localities.

The article rightly points out that with travel limited, ‘the local high street has come into its own and corner shops have often proved to be better stocked than supermarkets’. I’ve certainly made some interesting discoveries in smaller shops, which could start doing better because of the reluctance of some customers to enter big supermarkets which don’t enforce distancing in the aisles. Vanstiphout believes there is now ‘more of a sense of the city as a place of safety, of home and continuity. It’s a warning against tourism and the inequality that causes labour migration on a temporary basis; a warning against the gig economy and the devastation of public services. There is something really clarifying about a pandemic: you can see the absolute necessity of a public health service and a proper social welfare system. It creates a very clear picture of what is good’.

Although it’s positive that designers and policymakers are thinking about what kind of buildings and urban planning we need for the future, this will inevitably only apply to a small number of buildings and the cost could be prohibitive. While some will like the concrete and glass high tech environment, others will feel uncomfortable with it and their mental wellbeing could suffer in the same way as it already can do when people are made to work in a basement or somewhere else without natural light. Current homes and workplaces will have to be adapted very quickly and that task could prove more challenging.

Finally, the huge rise in the use of Zoom has sparked interest in backdrops and bookshelves which look suspiciously ‘curated’, conveying powerful messages about their owners. Not everyone realises that you can create a virtual background in Zoom, if there’s a particular need to neutralise your surroundings, as required by psychotherapists, for example. But these can look a bit boring and depersonalised, for example closed curtains or a bland piece of art on the wall. Michael Gove’s bookshelf has attracted comment for its inclusion of biographies of Napoleon and Hitler, Tony Blair’s memoirs and books on Europe and American presidents, possibly intending to convey power and determination. The Guardian’s fashion expert advises on how to ‘get this right’, an interesting concept in itself.

‘The pandemic has forced us to make our private spaces public. And what may have begun as a voyeuristic interest is morphing into something else as the potential “new normal” sees us spend much more time at home long term’. ‘Winners’ include Meryl Streep, complete with martini in the foreground and no Oscars in the background, whereas ‘loser’ Vogue doyenne Anna Wintour’s was found unexpectedly dull (closed curtains). ‘It’s all wrong. What I want from Anna is a crystal vase of peonies, a Smythson notebook with a silk ribbon and a Diptyque candle’. Err, right. As someone not impressed with consumerist focus on brands, I’d have to disagree. Perhaps this much is true, though: ‘The pandemic has forced us to make our private spaces public….’, so maybe the Englishman’s home is no longer his castle, if ‘he’ Zooms!

Wednesday 13 May

Changes to lockdown restrictions dominate the news agenda, the main ones quite worrying. Many have returned to work today and Sky News showed footage of packed buses and tube trains in London, yet there is no plan to rely on anything more than people’s ‘common sense’ and public transport ‘marshalls’. The situation will need carefully controlling to avoid overcrowding and to allow distancing but the authority vested in these ‘marshalls’ is unlikely to be enough. Travelling on public transport at present could feel very frightening for commuters, who must go out to work to earn – a horrendous choice between risking their health and losing their jobs.

The other key change (for England) is the ability to drive (not sure about taking public transport) much further to take exercise and ‘care for emotional wellbeing’, so locals in beauty spots are bracing themselves for large numbers of visitors. ‘People should “stay local” and think twice before driving to parks, despite lockdown restrictions easing in England, said Kevin Bishop, the National Parks Officer and CEO of Dartmoor National Park. “We want people to be responsible and respectful. It’s a living, working landscape. How would you feel if you suddenly had lots of visitors suddenly descend on your home?”  This is yet another policy that doesn’t hang together because the visitor infrastructure isn’t there and police insist they will only be relying on ‘guidelines’. This can be seen from both sides – sympathy with locals being confronted with hordes, but cabin fevered city dwellers, who may already have had several holidays cancelled, will be champing at the bit to get to the country or seaside. Maybe it’s time to resurrect that 1960s staple –the thermos flask… but beware of locals manning the barricades.

Also in the news is what’s widely seen as lack of preparation and poor performance by Boris Johnson at PMQs, exacerbated by the new Opposition leader and lack of braying colleagues to enable deflections. Tom Newton Dunn tweeted: ‘Another powerful forensic assault by Keir Starmer today. Had PM on the ropes on care home testing and unexplained deaths in them, as well as international death comparisons. Lesson for No10 is Boris Johnson can no longer wing it at PMQs’. So the question must now be – can the PM change the habit of a lifetime, since there’s plenty of evidence from former colleagues that ‘winging it’ was his habitual modus operandi? Politicians, policymakers and the public are entitled to expect a PM to be well-informed and well-prepared in ‘normal’ times, but we especially need that reassurance during this crisis. 

Amongst other articles discussing COVID19 strategies adopted by other countries, online publishing platform Medium explores Sweden, widely associated with having decided not to shut down. It’s effectively a hybrid approach, designed to control the virus but not wreck the economy in the process. Although schools, businesses and parks remained open, it was recommended that people wash their hands frequently, maintain social distance, work from home if they can, and those who are elderly or more susceptible to Covid-19 stay home. Universities also switched to online teaching.

A name we’re now becoming familiar with – Anders Tegnell, the epidemiologist at Sweden’s Public Health Agency charged with recommending policy to the government – said: “Instead of saying ‘close down all of society,’ we have looked at society and closed down aspects of society where the disease is most likely to spread. I think that’s had a great effect.”

Although Sweden has a much higher death toll than other Nordic nations and its economy has been severely damaged, the author (Matthew Zeitlin) suggests ‘Sweden may not be so much an alternative, as a glimpse of the future’.

 The two key factors here seem to be Swedes changing their behaviour (eg reducing travel, especially public transport use) and having more trust in their government and institutions – exactly what we don’t have in the UK. The historian Lars Trägårdh said:

“We have a lot of social trust and a lot of trust in the institutions, and the institutions have confidence in the citizens. That’s why we decided to have this voluntary approach as opposed to one that’s more hardcore.” This reminded me of the article about contact tracing strategy in Taiwan, citizens and government both playing a role and effectively entering into a partnership for the common good, as opposed to control and command structures, which could lead to non-compliance with sensible policies. There seems an implication behind several articles on COVID19 strategy that what we’re seeing right now will come to be seen differently over the longer term. Time will tell.

Meanwhile, Britain’s reputation for its handling the pandemic has taken another hit after newspapers in Europe and the US reported on the confusion and internal divisions of the government’s approach. These papers include German’s Die Zeit and Frankfurther Allgemeine Zeitung, France’s Le Monde, Spain’s El Pais, Italy’s Corriere della Serra, the Netherlands’s de Volkskrant, Sweden’s Svenska Dagbladet and the Wall Street Journal and New York Times in the US.

It’s rather shaming that Die Zeit puts the UK near the bottom of the league table and suggests ‘the government is now trying to pretend to the public that it has the situation under control”, whereas Frankfurter Allgemeine Zeitung identifies factors contributing to the poor management eg ‘Many Britons live in metropolitan areas where the virus spreads faster. With the state’s National Health Service, the nation has also given itself a health system that is cumbersome, bureaucratic and has been underfunded for some time.” Le Monde described the new Stay Alert slogan as ‘cringeworthy’ (anyone know the French for that?), suggested the UK itself was ‘fading’ and was mystified by the still high ratings the PM enjoys. You don’t need to know German to understand the Suddeutscher Zeitung’s headline: ‘Johnsons Fahrplan ins Chaos’. Although many would agree with the writers, there also seems a whiff of displaced Brexit antipathy in such reports.

Radio 4’s File on 4 Coronavirus – stories from behind the mask, is currently focusing on the experiences of frontline clinicians, powerful and poignant stories we wouldn’t normally hear. The series should be compulsory listening for the government. ‘In these recordings for File on 4, doctors and nurses take off their masks and reveal their private emotions and professional fears. They talk from the heart, sharing how they feel about their patients and the emotional toll on them and their families. For the diarists, it’s a rare moment to stop and reflect, to mourn the losses and hold on to the glimmers of hope.’

https://www.bbc.co.uk/programmes/m000j22z

On a lighter note, it was Tate Modern’s 20th anniversary on Monday and we’re told that ‘Tate Modern has welcomed nearly 100 million visitors since it was first officially opened by Her Majesty The Queen on 11 May 2000, and it is now the world’s most visited museum of modern and contemporary art. From its long-term commitment to research, ground-breaking approach to collection displays and exhibitions to its unique commissions in the Turbine Hall and live programme in the Tanks, Tate Modern has transformed the British public’s relationship with contemporary art in the 21st century’. I remember what a splash it made and how it’s also been in the news for non-artistic reasons, eg the residents of adjacent luxury apartments taking the Tate to court for invasion of privacy enabled via its 10th floor viewing platform, and shockingly, the case of the French boy being pushed off the platform, sustaining life-threatening injuries.

The Tate’s email included links to pieces about their major exhibitions. I remember being introduced to Ai Wei Wei via his impacting sunflower seeds installation and accompanying film – rather sobering to be reminded that it was ten years ago. It was amazing to learn that each ‘seed’ was handcrafted and painted by scores of Chinese craftsmen. ‘Sunflower Seeds invites us to look more closely at the ‘Made in China’ phenomenon and the geo-politics of cultural and economic exchange today’, said the description. It was a bit depressing to see some visitors actually taking one or more ‘seeds’ but,surprisingly, there was no one around to stop them. I’m really missing visiting galleries, museums and heritage venues – who knows when we’ll be able to return and what these places will feel like when we do!

Monday 11 May

The main thrust of today’s news is the government’s ‘roadmap’ for this ‘second phase’ of the pandemic. There are almost no words to describe the PM’s speech last night, which caused confusion all round, one measure effectively being contradicted just hours later by Dominic Raab on the Today programme and later withdrawn. This can only increase public anxiety further. Comms experts commented on what a poor example of communication it was and it’s clear that the essentials which would need to underpin this roadmap, including safe staffing, PPE and transport, just aren’t consistently there and haven’t been thought through. Even more confusion and annoyance have been caused by the PM going ahead in the face of other UK nations taking different paths, not sharing it with them in advance, failing to issue the 50 page document which allegedly details the revised approach and not alerting venues such as golf courses that they could re-open on Wednesday. One commentator said: ‘That was the most confusing Prime Ministerial broadcast I have ever seen. The point of such unusual interventions is to offer leadership and a clear sense of direction. That didn’t do either’.

Keir Starmer said: ‘What the nation was looking for this evening was clarity and consensus. The truth is, the Prime Minister’s statement raises more questions than it answers. Those questions need answering if the public is going to have confidence in what happens next’.

Some scientists have questioned the evidence informing the policy: “It’s very difficult to see how underlying science has informed the measures announced,” said Jonathan Ball, professor of molecular virology at Nottingham University. “I think the reality is, this is a statement driven almost entirely by an economic agenda and in truth lacks clarity in terms of future control of the virus epidemic.”

Some clinicians and the British Medical Association have expressed similar concerns and Antonello Guerrera, UK correspondent for Italian newspaper La Repubblica, said his  paper had acknowledged the “grave errors” made in Italy, but observed that the “confusion and contradictions displayed by the British government in the past few months have few equals…The way the world is looking at the UK is not the way the UK is looking at itself’. Perhaps that should read ‘…how the UK government is looking at the UK’.

Given the marked success of Germany in dealing with the crisis, it’s timely that The Week carries a useful briefing explaining how this has come about. The German health service is funded by statutory health insurance rather than taxation and besides spending more per head than the UK, has far more doctors and hospital beds per 1,000 people than the UK. A Berlin hospital developed a test very quickly and made this available throughout the country and this was accompanied by a contact tracing procedure. The health service operates in a decentralised way (which public health experts like Professor Allyson Pollock pointed out the lack of in the UK crisis response), involving the country’s 16 states, enabling a more rapid response. Such agility, involving action at local level unhindered by national bureaucracy, seems to be a crucial factor in making progress quickly. The service involves the private sector, eg laboratories, enabling access to a breadth of expertise, and the article also stresses the role of a cultural factor, the German flair for Ordnung, organisational discipline. When the public inquiry into the management of the pandemic finally takes place, it should surely look at how responsive our NHS can be within its current structure and modus operandi.

It’s not the first time this has been suggested but the crisis has highlighted what many are finding unsatisfactory about the way we measure growth in this country. A YouGov poll has found eight out of 10 people would prefer the government to prioritise health and wellbeing over economic growth during the coronavirus crisis. Six in 10 would still want the government to pursue health and wellbeing ahead of growth post-pandemic, though nearly a third would prioritise the economy instead at that point. A new report launched today by Positive Money called The Tragedy of Growth, backed by politicians from several parties, calls for a shift away from GDP as the government’s core measure of success. (Positive Money describes itself as campaigning for ‘a money and banking system which supports a fair, democratic and sustainable economy. Set up in the aftermath of the financial crisis, Positive Money is a not-for-profit company funded by charitable trusts and foundations, as well as small donations from its network of over 65,000 supporters’.)

https://bit.ly/2yEBK1Y

You might be interested in this new 12 part radio series about the history of writing exploring mental ill-health and its treatment. The Anatomy of Melancholy (1621) is thought to be the first exploration in the Western world of depression. A shame the talking treatments bit today is about the biomedical, non-relational CBT, allowed to disproportionately influence the mental health discourse, so let’s hope forthcoming episodes include coverage of relational therapies.

https://www.bbc.co.uk/programmes/m000j1yc

Finally, Zoom users will have heard about the problems of ‘zoombombing’, whereby meetings have been interrupted by invading hackers or abusers (Zoom has now taken steps to prevent this eg via compulsory password use). But just say you wanted it to happen for fun. The Week tells us that a US farm in North Carolina is now offering housebound workers the chance to hire animals to crash their meetings for ten minutes. The donkey costs $50 but if you don’t fancy that there’s a choice of horses, ducks and chickens. I wonder how well that goes down with colleagues and bosses and to what extent the selected animal cooperates and gives good value for money. It’s a serious point, though, showing how some businesses are increasingly diversifying to compensate for lack of demand for their main products and services.

Sunday 10 May

Now we have the government’s new roadmap slogan with a different background designed (apparently) to be less alarming than the first one: Stay Alert, Control the virus, Save lives. This has attracted ridicule in some quarters including public figures like J K Rowling. At the #stayalert hashtag ‘Mrs Nigel Farage’ tweeted ‘We are calling for ‘alert’ volunteers to join our VirusWatch Scheme here in Brexit-on-Sea. You will be equipped with a free pair of binoculars to help spot the virus, a net to catch it with and a bag to put it in’. ‘Parody Boris Johnson’ tweeted: ‘Tricky night. I was busy staying alert when I heard the virus’s heavy footsteps on the stairs. I controlled it by wrestling it to the floor then spent the rest of the night staying alive’.

Re the lockdown ‘mixed messages’, police in the London borough of Hackney should have an easier job today, given the much cooler weather, than yesterday when they were ‘fighting a losing battle’ to deal with large numbers of people in parks, ‘drinking beer and wine and eating pizza’. There’s increasing concern about having to make a choice between more freedom and endangering health on returning to work because of the need to earn. A Radio 4 The World this Weekend contributor made a key point about what people need in government communications: absolute clarity and for ministers to speak as ‘guardians’ of people’s health, not as politicians (the very thing leading to mixed messages, dancing on the head of a pin to have all bases covered when this is cowardly, unworkable and undermining of mental wellbeing).

Examples abound of people still not understanding distancing at the time it’s being eroded anyway. An Isle of Wight businessman observed a woman complaining to a fellow shopper that he was too close to her in a supermarket and he replied ‘Don’t worry, I’ve got the app’. Not dissimilar to having to ask two men sitting together at the top of some steps to move aside and one said ‘It’s ok – we live in the same house’. Besides being called upon to defend this new ‘second phrase’ approach, the government will also face questions about having had to send 50,000 test samples to the US for analysis. The problems were attributed to ‘operational difficulties’ and ‘teething problems’.

An anonymous writer in The Guardian describes how child mental health was in crisis before Covid-19 and how ‘going back to normal’ isn’t an option. A disproportionate mental health burden is borne by children and young people because of the unprocessed effects of ACEs (Adverse Childhood Experiences, due to neglect, abuse, parental addiction or domestic violence etc); already long waiting lists for appointments and then treatment are lengthening; COVID19 testing isn’t universally in place; clinicians are getting mixed messages from management about who they should be prioritising given their much reduced staffing (new referrals or supporting the existing ones?); disturbed teenagers don’t necessarily want to talk on the phone and some are overdosing at home because of fear of attending A&E.

‘Even if we can check in with families and young people, mental health interventions rely so much on being able to see someone and understand what is being said without words. Some input – trauma work, for example – is risky to carry out over the phone…. My worry is that we will simply place vulnerable children back in the same situations that were causing a mental health epidemic pre-coronavirus’. Not unlike the social care area, the parlous state of mental health services will need to be seriously addressed when we emerge from this crisis because neither area can continue as they are.

Although mental wellbeing depends to some extent on the capacity and preparedness to get out of comfort zones and take risks of trying new things, etc, we also need our routines and comforts – even more in these uncertain times. The slimmed down radio and tv schedules have already removed some of these eg no new The Archers episodes for some time and arts programming has suffered for obvious reasons. Since a major source of comfort is food and drink, it’s interesting to see The Times report on the ridiculed takeover of Rank Hovis McDougal by Premier Foods in 2006, when Premier had boasted about ‘mouthwatering brands’ like Angel Delight, Atora suet and Mr Kipling’s cakes. But now Premier has had ‘the last laugh’, because items like flour, stock cubes and custard powder, associated with early 1950s ration books, are flying off the shelves and Premier shares have doubled in the past month. Sounds like lockdown cake consumers might divide between those buying the flour to make their own and those going for Mr Kipling’s ‘exceedingly good cakes’, though these days the high sugar content mightn’t be to everyone’s taste.  

On a lighter note, today is National Garden Day, ‘a day dedicated to celebrating being in our gardens and open spaces’, and we’re told gardens are blooming and benefiting from the extra attention many are getting.   The UK’s thousands of garden centres and their suppliers have collectively lost millions over recent weeks but hope to claw back some of those losses if they’re allowed to open over the late May holiday. James Barnes, chairman of the Horticultural Trades Association (HTA), said the country’s 23 million gardeners were ‘itching’ to get down to their local store to buy plants and other gardening paraphernalia.

“We know there will be a huge surge in demand. We would ask customers not to rush to retailers and buy more than they need.” Brace yourselves for those queues: we could be facing geranium rations instead of a toilet paper deficit.

During the last few weeks there have been several losses of key music industry figures, including Stranglers keyboardist Dave Greenfield, Kraftwerk’s Florian Schneider and now Little Richard, described in The Guardian as ‘an ultra-sexual force of anti-nature’. It’s worth  catching The Times’s topical take on 1955 hit Tutti Frutti’s lyric ‘awopbopaloobop alopbamboom’ on Radio 4 (09.21 minutes in).

https://www.bbc.co.uk/sounds/play/m000j11r

Saturday 9 May

There are almost no words for the announcement that, from the end of May, incoming air passengers will be quarantined for 2 weeks, something which should have been implemented months ago.

As posted here earlier this week, there was always the possibility of the contact tracing app being challenged in the courts because of privacy concerns. Now, in what could be quite some climb-down, we hear the government is seriously considering switching to the Apple/Google decentralised model. If this comes to pass, will the payment which will have already been made to Ben Warner’s brother’s company be rescinded? Or will that be another bad debt like so many other examples during the last few years?

As the lockdown debate continues throughout the Bank Holiday weekend (and many more people out and about than there were), there’s mounting pressure for a more nuanced approach to prevent further unnecessary mental distress. I don’t think there are clear figures for the UK yet but for Australia we hear modelling from the Sydney University’s Brain and Mind Centre predicts deaths linked to suicide would be more than four times those directly caused by coronavirus. It’s also well-known that much mental distress will be experienced behind closed doors, people not necessarily publicly acknowledging it. Age UK and various MPs have said there can be no justification for keeping the over-70s at home while other age groups are given more liberty unless there is clear medical advice. I wasn’t expecting to be quite envious of the Welsh if they’re soon to be allowed access to libraries and recycling tips! It’s essential that we  encompass some risk in life, because life itself is a risk and not doing so constitutes existing rather than living. Writer and academic A L Kennedy spoke last night about the perception of risk.

https://www.bbc.co.uk/programmes/m000hwsz

What did you think of the Queen’s VE Day message? Whether you’re a royalist, republican or some way in between, these broadcasts are quite powerful, partly, perhaps, because we can derive more reassurance and psychological holding from our monarch than our elected leaders. “Never give up, never despair – that was the message of VE Day”.

There were certainly mixed views about this event and it’s sobering to be reminded of the connection between VE Day and the crisis. A Today programme listener tweeted: ‘The veterans we honoured yesterday are the same ones we are failing to protect in care homes, dying as a result of lack of PPE and testing’.

In the context of the need to keep pollution down, social distancing lasting for another 12-18 months at least and the urgent need to enable alternatives to public transport and the car, measures like widening of pavements and more cycle lanes are being planned. But a key point captured by some including natural world writer Rob MacFarlane is that this isn’t ‘just’ about travelling – it’s about the much wider opportunity to redesign our cities, one we should seize. The BBC reports that just 9% of people want a return to pre-lockdown life. Although habit change is difficult, ‘the crisis has transformed behaviours overnight’. This sounds genuine and not the comment of an opportunist: “We’ve got this really precious moment to change how we live and we can’t let it slip between our fingers. Let this tragedy re-define, in a positive way, what living in cities is about,” (Will Butler-Adams, the CEO of UK bike manufacturer Brompton).

There are three radio programmes later you might find interesting and if you miss them at the time you can catch up on BBC Sounds. One is the regular (only 15 minutes) Profile series on key figures, tonight’s being New York governor Andrew Cuomo, who’s gained more public recognition for his honest and humble COVID stance, in contrast to that of POTUS.

https://www.bbc.co.uk/programmes/m000j12p

The second is the series featuring the Poet Laureate, Simon Armitage, talking to other artistic figures in his shed – tonight Anthony Gormley. These conversations always sound so natural and engaging you wonder if Armitage already knows his interviewees or can just relate to them and draw them out immediately, although some will need less drawing out than others.

https://www.bbc.co.uk/programmes/p0884kv9

In the third, highly relevant because so many are complaining of it and the ‘I’m bored’ hashtag is trending on Twitter, comedian and performance poet Phil Jupitus explores and reframes the concept of boredom. ‘So do we still need to be bored? And what would we miss if we did eliminate boredom completely from our lives?’ Should be thought-provoking.

https://www.bbc.co.uk/programmes/b082szm7

Finally, we must be relieved to hear that after a dispute lasting months, the prestigious Forbes magazine has now conceded to recognise rapper Kanye West as a billionaire. (Although West had been featured on August’s cover the accompanying profile had apparently not acknowledged his wealth). Nothing like having a sense of priorities!

Friday 8 May

Following what many found mixed messages about lockdown strategy over this long weekend, not to mention the PM’s absence from last night’s Downing Street Briefing, heads of police forces have confirmed that lockdown is slowly ‘ebbing away’. They reckon there’s about a 10% increase in foot and road traffic compared with the start, and that they won’t be able to police it this weekend. A south of England chief said ‘The public are getting tired’ – a key point because behavioural scientists (if they were asked) might say that 6 weeks is the limit of people’s tolerance given confused policy on most aspects of this crisis strategy. Dominic Raab nevertheless stuck to his script, which is making less and less sense by the day because people are seeing a change, reinforced by the press: “As we enter another long bank holiday weekend I think the message is very clear: follow the guidance. There is no change today in the guidance or in the rules, but the prime minister will set out a roadmap on Sunday.” Some descriptors said to be characterising the ‘roadmap’ are modest, small and incremental, thought to show the government’s nervousness about it, suggested one commentator. Just see what happens around your way over the weekend – lockdown has been ebbing away for some weeks now. 

I’d imagine quite a few were shouting their radios and tellies during last night’s broadcast of Question Time. Writer and broadcaster Afua Hirsch was impressive, putting environment minister George Eustice’s poor performance even more in the shade. He couldn’t defend the government’s record (the predictable subject of the first question, asked by Margaret), kept resorting to the now risible ‘ramping up’ cliché, and couldn’t explain how the contact tracing app would work even though it’s currently being trialled in the Isle of Wight. After the panel’s contributions Margaret was asked by Fiona Bruce whether she was now satisfied and the response was a one word ‘No’.

Although the PM’s approval rating has declined since the start or lockdown (67% to 52%), it seems a substantial number still see him as managing the crisis well in the face of solid evidence to the contrary. Could this be one of the reasons, besides a reluctance to criticise authority? And reluctance to have doubt cast on their judgement if they voted for him?

Radio presenter James O’Brien tweeted: ‘So many people remain incapable of contemplating the possibility that Boris Johnson has been appallingly negligent & dishonest about *this* because it would mean they had to accept the possibility that he had been appallingly negligent & dishonest about *that*.’

Re the contact tracing app, which has raised privacy concerns, an interesting piece on Bloomberg Opinion by Andreas Kluth (If we’re going to build a surveillance state let’s do it properly) captures the dilemma most countries are facing. This is ‘balancing individual freedoms with the need to collect data’ (and at least one on BBCQT said we must sacrifice the first in order to save lives via the second). Kluth suggests we need a hybrid model, avoiding the extremes of ‘US libertarianism and Chinese authoritarianism’, citing the example of Taiwan, which is using ‘participatory self-surveillance’. In this model, citizens voluntarily partner with the government in a two-way information exchange, top down and bottom up (and it’s surely bottom up we are missing here), so that everyone’s involved in a joint enterprise of data capture and use. Kluth sees the only real alternative to this as ‘interminable lockdowns that rob us of more freedom’. Can anyone see participatory self-surveillance happening here? Even if the idea got public support, it seems unlikely that such a centralised, command-style government would take it up.

https://bloom.bg/3crVV1P

To what extent is VE Day being used to deflect from shambolic pandemic crisis management? Quite a bit, it seems, if media coverage is anything to go by. No doubt later there’ll be substantial coverage of fluttering bunting, distanced gatherings, singing and so on, but my mini research poll suggested little appetite for it. Some respondents declared themselves patriotic, planning to drink champagne, but mostly the feeling was that it would be tasteless to celebrate amid so many COVID deaths. It seems important to quietly recognise the sacrifices so many made during WW2 but many won’t feel like partying. A small group of neighbours here observed the two minute silence at 11 am and that feels enough. “The people who thought least celebrated most and the people who thought most celebrated least”, observed Max Hastings on BBC World at One.

The latest piece of programming on Coronavirus fallout is one focusing on the economy, asking what damage are the pandemic and lockdown doing to the economy and what could happen next? ‘David Aaronovitch explores the economic impact of physical distancing on business, whether our fast expanding national debt is sustainable and the threat posed by declining consumer confidence on our economic recovery. Does history offer a guide as to how and when people should return to work and government support be turned off? And what will our economy look like when the lockdown is eased?’

https://www.bbc.co.uk/programmes/m000hvtj

Health Science Journal reports that Care Quality Commission data now reveals that deaths of patients detained under the Mental Health Act are running at five times the rate of 2019, half due to the virus. This confirms the fears expressed anonymously recently that psychiatric wards were especially difficult environments, because of lack of PPE and patients’ lack of capacity meaning they wouldn’t understand why they should distance, receive no visitors and have no leave. 112 died between March and May (in hospital and the community), compared with 56 deaths during the same period of 2019, 61 deaths in 2018, and 70 deaths in 2017.

Dr Kevin Cleary, deputy chief inspector of hospitals and lead for mental health said: “That a number of people detained under the Mental Health Act have died from suspected or confirmed coronavirus is a particular worry as these are some of the most vulnerable people in society.”

https://bit.ly/2YKwHaB

On the theme of mental wellbeing again, what’s known as the gratitude exercise (or similar) is very helpful to engage with, although it might sound a bit cheesy if you haven’t come across it previously. It basically means thinking of and appreciating 5 -10 things in your day which have been positive, however small. It’s common to overlook small things and maybe think nothing good’s happened today, but reflecting for a few minutes will usually throw up at least four or five, such as someone smiling at you while out walking/shopping or whatever. Today I had at least three good things before lunchtime: someone buying me a pasteis de nata (Portuguese egg tart); getting a good view of the recently hatched baby coots because the hen bird was off the nest for the first time during my visits; and sniffing a delicious lilac not far from home, discovering the gardener was a nodding terms neighbour and having a good conversation about gardening and other things. Hoping to have a few more before the day’s out!

Finally, The Week tells us that the Oxford English Dictionary has added another print run in order to include COVID-related terms which have come into common usage. These include ‘social distancing’, ‘personal protective equipment’ and ‘flatten the curve’. Separately, social media have listed about 20 soundbites, including ‘ramping up’, ‘straining every sinew’, ‘working around the clock’ and ‘following the science’.

Thursday 7 May

Speculation about today’s and Sunday’s announcements on lockdown strategy has led to  #Keepthelockdown  trending at no 1 on Twitter, while many media sources and politicians are calling for its end or phasing out, for the sake of the economy, mental health and so on. There’s concern that the government wanting to convey an impression (delusion?) of progress (via lockdown end) will undermine public safety, not to mention lead to mixed messages and confusion. One frustrated individual tweeted:  “Lockdown” is expected to be extended today by another 3 weeks. But on Sunday, restrictions will be partly relaxed, apparently. Will we still be in “lockdown” after that? If so, what does “lockdown” even mean? If not, wtf does the government think it is doing?’ The key thing we need right now is clear messages based on scientific consensus, not vague statements allowing the government to abdicate responsibility further down the line. The ‘messages’ of the today’s Downing Street Briefing (minus the PM again) weren’t found clear, especially by Beth Rigby of Sky News, who suggested the public would be confused by not having firm guidance before the Bank Holiday weekend. The existing guidance is supposed to remain but suggestions of sunbathing and picnics being amongst Sunday’s possible lockdown relaxation measures, plus the fine weather, could result in confusion and people jumping the gun.

More than a fortnight after the Turkish supply of PPE debacle, it has emerged that all of the 400,000 protective gowns that eventually arrived were impounded after being found not to conform to UK standards. Despite official sources claiming that all clinical staff have the PPE they need, a British Medical Association survey revealed that almost half of England’s doctors have sourced their own PPE or relied on a donation when none was available through normal NHS channels. Niall Dickson of the NHS Confederation is one of (probably) many stressing that rhetoric must match reality, that it’s better to promise less and deliver more than make over-confident claims which then fail, because this undermines public confidence. That’s putting it mildly. Alluding to another kind of opacity, the often apoplectic but forensic Piers Morgan tweeted earlier: ‘The UK Govt has banned any ministers from appearing on GMB after a series of them made complete fools of themselves in the face of basic & important questions. This is a pathetic & cowardly response to THEIR shameful incompetence’.

There’s naturally a great deal of interest and speculation about what sort of world will emerge from this crisis and an interesting piece in the Guardian focuses on the work of Austrian economic historian Walter Scheidel. In his book The Great Leveler: Violence and the History of Inequality from the Stone Age to the Twenty-First Century, he suggests that throughout history, pandemic is one of the only four events capable of bringing about greater equality. (War, state collapse and revolution are the other three). Re pandemic, he showed how the Black Death in the 1300s killed a third of Europe’s population and massively reduced inequality by raising the price of labour.

We’ve already seen evidence of the clash he predicts: between those determined to go back to the status quo (‘normal’?) even at the price of making inequality worse and those who want a reset. Because human beings struggle with uncertainty and Not Knowing, leading to a desire for false reassurance, there’s a strong pressure to go back to business as usual. “There will be a strong push to go back to growth to finance the huge deficits that governments have been racking up, so, if anything, growth will be more important than before. At the same time, if the effects of the pandemic polarise societies even more, there will also be stronger agitation for more progressive or distributive policies. It will be very difficult to reconcile those two motivations.”

https://bit.ly/35Fckgq

Looking at the more immediate aspects of recovery, Peter Molyneux (chair of Sussex Partnership NHS Foundation Trust), whose blog appears on the NHS Confederation website, suggests a promising route based on mental health recovery principles. These are: connectedness, hope and optimism, identity, meaning and purpose, and empowerment. He makes a key point about trauma at both individual and societal levels, acknowledging the knock-on effects inherent in the overall system, and makes a compelling case for an overarching, systematic approach. (One of the most criticised aspects of government strategy so far has been its piecemeal and over-centralised nature).

‘We will need to understand the trauma that occurs in individuals and which affects populations, which will be experienced in different ways. The commitment in the Long Term Plan on population health will now need even greater focus on population mental health, both in terms of health and care and the economic and social impacts. Sussex is already being hit hard by the impact of the pandemic on Gatwick, as well as the cancellation of events which are the engine-room of the seasonal economy. This is affecting unemployment rates and will have a resulting economic and social impact on population health. 

This implies discussing how we can achieve a more systematic approach to population mental health. There are some fantastic examples of places where this is happening, but it is patchy and fragmented. So across systems, we need to co-produce with communities and wider civil society ways in which we can support individuals but also reduce some of the underlying causes of mental distress – and the unequal way in which this is distributed across populations and communities.’

https://bit.ly/3dqE6QM

It’s common now to come across tips on surviving lockdown and most of these are actually based on the useful wellbeing principles developed some years ago by the New Economics Foundation, a British think-tank aiming to promote “social, economic and environmental justice”. The five principles are Connect (with the people around you: family, friends, colleagues and neighbours at home, work, school or in your local community – mostly online at present); Be active; Take notice (be observant, look at something beautiful eg in the natural world, meditate); Keep learning and Give (in the wider sense of the word). It’s really helpful to do one or two things every day for both our mental and physical health and a current example I’ve not tried yet (but will) is taking a virtual museum tour – you can even ‘visit’ the Vatican. For ‘taking notice’ I’ve been visiting local waterways and woodlands, most of them a 90 minute round trip so a decent walk on top of the Joe Wicks live ‘PE’ sessions. (Incidentally, I gather the Wicks workouts and baking banana bread are now regarded as lockdown clichés but they’re good to do so I won’t stop!) Today I took my binoculars to the viewing platforms over the reservoir local birdwatchers had alerted me to. Nothing that exciting came into view but I’m told there are swifts, swallows, egrets and cormorants to be seen, so maybe another day….

Finally, consumer goods giant Unilever reports that its sales of products like shampoo and deodorant are significantly down since the start of lockdown, whereas household cleaning products are ‘flying off the shelves’. This suggests that some of the care we were formerly lavishing on our personal grooming is being diverted to our perhaps neglected abodes – maybe now Quentin Crisp will finally be proved wrong!

Wednesday 6 May

The COVID19 death toll has naturally focused more attention than usual on the ways death and mourning are observed. Funerals, now very restricted, have always been a way to mark an individual’s passing but in this extreme situation it could be argued that a much more public commemoration is called for. ‘It’s very weird how there’s been no collective mourning for all the dead. No television specials honouring them, almost no mention of them, nothing at all’, tweeted a Radio 4 listener. As is well known in the field of bereavement, what Freud called ‘the work of mourning’ will be arrested, suppressed or exacerbated by the absence of public ritual. Surely an acknowledgement and commemoration of those losses should be urgently considered, not just left till when the pandemic has run its course.

What a shame ‘Professor Lockdown’ Neil Ferguson let himself down and had to resign from SAGE because of breaching the lockdown he’d so strongly advocated. But perhaps, as is evident all around us, there’s a limit to people’s tolerance of lockdown, which has been gradually breaking down over the last few weeks, not to mention the persistent illogicalities like packed public transport and allowing in flights with no quarantining of disembarking passengers. Could this resignation mean we will now see more mainstream media attention directed to the deliberations of Independent SAGE?

“There has to be the development of a local based primary care, social care, locality based approach to this whole process of being able to continue to monitor infections”, suggested IS member Professor Deenan Pillay (UCL), in direct contrast to the government’s continued centralisation policy. This raises interesting issues about the nature of authority: if the de jure source is seen to be lacking people will look for de facto guidance elsewhere and perhaps Independent Sage will now come more to the fore.

Amid calls for a public inquiry on the government’s handling of the pandemic, statistician David Spiegelhalter said: “Well over 3,000 [of the excess deaths] weren’t labelled as Covid. So nearly a third were from something else. There is a continuing anxiety that many of these are due to the lockdown itself. The one thing we do know is that the health service has been hugely disrupted, not just in terms of routine care, cancelled chemotherapies and radio therapies and elective surgeries, but also of people with symptoms not going to hospital.” This is another area which seems to divide opinion: those wishing to avoid or delay scrutiny and reluctant to challenge authority arguing that we don’t have the full picture and that will only be possible post-pandemic, and those pressing urgently for an inquiry so that lessons can be learned now and used to inform how we go forward. It seems quite common to see comments eg on social media suggesting that the government ‘is doing its best’ and we should ‘leave them alone’ and ‘not whine’ – aka holding the government to account. Not surprisingly, one who presented the defensive argument was Home Office security minister James Brokenshire on the Today Programme – ‘now is not the time’ – allowed by presenter Justin Webb to get away with it.

There’s not much time before Sunday for the government to take this on board for its lockdown exit strategy but it’s positive that a more nuanced approach than the hitherto simplistic one has emerged from researchers at Edinburgh. They’ve suggested ‘segmenting and shielding’, based around relaxing restrictions on more than half of the population and beefing up protection for those over 70 and vulnerable people, eg their contacts being only carers and family members free from infection. These ‘shielders’ would be tested regularly and the entire strategy could be phased in over a 3 month period. It makes one wonder why such a sensible plan hasn’t been thought out before in government circles, especially bearing in mind that the policy of lumping together all over 70s, condemning them to many more months of isolation, has been very stressful for them. If this approach can be incorporated into the exit strategy it will provide some sorely needed reassurance.

https://bit.ly/2yoqBCk

Adding to private sector inroads already made into the NHS, it seems more privatisation by stealth is being facilitated by the pandemic. Doctors, campaign groups and academics have raised the alarm that Serco was being positioned to win a deal to supply 15,000 call-handlers for the government’s tracking and tracing operation. It’s also not commonly known that Deloitte, KPMG, Serco, Sodexo, Mitie, Boots and the US data mining group Palantir were given contracts to manage Covid-19 drive-in testing centres, the purchasing of personal protective equipment (PPE) and the building of Nightingale hospitals. These arrangements haven’t been scrutinised because special powers have been used to bypass normal tendering, awarding numerous contracts without open competition. It’s also been suggested that the move from individual NHS trust procurement to centralised purchasing will lead to more control by Deloitte and co. Surely this should have been raised at PMQs today.

The Guardian quoted Tony O’Sullivan, a retired paediatrician and co-chair of the campaign group Keep Our NHS Public, who said this was a “dangerous time” for the NHS, and that the “error-ridden response” from government had exposed a decade of underfunding. ‘Now, rather than learning from those errors they are compounding them by centralising decision-making but outsourcing huge responsibility for the safety of the population to private companies’. Labour MP Rosie Cooper and Health and Social Care Committee, said these contracts must have a sunset clause, enabling the arrangement to be reviewed after 3 or 6 months. Who knows whether these contracts have such a thing?

Health Secretary Matt Hancock is the Guardian’s parliamentary sketch writer John Crace’s subject this week. In a withering but funny article, he alludes to ‘the battle between his (Hancock’s) career and his conscience’….The career is still winning. But the gap is closing. Part of him longs to tell the truth. About the uselessness of his predecessor, Jeremy Hunt, who ran down the capacity of the NHS to unsafe levels. About the self-indulgence of a prime minister who prioritised celebrating Brexit and sorting out his private life over trying to make sure the country was prepared for the pandemic. Yet he can’t quite go there yet. So instead he attacked Allin-Khan for adopting the wrong tone. In time, he will see that it was he who got the tone wrong’. A major point he makes is Hancock seeming not to understand why he’s being challenged on the failings as he’s expecting to be congratulated on the 100,000 tests, when this has widely been seen as a meaningless goal. But his increasing tetchiness may also be due to being hung out to dry by his boss.

Finally, it’s positive that public libraries, a hugely undervalued community resource, are doing a roaring trade online, producing online content, answering queries and phoning elderly readers for a chat. An amusing Twitter exchange between librarians focused on interesting ‘bookmarks’ they’d found in books, including an After Eight mint still in its wrapper and a Blockbuster card (“a proper ancient artefact”). From librarianship days this brought back memories of the stories (mythology?) which grew up around this topic of weird bookmarks encountered in returned books, including a fish spine. Quite often, though, the less obvious ‘bookmarks’ don’t come to light until the next reader borrows them. Numerous library users will have found various items over the years, including old bus or train tickets, receipts and heaven knows what else. Feel free to let me know what you’ve found left in a library book!

.

Tuesday 5 May

Although some caution must be exercised because of different ways of handling statistics in different countries, it’s shocking to learn that the UK has overtaken Italy for the highest number of COVID-related fatalities in Europe – more than 32,000 according to the latest ONS figures released today. Although the causes are well known, especially the tardiness in addressing the crisis, several pieces of news this evening will reinforce them, eg the PM continuing to shake hands with colleagues after clinical advice to the contrary and 18m people being allowed into the UK early in the New Year and not quarantined. 

The contact tracing app leads the news, with some pointing out that it shouldn’t be called the ‘NHS app’ since it’s being developed not within the NHS but by the company belonging to the brother of a no 10 ‘adviser’ (Ben Warner). And why reinvent the wheel when the Google and Apple enabled ones already exist and other countries are using them? British exceptionalism again? As co-author of the legal opinion suggesting the app could be challenged in the courts on privacy grounds, QC Matthew Ryder told BBC Radio 4’s Today programme that the Government is yet to “present the evidence or the material it would need to justify the course it is taking”. He said the government is ignoring Information Commissioner’s Office advice, which suggested that a decentralised approach would best protect user privacy rather than the government’s centralised approach to this whole crisis.  

Former Health Secretary Jeremy Hunt told BBC World at One that people should download the app but some at least feel that lack of trust will be a disincentive. A listener tweeted: ‘It’s too late. They’ve already lost our trust in the contact tracing app by using their mates who developed the tech for Vote Leave and then centralising the data. They will never get that trust back’. This issue has also raised concerns at the possibility for use being made compulsory or least people being subjected to heavy pressure – could ‘recalcitrants’ be traced via their phone and made to use this app? Needless to say, loss of trust in our leaders (or politicians’ failure to instil it in the first place) will exacerbate pre-existing anxiety.

Regardless of how the Isle of Wight trial goes, it seems that two key challenges have yet to be navigated. One lies in the failure to pass NHS tests so far, according to Health Service Journal. ‘Senior NHS sources told HSJ it had thus far failed all of the tests required for inclusion in the app library, including cyber security, performance and clinical safety’. The second is that at least one data expert, Nyasha Weinberg (Research Fellow in Rule of Law Measurement at the Bingham Centre UK Constitutional Law Association), argues that the app needs primary legislation to provide safeguards and legitimacy. https://bit.ly/3b2VVDC

Can such hurdles just be disregarded with the likely argument that there’s no time to address them? This issue highlights further the conflict between the needs to protect privacy and to urgently accelerate testing.

Another example of opacity is the news that coroners are effectively being silenced and hampered in their roles. The Independent reported that more than 100 health and care staff are thought to have died after contracting the Covid-19 virus. Although coroners will be able to investigate these deaths due to lack of PPE, they won’t be allowed to question national policy. This could risk hospital CEOs and GPs being unfairly blamed, leading to expensive litigation.  

Meanwhile, scientific opinion remains divided on the wearing of masks, this inconsistency being confusing and unhelpful for the public. Although a report from a multidisciplinary group convened by the Royal Society called Delve – Data Evaluation and Learning for Viral Epidemics – has considered the evidence and decided in favour of public wearing of face masks, other scientists disagree. Dr Ben Killingley, consultant in acute medicine and infectious diseases at University College London hospital, said: “The report is overly optimistic about the value of face coverings and it is incorrect to conclude that the evidence shows that face covering can reduce viral transmission in the community…There is in fact no good evidence that face coverings achieve this.”

It won’t help Brexit talks that a European body has criticised UK strategy, despite the PM’s claims of success. Andrea Ammon, director of the European Centre for Disease Prevention and Control (ECDC), suggested on Monday that the UK had yet to progress as far as the majority of European countries in tackling the disease. ECDC reckons that only the US exceeds the UK’s total of 186,599 confirmed cases and 28,466 fatalities, a death count second only to Italy. [Later news above confirmed that UK has now overtaken Italy]

Here are two radio series you might enjoy for some light relief, although the second could make you think about what it could be like returning to a pre-NHS health service if privatisation continues unabated. On Radio 4 the engaging music journalist Pete Paphides (married to writer Caitlin Moran) reads his autobiography (Broken Greek), which describes his childhood experience of selective mutism and the upheaval of his family’s enforced move from Cyprus to set up a fish and chip shop in Birmingham.

https://www.bbc.co.uk/programmes/m000hvm3

This adaptation of A J Cronin’s novel The Citadel makes for compelling listening, focusing on medical life in the 1920s. Wikipedia tells us: ‘The Citadel is a novel by A. J. Cronin, first published in 1937, which was groundbreaking in its treatment of the contentious theme of medical ethics. It has been credited with laying the foundation in Great Britain for the introduction of the NHS a decade later’.

https://www.bbc.co.uk/programmes/m000hvky

Finally, during her recent Evidence programme for the BBC World Service, author and broadcaster Claudia Hammond coined a useful moniker for the state of COVID-related anxiety we are all experiencing at some level:  Coronacoaster. It might just catch on.