Saturday 30 May

What a terrible news week it’s been. With COVID deaths moving towards the 40,000 which sounded horrific when first estimated months ago and still does, there’s been the Dominic Cummings debacle and further erosion of confidence in the PM on continuing to back him despite 44 of his own MPs including former ministers calling for Cummings’s resignation; 61 speaking up against his retention; the resignation of Under-Secretary of State for Scotland Douglas Ross; absurd defences of Cummings offered by numerous ministers and others; the removal of Emily Maitlis from BBC2’s Newsnight; Durham Police deciding, contrary to evidence, to take no action against Cummings and the PM insisting the matter is closed; Matt Hancock exhorting the public to do their “civic duty” and stay at home as he launched the new test and trace system despite local authorities lack of appropriate involvement and powers; continuing delays with the contact tracing app; the PM effectively silencing the Chief Medical Officer and Chief Scientific Officer at the daily press briefing; and eased lockdown rules which are riddled with inconsistencies, not least with the lockdown rules in Wales, Scotland and Northern Ireland.

It’s been shown that the already increasing breaches of lock down intensified after last week’s revelations that Cummings had so blatantly and unapologetically disregarded the ‘guidance’ everyone else was expected to follow, even if it meant not seeing loved ones at the end of their lives, attending funerals, seeing friends and family and numerous other sacrifices. Tory MPs have reported ‘bulging’ postbags and inboxes, complaints from aggrieved constituents askance at the apparent allowances being made, absurd accounts of events accepted and bending of the rules to suit this one adviser, when many have coped with far more challenging situations than those which faced Cummings.

The most worrying thing, though, has to be what’s emerged as the PM’s absolute dependence on Cummings, the one who clearly supplies the strategy and detail the PM clearly demonstrates he is incapable of. The PM was eviscerated by Guardian parliamentary sketch writer John Crace – ‘Clueless on health policy, clueless on benefits. No wonder Dom is still in a job – he runs the show’, while the New Statesman captures the PM’s dilemma: ‘Boris Johnson is in an awful bind. He can’t afford to sack Dominic Cummings, but nor can he afford to keep him’. The government is fast losing authority and credibility because of this saga, an embarrassment to the UK’s standing in the eyes of the world besides causing much anger and unhappiness here in the UK.

One poll suggested that Boris Johnson’s approval rating fell by 20 per cent in the space of four days. The whole debacle reveals the PM and ministers as inhabiting a strange kind of alternative reality, in denial about the damage it’s causing and caught up in an Emperor’s New Clothes scenario. This was exemplified by lockdown breaching minister Robert Jenrick defending Cummings’s inappropriate use of a childcare exception only intended for safeguarding in potential child abuse situations. What they don’t seem to yet realise is that the short-term saving of Cummings will cause much longer term damage – the matter is by no means ‘closed’.

This stance is also personally damaging for apologists. An Any Questions listener tweeted: ‘When will ministers realise what harm they are doing themselves through cognitive dissonance? At some level, however deeply buried, they know what they’re saying is wrong and the inconsistency between what they know and what they present will be unhelpful’.

The supreme irony has to be Matt Hancock stressing the importance of us doing our ‘civic duty’ regarding the track and trace strategy. This didn’t escape an incredulous Stephen Fry, who tweeted: ‘You. Are telling us our civic duty. You?’

Meanwhile, the controversy has spawned numerous social media spoofs, the humour perhaps helping us to cope with a situation we’re mostly powerless to change. Serious contenders for the best of these must be the Barnard Castle Specsavers ‘advert’ and the alternative version of the Proclaimers’ I’m gonna be (500 miles).

As if this wasn’t enough, ITV News announced that it had obtained evidence that it was always the plan to discharge Covid-19 patients into care homes. 1,800 beds were block booked in care homes by the NHS and councils for that exact purpose. …’And they’re still being discharged’. An article by an NHS consultant writing anonymously in the Guardian is sobering and worrying on various levels and they must be very unsettled by damaging policies imposed from above, like the care home discharges. He or she is particularly concerned about the possibility of a second wave, due to people feeling too relaxed about lockdown easing, about those who haven’t been to hospital with worrying symptoms now being found (for example) with only days to live due to undiagnosed cancer and about the ongoing lack of bedside testing. ‘This new phase is difficult, uncertain, draining. There are endless planning meetings and constantly changing advice. Many of us still struggle with insomnia and then there’s the toll on our mental health’. This toll is not only due to the challenging circumstances these clinicians have to navigate every day but also the lack of psychological ‘holding’ from policymakers above, not dissimilar to what the public is experiencing with our political leaders.

Many are concerned that the government is rushing ahead with reopening shops, businesses and schools when it’s not safe to detract from their ongoing series of errors and to suggest we’ve made more ‘progress’s than we have. Other countries like France and Italy undertook the hard work of complete lockdowns, with exceptions documented and policed, so were able to reap the benefits of lockdown easing. It could be argued that the only partially locked down UK is trying to prematurely get to easing without having invested initially in the appropriate measures. 

It won’t please the government that some SAGE members have publicly expressed unease over lockdown easing new lockdown rules while there are 8,000 new infections every day in England, excluding those in hospitals and care homes. “We cannot relax our guard by very much at all,” said John Edmunds, a professor of infectious disease modelling at the London School of Hygiene and Tropical Medicine who attends meetings of SAGE.

But this debate increasingly focuses our attention on risk – some are more naturally risk averse than others but others are deciding they’d rather live fully than spend the rest of their lives in a very restricted lifestyle. Life is a risk and being unprepared to accept any leads to existing rather than living. Some shielding and clinically vulnerable people expected to continue in lockdown feel aggrieved that they’ve not been considered sufficiently and have decided in some cases to ignore the advice. It’s possible to do this without endangering others, as described by a man with a terminal diagnosis interviewed on the Today programme. It was promising to hear statistician Professor David Spiegelhalter talk about the UK leading on the development of a risk assessment tool, which may in future help individuals to accurately gauge their risk but in the meantime we have to decide ourselves. The Professor was worth listening to on Today for another reason, surely the quote of the week: invited by Nick Robinson to state his views on SAGE issues, Spiegelhalter wouldn’t be drawn and said his approach is to ‘’focus on the things you do know about and shut up about those you don’t’. Politicians and media, take note?

Concern continues about the track and trace strategy and how effective this can be without the once much trumpeted app and without the local public health infrastructure in place. Many have also wondered why former TalkTalk CEO Dido Harding was brought in to chair this strategy rollout. Now an anonymous former call centre recruit writing in the Guardian reveals a shambolic picture behind the scenes. The advert had read ‘You must have your own computer and high-speed internet to download our software and communicate with our customers … Don’t let lockdown stop you getting your dream job.” The ‘dream job’ began with what sounds a fiasco of a training, which took two hours to start and which was ‘very basic’, with little support from the trainer or afterwards from a supervisor. Having been thrown in at the deep end, trainees then found that they were kept waiting for days without work, despite being assured they’d be paid. ‘Two days later I logged in for my weekend shift and discovered nothing had changed – and that I had clocked up 40 hours of key worker pay for doing absolutely nothing. After the Dominic Cummings story broke I started hearing more media stories about the track-and-trace programme. Health secretary Matt Hancock claimed that “highly trained track-and-trace staff” were in place. I still had not seen the government system we were supposed to use.’ This ‘key worker’ quit shortly afterwards but observed: ‘Despite what the government is saying, it seems the relentless problem “with the system” is another pandemic without a cure’. Many of those recruited felt angry and confused and ‘none of them have any faith that we’re properly set up to fight any increase in infection rate from this pandemic’.

You might be interested in a few tv and radio offerings later today (and afterwards available on Iplayer or BBC Sounds). At 9.30 pm on BBC2 there’s a documentary about renowned jazz singer Ella Fitzgerald. It ‘traces Fitzgerald’s life from appearing at 16 in a talent contest at the Harlem Apollo while she was homeless to facing horrific racism as a singer in the 1940s before becoming one of the leading voices in the civil rights movement’.

Political Thinking with Nick Robinson at 5.30 today features former Supreme Court justice Lord Sumption, a former Reith lecturer but now perhaps better known for his anti-lockdown stance.

https://www.bbc.co.uk/programmes/m000jns4

Archive on 4 explores the wellness industry, said to be worth over $4 trillion a year despite no published research proving the benefits quoted for some of these products. ‘Online at least, self-care seems to revolve around buying stuff – luxury oils, face creams, scented candles, face rollers, bath bombs, silk pillows, cleansing soaps and stress-relieving teas. Or we can cherish ourselves by paying someone else for a service, from a yoga session to a delivery of artisan chocolates. Some doctors offer complementary therapies alongside conventional medicine’. This should be an interesting listen as it’s so common to hear people extolling the benefit of some product or diet, which often, unfortunately, are used as substitutes for healthy diet or exercise.

https://www.bbc.co.uk/programmes/m000jnsh

Finally, here’s your chance if you ever fancied yourself on Desert Island Discs. I can’t remember which one it was but a 1970s play featured a character endlessly obsessing about what they would choose, those choices clearly being governed more by what impression they’d make than how meaningful they were to him. But now the BBC wants us to submit our lists and get others to join in. They recognise that narrowing down your choices to 8 has long proved difficult so the website gives tips on how to do that and also provides templates. ‘Be yourself’, says the Beeb: ‘choose the music that matters most to you, rather than worrying about what others might think’. A friend says she’s listening to my choices and wants me to tell her why I’ve chosen them and what they bring up for me – as close to the real thing I’ll get and I will do the same with hers!  

https://www.bbc.co.uk/programmes/articles/5q0Ls856XYZ5VzlMQ1Lgjxf/desert-island-discs-challenge-and-how-to-choose-your-list

Monday 25 May

Not surprisingly, the Dominic Cummings revelations continue to dominate the media and infuriate many who have, despite considerable difficulties, mostly stuck to the rules which he chose to disregard and cover up. His actions further leach trust in the government, undermining authority and thereby its mandate to govern, although this doesn’t yet seem to have been grasped. Equally galling and painful is the way ministers and some others lined up to defend him, citing ‘circumstances’, as if these didn’t also apply to the millions who have adhered to the guidance. This kind of cognitive dissonance demonstrated by Grant Shapps and company is likely to backfire on them because of the psychological unease it gives rise to. At least it’s positive that backbenchers are opposing this stance and the first to do so, 1922 Committee member Steve Baker, got to the heart of the problem, warning that the strategist was “burning through Boris’s political capital at a rate that we just can ill afford in the midst of this crisis”. Piers Morgan didn’t hold back, tweeting: ‘Cabinet ministers rushing to publicly support Cummings breaking the Govt’s own lockdown rules just about sums up their collective moral bankruptcy & fridge-hiding, accountability-avoiding cowardice. The public won’t stand for this shameful hypocrisy, whoever they vote for’. Perhaps the most deadly rejoinder was J K Rowling’s to Culture Secretary Oliver Dowden’s ‘move along, nothing to see here’ one, finishing with ‘End of story’. Rowling responded: ‘I know ending stories and this ain’t it, chief’.

The difficulty for the PM is that keeping Cummings in post will dent his credibility even further but sacking him will mean (unless the adviser continues to pull the strings behind the scenes) finally having, after all these years of avoidance, to engage with strategy and detail, buckling down to the work this involves. Bluffing and buffoonery are no longer enough, if they ever were. Whatever choice is made, a backbench rebellion will make it harder. Journalist Jonathan Freedland tweeted: ‘Dominic Cummings made his name denouncing what he regarded as a hypocritical Westminster elitism contemptuous of ordinary people. Now he is the face of it.’ The febrile atmosphere intensified as the PM, making a ‘last minute’ decision to head the Downing Street briefing, gave a series of poor excuses for Cummings’s conduct and seemed to think the rest of the briefing could be taken seriously when the key issue remained unresolved. The incredulous and exasperated expressions on the faces of journalists like Robert Peston said it all.  Sidestepping this decision will not help the PM and this is unlikely to be the end of it, given the anger of many in the country and in Parliament. Adding to the drama was a ‘rogue’ tweet sent from the Twitter UK Civil Service account, reading “Arrogant and offensive. Can you imagine having to work with these truth twisters?” This was widely shared before being taken down but not before thousands had seen it.

Two other debates are rumbling on, continuing to illustrate worrying divisions, namely the reopening of schools and the return of MPs to Parliament. Besides the very real safety concerns, school heads are wrestling with the practicalities of reopening primary schools for some year groups in just a week’s time in England. An Opinium poll for the Observer found that 43 per cent of primary school parents and 54 per cent of secondary school parents feel anxious about the prospects of pupils returning. Getting on for half of those surveyed sounding reluctant to send their children back to school represents quite an obstacle for ministers to try to overcome in just one week, not looking good for getting parents back to work. Many are concerned that kick-starting the economy is being prioritised over the safety of pupils and teachers and the return policy is not being supported by SAGE.

Some parliamentarians are equally concerned about being expected to return to Westminster on 2 June, despite Jacob Rees-Mogg’s argument that it was necessary in order to progress badly needed legislation. He said that hybrid parliamentary proceedings (most MPs contributing via video-link) didn’t allow sufficient scrutiny of policy matters but some MPs are worried about their vulnerability and risk because of underlying health conditions. In both these controversies we can sense the government’s urge to get the economy moving, which is understandable but not at the expense of safety.  

The Guardian’s weekly Upside feature asks if the pandemic has made us nicer, for example the focus on community and people helping each other. ‘The revival of community has been one of the more exciting upsides from Covid-19. Homo sapiens got where they did by being cooperative and collaborative, and we’ve seen that on a daily basis: the seed sharers, mask weavers, happy clappers, valiant volunteers, community choirs and online orchestras’. Implied but not specifically stated apart from seed sharing is the giving and receiving of small gifts (eg a plant, bottle of wine, a jar of jam, piece of homemade cake etc) which I hope continues. The article invites us to nominate our community heroes and also to take part in a live streamed discussion on 5 June (1-2 pm) about the rise of community. I’m nominating someone – might you?  

https://bit.ly/36u1tX3

Now that the woman who initiated the weekly clapping for NHS and frontline workers has said it should now stop, I wonder who will stop and who will want to keep on clapping. I suspect many will continue, despite Annemarie Plas, a Dutch national living in south London, saying she was “overwhelmed” by the support for the ritual Clap for Carers, but it was better to stop while it was ‘at its peak’. She’s concerned that, as we move into the 10th week of lockdown, it’s becoming ‘politicised’ but suggests we can show our appreciation ‘in other ways’ and we should resurrect it in a year’s time to mark the anniversary of the pandemic’s outbreak. Yes, it’s about appreciation but it’s also about community engagement and neighbourhood solidarity during lockdown, an opportunity for people to come out and have a chat.

But a doctor writing anonymously in The Guardian explains his dislike of the weekly custom. ‘I know many of my colleagues appreciate the clapping, saying that they feel moved and grateful, that the coming together of the community to support the NHS warms the heart. There are others, like me, whose response is that it is a sentimental distraction from the issues facing us. The NHS is not a charity and it isn’t staffed by heroes. It has been run into the ground by successive governments and now we are reaping the rewards of that neglect, on the background of the public health impact of years of rampant inequality in the UK’. This doctor won’t be only one who, rather than clapping, wants fair pay and conditions for NHS staff, to have their concerns listened to and for whistleblowers to be able to speak out without fear of retribution.

Zoom has quickly become a lifeline for many, a crucial tool for business and the closest we get to social life. Numbers of daily users have reportedly risen from 10 million in December to 200 million by March, many getting into this technology for the first time. But there are downsides, such as the system crashing, meeting time eroded by having to ensure participants are all tuned in with video and audio, and it’s been acknowledged this communication channel is more challenging and tiring: silences don’t work well in videoconferencing, body language demeanour and body language can’t be so easily picked up, we can be self-conscious about constantly seeing our own faces in a way we wouldn’t normally and there are the distractions of backgrounds including the contents of bookcases. The ‘Zoom boom’ has also shone more of a light on the digital divide, as numerous people don’t have the kit or broadband access.

The internet, including Zoom itself, offers examples of Zoom etiquette and it’s to be hoped such guides become better known as time goes on. The second tip on one list said ‘don’t wear your pyjamas’, though one meeting participant proudly tweeted that he wore a smart shirt on the top half and pyjama bottoms on the other. I asked him what if he had to get up but didn’t get an answer. Seriously, it would be good if there was more awareness of the irritations of people fidgeting, getting up and down, taking phone calls, holding pets on their laps, talking to others in the background and worst – eating/drinking/clattering around with utensils and what one list calls ‘doing private things while on a meeting’.

Finally, the growth of ‘slow’ this and that (having started in Italy with slow food) has seen a rise in slow radio and podcasts in recent years. Listeners to BBC Broadcasting House on Sunday mornings are regularly treated to calming sounds like birdsong, creaking trees in a forest and rain on a tin roof, surprisingly nourishing for the senses and an aid to mindfulness and meditation. Alan Davey, the controller of BBC Radio 3, which has made slow radio a speciality, says:  ‘Radio is a very intimate medium. It’s a very close relationship between what’s being broadcast and the listener. And, especially if you listen on headphones, you can really immerse yourself in it and get lost in it.” I suspect there’s something about this kind of material which accesses a certain part of our brains, perhaps the limbic system, which isn’t always discernable to us, the territory of neuroscientists and trauma specialists. Anyone interested can check out some ‘slow’ offerings here – the kind of thing that’s going to be helpful during lockdown.

https://bit.ly/3gmlfIE

Friday 22 May

Apart from the ghastly death toll (now over 36,000) several issues dominate the news agenda. The PM’s humiliating (for him) U-turn on the NHS surcharge for overseas NHS and care workers seems to have resulted more from the threat of a backbench rebellion than by any understanding of what an unjustifiable policy the surcharge was. This U-turn was described as the first of his ‘premiership’, but arguably the schools reopening debacle also constituted one, because it was only narrowly averted by ministers realising its weak position and deciding not to sanction ‘rebel’ councils. Whatever you want to call them, these manoeuvres will only serve to further undermine the government’s authority. Independent SAGE, which believes 1 June is too soon for schools reopening, has met today to discuss the issue. It’s probably unrealistic to hope that ministers will take account of its discussions but it would be interesting to know if the de facto SAGE feels threatened by the existence of an alternative body of experts.

Senior scientist Sir Paul Nurse expressed concern again on the Today Programme about the lack of accountability: ‘Who is in charge? Is it ministers, PHE, SAGE? I don’t know, do they know? It’s been like pass the parcel. We are desperate for leadership at all levels’. Besides again encapsulating the lack of psychological ‘holding’ of the public by their leaders, this relates in part to the PM’s continued absence from forums he is responsible for, for example the daily press briefings, leaving loyal lieutenant Matt Hancock to field tricky questions and to defend the indefensible. The Guardian’s parliamentary sketch writer, John Crace, excels himself today with his latest take on the Health Secretary’s plight.

https://bit.ly/2XnkqXo

Understandable exasperation has been expressed over the new quarantine policy – far too late in the day and illogical in applying to UK arrivals except those from the Republic of Ireland. It must be exhausting for ministers, trying to apply retrospective logic and planning to manifestly illogical and absurdly delayed policies and expecting the public to buy it. A BBC World At One listener tweeted: ‘Quarantining arrivals must surely have been a topic for Sage back in early March when the rest of the world was doing it. I wonder what their opinion was then. Did govt say no & if so why? Will we ever know? Transparency’. This issue is expected to dominate the Daily Press Briefing later so can we expect clarification or further obfuscation?

Still very much in the news is the test, track and trace strategy, especially given the admission that the much-trumpeted tracing app will not be ready by the 1 June, when the strategy is meant to be ‘up and running’. Last night on Question Time a hitherto unknown junior minister called Chris Philp was bullish about the strategy and said the app was not needed to make it work, a statement some may find strange given the obvious lack of experience the newly recruited tracers will have. Niall Dickson, head of the NHS Confederation (membership body for organisations which commission and provide NHS services), has written to Matt Hancock, expressing his members’ concerns about implementing a clear strategy by 1 June, saying time was running out to prevent a second wave of COVID19. Ministers don’t have that long to convince NHS workers and the public that there is a clear strategy and to provide evidence of it. Along with experts like Professor Allyson Pollock (a member of Independent SAGE) he stresses the need to understand the local context: ‘I think there is concern among those at local level because we’ve seen – not occasionally, we’ve seen often – where national stuff is done with the best of intentions, but unless the local context is understood it doesn’t really work as well as it should.” As Professor Pollock said: ‘You have to know your local community. You can’t put the fire out from the centre.” It seems the government has been very slow to grasp this, still trying to control everything nationally from the centre, along with all the bureaucracy and delay this involves. 

While it’s positive that the media have covered Mental Health Awareness Week, some of the BBC’s coverage has been disappointing, in my view. On Wednesday, Radio 4 Woman’s Hour tackled the worsening situation regarding young people’s mental ill-health and long NHS waiting lists those seeking help have to navigate, many unable to get help. No disrespect to the two interviewees (a mental health campaigner/blogger and a wellbeing practitioner) but why on earth didn’t the editors invite a qualified and experienced counsellor specialising in working with children and young people, or a CAMHS (Child and Adolescent Mental Health Service) specialist? What’s worrying about such coverage is that listeners not acquainted with this area will get a rather narrow view of the situation and remain unaware of ways to seek help independently of the NHS, if necessary. 

https://www.bbc.co.uk/programmes/m000j94h

Last night, BBC2’s Horizon (What’s the matter with Tony Slattery?) focused on the former comedian, who seemed to suddenly disappear from the airwaves in the 1990s after a sparkling and ubiquitous media presence. Having experienced longstanding mental health problems, these became worse as he descended into heavy cocaine and alcohol use. Accompanied by his very loyal and supportive long-term partner, Mark, the filmmakers undertook to further explore the charismatic Slattery’s distress, given different diagnoses over the years, including severe depression and bipolar disorder. Both men were commendably open and generous in what they shared with viewers. The problem was, in my view and those of others, is that this exploration was predicated on a longstanding and unhelpful biomedical view of mental functioning, which basically asks ‘what’s wrong with you?’ rather than ‘what’s happened to you?’ This approach is based on psychiatrists making a diagnosis, which can often change, and usually prescribing medication, open to question given the close relationship between the psychiatry discipline and the pharmaceutical industry. Besides the fact that many of these medications have undesirable side-effects and only mask the symptoms rather than addressing the underlying causes, there are no biological markers which make it possible to determine with certainty what the ‘disorder’ (another biomedical term) could be. The problems with DSM (Diagnostic and Statistical Manual of Mental Disorders produced by the American Psychiatric Association), the psychiatrists’ ‘bible’ informing diagnosis, are now well documented.

Effectively exploring the root causes of mental distress involves talking treatments and as it’s known that difficulties like this often emanate from childhood trauma, a skilled trauma therapist. Not surprisingly, it turns out that Slattery experienced sexual abuse as a child but didn’t feel able to tell anyone about it at the time, or as time passed, by the sound of it. This results in a significant and lonely burden, shame and fear of stigma, often carried for many years. It’s to be hoped that Tony Slattery can now access the help he needs.

https://bit.ly/2ZsyzoX

An issue I doubt we’ll see media coverage of but is very real nevertheless, is the lack of government attention to the effects of lockdown on those living alone, especially given the significant growth in single person households in recent years. These concerns were well articulated by someone commenting on a Guardian article about being ‘imprisoned’.

‘Very little attention has been paid during lockdown those who live alone. There’s some concern and support for the elderly, but approximately 50% of the 8.2m single-adult households in the UK are people aged under 65. We’ve been totally ignored by the government and media, though many of us have very little support and of course are not allowed to go within 2 metres of ANY other human being, with no end in sight. “Bubbles”, if they come, wouldn’t benefit many of us because couples and families, and single friends fortunate enough to have family nearby, will, understandably, choose to be in a “bubble” with them rather than friends. But our dilemma is receiving no attention at all – this weekend the Guardian and Observer again had articles on families, couples, relationships in crisis etc etc. Nothing about those of us who are now left physically and emotionally isolated, no requests to tell Guardian Community how it is for us – nothing. I’m seeing mental health issues in people who 2 months ago seemed strong and resilient but are buckling under the strain of isolation and lack of human contact.’

Finally, a good example, perhaps, of ‘first world problems’ is news that COVID19 has delayed progress in developing new emojis, so there might be no new ones in 2021. This could feel very minor, but we’re told there are important aspects to it. ‘On an emotional level, the rollout of new emojis is important people who want to represent themselves in the lingua franca of the 21st century. And on a technical level, the pictograms are an important carrot dangled by the smartphone manufacturers to get people to go through the effort of installing software updates, which are crucial to protect users from security vulnerabilities and hacking attacks’. We’re told that some 2020 ones are on the way and will ‘hit phones this autumn’. So that’s ok, then!

https://bit.ly/2WTl8MW

Wednesday 20 May

It seems to me the government could be sleepwalking into another crisis of its own making, one which is fast undermining its authority and thereby its mandate to govern. Up to 1,500 primary schools in England are expected to remain closed on 1 June after a rebellion by at least 18 councils forced the government to say it had no plans to sanction them. This schools reopening controversy is potentially the fulcrum of lack of trust in the government, leading to a slippery slope of emasculated de jure authority, when de facto authority is being assumed by the other three nations and ‘rebel’ councils. It’s humiliating they’ve had to capitulate to these councils and affect a ‘generous’ response in not sanctioning them. Rapidly declining trust in the government is the direct result of lack of transparency or selective transparency: ministers are happy ‘to level with the public’ when it comes to the likelihood of forthcoming austerity but not when it comes to its numerous mistakes, errors of judgement and failure to disclose important findings promptly.

During another widely criticised PM performance today at PMQs, it was shocking to hear the confirmation that 181 NHS staff and 131 care workers have died from COVID19. Surely a high number of these must be due to insufficient or non-existent PPE and lack of consistent testing? A number of observers have been struck by how lost the PM seems without the support of his usual chorus behind him. Journalist Kevin Maguire tweeted: ‘Very noticeable that Johnson looked behind in the hope of finding Tories to roar him on at PMQs as Starmer exposes his evasiveness over terrible care home deaths. The largely empty green benches leave the blusterer defenceless’.

Despite ministers’ and clinicians’ assurances to the contrary, the fear that cancelled surgery and halted cancer treatment could cause more unnecessary deaths is likely to be realised, because of the massive diversion of NHS resources to COVID19. Research by the Institute of Cancer Research (ICR) suggests thousands of cancer patients could die prematurely because so many hospitals have had to suspend their normal schedules. Professor Clare Turnbull (consultant at the Royal Marsden in London) said: “For people with prostate cancer, a delay of a few months won’t make much difference. But bowel cancer and bladder cancer are ones you wouldn’t want to leave. If you delay for three months, 10%-15% of people who would get cured don’t, and if you leave it for six months then it’s 25%-30%.” Modelling of Public Health England data suggested that we could be looking at deaths of 4,755 more people than the usually expected number. Charity Breast Cancer Now also carried out some research which supports the ICR findings. This will obviously be terribly distressing to patients in this situation and their families and friends. It’s all very well NHS England (which dismissed the research) and other NHS officials telling trusts that they must get on with this surgery but what can these hospitals do given their underfunding and reallocated resources?

On the theme discussed in previous posts about the huge need to reconfigure key services like social care, transport, mental health services, etc, NHS commentator Roy Lilley, in his daily blog, has come up with a good formula to begin this now and he’s absolutely right about the trust issue (see above). He says: ‘HMG needs to regain public trust.  Trust is not a mechanical thing, built on graphs and numbers.  It’s an emotional thing’. He then recommends the following measures, at least some of which have been emphasised by Independent SAGE experts:

  • Scrap the 5pm briefings, they’ve lost credibility.  Change the format, make BoJo do them all, like Sturgeon, Macron and the Governor of New York.  Hold his feet to the fire.  
  • Get journalists like Andrew Neil back in the room.  Proper questions from a proper journalist, not TV news celebrities.
  • Focus on the positives.  How many people have survived CV-19, last week?  Dunno…
  • Honesty; we know there are problems, discuss them openly, with the people most affected… us.
  • Stop making announcements and changes and expect people to catch-up and go-along-with-it.  Include them.
  • Start a national conversation about what comes next.  Then shut-up and listen.
  • Admit mistakes, say what went wrong and tell what you’ve learned.  Like buying rubbish from Turkey and calling it procuring PPE.
  • Ask people how they are doing, set up national listening networks.
  • Pass more of the decisions down-the-line to regional and county level.  The only thing R0 is good for is to tell us where we are different.  Let people find local solutions to national imperatives.

‘Real leaders learn, trust is the glue of life.  We are where we are…  where’s that?  Unglued’. Spot on. Roy Lilley also has plenty of ideas as to how the reconfigure the NHS more fundamentally. You can follow him on Twitter at @RoyLilley and sign up for his daily blog at

roy.lilley@nhsmanagers.net.

Also on reconfiguring services and systems, the TUC has issued a report calling for the creation post-pandemic of a national recovery council, which would (crucially, the opposite of current top-down one-way strategy) ‘bring together government, unions and employers to create a greener and fairer economy’. A Better Recovery argues that ‘choosing the wrong approach to recovery now risks embedding low growth, long-term unemployment and all the social ills that go alongside’. It carries 6 major recommendations, such as new ways of doing business (including fair pay and a fair tax system), a real safety net, equality at work, sustainable industry, and (critically) rebuilding public services. TUC General Secretary Frances O’Grady said what the government won’t want to hear, except this crisis has forced them, against their natural conservative inclination, to massively invest in the state: “We’ve got to get that safety net strung again, we’ve got to invest in our public services, which may have to build resilience for a long time to come…Unions are back … but the state is back too.”

https://www.tuc.org.uk/ABetterRecovery

This sounds like essential and sobering viewing on Channel 4 this evening, a documentary featuring how lockdown has been for over 70s in the vulnerable category. It includes the stories of ‘people from all over the nation and filmed on location, conveying the immense challenge of being especially vulnerable in the midst of a pandemic’, and how they’ve been adapting.

https://www.radiotimes.com/tv-programme/e/mbr7bg/old-alone-and-stuck-at-home/

Finally, I’ve been heartened by the giving and receiving of small gifts during lockdown, a lovely community-based activity. Asking around about this has thrown up numerous examples including a U3A member who found an Easter egg on her doorstep, a friend was invited for (suitably distanced) Prosecco by neighbours she’d never met before and another has been distributing little jars of her homemade jam and chutney. Both giver and receiver get a boost as it shows we’re being thought about. What’s your experience been? I’ve been making and distributing banana bread and during the last week I was given (by different people) a pot of marigold seedlings, a cake, a glass of special white wine, a packet of nail files and today a piece of carrot cake and baby redcurrant bush. The nice thing is it’s not a tit for tat exchange – it’s more a case of what goes around comes around. The existence of the Twitter hashtag #lockdowngifts shows this spirit of generosity is alive and kicking, a positive thing indeed in these surreal times.

Tuesday 19 May

I won’t have been the only one shocked at the news that the loss of taste and smell is only now being included in the list #COVID19 symptoms to be tested for, when the World Health Organisation has recommended this for some time. Experts warned that tens of thousands of cases of Covid-19 were being missed because the government only recognised a fever and a cough as symptoms. ‘The UK needs to get in line with the rest of the world’, said one. British exceptionalism again but how many lives lost due to this hitherto exclusion? The Deputy Chief Medical Officer for England, Jonathan Van-Tam, seemed to make light of this, suggesting this would only pick up 3% more cases. Different stances taken by scientists make it difficult to know.

Despite Matt Hancock saying anyone over the age of 5 with symptoms was ‘entitled to’ a test, last night those trying to book one online were told: “There is very high demand for tests at the moment. People in hospital and essential workers, including NHS and social care staff, are getting priority. Even if you are successful in requesting a test, we cannot guarantee you will get one. It depends on how many tests are available each day in different parts of the country.” This seems just one more demonstration, as with PPE and care homes, that the government doesn’t know what’s happening on the ground.

Lack of transparency and delayed disclosure of important findings is a continuing concern. It’s emerged that up to a fifth of patients with Covid-19 in several hospitals contracted it while already being treated there for another illness. In some cases it was passed on by hospital staff  unaware they had the virus because they had no symptoms, so another failing of the limited testing regime? In another change of tack, ministers and clinicians have more recently been telling people not to avoid hospital if they have serious health concerns but this will surely make them think twice.

In the House of Commons Matt Hancock has just defended the government’s performance on COVID deaths in care homes, yet this is trying to defend the indefensible because it’s manifestly untrue that ‘a protective ring was thrown around our care homes’ in March. A quarter of all COVID19 deaths have been in care homes and, in another example of delayed disclosure, it only now emerges that temporary care workers transmitted Covid-19 between care homes as cases surged, according to an unpublished government study which used genome tracking to investigate outbreaks. This was allowed to happen despite a 2019 Public Health England study about flu pandemic preparations (Infection prevention and control: an outbreak information pack for care homes) urged care providers to “try to avoid moving staff between homes and floors”. The Department of Health and Social Care appears to have ignored or overlooked this because its Social Care Plan, published on 16 April, has nothing about restricting these movements in its chapter “Controlling the spread of infection in care homes”. Although the DHSC knew about the findings of the more recent PHE study since April, it only disseminated them to care home providers, councils and public health directors last week.

Shadow care minister Liz Kendall, criticising this damaging delay, said the crisis had “brutally exposed how insecure, undervalued and underpaid care work is’. Former PM Gordon Brown weighed in, calling the care home deaths debacle ‘a major public policy failure’. How much else could the government be suppressing? Thank goodness for investigative journalism, without which we would know a lot less. Meanwhile, with the continuing non-appearance of the PM, #WhereisBoris is trending on Twitter. Could he have unofficially taken paternity leave but not told his colleagues or us?

Many could be wondering how the contact tracing app trial in the Isle of Wight is progressing and the BBC tells us it’s a ‘mixed bag’. Although sufficient people have downloaded it, many are in lockdown so are unlikely to have come in contact with the virus. It only asks about two symptoms, high temperature and a continuous cough (not the latest loss of smell and taste symptom) and also doesn’t tell people what to do about their contacts because it’s not possible to enter your test result. So now a version 2 will be trialled and meanwhile the clock is ticking, delaying its rollout throughout the UK, and what about the other issues eg concern about legal challenges due to privacy concerns?

It’s timely that during Mental Health Awareness Week gambling addiction is again in the news, research suggesting it’s an even worse problem that we’d thought and that half of those experiencing this aren’t getting help. This is especially interesting given that incomes of companies like William Hill have plummeted because of the lack of sporting events and closure of their shops, probably pushing more gambling activity online, which is more difficult to monitor. In a survey commissioned by the GambleAware charity, YouGov estimated that up to 2.7% of adults in Great Britain, or nearly 1.4 million people, are problem gamblers. Some experts urged caution over the figure but one has to wonder at the source of these doubts, eg coming from the industry regulator and some bodies funded by the gambling industry itself. And besides the problem gamblers themselves, we shouldn’t forget those negatively affected by someone’s gambling, as many as 7% of adults, or 3.6 million people. Treatment for gambling addiction is very patchy indeed and it’s another area under the mental health service ‘umbrella’ which will need reconfiguring when this crisis has abated. Or perhaps it’s not too early to expect DHSC civil servants, policymakers and clinicians to start planning this work now.

Meanwhile, Matt Hancock’s tweet at the start of MHAW yesterday drew some flak: ‘It’s Mental Health Awareness Week. This year of all years it’s so important we look out for one another. Seeking help and support is vital – the NHS is open to us all’. Of course, this ignores the longstanding underfunding of the NHS and of mental health services in particular and his exhortation to ‘look out for one another’ could be found somewhat galling in the circumstances.

It’s a sad fact of life that fraudsters will take advantage of anxiety and crisis-heightened anxiety to devise new ways of scamming us. Although it’s been going on a while, ‘romance fraud’ has come to the fore again because of more isolated and vulnerable people trying to find company and establish relationships in these surreal times. The BBC reports on Victim Support research which suggests men and women equally are falling prey to fraudsters, losing on average £47,000 each. Scammers obviously think it’s worth their while to play a long game, investing months in grooming victims, encouraging them to believe they’re in a genuine relationship with someone who cares about them. Then the requests for money start, sounding convincing at first eg funds for hospital treatment, to prop up their struggling business, and so on.

One victim admitted: “In a fantasy world, I let myself think he is going to turn up and be real. You can be too emotionally involved in it. “This “addiction” to hear someone saying nice things to you, and which blinds you to the reality, is common among victims’, according to Lisa Mills, senior fraud manager at Victim Support in Sussex. The problem could be much worse than we think because many will be ashamed and embarrassed to report such a crime and this in turn could exacerbate their sense of isolation.

https://www.bbc.co.uk/news/business-52664539

A reminder about this series, based on what’s considered the oldest book in the Western world exploring ‘the causes, symptoms and treatments of that universal human experience’, Robert Burton’s The Anatomy of Melancholy (1621). I’ve found it a bit of a mixed bag but quite good today, on depression, the effects of isolation and loneliness, and the benefits of social prescribing.

https://www.bbc.co.uk/programmes/m000j80m

Finally, we can only look on with envy at Italy re-opening after weeks of lockdown and restrictions much more severe than our own. In the Guardian Erica Firpo describes what’s happening in Rome, some shops open, a long queue for the post office, customers back in cafes hugging and kissing each other (while wearing masks) and the bike shop preparing for a brisk trade. A flower seller told her: “It’s much quieter, less people. But we’ve been given a chance to see a Rome that perhaps we lost for a while… Will it pick up? We need to wait before we have an idea what reality will be like … before we have equilibrio.”  While they wait for customers and for post-pandemic life to reassert itself, at least Romans can now go to bars, restaurants, shops and beauty salons, when all this still feels like a distant dream here.

Sunday 17 May

As the COVID19 death toll passes 34, 466, so it appears do divisions in society about key issues like the balance between freedom and safety. The debate surrounding lockdown easing is intensifying, many having decided to stick to the former regime and others feeling this is an attack on liberty, leading to a police state. This stance was reinforced by former Supreme Court judge Lord Sumption writing in the Sunday Times today. Perhaps not surprisingly, far more people admitted to breaching lockdown in an anonymous survey than if they were identified: with anonymity, 31% admitted to meeting up with friends and relatives from other households and 35% admitted breaching the 2 metre rule (Decision Technology/The Times).

Nineteen arrests were made at a demonstration against lockdown in Hyde Park, yet a number of councils in the north of England, where COVID19 rates are higher, are resisting opening schools on 1 June. During the last few days some extremely distressed callers to Radio 5 Live’s Stephen Nolan programme related their heartrending experience of illness and death in their families and said if libertarians had any idea what it was really like they would never take the risks they do, gathering in large numbers without distancing, as in yesterday’s demo. One caller repeatedly asked ‘where’s the justice in that?’ on the policy of only 15 being allowed at a funeral, yet thousands have been packing onto buses and trains to get to work in recent days, sanctioned by the government and thousands of air passengers have been entering the UK, with no checks and no distancing within airports.

Marking such a key loss as a close family member or friend is difficult enough anyway, but now stories abound of people unable to attend funerals because of this 15 person limit and this will impact on their mental health because that public ritual is an important part of mourning. One bereaved daughter thought her father’s funeral would have drawn 300-400 but only immediate family could attend.

Social inequalities could open up further as it becomes clearer that up to 10 million people could be excluded from the contact tracing app because of lack of digital access or skills, including numerous older people and those also more vulnerable to COVID19. Liz Williams is chief executive of FutureDotNow, which is running a campaign to get devices to the country’s most vulnerable. She says they risk being shut out of access to this smartphone-based contact-tracing app, unless the government urgently funds way to bridge the gap with digital training and support. ‘Missing out on the app has the potential to exacerbate those problems….My concern is it has the potential to add to social divides and employment outcomes… It would be easy to imagine a scenario where employers require it to access work.”

It will be interesting to see what happens, as 70-80% population penetration is needed to make the app viable and this is unlikely to happen if so many are excluded. There are also those who have smartphones but refuse to use the app because of privacy concerns. This could be one of the many issues with the capacity to change society, like those affecting transport and city planning. A very welcome decision is the one to close large areas of London to cars and vans in order to enable safer walking and cycling. Mayor Sadiq Khan announced what’s thought to be one of the biggest car-free initiatives of any city in the world.

The Royal College of Psychiatrists’ announcement about the marked rise in mental health presentations, including those experiencing difficulties for the first time due to lockdown, isolation, job insecurity, relationship and bereavement, comes as no surprise. There’s also the obvious fear of contracting COVID19 and people being cut off from their friends, families and normal social networks, leading clinicians to coin the terms ‘lockdown anxiety’ and “corona-psychosis”. Because of job loss or being furloughed, many will have more time to experience these distressing symptoms such as loss of sleep, anxiety. Although it’s not often referred to directly, one of these distressing phenomena is that of ‘skin hunger’, whereby people feel starved of physical contact with others, whether that’s hugging and kissing friends and family or the more intimate kind of contact. Without touch, which reduces stress hormones, humans are thought to deteriorate physically and emotionally. “We know from the literature that lack of touch produces very negative consequences for our wellbeing,” says Alberto Gallace, a neuroscientist at the University of Milano-Bicocca. This sheds further light on the isolated elderly people confined to their rooms in care homes and the suggestion that many are ‘fading away’.

An NHS spokesperson said: “Although there can of course be no reliable data as yet on any medium- or long-term impact of the coronavirus pandemic on mental health, the NHS has been adapting our services to ensure people can still get care like talking therapy or counselling with their clinician, even while still adhering to government guidance.” As a therapist, I find such statements concerning, because we know that despite these bland assurances, many do have difficulty in getting NHS help and in primary care there are often long waiting lists and a poor choice of talking therapies. And many can’t afford to wait: they need help immediately, but going privately may be unaffordable for them. At present, therapists can only work remotely, either by phone or online, and although some studies suggest that this can be as effective as face-to-face work, many clients will find it unsatisfactory and it curtails the practitioner’s opportunities to observe important aspects of the client’s demeanour and body language.

It’s timely that Mental Health Awareness Week starts tomorrow (18-24 May), run by the Mental Health Foundation, with the theme of kindness (research shows kindness is strongly related to good mental health).  While not a substitute for professional help, such campaigns help raise awareness, raise funds and perhaps most importantly, tackle stigma which has too long caused many to hide their distress.

https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week

All these issues have marked psychosocial dimensions and it’s becoming increasingly clear (Robert Chote of the Institute of Fiscal Studies is the latest to acknowledge this) that long-neglected areas like social care, mental health services, digital access, transport, leisure activities, city planning and job design/employment patterns will have to be radically changed or at least reengineered in the aftermath of this pandemic. A very welcome decision is the one to close large areas of London to cars and vans in order to enable safer walking and cycling. Mayor Sadiq Khan announced what’s thought to be one of the biggest car-free initiatives of any city in the world.

There can barely be anyone on the planet now who hasn’t heard of Joe Wicks, the chirpy and charming exercise and nutrition guru, who took on the role of ‘the nation’s PE teacher’ during lockdown, presenting his daily fitness videos on YouTube. But it’s not just ‘the nation’: he has followers all over the world, viewers tuning in from as far afield as Moscow, Nigeria, California and the United Arab Emirates. He’s so positive, humble and engaging he’d probably be able to motivate the most recalcitrant non-exerciser. But perhaps the key aspect of his approach (besides that of getting families exercising together) is his focus the mental health benefits of exercise, which are often overlooked in the general emphasis on physical fitness. He was interviewed recently on Radio 5 Live and here he is on the Radio 4 Food Programme, since he first came to fame for his cookbooks.

https://www.bbc.co.uk/sounds/play/m000j79j

Finally, we have to take our hats off to organisations and individuals who come up with novel or ingenious ways to make lockdown restrictions more bearable. The Week tells us that in Berlin, residents of apartment blocks are being treated to film screenings, the film being projected against a blank wall they can all see. The WindowFlicks project is run by architecture and lighting company MetaGrey, and as if that wasn’t enough, another company is distributing free popcorn. Similar schemes have taken off in Paris and Rome so how long before some UK innovators follow suit here?

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.