Saturday 10 October

I seem to be saying this most weeks but it has indeed been another eventful week, some developments proving quite shocking when we thought it couldn’t get any worse. Leaving aside the drama across the Atlantic, the main one here must be being the loss under the aegis of Public Health England and the discredited Serco Track and Trace of 16,000 tests, meaning so many details weren’t entered into the system until a week later. Their contacts were therefore not traced, leading to possibly thousands of potential people remaining uninformed and at risk of spreading the virus. IT experts and others were shocked on learning that what ministers tried to dampen down by calling a ‘glitch’ was largely due to trying to send data via an outdated version of Excel, spreadsheet software not designed for mass data transmission, rather than a recognised database platform.

The wider context of the ‘glitch’ is a system which simply isn’t working, despite Health Secretary’s protestations to the contrary. Matt Hancock was lambasted in the House after it was revealed that just 33% of in-person test results were returned within 24 hours, months after the PM said he wanted all test results delivered within a day. As cases are rapidly rising, prompt testing is needed more than ever, but supply problems persist, many being forced to isolate at home because they can’t obtain a test or get to a centre. And more is emerging about the prevalence of asymptomatic cases: in a national survey more than 80% of people who tested positive had none of the core symptoms of the disease the day they took the test. Matt Hancock seems to have adopted a defensive strategy which consists of no longer attempting a response to critics but simply rudely dismissing them or coming out with a non-sequitur statement, as he did with Labour’s Dawn Butler last week.

Hot on the heels of the testing debacle came news, not surprising, of further restrictions in the North of England and elsewhere, and a leaked plan for a three-tier approach to restrictions and lockdowns. More and more areas are being subjected to lockdowns, possibly a cynical ploy to increase the numbers of locked down areas, approaching a general lockdown in all but name. Meanwhile, north of England mayors and public health experts are up in arms about the lack of consultation, despite business minister Nadhim Zawahi emphatically declaring that they had been consulted. I’d be more inclined the believe the angry Greater Manchester mayor Andy Burnham, who described on Question Time and other programmes a discussion with ministers where agreement appeared to be reached, but it actually hadn’t, and the first the mayors knew about imposition of further restrictions like households not mixing was seeing it in the papers. The government seems to have no idea how contemptuous this would feel to the northern politicians and how difficult it would be for them to deal with the fallout. Besides the need for proper consultation, Burnham’s key demand was no further restrictions without support: the thousands of staff working in the bars and restaurants shut down overnight had no source of income.

One of Guardian sketch writer’s Boris Johnson eviscerations this week naturally focused on his appalling conference speech, where he sounded like a parody of himself, talking bullishly about COVID19 being ‘the trigger for major social and economic change. Try to think of the virus as an opportunity rather than a disaster’ etc. ‘But up until now, he’s got away with it (being a ‘conman’) – in his public life at least – because the country has been happy to collude with him. It wanted someone who could tell a few gags and promise that everything would be OK in the end. The narcissistic fantasist as national saviour. But the last eight months have changed all that. The country has grown up in the time of coronavirus’. Felt to be a profoundly misjudged speech, in which Boris alluded to people being ‘fed up’ with the virus and how he was working to get things back to normal…. ‘There was nothing on the toll the last eight months had taken. No apologies for government inaction, failure and incompetence that has seen the UK leap to near the top of the global COVID mortality scale’. A fantasy land speech including the promise to fix social care (a can kicked down the road so often it must be severely dented by now) where the PM failed to even convince himself, let alone party members and viewers.

The second John Crace evisceration focused on Boris Johnson’s increasingly poor and bizarre performance at Prime Minister’s Questions. Resorting defensively to questioning the Labour leader when he’s the one supposed to answer questions, his defeated demeanour apparently contradicted his assertion the night before that he had rediscovered his ‘mojo’. ‘None of this is what Boris had ever wanted or planned. He had signed up for the glory and the applause. Not to see the country through its biggest health crisis in 100 years. Six months in and he’s all but out of ideas. He knows that. And more importantly his own backbenchers know that. Even though the whips have tried to get MPs to sound more enthusiastic, no one is fooled.’ The Labour leader kept hammering home the severity of the missing cases and contacts, getting deflections and non-answers in response. One of the embarrassments for the government is the cases have actually risen in 19 of 20 lockdown areas, proving the strategy isn’t working. ‘Boris chuntered on, but by now no one was listening. Rather there was a general feeling of futility on both sides of the house. The Tories despair of a leader who gets weaker with each outing and no longer appears to really want the job’.

What must be puncturing the PM’s increasingly effortful joie de vivre even more is that normally loyal right wing newpapers are beginning to challenge him, the Telegraph and the Mail leading the charge. Both papers criticise the lockdown strategy for curtailing freedom but also question the effectiveness of the measures introduced. While a no 10 spokesman said: ‘We live in a liberal democracy and you would fully expect open debate on these matters’, it could prove unsettling for the government as the winter approaches if more papers go the same way.

It stands to reason that in order to ‘beat the virus’ (in gung-ho government parlance) or even live with it, we need to operate within the context of decent public services. Unfortunately, these have been decimated in recent years and in the Guardian Richard Vize describes a disconnect with the Build Back Better slogan. ‘But to stand any chance of improving public services, the government has to understand the significance of the wreckage around us. Covid-19 has laid bare the destruction caused by a decade of austerity. Everywhere there is a lack of capacity, from too few respirators to threadbare public health teams in local authorities…. Tens of thousands of deaths from disrupted healthcare could follow’. Apart from the longstanding crisis in social care, nearly every part of the public sector is short-staffed – this needs rectifying and the ‘excessive dependence on consultants’ needs to end. Vize effectively suggests a reconfiguration of government, enabling public health to be ‘brought out of the shadows and put at the heart of public services’, and it must be brought into overarching policy rather than left in a silo. ‘The pandemic has shown how public health permeates everything from industrial production to transport. It needs to be integral to public policy’.

Talking of consultants, Brexit preparations have apparently involved the government spending amounts rising by 45% to more than £450m in three years. Eight top management consultancy firms were cited, the top of the heap being Deloitte, which pocketed £147m in 2019/20 alone. ‘While 1% of civil servants are paid more than £80,000 a year, day rates for management consultants working in the public sector range from about £1,000 for junior consultants to about £3,500 for partners’. It’s rather shocking to see the table detailing what each government department spent on consultancy over the last three years. Just imagine what could have been done with that in the NHS or social care. Yes, there will be a need for some consultancy, but this level is simply off the Richter Scale and begs the question, where is Whitehall’s own expertise? While Deloitte said ‘We are confident that our work adds significant value to the public sector organisations we work with’, a government spokesman said they didn’t recognise some of the figures quoted and ‘We continue to take considerable steps to reduce unnecessary spending and protect taxpayers’ money’.

Keep a look-out for the green lapel ribbons today and wear your own if possible – it’s World Mental Health Day (the theme of mental health for all is set by the World Federation for Mental Health and led in the UK by the Mental Health Foundation). Various pieces of research are underway, including MHF’s own work on resilience (or not) across the UK during the pandemic. One finding was that ‘most people (64%) say they are coping well with the stress of the pandemic. However, many are struggling with the current crisis’.  The Resilience Research Centre defines it this way: ‘In the context of exposure to significant adversity, resilience is both the capacity of individuals to navigate their way to psychological, social, cultural and physical resources that sustain their wellbeing and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways’. ‘Resilience’ has become a controversial concept in the mental health field because it’s felt in some quarters to put disproportionate responsibility onto the individual to resolve their difficulties, to justify offering fewer services on the NHS, and to ignore the underlying systemic issues such as poverty and poor housing which contribute to mental ill-health in the first place. On the other hand, it is a necessary personal quality to cultivate, so the term needs treating with some caution.

At the same time is the not surprising news that, based on research carried out for the Royal College of Psychiatrists, one in four are waiting more than three months for mental health treatment – this is putting it mildly. We hear of much longer waiting lists, longer than a year in some places. ‘The delays are leading to patients ending up in A&E, seeing their mental health decline and experiencing problems with their work, finances or relationship. RCP warned that the big increase in mental health problems caused by the Covid-19 pandemic could result in even longer waits for care’. We already know there’s a ‘mental health pandemic’ and this research reinforces earlier findings. A Department of Health and Social Care spokesman acknowledged the pandemic-related need and said: ‘We are committed to increasing the mental health workforce. Mental health services will expand further and faster thanks to a minimum £2.3bn of extra investment a year by 2023/24 as part of the NHS Long Term Plan.’ The problem is that this ‘expansion’ has been left vague and the amount is insufficient to even plug earlier gaps in services: professional bodies like the BACP (British Association for Counselling and Psychotherapy) are regularly pressing the government on what this boosted workforce will look like, when the desperate need is for more qualified and experienced professionals to offer psychological therapies of choice (not restricted to CBT, which many find doesn’t touch the sides).

This year the Queen’s Birthday Honours have especially recognised people’s contributions during the pandemic –  two high profile ones being fitness guru Joe Wicks, the ‘nation’s PE teacher’ and footballer Marcus Rashford, who forced the government to U-turn over free school meals. Both get MBEs. Yet again, though, it does prompt the wider question of the uses and abuses of the honours system, which too often, especially in the recent Prime Minister’s Honours, is seen as a route to bribing or acknowledging cronies.

You might be interested in the new series on Radio 4 of the Moral Maze, which involves a panel of public figures interviewing a series of ‘witnesses’ on a key topic, this week being the role of lived experience in policymaking. How much of a role should it have? Is it essential or does it cloud judgement? This is a key theme in discussions on mental health policy but I don’t think this episode focused on that, interestingly.

Finally, fans of the Sicilian detective Salvo Montalbano will be delighted that he’s back on BBC4 tonight, and yes, it’s new, not a repeat, with actor Luca Zingaretti credited as co-director for the first time. Even if you don’t care for Montalbano, it’s worth tuning in for the ‘gorgeous Sicilian backdrops’ and the opening sequence of that inimitable theme music accompanying the swooping camera shots panning the mountains and bays of South-east Sicily.

Saturday 3 October

Not eclipsed by the news about POTUS, another eventful week, to put it mildly, and perhaps we should no longer be surprised that both our PM and skills minister Gillian Keegan on Tuesday couldn’t answer questions on the detail of local lockdown restrictions, which of course makes them less enforceable. It’s been very telling that there was such a backbench rebellion and Speaker condemnation about Parliament not being consulted on COVID legislation. Boris Johnson seems to have quelled this for now, but it was noticeable that Parliament was only promised consultation ‘as far as possible’, keeping the government’s door open for unilateral imposition. And local government is still not being properly involved in local lockdown decision making and in crucial data sharing. This time it was the turn of Secretary of State for Business, Energy and Industrial Strategy, Alok Sharma, to defend the indefensible. In a car crash interview on Radio 4’s Today programme, he was very defensive and kept repeating that people should consult the government website to check the regulations for their areas. Quite apart from the fact that all ministers should be abreast of the changing regulations, there’s the issue of the digitally excluded, who would not be consulting the government website any time soon.

In one of his habitual eviscerations, Guardian sketch writer John Crace dissected the PM’s poor performance at Prime Minister’s Questions and even poorer one at the later press briefing. ‘We will fight and beat the disease, Boris said, as if every other country had just given up on the idea. ‘We will not throw in the sponge’…. Though, in truth, it rather looked as if Boris had done precisely that. He looked dreadful, his eyes puffy and bloodshot and his complexion pasty, as he repeated the measures he was taking that were clearly not really working that well. He sounded like a man waiting on a miracle’. I can’t have been the only one half expecting Boris to follow the ‘sponge’ comment with a reiteration of the previous week’s proverb, ‘a stitch in time saves nine’, although, manifestly, there have been no ‘stitches’, or the wrong ones, that failed to keep the knitting together.

On the subject of performances, surely one of the most disgraceful for some time, (astonishingly, not picked up by the Speaker) was when Slough MP Tanmanjeet Singh Dhesi asked when the Slough test centre would be back up and running, some locals having been forced to go to the Isle of Wight for a test. Instead of answering the question, Matt Hancock said how hard work test centre staff had been working and ‘I simply won’t have it, this divisive language’. This is a shocking example of misrepresenting legitimate concern and scrutiny.

As COVID cases continue to rapidly rise and fears of another general lockdown increase, a poignant article in the Guardian highlighted the existence of a frailty scale (endorsed by NICE, the National Institute for Health and Care Excellence, which determines NHS policy and treatment). This is said to effectively ration treatment for older and disabled people who become COVID patients. Of course we’ve heard statements on this issue before, but this is the first time I’ve heard of a firmly documented scale. The Clinical Frailty Scale is described as ‘a worldwide tool used to swiftly identify frailty in older patients to improve acute care’, but the article’s author doesn’t see it as a tool to ‘improve’ care. ‘Rather than aiming to improve care, it seems the CFS – a fitness-to-frailty sheet using scores from one to nine – was used to work out which patients should be denied acute care. NICE’s guidelines advised NHS trusts to sensitively discuss a possible ‘do not attempt cardiopulmonary resuscitation’ decision with all adults with capacity and an assessment suggestive of increased frailty”. Chilling stuff: it’s not hard to imagine the fear this would strike into the hearts of vulnerable patients. The NICE statement is worded diplomatically (some may say euphemistically) but we have to wonder whether a properly resourced NHS would have to resort to such a thing. ‘The human race has progressed to an era where diversity and inclusion enriches us all, but a deplorable NICE Covid 19  policy has instead regressed 100 years to the darkest era of social Darwinism where medical care could be denied to those of us who are less fit and healthy’.

Radio 4 recently serialised ‘Dear Life: a Doctor’s Story of Love, Loss and Consolation’ by palliative care doctor Rachel Clarke, aka ‘doctor_oxford on Twitter, where she often takes Matt Hancock to task for misleading statements and the like. Described by the blurb as ‘a thoughtful and uplifting meditation on mortality and end of life care’, it’s another reminder of the difficulty much of society still has around death. You may have heard an excellent series a while back, presented by the inimitable Dame Joan Bakewell – We Need to Talk About Death. The pandemic has increased awareness of this need to talk about it and not to push it under the carpet in the stigmatised way it used to be. The blurb is right to use the word ‘uplifting’: despite the subject matter it’s not at all gloomy and the part about her father’s illness, decline and death is almost unbearably moving.

A number of articles have recently focused on how well Italy has managed the pandemic overall, when it might have been thought at the start that the exuberant Italians wouldn’t have been prepared to comply with rules. As one Italian author puts it: ‘My native land is usually depicted as a beautiful place whose abundance of natural and cultural treasures is entrusted, alas, to its disorganised, corrupt, unruly inhabitants… Now, an article on the US website Foreign Policy presents Italy in almost mystical tones, as the country that “snatched health from the jaws of death”… Is this global surprise at our collective behaviour flattering or patronising? Most of all, our national pride is sobered by the understanding that things are far from over’. No hubris here.

What follows is a useful analysis of the contrasting approaches of Italy and Sweden, at the same time being very clear that we’re not ‘out of the woods’, cases are rising again and that it’s too early to say which country will be shown to have had the best strategy. She believes the main issue is the contrast between governments which are ‘taking full responsibility for their actions and those that leave their citizens in a haze of uncertainty, and have unaccountable leadership’. Which ones could she possibly be talking about? She finally suggests a new understanding of the nature of democracy: ‘Accountability and transparency no longer look like the outer frame of democracy into which the more relevant policy details are placed. We now see them clearly as democracy’s very fabric. Something without which everything else – health, society, peace, life itself – is in grave danger’.

An article in Psychology Today (How COVID 19 hijacks a psychological vulnerability) focuses on the still-neglected area of the pandemic’s effects on mental health, inter alia puncturing the myth that ‘the virus doesn’t discriminate’. The intertwined relationship between our physical and mental health has been known for some time, yet it still doesn’t filter through to common understanding or what we experience from GPs, who often continue to treat only the physical symptoms. ‘Our psychological states, especially the experience of chronic stress, may present a major vulnerability for severe COVID-19 complications. Even more worrisome, COVID-19 may be worsening the very mental patterns that are contributing to our current predicament’.

Evidence now shows that the virus does ‘discriminate’, for example by disproportionately affecting older people, black and Asian people, the obese and those with underlying conditions such as heart disease and cancer, these very conditions strongly correlated with increased stress. ‘Scientific research also sheds light on the strong tethers between chronic stress and immune dysfunction. This is a central focus of the growing field of psychoneuroimmunology’. The article then describes the important links between these health conditions, stress, inflammation and compromised immune systems and makes a case for the role of stress in COVID 19 to be more generally acknowledged and addressed. A key point it doesn’t mention is that stress and anxiety are greatly exacerbated when we cannot trust our leaders to devise and implement an effective pandemic management strategy.

Still on mental health, it’s good to hear that, following earlier work this year on the importance of touch, which invited us to participate in a survey, psychologist Claudia Hammond will next week be presenting a series of short programmes (Anatomy of Touch), focusing on the effects of COVID 19. There had already been a decline of touch in society but overnight it plummeted, given social distancing requirements, and the effects of this are rarely openly discussed. The programme blurb’s allusion to ‘touch hunger’ made me think this was the kind of concept there’s often a long, compound German noun for. I’ll be checking with a few Germans. A social media source had a discussion about this, some saying there wasn’t a word for it, but one suggestion was Nähebedürftigkeit (craving closeness).

Some positive news this week was that in the smart Surrey town of Walton-on-Thames, a letting agency has opened in a prime site, one designed for homeless people, thought to be the first of its kind in the UK. RentStart has been operating for a few years but perhaps in a less prominent and upmarket location. CEO Helen Watson pointed up the levels of deprivation in that area despite its initial impression, saying ‘I thought ‘why don’t we seize the high street back for us? And why don’t we make our clients have the best experience? We’re making a stand about it, saying ‘come in’, removing the stigma and being proud of who we are’.

Exemplifying the level of hidden housing need, about 450 contact RentStart every year, 150 finding accommodation with the 30 private landlords who work with RentStart to offer accommodation to low income people. Good for these landlords but it’s reassuring for them that they’re given a written guarantee that any unpaid rent will be covered and one month’s rent will be paid in advance. Even more positive is that the charity offers more besides accommodation, helping clients with skills training, such as budgeting, CV writing, or setting up meetings with potential employers. It also runs and runs a matched-savings scheme to help people start saving, so enabling them to put into practice some of this skills training.

What a great example of meeting need, in contrast with the longstanding chaos of the housing market. Ms Watson wants to see similar organisations all over the country and ‘is interested in helping others replicate what it does’. She believes that the pandemic has made people see more clearly that ‘personal circumstances can change in a nanosecond and that homelessness can affect anyone, even in leafy towns and villages’.

Finally, you might be interested to see this lovely little film, made during lockdown by a local film director about a community café many of us visit around here. A great example of community engagement, even more important during these surreal times, it’s the story of the café and its owner, a French-speaking Algerian brought up in Normandy, what the café means to him and also to locals, several of whom (including me, looking too serious) feature in it.  

Sunday 27 September

During a week when the Support for Jobs scheme pushed the descriptors ‘viable’ and ‘non-viable’ to the fore, with robust debates about how ‘viable’ jobs should be defined, using the terms in other contexts has been too tempting for some to resist. John Crace has written about ‘our semi-viable leader’, whose position is looking increasingly uncertain given his own poor performance, the rise of Young Pretender Rishi Sunak and demands for cross-party consultation on restrictions and lockdowns. ‘Sunak did get a slightly harder ride from journalists at the Downing Street press conference. He couldn’t totally explain what was and was not a viable job – some jobs that are not viable now may be so again in a year’s time- – the latter being a key argument not yet responded to by the government’. Of Sunak, he observed: ‘For an hour or so it felt like there was an adult running the country. Or as close as we’re likely to get to one in the Conservative government during the coronavirus pandemic. It might still all be an illusion, of course…’

Being PM is proving a lot harder than Boris ever expected – he has no desire and no idea how to build cross-party consensus at a time of crisis and the chickens of his erosion of democracy over the last few months are coming home to roost, eg suspension of normal tendering procedures, handing £m to private providers, and not consulting Parliament or local government about restrictions and lockdowns. ‘An extraordinary cross-party backlash against Johnson’s “rule by diktat” from Downing Street was taking shape on Saturday – ahead of a key vote on Wednesday – as a new poll for the Observer showed Labour has overtaken the Tories for the first time since Keir Starmer became leader in April’. 50 Tory MPs have apparently written to the PM to ask for a vote on COVID restrictions prior to their imposition: if this had been purely opposition parties it could be ignored but the fact that it’s the PM’s own party spearheading it should give him pause for thought. (Correction – give Cummings pause for thought).

Meanwhile, still taking centre stage is the very worrying situation about the testing and track and trace programmes, which, despite ministerial bluster, continue to underperform in the numbers of tests actually carried (not ‘capacity’!) and contacts traced. The new COVID19 app everyone’s been urged to download has come under fire for not working on some phones (and what about people with dumb phones or no mobile at all?) but, most scandalously, not being enabled to use NHS data – only Serco programme data can be  processed. Since it’s supposed to be an NHS app (and media people continue to misrepresent it as such), this would be risible if it wasn’t so concerning. There’s also a significant body of people not planning to download it because they don’t trust its data gathering properties or don’t want to risk being asked to self-isolate.

Thanks to Emma for the heads-up on this useful article in Wired: it’s very informative and also states that ‘from September 28 it will be illegal for people not to self-isolate once they been contacted by Test and Trace and the government can issue £10,000 fines to people who break the rules’. We already know, though, that 20% of those asked to self-isolate have either not done so or have reneged on the conditions so it will be interesting to see if the threat of such a fine makes a difference. The article is quite reassuring on the issue of use of personal data, but it does discuss risks eg the possibility of false positives. Crucially, it reminds us that its success will depend on large numbers of people using it, but a key issue is surely around confidence in the government, which seems at an all time low. ‘Trust in the government will play a big part in this’. Interestingly, whereas the failed app was said to need 80% to sign up, it’s thought 60% will be enough this time to rein in the virus. Even more important is an understanding that an app alone isn’t going to do the business. ‘Contact tracing apps may be one small way of reducing Covid-19 spread. Equally important are robust testing and human-led contact tracing systems. All of these elements need to be functioning correctly to control the spread of the virus’.

There’s an obvious interest in how other countries are coping. This is quite a lengthy read but a very useful listing of what different countries are doing in essential areas, such as mask wearing, opening schools and leisure venues, limits on gatherings and so on. Some surprising facts are that in Sweden masks are not recommended and in Croatia bars and clubs don’t have to close before midnight (not much of a hardship), although restaurants can only serve people outside. More use of outside space has an environmental downside, in that it’s bound to increase the installation of patio heaters, unless the Croatians are a much hardier lot than Brits.

This week’s Briefing Room on Radio 4 usefully looked at Sweden, criticised for its strategy of not locking down but perhaps with some benefits to that approach which weren’t apparent at the start. Sweden was described as a compliant society, and presenter David Aaronovitch explored the Swedish experience of the pandemic, which eschewed lockdown but which still instituted ‘significant changes to everyday life, from school closures to social distancing and the cancellation of theatre shows and concerts’.

Depressing but predictable is news about how the UK is seen abroad, one headline reading: ‘Mr Brexit to Mr U-turn: German commentators befuddled by Johnson’s zig-zagging’. We learn that an editorial in the Süddeutsche Zeitung was titled: ‘Johnson’s skittishness endangers his country’; Wirtschaftswoche weekly business magazine said “one of the main reasons for the ongoing coronavirus chaos” in Britain was Johnson’s decision ‘to occupy lots of ministerial posts with Brexit hardliners’, and perhaps most impacting, given his experience and conservative stance, the ‘veteran Britain watcher’ for Die Welt, Thomas Kielinger, observed: ‘The perplexity of the British public is rising ….Its government appears to be stumbling through a forest of lunacy … and it’s dawning on many that Boris Johnson is the wrong man to cope with an emergency’. He also points up the irony of a Brexit-committed government in copying a longstanding (since the early 1900s) German approach – Kurzarbeit (short work), whereby ‘workers can be sent home or their hours significantly reduced, and the state will pick up a large portion of their lost income’.

Not surprisingly, there seems to be an increasingly febrile and anxious atmosphere at the rapid rise in COVID cases and fears of another general lockdown, since some experts believe the current restrictions don’t go nearly far enough. Yvonne Doyle, Public Health England Medical Director, said the number of new cases was “a stark warning for us all…The signals are clear. Positivity rates are rising across all age groups and we’re continuing to see spikes in rates of admission to hospital and critical care’. We’d better do what we want to do and go where we want to go within the next fortnight, because after that we can’t be certain we will have that freedom.

As featured in previous posts, the mental health ‘pandemic’ is growing, with need manifestly not being met by the inadequate NHS primary care services and many unable to afford private help. Many are just trying to manage on their own and being encouraged by various articles and pundits to reframe and develop a positive mindset. While a certain amount of mental wellbeing work and self-talk is helpful, it’s not sufficient for those with longstanding conditions and a level of anxiety which needs much more than this. There’s also a strong argument that the emphasis on ‘wellbeing’ is used cynically by policymakers responsible for reducing and underfunding mental health services in order to shift the entire responsibility from the state to the individual.

Besides the rise in anxiety and depression, there’s the obvious trauma resulting from all the COVID-related deaths which have occurred this year, when those bereaved could not even hold the usual kind of funeral or be with the dying at the end. Covid-19 Bereaved Families for Justice, together with organisations, including the British Association for Counselling and Psychotherapy (BACP) and the National Bereavement Partnership, are pressing the government to use the comprehensive spending review to fund ‘culturally specific’ measures addressing particularly traumatic forms of grief. Psychotherapist Kathryn de Prudhoe, a representative of Covid-19 Bereaved Families for Justice who co-wrote the submission to the Treasury, lost her 60-year-old father in April. She said: ‘The majority of people are floundering and don’t really know where to go or what to access…There is the constant reminder of the virus, the anxiety that people have that they’re going to fall ill, or that another family member is going to die. If we don’t act now, in six months’ time we’re going to have a mental health crisis on our hands as well as well as a viral one’.

At the risk of verging on ‘wellbeing’ territory it’s quite interesting and useful to read about how the Norwegians approach the lengthy winter, by developing a mindset which helps cope with the ‘long polar nights’. A psychologist studied what gave rise to the Norwegians’ resilience and concluded that much was due to what we’d call reframing but it sounds more like ‘framing’, because of it being so embedded in the psyche, not requiring the conscious process of mindset change. The psychologist designed a ‘winter mindset scale’, which requested agreement or disagreement with statements such as ‘there are many things to enjoy about winter’ or ‘there are many things to dislike about winter’. Confirming longstanding evidence that experience can follow the attitude adopted, she found that participants’ responses determined their wellbeing over the coming months; ‘the more they saw the winter as an exciting opportunity to enjoy a glacial climate, the better they fared, with high levels of life satisfaction and overall mental health’. It’s quite a cognitive approach, acknowledging the role of choice in how we experience things, not just believing our mindset is set in stone. People ‘feel like they’re just someone who hates the winter and there’s nothing they can do about it… But once you put it in people’s heads that mindsets exist, and that you have control over your mindset – I think that that’s tremendously powerful’. Hmmm – it might take more than this to persuade some of us that there’s ‘much to enjoy’ about winter.

As a bit of an antidote to what the BBC’s Paddy O’Connell this morning called a ‘diet of doom’, the Guardian predicts that during the next lockdown the last one’s focus on sourdough and banana bread (guilty here) will move to much more exotic creations. With the headline ‘Let us eat cake: Britain turns to baking to banish the blues… As nights draw in and months of uncertainty loom, many are seeking the therapeutic benefits of creating elaborate treats’, it describes the therapeutic process of baking, the grounding effect of using family recipes, the role of this sharing and kindness and the Instagram effect of constructing increasingly elaborate cakes. Waitrose has reported huge rises in sales of both cakes and baking ingredients: does this mean that the flour shortages experienced months ago are now a thing of the past? Two of the photos in the article feature the bakers’ ‘sculpted’ heads – great for social media pics but I wonder how many would feel comfortable consuming such a thing!

Thursday 24 September

This blog post is late because I was in North Wales over the weekend, where I found people much more compliant than in London about wearing masks and venues much more consistent about requesting contact details for Track and Trace but the most nightmarish part of the journey was the third ‘leg’, courtesy of Transport for Wales (formerly Arriva Wales). The two carriage train from Chester to Holyhead was packed to the rafters, marshalls seemingly having no choice but to allow this and the driver had the nerve to tell anxious passengers ‘You shouldn’t be travelling’. One rejoinder was ‘You shouldn’t be selling tickets, then’. Another pointed out that more carriages should have been attached. This week Transport Minister Grant Shapps announced (finally!) that rail franchising was to be brought to an end because of ‘fragmentation’ – not a minute too soon.

Again, it was an eventful news agenda last week, notably the second reading, which passed by 77 votes, of the Internal Market Bill, with controversial clauses potentially leading to breaches of international law. Many, including senior Conservatives, have been appalled that such a thing would even be entertained, and despite obfuscation by some ministers, Brandon Lewis, Northern Ireland Secretary,  admitted that it ‘does break international law in a very specific and limited way’. This gave rise to a series of amusing (if it wasn’t so alarming) social media posts, about something reprehensible being ok, as it would only be done in a ‘very specific and limited way’. Many politicians and commentators, including former PMs Blair and Major, spoke out against this legislation and former Attorney General Geoffrey Cox accused Boris Johnson of doing “unconscionable” damage to Britain’s international reputation. In what sounds like an example of brinksmanship, the Times told us that ‘in a move being seen as an attempt to assuage European concerns, ministers have indicated that the internal markets bill may not be debated in the House of Lords until after a make-or-break summit with EU leaders in mid-October’.

The severely underperforming Covid testing and Track and Trace programmes came in for more flak, when further evidence emerged of there being no tests available in many areas and people being directed to test centres hundreds of miles away. It was barely credible that the Health Secretary then sought to blame the public for ‘frivolous’ use of tests and some politicians, notably Jacob Rees-Mogg, accused desperate self-isolators waiting endlessly for tests, of ‘carping’. It’s been estimated that as many as 20% of those meant to be self-isolating are not doing so: in some cases this will be wilful non-compliance but in others it will be those unable to get a test and not being able to afford time off work. Even now, ministers continue claiming that 240,000 tests are carried out daily, whereas it’s more like 80,000, because the first figure is actually the much-trumpeted ‘capacity’ – a point Fiona Bruce pursued at some length with Nadhim Zahawi on BBC’s Question Time. Health Secretary Matt Hancock continued to defend testing boss Dido Harding, despite her rough ride at the Commons Science and Technology Committee, at the same time as admitting testing will take 3 weeks ‘to sort out’. His various claims were deconstructed as skilfully as ever by the Guardian’s parliamentary sketch writer, John Crace: ‘MPs try to talk Matt Hancock down from the heights of delusion’.

Concerning as all this clearly is, it’s been supplanted by the announcement of further restrictions in response to the marked rise in COVID infection rates. Typically, the PM made his announcement when the ground had been well and truly prepared by the media and by Chris Whitty and Patrick Vallance the day before. I doubt whether I’ve ever seen a more abjectly embarrassing political broadcast than the ‘Covid briefing’ last night: packed full of clichés, faux Churchillian rhetoric and over-optimistic reassurances, its blustering and over-emphasised delivery was painful to watch. John Crace began his analysis: ‘Where to start with the prime minister’s TV address to the nation? The trademark smirk? The nervous hand gestures? The fact he thinks he’s fighting a war, not a pandemic? Or just the brazen cheek as Boris tried to claim the credit for what he called the stunning triumph over the coronavirus so far?’ Many fear that the measures don’t go far enough – perhaps, not for the first time, England won’t be too far behind Scotland in adopting stronger measures, if not full lockdown then restrictions on numbers of households meeting. Such restrictions capture the key dilemma: the health of the nation or the health of the economy? High profile hospitality figures such as Tim Martin (Wetherspoons) and Julian Metcalfe (founder of Pret a Manger and Itsu) are livid about the restrictions, their stance seen by some as concern for their workers and their jobs and by others as more cynical concern for their wallets.

With rather more focus on the PM’s increasingly bizarre performances at Prime Minister’s Questions, contrasting with the increasingly impressive one of Labour leader Keir Starmer, it shouldn’t be overlooked how impressive shadow Business Secretary Ed Miliband was when standing in for Starmer. Described as having ‘comprehensively ripped Boris Johnson’s facile and fraudulent arguments to shreds….. Miliband knew he had Johnson bang to rights as a second-rate conman and wasn’t going to let him off the hook. All his arguments were delivered with the panache and flourish of a man who knew he had right on his side. Even the Tories sensed it with only Bernard Jenkin foolish enough to intervene on the prime minister’s behalf…It turns out that Boris does have a humiliation threshold after all. And Miliband had just found it’. Good to see Miliband back on fighting form and let’s hope this isn’t a flash in the pan.

It remains to be seen how the Chancellor’s newly announced Job Support Scheme will be received, already thought to be far less generous than furlough. It looks generous at first sight but there are key omissions, eg the 3m freelancers (again). Rishi Sunak has been firm that they won’t be supporting ‘zombie’ businesses – many more job losses are predicted. An estimate of a million newly unemployed has been made, partly due to the hospitality industry having to operate shorter hours.

The mental health ‘pandemic’ resulting from COVID19 and restrictions has been increasingly recognised in recent months, if not acknowledged and acted upon by the government. The latest set of restrictions and the fact that a significant areas of the country are already in lockdown will further aggravate this situation. A major study (University of Nottingham and King’s College, London) found that in the early stages of lockdown 57% of participants reported anxiety symptoms, with 64% recording common signs of depression. The situation improved when lockdown was eased but there’s concern that difficulties will recur as restrictions are reimposed in response to the rising infection rate. Gloomy winter weather will also not help. ‘Women, young people and those in high-risk categories for Covid-19 were most affected, the researchers found, though different factors probably drove the mental health difficulties in each group. While the fear of catching the virus was likely key to those with underlying health conditions, young people and women may have felt more distress through work insecurity, loneliness and domestic violence’. Although the government has got a lot on its plate, it needs to recognise this other, very damaging crisis and reengineer and fund NHS mental health services to enable availability to those who need them, rather than putting obstacles in the way such as eligibility threshold tests.

A separate, large scale study based at University College, London, concluded there has been an “explosion” in anxiety in Britain over the past decade. Anxiety is thought to have tripled among young adults, affecting 30% of women aged 18 to 24. It also increased generally among people under 55. The study is one of the largest of anxiety undertaken in the UK for many years, examining trends in diagnosis and treatment by GPs since 1998 by analysing 6.6 million patients at 795 practices across the UK. This anxiety has been attributed to the financial crash, austerity, Brexit, climate change and social media but (as per the theme of this blog) it will also be attributable to the lack of psychological ‘holding’, known as ‘containment’, offered by this government which many have lost trust in. Generally but especially in dire circumstances, people need to at least feel that their leaders are actually in charge (not just in office), know what they’re doing and have well-reasoned and consistent strategies for addressing the crises we are having to navigate.

Partly thanks to the Black Lives Matter movement, the issue of unconscious bias has come more to the fore and now a crossbench peer and anti-racism campaigner, Simon Woolley, has spoken up when it emerged that up to Tory MPs are thought to have refused to participate in classes. ‘Every parliamentarian should undertake unconscious bias training if asked so they can be better at their jobs’, he said, ‘appalled’ that any MP would refuse. Mansfield MP Ben Bradley (described in his Twitter profile as The first blue brick in the red wall), said: “In my view we should be unabashed in our cultural conservatism, sticking up for free speech and the right to ‘make my own bloody mind up, thank you very much’, and stepping in to block this ‘unconscious bias’ nonsense.” I was struck by how very nice, tolerant and jolly Simon Woolley sounded when he was interviewed about this alongside Conservative stalwart Sir John Hayes.

It’s long been known that diagnosis of concerning symptoms was way below the norm during the pandemic, partly due to patients’ fears of contracting COVID19 but also due to lack of resources and constant pressure to ‘protect the NHS’, despite this being a legitimate use of the NHS. More research has now emerged which puts figures on these concerns, including analysis of GP records which reveal diagnoses of conditions from cardiovascular problems to mental health problems were up to 50% lower over the spring than expected. (This research only covered Salford, but the researchers were confident that these figures could potentially be extrapolated to other areas of the country).The government’s guilt tripping was successful, demonstrated by an NHS England poll in April, showing that 40% of patients said they were avoiding contacting their GP so as to avoid ‘burdening the NHS’.

Urging anyone concerned about symptoms to come forward notwithstanding a COVID19 second wave, Professor Martin Marshall, chair of the Royal College of GPs, said: ‘During a pandemic, other health conditions do not cease to exist, and we’ve seen from health crises in the past that there are sometimes more deaths from conditions unrelated to the pandemic than the virus causing the pandemic itself’. Related to this is the anger some GPs are now  experiencing for being criticised by the government for not having seen more patients, at a time when the government was urging as many virtual GP consultations as possible. Various GPs and their representative professional bodies have been warning for some time that much can be missed via virtual consultations. Let’s hope the GPs get sufficient resources to deliver more in person consultations, which would save resources long term by enabling early diagnosis of conditions potentially missed via virtual appointments.

Housing is such an important issue in its own right, but especially as it links to mental and physical health and other aspects of living. It’s been clear for some time that the situation facing older people in this country is far from ideal, not least because so many people living alone is a key contributor to loneliness and social isolation in this age group. Now a Swedish experiment in multigenerational community housing is attracting international interest. In the UK we’ve seen several innovatory schemes which co-locate nurseries with care homes, with good results. Sällbo ‘a radical experiment in multigenerational living’ is located in Helsingborg, a small port city in southern Sweden. We’re told its name is a combo of the Swedish words for companionship (sällskap) and living (bo), summing up the project’s goals of combating loneliness and promoting social cohesion by giving residents incentives, and the spaces, for productive interaction. About half the 72 residents are 70 and older, the other half aged 18-25, described as ‘a mix of personalities, backgrounds, religions, and values’ and including some refugees. Everyone had to sign a contract promising to spend at least two hours a week socialising with their neighbours. Some touching examples are given, such as older residents teaching English to refugees, and the younger ones helping the older ones with social media and new technology. We’re told the Swedes are fiercely independent, with social policy aimed at enabling people to stay in their own homes. It could be Brits would also like to be more independent but housing and social policies have militated against that. British policymakers, take note.

This relates to support the public has given to a plan for the UK to become ‘a greener, fairer more equal society’ as it emerges from the pandemic (perhaps that should read if it emerges…).  An inquiry by the All Parliamentary Group on a Green New Deal found that the pandemic had further boosted a strong desire for change. ‘On housing, fewer than one in five thought the government’s housing policy was working and there was strong support for rent caps and more investment in social housing. Participants were also concerned about homelessness and, having seen government intervention during lockdown, want action to end street homelessness permanently’. Effectively, this could amount to a new social contract for the UK and it’s interesting that people are evidently enthusiastic for change, wanting to build on community connections, in direct opposition to what often seem like government attempts to sew division. The Green Party’s Caroline Lucas, the co-chair of the Group, said the UK was at a crossroads: ‘This is not a moment for timid tinkering with the status quo, it’s the time to build a fairer, greener Britain where the national effort is focused on health and wellbeing. There is a popular mandate for deep-rooted changes in our economy and society. The government must seize this moment and deliver on people’s hopes for a better Britain’.

Finally, it was interesting to read that, as part of last weekend’s London Open House festival, a company of tour guides put on walks which focused not simply on the general history and architectural details, etc but on the less savoury aspects of history, such as links to slavery. The walks were fully booked but the company plans to run the same walk on various dates in October. This reminded me of someone some years ago who offered alternative tours of galleries and museums, again highlighting the less positive aspects of the exhibits. I can imagine that directors of cultural institutions may not have been too keen on this initiative, but in recent times, related to the Black Lives Matter movement, organisations such as the National Trust have come to terms with the colonial history associated with many of the objects and properties in their care, with some actively promoting better understanding of these issues.

Sunday 13 September

It seems every week packs a punch in terms of hefty and impacting news items, but this last one must be in pole position, with (quietly and predictably) Portugal once more removed from  England’s non-quarantine list, the worrying rise in new COVID cases, the lack of test availability, the limit of 6 gathering inside or out being reimposed from Monday, Birmingham hovering on the brink of lockdown and now the outcry over the government’s Internal Market bill, which seeks to break international law ‘in a small and significant way’. It seems only now are some senior Conservatives, including Theresa May and Lord Howard, seeing what the last few months have led to, some reacting with dismay as it if it couldn’t have been predicted. It’s seen as an example of extreme bad faith and an overturning of the Good Friday Agreement. Labour peer Andrew Adonis tweeted: ‘A European ambassador in London said to me last night: ‘It is a real problem for the west when Britain has rogue government which announces it won’t abide by treaties it has signed. My country did that in the 1930s. Look what happened’.

This international embarrassment also caused the government’s top lawyer, Sir Jonathan Jones, to resign, the 6th senior civil servant to depart this year. The Financial Times first broke the story, linking his departure to “suggestions that Boris Johnson is trying to row back on parts of last year’s Brexit deal relating to Northern Ireland”. The FT reported people close to Sir Jonathan as saying ‘he was very unhappy about the decision to overwrite parts of the Northern Ireland protocol’. Such upheavals will no doubt cause more to supplement their No Deal stockpiles during the next few months.

Meanwhile, Matt Hancock was reprimanded for issuing the Rule of 6 (sounds like something from a conspiracy theory) via Twitter rather than first announcing it in Parliament. Not for the first time, the plan was announced without consultation with local government as to how the proposed enforcers (COVID marshals) were to be funded and recruited and at least one Police Federation head has said enforcing this limit won’t be their priority. It also sounds as if the police are becoming increasingly resentful about the additional duties imposed on already stretched forces. Those planning big gatherings before the rules kick in on Monday might feel less pressure because there’s such a low chance of enforcement. John Crace offered another eviscerating account of the Health Secretary’s ‘rant’ in Parliament, when derision greeted his announcement of ‘moonshot’ testing. ‘One of the glories of Matt – the thing that makes him a near national treasure – is that he has no idea that it is the seriousness with which he now takes himself that makes him a laughing stock to the rest of us’.

In The Guardian, George Monbiot rails against what he sees as the UK’s corruption: ‘Every week, Boris Johnson looks more like George I, under whose government vast fortunes were made by political favourites, through monopoly contracts for military procurement. Any pretence of fiscal rectitude or democratic accountability has been abandoned. With four more years and the support of the billionaire press, who cares?’ He says that although people may be shocked when the words UK and corruption are mentioned in the same breath, as the UK is low down the official international corruption rankings, these listings’ criteria are narrow. What’s not fully considered is corruption of a more sophisticated kind, especially via laundering the money of other countries’ illegitimate activity and organised crime. This is the first time I heard that the City is protected from FOI: ‘The City of London’s astonishing exemption from the UK’s freedom of information laws creates an extra ring of secrecy’. Monbiot believes the situation will become even worse as a result of a no deal Brexit: ‘When the EU’s feeble restraints are removed, under a government that seems entirely uninterested in basic accountability, the message we send to the rest of the world will be even clearer than it is today: come here to wash your loot’.

As the working from home vs returning to the office debate rumbles on, the BBC has continued its interesting Rethink series, looking at how life could change as a result of the pandemic. This episode specifically focuses on cities. It asks ‘does a combination of Covid-19 and new technology mean that the need for dense concentrations of people is lessening? Many city dwellers – especially those recently forced to work from home – have wondered why they were paying high urban prices during lockdown and looked enviously at those in larger homes in suburbs or the countryside. Is now a moment to rethink conurbations – in terms of transport, planning and amenities – to move from a concrete jungle to a green and pleasant cityscape?’ This seems very likely, as a good number of workers welcome the absence of a stressful commute, can spend more time getting to know their local area and supporting that local economy rather than the anonymous central one, and estate agents are seeing higher demand for properties by the sea and in the countryside.

The question would then be what happens to the resulting central ‘ghost towns’ like Canary Wharf, which CBI head Carolyn Fairbairn warned about. Maybe people are less worried about this than she expects, as the urging back to the office is often seen as a cynical way of boosting corporates’ businesses at workers’ risk. ‘We have to get closer to nature’, said one contributor, rather than continuing with faceless blocks built for the benefit of developers rather than the welfare of those working in them. ‘Cities have to be about more than economics’, says presenter Amol Rajan, the BBC’s Media Editor. The programme also features a global panel of contributors based in Copenhagen, Beijing, Washington, Sao Paulo and Kampala. At least some experts agree that we have to get together at work (at some points), otherwise we’re just many isolated units, with all the implications this has for the organisation’s mission and esprit de corps, so a consensus may emerge of WFH some days and going into the office on the others.

Two well-known newspaper columnists, Nigella Lawson and Oliver Burkeman, have recently written their last columns, both giving tips on how to live well. Burkeman’s were particularly worth thinking about: ‘…..these are the principles that surfaced again and again, and that now seem to me most useful for navigating times as baffling and stress-inducing as ours’. All his eight ‘principles’ are interesting and invite reflection, eg ‘There will always be too much to do – and this realisation is liberating’ (…you needn’t berate yourself for failing to do it all, since doing it all is structurally impossible) and ‘When stumped by a lifechoice, choose “enlargement” over happiness’. Burkeman has written in at least one book about the illusory pursuit of ‘happiness’, a goal and expectation embedded in our culture, which needs challenging and deconstructing. He credits Jungian therapist James Hollis for the advice that ‘major personal decisions should be made not by asking, “Will this make me happy?”, but “Will this choice enlarge me or diminish me?” Well worth a read: he will be a hard act for the next columnist to follow.

An online lecture last week from Birkbeck College, University of London, featured Professor of Psychology Renate Salecl (author of The Tyranny of Choice and other works) talking about her latest book, A Passion for Ignorance. Informed by philosophy, social and psychoanalytic theory, popular culture, and her own experience, she explained how the passion for ignorance plays out in many different aspects of life today, from love, illness, trauma, and the fear of failure to genetics, forensic science, big data, and the incel movement. Interestingly, she concludes that ignorance is a complex phenomenon which isn’t always a bad thing – in some circumstances she argues that it can benefit individuals and society as a whole. Her arguments about the ‘post-truth’ world reveal how some react to the ‘constant flood of information and misinformation’. If people feel overwhelmed and sceptical, unable to distinguish truth from falsehood, it can lead to a distrust of expertise and a preference for some kind of certainty, however dubious, rather than engage with the complex, nuanced and messy entity which actually characterises human existence.

Professor Salecl would have been writing this book for some time but her lecture felt very central to what we are seeing now, for example a government economical with the truth and groups of people resorting to conspiracy theory or preferring to believe COVID doesn’t exist or climate change isn’t happening because it’s easier than coming to terms with the sheer uncertainty of our situation and the fear this can generate. She refers to Nancy Tuana’s Four Kinds of Ignorance (which we learned in psychotherapy training as the Johari Window), the worst being ignorance of ignorance, how the mechanics of power help keep people ignorant, and the quality of blindness preventing us from seeing, preferring the preservation of illusions. It’s certainly a timely exploration of (as the blurb suggests) ‘how the knowledge economy became an ignorance economy, what it means for us, and what it tells us about the world today’.

At a time when much of the culture and heritage industry is under severe financial pressure, it was good news to hear this week that the Bronte Parsonage Museum has received a grant of £20k from the estate of T S Eliot. The museum had been closed during lockdown and had launched a £100k crowdfunding appeal when this boost arrived, apparently made possible by the royalties the estate receives from the musical Cats.

Finally, The Week reported a serious but amusing prank, which took place in Israel last week. Hundreds of bags of cannabis were dropped by drone onto Tel Aviv, organised by advocates of legalising cannabis, who messaged on the Telegram app: ‘Is it a bird? Is it a plane? No, it’s the green drone handing out free cannabis from the sky’. The two drone operator suspects were later arrested, but we’re not told how many bags made it into people’s homes.

Sunday 6 September

This last week has seen yet another U-turn (the PM now refusing to meet COVID 19 Bereaved Families for Justice UK), the return of Parliament from its summer recess, the return of Dominic Cummings from surgery and growing disillusionment with the government on the part of senior Tories, including Sir Charles Walker and Huw Merriman. You could wonder how it’s taken them so long to see the light. On Wednesday the PM gave what some commentators have called his worst ever performance at Prime Minister’s Questions, and was effectively skewered by Keir Starmer, who began by describing the series of U-turns over the summer as ‘serial incompetence’. Disgracefully (to the extent he was even reprimanded by the Speaker), Boris Johnson tried to counter this by several untruths, such as Labour had never wanted children to go back to school and the Labour leader was an IRA supporter. There was no apology.

‘After that, Johnson had a full-on meltdown’, said John Crace in the Guardian ‘Even the few Tories in the chamber had the grace to look embarrassed. Many prime ministers have discovered that being in the top job requires a different skill and mindset to that of getting the top job. The difference with Boris is that he shows no signs of being willing to learn how to adapt to the change. Rather, he appears to be getting worse and worse at being prime minister. Limitations that are increasingly being exposed in laziness, short-temperedness and forgetfulness’.

We now learn via The Observerthat Johnson was so furious after last Wednesday’s prime minister’s questions, having been told by the Speaker to withdraw his comments about the Labour leader, that ‘he turned on his staff for leaving him under-prepared, and asked them to come up with more attack lines on the Labour leader’s career as a lawyer’. Let’s hope the Speaker is ready to do some more reprimanding.

Perhaps the main concern has been the rising rate of new COVID cases, highlighted by the return of children and young people to schools and universities. Some areas in the north of England won’t know whether they’re coming or going, given the hokey-cokey of restriction imposition and easing (in, out, shake it all about), in some cases within a matter of hours. Around here the director of public health felt compelled to issue a statement of concern about the rising number of infections, linked to the oblivious behaviour on high streets including lack of distancing. Unfortunately, there’s never enough effort to get messages across to different sections of the community: how many are going to see the local government website unless they have a specific reason to consult it?

The abolition of Public Health England at such a vital time is seriously worrying clinicians and health organisations, 70 having written to Boris Johnson about their concerns, including the important question of where key work areas like obesity, smoking and alcohol misuse will go since the replacement will only be focusing on pandemic prevention. Signatories include the Academy of Medical Royal Colleges, which represents the UK’s 240,000 doctors, the UK Faculty of Public Health and the Richmond Group of health and care charities.

Quarantine policy on returning air passengers continues to be awkward for the government and infuriating to tourists when the countries they’re visiting are suddenly taken off the ‘safe’ list, leading to last minute scrambles to book replacement flights and ferries before the deadline. This has shone a light on devolution, as the latest example of Portugal has shown the four nations at odds, on England’s safe list but Welsh and Scottish governments insisting passengers quarantine for 14 days. Public Health Wales, with its own track and trace system sounds better at checking up on returners than England, where it’s the task of the discredited Serco scheme. Only one in four are allegedly followed up and now Border Force officials are asking for ‘further action’. In the context of the number of new infections being at its highest since May, the Guardian tells us that ‘leading scientists are warning that the UK is fast approaching a pivotal moment. With another surge in the number of positive cases recorded on Friday, they urged people to keep following the rules or risk the return of widespread lockdown across the UK’.

Quarantine rule breakers may be unconcerned for various reasons, not least because despite the government’s bullish ‘instructions’, fewer than ten fines have been issued since June. Another reason for non-compliance is that many cannot afford to miss work, especially if self-employed and not eligible for financial help. Others simply don’t see themselves as a risk or think the rules don’t apply to them, like the man interviewed on R4 Broadcasting House, who spoke about his own safety, seemingly oblivious of the risk he could pose to others.

Meanwhile, the debate about returning to the office versus working from home rumbles on, some workers determined to stick with WFH, without the stress of commuting and uncertainty over how COVID secure workplaces are, and others keen to return as their mental health may have suffered through lack of interaction with colleagues. The government, retail and catering lobbies are very keen for people to go back because of the effect on city centre economies, with shops and cafes taking a hit, but there’s a powerful argument for instead boosting local economies enabled by WFH. The government also doesn’t seem to realise that, having scared people half to death for months on end (‘Stay at home’, ‘Protect the NHS’ etc) it now can’t expect to turn the tanker around mid-ocean overnight. It will take time for people to get used to using public transport and getting out more. A more sensible approach emerging is not the polarity of one of the other but a hybrid solution, people working at home some days and going into the office on others.

Given the departure of five senior civil servants this year, including the Service’s head, Sir Mark Sedwill, you may be interested in this succinct profile of his replacement, Simon Case. At only 41, and a CV which includes GCHQ, Kensington Palace and the role of PPS to Theresa May, he’ll nevertheless have his work cut out to steer an effective path between the demands of an erratic government directed by Dominic Cummings and the needs of his staff, some of whom are now threatening to go on strike if they’re forced to return to their offices. Case is said to have ‘a muscularity of mind’ – he’ll need it.

Many would agree it’s nothing short of shocking the way care home residents have been treated since the start of lockdown. Contrary to the narrative of having from the start thrown ‘a protective ring around our care homes’, we learn that care homes have only just received testing kits, much later than promised. We regularly hear heartrending accounts of those unable to visit residents, being urged to stay away and about the limited care residents receive. This was always the trouble with opening up social care to the private sector, where profit is the bottom line. An article in the Guardian rightly argues for much more attention to the care sector, how visits can be managed and how residents can be kept occupied and cared for in such a way which enables them to live, not just be kept alive. ‘We need to find better ways of protecting the people who live in our care homes without isolating them, or we risk forcing vulnerable people, and their families, to choose between their physical needs and their emotional ones’.

The way care homes have been left to cope on their own, with no real support, has been appalling and an undeniable argument for the long-awaited overhaul of the entire social care sector. ‘Nobody realistically thinks we can be back to normal by Christmas, and care home managers, already exhausted by the outbreak and still grappling with the day-to-day challenges of sourcing PPE and testing kits, need help and support with these questions that are not even acknowledged in the national guidance’.

Last week also saw the resurgence of Extinction Rebellion, in the news for protests against Murdoch newspapers, demonstrators blocking access to two print works in Hertfordshire and Merseyside, causing delays to newspaper deliveries. Some news media have portrayed this as ‘censorship’, rather than drawing attention to what the protesters see as Murdoch newspapers’ ignoring of climate change issues.ER activist Gully Bujak, 27, said: “You cannot have a functioning democracy with a mainstream media that is ruled by a small, unrepresentative sect of society, who are in bed with politicians and the fossil fuel industry. The climate emergency is an existential threat to humanity. Instead of publishing this on the front page every day as it deserves, much of our media ignores the issue and some actively sow seeds of climate denial’. And you couldn’t make it up: the PM has now has accused XR of trying “to limit the public’s access to news” and Matt Hancock was pictured in weekend mufti, without his regulation pink tie, saying how ‘outrageous’ the protests are. What’s surely very worrying is news that ministers are now considering designating ER ‘an organised crime group’: this is how police states start. 

Mental health has been a key concern in the wake of lockdown and as further uncertainty continues, seriously aggravated by the lack of trust in our politicians. It’s doubtful that already struggling NHS services will be able to cope with the predicted mental health ‘pandemic’ and not everyone can afford to seek help privately. While not a panacea, a number of activities like gardening and being close to nature are well known to contribute to mental wellbeing. Recently it was National Allotments Week and, having requested people’s personal stories, the Guardian featured the lockdown experiences of allotment holders and community gardeners. ‘…many found new solace, sanctuary and community spirit over the course of the summer. Those working from home found extra time to spend at their plots, while key workers gained particular pleasure from the quiet after exhausting shifts’. Some used their space for outdoor meetings and to run classes, facilitating community engagement, many spoke of the joy of seeing things grow, others said it was the only place they felt safe, and one took comfort from having been offered an allotment just after her wedding had been cancelled. This comment seems to capture what’s important about this activity and how it can enhance mental wellbeing. ‘Whenever I got to my allotment, I was able to focus on repetitive tasks and stop worrying about the pandemics and what ifs. I found great comfort in the predictability of nature and the changing seasons. The great wheel was still turning, despite us being in a scary and strange limbo’.

Still on the subject of the importance of nature and the environment, a YouGov survey for the National Trust found that for 38% of adults spending time in nature was the moment they looked forward to most each day during lockdown. A third said their interest in nature had increased since they were confined to their homes. The Trust is said to have lost up to £200m this year due to the pandemic and has now launched an appeal for funds to continue projects which had to be cancelled. These include restoring and creating new species-rich grasslands to conserve more than 50 threatened species, such as the Glanville fritillary and Duke of Burgundy butterflies and flowers like early gentian and ground-pine. It will be interesting to see how the appeal goes, as many are finding their incomes reduced and there seems to be an ever-increasing list of organisations asking for donations. This is such an important one, though, because of the need to counter the damage of climate change besides enabling beautiful places for people to visit.

Not least because of our experience of lockdown, you might be interested to catch up with a new series about the important but often overlooked topic of solitude (not to be conflated with loneliness, as many mistakenly do). This first episode, accompanied by appropriate poetry and music, examines extreme forms of solitude eg the closed religious order or living as a hermit, and also reveals how, partly due to the lack of domestic privacy at the time, being alone was regarded as terrifying in the 17th century.  This topic has strong mental and emotional health dimensions, because the capacity to be alone, besides the capacity to be with others and form relationships, is important for psychological development

Finally, a news item which has deeper implications than initially apparent relates to a German university’s scheme to issue grants for successful applicants to study ‘active inactivity’, jokily alluded to as ‘idleness grants’ by some news sources. ‘Applicants for the €1,600 grant have been set four questions to answer: What do you not want to do? For how long do you not want to do it? Why is it important not to do this thing in particular? And finally, cutting to the chase, why are you the right person not to do it?’ It may sound comical or downright weird at first, but it’s not such a bad idea, given recent dissatisfaction across the board with target-driven cultures, recognition of the need for more mindful lifestyles, concern about climate change, the likelihood of mass unemployment and discussions in the UK about a Universal Basic Income. Designed by prominent architect and design theorist Friedrich von Borries, the project is predicated on the conviction that “inconsequential” is not a synonym for “unimportant”. ‘Doing nothing, properly understood, can be an enriching way of experiencing the world without needing to extract something from it or do something to it’. It will be very interesting to find out who gets the grants and (if they’re in the public domain) perhaps read some of the reports when they emerge in January.

Sunday 30 August

Apart from the latest government U-turn, this time on facemasks in schools, the key news items generating much heat and some light continue to be the return to work debate and the series of departures following the A levels debacle. There seems to be a strange belief in government that throwing other key players under the bus, in this case Sally Collier of Ofqual and senior civil servant Jonathan Slater, is a reasonable substitute for the resignation which should actually take place, that of Education Secretary Gavin Williamson. Of course these departures were presented as the individuals’ choice but there’s little doubt they were ‘asked’ to fall on their swords. Williamson could then afford to be gracious in victory, paying tribute to Slater: “I would like to thank Jonathan Slater for his commitment to public service, including over four years spent as permanent secretary in the DfE. Like the prime minister, I appreciate the hard work of officials across government, particularly during this unprecedented time’.

Dave Penman, the general secretary of the FDA, the senior civil servants’ union, said Slater’s abrupt departure was proof that “ministerial accountability is dead and the message to civil servants is that they are expendable the moment life gets tough for a minister’. There’s something primitive and survivalist about this shameful strategy which I think marks another downward step in this government’s conduct. An Any Questions listener tweeted: ‘There was something very primal about the enforced ritual sacrifice of Sally Collier and Jonathan Slater, redolent of ancient Greek mythology but it doesn’t absolve Gavin Williamson from blame. The government is naive in believing it does’.

In the Guardian Gaby Hinsliff discusses the abdication of responsibility which characterises this government. ‘Whatever happens, it is never, ever their fault. Disasters may come and disasters may go, but the defining characteristic of this government is a cast-iron refusal to accept responsibility for any of them. If pushed, then deputy heads must roll. But in general the buck stops – well, anywhere but here…. If the purge of civil servants is intended to restore public confidence then it’s having exactly the opposite effect’. Slater’s departure takes to five the number of senior civil servants who’ve lost their jobs – no mean feat for a government only elected in December.

Besides the premature blame attributed to Collier and Slater, she also discusses the problematic abolition of Public Health England: it’s not only the dangerous timing, during a pandemic, but the organisational challenges of setting up a new organisation which, it appears, isn’t charged with the non-pandemic responsibilities PHE had, such as prevention, anti-smoking and obesity strategy work. Again, this smacks of an apparent conviction that being seen to take action and blame something or someone will convince the public that something useful is being done when this is not the case. ‘While neither Ofqual nor PHE have entirely covered themselves with glory this year, and any inquiry might well find reasons to criticise both, for now all we’re getting is one suspiciously flattering side of the story’.

The PHE blunder is discussed at some length in the Guardian: ‘…borne on the tidal wave of his self-confidence, Matt Hancock crashes from one unforced error to the next, never troubling himself to pause to count the financial and human cost. His latest masterstroke is to abolish the country’s public health agency in the middle of a pandemic… Everyone who works in the UK public sector knows that endlessly demolishing and rebuilding its structures undermines morale, wastes time and money, haemorrhages expertise and experience, and rarely solves problems’. The article points out that this not only leads to uncertainty and job insecurity for PHE’s 5,500 staff, but the approach of winter will intensify health challenges and lead to ‘a tug of war between local government and the NHS as the long-term solution is debated’.

Matt Hancock also managed to make another embarrassing howler when he suggested the government would change the law to allow nurses, pharmacists and technicians to administer flu jabs, when nurses and pharmacists already do. It’s quite something that the Health Secretary for England was unaware of this, further proof of the folly of giving politicians ministerial roles when most have never had ‘a proper job’ outside Westminster.

In a humorous analysis of the litany of government errors, Marina Hyde in the Guardian discusses what appears to be the PM’s new mantra: ‘Leave home. Forget the NHS. Save Pret’. No longer ‘stay at home, save lives, protect the NHS’ or even ‘Stay alert’, the key preoccupation now seems to be getting people back to the office (not work, as some have pointed out) in order to support city centre economies, despite the risks workers expose themselves to by commuting and mingling with others in what might not be ‘COVID safe’ places. The government is now hinting that people could be sacked for not returning (though this is for the employer, not them, to decide) and some ministers have even resorted to moral blackmail, implying that continuing to work from home will threaten the jobs and incomes of their neighbours, quite a guilt trip to lay.

Regarding the PM’s abdication of responsibility and slowness to act, Hyde’s ‘quote of last week came from a longtime ally of Boris Johnson, who told the FT: “At the beginning of every big job Boris takes over, he prefers to stand back and act as chairman … But there comes a point at which he gets fed up and personally intervenes. I think we’re quite near that now.” ‘What can you say? Other than: righto. In your own time, luv’. What an understatement.

Re the working from home debate, there are complex issues to balance here. There are indeed risks to returning, not to mention the amount of time spent commuting, but I think that despite his vested interests Pret owner Julian Metcalfe does have a point in saying how important it is for staff to get together (and Zoom’s not a substitute) for their own mental health and the health of the organisation. There are those not wishing to return because they don’t get on well with their colleagues and find the atmosphere stressful, and this needs to be considered, but an organisation has to be more than isolated units working individually and effective organisations will foster an inclusive esprit de corps or suffer the consequences.  

Back in March University College London UCL launched a study into the psychological and social effects of Covid-19 in the UK. Researchers recruited a large sample of UK adults to help understand the effects of coronavirus and social distancing measures. Those of us participating had to fill in a detailed survey each week about our activities, experiences and concerns, one aim being to track changes over the course of the study. It felt almost emotional to read this at the start of their last email. ‘It is now 12 weeks since you first joined this study. Your participation has been incredibly valuable in helping us to understand the impact of the pandemic and has already led to dozens of reports and scientific papers’. One of the interesting things is seeing how research is fed into media reports, eg this article asking on whether England has learned lessons from the first wave of coronavirus has input from UCL’s Professor Susan Michie, on the ‘weak link’ regarding contact tracing in the UK.

The UCL website tells us: ‘As coronavirus spreads around the world, UCL experts are taking a prominent role in advancing public knowledge about the virus by advising world leaders, providing expert comment in the media and urgently researching new ways of tackling COVID-19’. UCL has a multidisciplinary research team studying these issues so let’s hope the experts manage to make some impact in government circles. I think at least one UCL expert is on Independent SAGE, the body the government and BBC often seem to ignore, which has often advised strategies differing markedly from those advocated by official SAGE.

Mental health has naturally been an important focus for researchers during the pandemic as a whole and lockdown in particular. One survey, perhaps not surprisingly, found that the mental health of the LGBTQ community worsened considerably, partly due to people being cut off from their normal networks and being in close proximity to ‘bigoted relatives’. 69% of survey respondents reported suffering depressive symptoms, rising to about 90% of those who had experienced homophobia or transphobia. ‘Many younger people said they had been unable to access the support of LGBTQ peers or allies while with their families, and those who had moved in with relatives during lockdown felt they were being pushed back into the closet’. That closet could feel especially suffocating if that individual hadn’t come out to their family at all or perhaps had to only one family member. It would be impossible to live authentically in such a situation. Two LGBTQ helplines reported receiving many more calls than usual during lockdown, up from between 25% and 33%, giving rise to requests for more government support for the charities running these helplines. We’d better not hold our breath for any response to this.

This week there was news that the attorney general for England and Wales, Suella Braverman, is considering trying the wife of a US intelligence officer in absentia on a charge of causing the death by dangerous driving of the teenager Harry Dunn. This ‘consideration’ was facilitated by the family’s MP, Andrea Leadsom. The Dunn family and their representatives have done well to get this far, it seems, as diplomatic attempts to get Anne Sacoolas extradited didn’t get far, partly due to the Foreign Secretary Dominic Raab’s reluctance to sufficiently challenge the American authorities on the extradition refusal. Although crown court trials in absentia are rare, we learn that a landmark ruling by Lord Bingham (House of Lords, 2002) supported the principle that they can be conducted where a defendant will not participate. It seems the family’s lawyers are envisaging Sacoolas attending virtually but what is the law if she still refuses to take part? Could some kind of trial still go ahead if she refuses, based on statements and evidence previously submitted? That could constitute one form of trial in absentia, but lawyers would obviously have to decide on such a possibility.

One aspect of this which doesn’t seem to have received any attention is the mental health effect, the corrosive effect this continuing situation will be having on Sacoolas herself, her family and friends. The fact that it’s been so widely reported and commented on means that whatever she does, wherever she goes, there can be no escape from it. One thing’s for sure, this isn’t going away any time soon.

On a lighter note but still an important one, as it concerns our heritage, is a competition urging us to bring to light overlooked or forgotten follies, castles and monuments. ‘Few things are more atmospheric than an ancient stone circle, the overgrown remains of a hill fort, or centuries-old chapel left to return to the wild. The UK is scattered with such ruins, telling tales of the past – and we’d love to hear about a favourite you have discovered. We’re looking for lesser-known suggestions, please. So, tell us about a wild folly, an abandoned castle or remote sacred site – and why (or how) it became special to you’. It should be interesting to see what emerges, though I’d personally pass on the prize of a glamping voucher!

An under-recognised aspect of the working from home debate has been the effect on clothing manufacturers, since the need for smart clothes has declined dramatically. The Financial Times carries an article about the death of the middle market in menswear (‘the toughest part of every industry’, since ‘most men today’ have their best stuff and jeans and tshirts (what about the track suit bottoms?) but nothing much in between. The author worries that those who enjoy ‘variations in sartorial tone have become oddball hobbyists, like birdwatchers or opera buffs’. Something similar is probably happening with womenswear as well, since many women won’t have had the opportunity to wear smart stuff in recent times, so this could signal yet more job losses as these manufacturers and retailers are threatened with bankruptcy.  

Finally, remember turkey twizzlers, which became a byword for junk food 15 years ago due to celebrity chef Jamie Oliver’s campaigning? They’re making a comeback. Bernard Matthews will now produce a healthier version, with less fat, at least 67% meat and no E-numbers. It will be interesting to see Oliver’s reaction to this and how the take-up goes. A key question surely is, will they pass muster with the government’s anti-obesity strategy?

Sunday 23 August

After months of other cancellations and weeks of uncertainty regarding ‘air bridges’, it was a relief and delight to finally get to Italy last week, where it’s immediately apparent how much more seriously the COVID19 risk is being taken. Mask wearing is obligatory inside various venues and on public transport, temperature ‘guns’ are in frequent use, hand sanitizer is everywhere and every alternate seat on buses, trains and in public spaces is marked out of use. The notices are mostly in Italian (Non sediete qui – do not sit here) but the message is nevertheless clear. For various countries air passengers have to complete paperwork declaring themselves COVID free and the normally disorganised Verona airport was quiet, with frequent reminders in both Italian and English about distancing and the correct way to wear facemasks. Return to Gatwick and there are no such requirements, yet the government continues to project its own incompetence onto countries with far fewer COVID cases than the UK. The most worrying aspect must be the lack of procedure for keeping tabs on those meant to be in quarantine: apparently only one in four is followed up, whereas in some countries passengers are immediately taken to a government-designated venue to make sure it happens.  

The tourist tax in Italy has often made me wonder why the UK doesn’t do the same thing – a no-brainer, surely. It could be this would have happened anyway but the regular sight of municipal cleaning services ensured the place was always spotless and litter-free. There was talk of such a tax being introduced in Bath but I’m not sure if that ever came to anything. Some UK seaside resorts could have benefited from a daily tax, to fund the clearing away of the vast amounts of litter left behind on beaches and open spaces.

During the last week something strange (statistical manipulation?) seems to have happened to the UK death toll, now quoted as just over 41k when last time I looked it was nearly 47k. I was told by a fellow tweeter there was a revision to remove deaths over 28 days after a positive test (‘ie to massage the figures’) and by another that the 65k excess deaths still stands so why bother with the massaging? Alas, some will still be taken in: ‘the government can put out significantly lower figures which will, in many minds, muddy the waters. Not everyone spends as much time on this stuff as we do, and that’s what the government is counting on’.

But one government debacle after another could have allowed less ministerial time for these statistics, in a week during which (is this a record?) responsibility abdicating ministers have been busy throwing both Public Health England and Ofqual under the bus. It seems extraordinary that ministers, science and medical advisers are trying to reassure parents that it’s safe to send their children back to school, as many will, after the pandemic mismanagement witnessed over the last 5 months, have little confidence in the government’s ‘confidence’. Meanwhile, appointing Baroness Harding as head of the new public health organisation will seem extraordinary to many, given the transparent cronyism and her poor performance in the TalkTalk and test and trace roles. Since the new National Institute for Health Protection (NIHP) is expected to focus on ‘preparing for external threats like pandemics’, we have to wonder what’s happening about the rest of the public health role, such as ill-health prevention. And yet the government still continues to use the ‘world beating’ descriptor for one ill-thought out policy or another, especially outsourced track and trace, which has failed to reach nearly half of potentially exposed people in England where COVID infection rates are highest. 

Perhaps the worst example of cronyism emerged during a recent Today programme interview with health minister Edward Argar, who defended Serco’s appalling record while trying to play down the fact that he had been head of PR there.

By now many will be aware of Health Secretary Matt Hancock’s enthusiasm for tech and apps but the medical profession has expressed disquiet recently at the intention to make in person GP consultations a relative rarity and for most to be carried out virtually. The letters of two GPs to The Times were reproduced in The Week, making clear the worrying downsides of ‘Zoom medicine’, the main point being that doctors need to use all their senses (including the 6th sense gut feeling) when seeing a patient, such as gait and demeanour etc. One cited two cases (in her practice alone) of women presenting with abdominal pain, only to find that lack of awareness or ‘deep psychological denial’ had led to them not realising they were in the advanced stages of pregnancy. This GP thought that a telephone or video consultation could have resulted in these women being prescribed meds for irritable bowel syndrome, perhaps, only to get a shocking surprise weeks later on going into labour. The other GP quoted former leading paediatrician Sir James Spence, who said: ‘The real work of a doctor is not an affair of health centres, laboratories or hospital beds. Techniques have their place in medicine, but they are not medicine. The essential unit of medical practice is the occasion when, in the intimacy of the consulting room or sick room, a person who is ill seeks the advice of a doctor whom he trusts’. This might be a good quote for a news presenter to use when interviewing ministers about what could be a damaging approach to cost cutting in the NHS.

One area, however, where a digital service is proving necessary and is apparently liked by patients, is a trial COVID recovery service based at Barts Hospital in London. Last week the i newspaper carried a special feature on post-COVID illness, suggesting numbers affected to be as many as 600,000. Clinicians generally have been surprised by the numbers of COVID patients still experiencing debilitating symptoms months after hospital discharge, one study estimating the numbers at 10%. The main symptoms of ‘long Covid’ are shortness of breath, extreme fatigue and mental health difficulties such as anxiety, depression and post-traumatic stress. This is very worrying, not only for the patients and their families but also for adding to the NHS burden. Although it’s now clear that being male, obese and of an ethnic minority background are predisposing factors for COVID, doctors are still trying to establish what the risk factors for ‘long COVID’ are. As rehab services are ‘thin on the ground’, let’s hope that the Barts trial will get the necessary funding to be rolled out more widely, so that those suffering such an aftermath can get the help they need. The mental health issues, though, will often need more than an app is able to provide.

Economist, broadcaster and journalist Tim Harford, known to Radio 4 listeners to his percipient debunking of statistical errors and opacity in the programme More or Less, recently wrote in the Financial Times about a subject many will have been wondering about: why we fail to prepare for disasters even when we know they’re on the horizon. ‘You can’t say that nobody saw it coming’, he begins, citing the 2005 Hurricane Katrina and the damage inflicted on New Orleans. Regarding pandemics, several warnings were given (and what about the UK’s own 2016 Cygnus exercise, the simulation exercise carried out by NHS England to estimate the impact of a hypothetical H2N2 flu pandemic?) but then there’s a ‘collective shrug of the shoulders’. Harford suggests a number of reasons for this reckless and senseless reaction, including ‘wilful blindness’; inaction in the face of danger psychologists call ‘normalcy bias’; the herd instinct tendency to take the cue from others, so if they do nothing there’s an illusion of safety in numbers; egotistical ‘optimism bias’, whereby people see the disaster as befalling others and not themselves; and ‘the limitless capacity for wishful thinking’.

A good number of us may argue that it’s the job of those in power, our elected politicians, to take charge and to anticipate and plan for such events. Harford could be seen as excusing them when he says ‘but the same mental failings that blind us to risks can do the same to our leaders…..powerful people feel sheltered from everyday concerns’. You can say that again. He does have a point, though, in reminding us that being prepared would have involved a huge diversion of resources from an already struggling NHS. (But then the reason it’s struggling is having been starved of adequate funding for years). He finally asks if we will be any better prepared for the next pandemic. Surely it will be shocking if we’re not, having witnessed and analysed the widespread socioeconomic and psychological impacts of the last few months’ failures.

There’s at least one book attracting a great deal of attention at the moment, reviewed in several papers and serialised on Radio 4. In The Week writer Ysenda Maxtone Graham explains that when her book (British Summer Time begins: the school summer holidays, 1930-1980) went off to the printers in February, she wouldn’t have been able to anticipate how very pertinent its subject matter would be. ‘Little did I guess, that, thanks to the pandemic, we would find ourselves in 2020 living through a British summer of unglamorous stasis very like those of 50 or 60 years ago’. The replacement of holidays abroad this year (apparently only one in ten Brits are taking a holiday outside the UK) with what some are calling the ‘staycation’, means British resorts are coming more into their own, building on a trend which started with the post-2000 gentrification of faded south coast towns like Margate. To those of us who grew up in the 1950s and 1960s, the territory described is both distant and familiar, conjuring images of: buckets and spades; building sandcastles on a rainy beach; granddads dozing for hours in their deckchairs; Thermos flasks and egg sandwiches; the inimitable hiss and roar of the old steam trains or, if yours was a car-owning family, kids being got up at the crack of dawn as dads were determined to get going early ‘to beat the traffic’.  Maxtone Graham interviewed hundreds of people for her book, including figures like Labour veteran Dennis Skinner, the PM’s sister, Rachel Johnson, and writer Jilly Cooper. A key point she makes is that this was a pre-internet and pre-Iphone world which assumed thrift and its capacity to enhance appreciation, which she believes the pandemic has returned us to. (Of course, some have always had to be thrifty, but you get the general point that ‘We, who have never been a thrifty generation, have rediscovered the old-fashioned pleasures of thrift’. I really hope the book does well and that it’s read by younger people as well, not just those who experienced these times.

Finally, amid strong feelings about the wearing of masks and debate about some kind of system for indicating an exemption (eg on health grounds), you have to admire or condemn the chutzpah of Hollywood online influencers, who defended their decision to hold a mask-free party for 70 TikTok stars by saying that fixing and attending parties was their work – ‘our jobs are to entertain people’. Since enforcement is so feeble here in the UK, imitators might well get away with such an excuse, but it wouldn’t wash in Italy, France or Spain.

Sunday 9 August

As the UK death toll reaches 46,574, this week started with no-nonsense senior scientist Sir Paul Nurse lambasting the secrecy which has dominated pandemic management: ‘Decisions are too often shrouded in secrecy. They need challenge and we need processes to ensure that happens. If they are going to keep the trust of the nation, they need to make those discussions more public…They seemed not to want to admit that they weren’t prepared, that they were unable to do the testing properly, because that would have been an admission of failure from square one…’. This sounds like a good argument for more notice being taken of Independent SAGE, whose experts have long advocated policies which the government only adopts when forced to, eg more local involvement of public health experts. Independent SAGE also has webinars anyone can join so there’s a good deal more transparency. Official SAGE, on the other hand, meets in private and members are expected not to talk about its deliberations. Co-chairs Patrick Vallance and Chris Whitty, Chief Scientific Adviser and Chief Medical Officer, are government employees, giving them limited room for manoeuvre.

Besides secrecy Nurse effectively alludes to the need for nuanced policy rather than the current blunt instrument blanket approach:  ‘What worries me is that we have an increasingly technocratic and complex society and we are going to increasingly need complex discussions involving science and the use of science that will impact on policy.’

Meanwhile, as if care homes hadn’t seen enough suffering, we hear that the regular testing of residents and staff, intended to on 6 July (when this should have been much earlier), will now be delayed until 7 September for older people and those with dementia.

In his highly percipient and worrying article entitled ‘Boris Johnson’s rise to power taught him all the wrong skills for a Covid crisis’,  Rafael Behr suggests the PM has the wrong kind of personality and is without the right skills for his job, because ‘it consists of constant, agonising judgments – picking between imperfect options, each with undesirable side-effects…. Everyone who has reached any position of Westminster seniority, whether as a minister or civil servant, ends up awed by the relentless demand on a prime minister to make those calls. Everyone, that is, except Johnson…’. Behr sees the PM’s skill set (if it can be called that) as evasion, trade-offs and denial, his power base Brexit-dependent. ‘He struggles with the job itself and with the wound to his ego from the discovery that governing is beyond his capabilities’. The heavy reliance upon rallying cries of ‘we’ must do this or that (including staying alert, of course) is seen as a giveaway, a projection of responsibility onto the public which he doesn’t feel capable of carrying it himself.

Amid fears of a ‘second wave’ and more evidence that many don’t understand the ‘guidance’ and ‘rules’ (hardly surprising given the so-called ‘swift’ changes like the restrictions this week placed upon Preston and different arrangements in the other three nations), journalist Andrew Rawnsley used a word which captures so well the government’s desire for all this to go away. … ‘They dreamed of returning to that prelapsarian age in which you could eat out with your family, go drinking with your mates, commute to work, celebrate a religious festival or jet off to a holiday somewhere reliably sunny without having to worry about catching or spreading a deadly disease… The fear swirling around Number 10 is that the public will be much less tolerant of a resurgence, especially if it looks like the result of incompetence and recklessness’.

The frequent attribution of the rise of new cases in Greater Manchester with inter-generational mingling in BAME communities had to be questioned this week, with the news that 80% were in the white community Nine of the region’s 10 local authorities are in the top 20 areas with the highest infection rates in England, according to NHS data for the week to Friday 31 July.

As the Spain quarantine debate rumbles on, many are feeling anxious as to whether their destination could suddenly find itself on the list, several more countries this week having been taken off the ‘safe’ list and fears growing about France. But some sceptics at least won’t worry: due to the lack of procedures and enforcement, not to mention lack of a COVID-secure environment at airports, it seems that only 11 enforcement orders have been made. Apparently only one in four (and that’s the official figure) passengers destined for quarantine are followed up. A Radio 4 listener tweeted: ‘Pathetic and entirely predictable. Macho government talks up stringent measures but doesn’t deliver’.

Major weaknesses are thought to include ‘cakeism’ (having it and eating it), dismissal of  others’ legitimate concerns, muddled communication and to hide or go AWOL when it becomes too difficult or uncomfortable. His approach ‘is primed for the ruthless crushing of enemies’ but this is only useful in campaigns: for the day-to-day business of government this bludgeoning and adversarial style just doesn’t cut it. ‘There are no traitors to be hounded in the battle against Covid-19’.

Other big news items this week, such as the Beirut explosion and large increase in migrant landings, have put first world problems like holidays into perspective. We’ve heard about the corruption long dominating politics in Lebanon and have to feel for the people there having to cope with bereavement, homelessness and shortages on a massive scale. Once regarded as the ‘playground of the Middle East’, recent years have seen Beirut subjected to one war and rebuilding after another, against a backdrop of poverty and political stasis. No wonder those interviewed in the media sound exhausted.

A strange coincidence on Friday (and I wondered if anyone else had noticed so tweeted the Guardian just in case they were interested in this historical perspective): on leaving the National Gallery via route B, I just caught sight of a small painting by an Egbert van der Poel called A view of Delft after the explosion of 1654. The accompanying text states that Delft experienced ‘a momentous catastrophe as the municipal powder magazine exploded, destroying almost a third of the town and claiming many lives’. Information from the New Netherlands Institute tells us that the painting is ‘made more poignant when we know that the artist’s son was killed the explosion’. How many similar disasters have occurred which the waters somehow close over with the passage of time? I wonder how many tourists get to hear about this – I certainly didn’t when I went there and that was with a Dutch speaker.  

Journalist Jonathan Freedland dissects the speedy path to corruption he believes the government has taken, getting there even more quickly than the May administration. From the PPE and track and trace procurement debacles to the awarding of numerous contracts to private sector companies, usually with government connections, and the creation of yet more politically motivated peerages, it’s not taken long. The conflict of interest in many of these contracts is plain to see but only because investigative journalism and lawyer Jolyon Maugham’s Good Law Project have brought them to light, for example ‘the government’s £15bn supermarket sweep approach to PPE procurement’. The Project has initiated proceedings over several deals with suppliers with no evidence of experience or expertise in PPE, including a pest controller and a confectionery wholesaler. The government used the pandemic to dispense with normal contact tendering procedures – just when do they intend to reinstate them, we might ask? The path to corruption has also, of course, been additionally paved by the shaming and arrogant antics of Dominic Cummings, Robert Jenrick and others plus the two MPs in the frame for sexual misconduct.

Freedland nails the short-termism underlying this strategy – the government thinks, with an 80 seat majority, they can get away with anything and may have felt rather clever, but the longer term damage they will sustain will be seen in the likely lack of public compliance with any future general lockdown.

Another form of oversight, though, sadly, without real teeth, is the All Party Parliamentary Group chaired by Lib Dem MP Layla Moran, which is holding a ‘rapid inquiry’ into the government’s handling of the pandemic. It seems a very large group, over 50 politicians having joined, including former minister David Davis. Some members were moved to tears by the testimony of a group of relatives of the deceased, Covid-19 Bereaved Families for Justice, which is calling for a statutory, judge-led public enquiry. The PM has agreed to hold one, but seems to believe this can be kicked down the road with no timeframe (‘there will come a time….’) – meanwhile more are dying. Psychotherapist Kathryn de Prudhoe, who lost her father, is also calling for substantial government support to enable the provision of counselling for the bereaved – very much needed.  

There was bad news for the government from a different direction this week – not long after the conviction for sexual assault of former Tory MP Charlie Elphick, it emerged that another (so far unnamed) Tory MP and former minister had been arrested and bailed for alleged rape. Just days later, this seems to have gone very quiet, but it was notable that, when asked about this on the Today programme, business minister Nadhim Zahawi repeatedly refused to be drawn on why the whip had not been withdrawn from this individual. This could be another example of short-termism: the PM defending his man, seemingly unaware of the long-term damage such a stance will do his government. 

Further to the obesity strategy discussed in the last post, Channel 4 this week aired a controversial documentary, presented by Dr Michael Mosley, called Lose a stone in 21 days. It featured a number of people who’d put on weight during lockdown, who were first given a number of tests we wouldn’t normally get on the NHS. What I thought was interesting was the wake-up call potential, since many don’t recognise being overweight or the dangers associated with it, eg of being told they were metabolically 20 years older than their actual age and/or they were pre-diabetic. It could be argued that without such a wake-up call, which shocked these guinea pigs then subjected to an 800 calorie a day diet, many would fail to see their weight as a problem.

The Twitter reactions throughout were interesting, some commending the approach but quite a few, including eating disorder charities and people having experienced these difficulties angrily

complaining of triggering. 800 calories a day is regarded as far too low in the opinions of many, including some clinicians. I did wonder, though, if the idea was to enable quick results, which could then motivate them to continue at a higher calorie intake: too often a complaint of dieters is that it takes too long to achieve results and meanwhile they’re thinking of food all the time. But, as ever, there’s too much emphasis on calorie counting and not enough on the underlying psychological reasons people are overeating in the first place. A key question that needs asking is will the programme makers track these people 6 months or a year down the line to check if their weight loss has been sustained? Or will it be short-term because basic eating patterns and prompts for eating haven’t been addressed? A key aspect of the timing, of course, is the proven link between obesity and Covid19 susceptibility, but a rounded analysis of the problem necessitates exploration of the psychosocial issues, the need for exercise (not just dieting) and the need to permanently change eating habits. I found the smugness of the presenters slightly offputting and a key disconnect was some of the ad breaks featuring fast food, but I’ll reserve judgement until the end of the series. One reviewer at least challenged the reservations over ‘shaming’: ….’Covid-19 has changed all that. The data is clear. Our lives, I think we can all agree, are more important than our feelings’.

Finally, in The Week’s column ‘It must be true, I read it in the tabloids’ is news of the Satanic Temple in the US, which campaigns against ‘Christian privilege’, launching a Devil’s Advocate Scholarship to help students into higher education. To win a $500 grant, applicants have to describe a teacher who ‘made you hate every minute’ of school. The scheme’s founder said it offered ‘a rare opportunity to be critical of an institution that only rewards sycophantic adulation’.

Sunday 2 August

As the death toll exceeds 46,201, the real total is thought to be around 66,000, so shocking it’s almost unimaginable. Yet the government sticks firmly to its script, heavily reliant upon mantras like being ‘guided by the science’, a rather selective process, it seems. It’s interesting that, throughout, neither the government nor the media have seemed to take notice of the experts on Independent SAGE. Despite different developments every day, leaving many more confused than ever, the news has continued to be dominated by the sudden announcement a week ago that all those entering the country from Spain would have to quarantine for two weeks. It was ironic that Transport Secretary Grant Shapps, besides a junior minister, were on holiday in Spain, Shapps quickly deciding to return so as to get his quarantine underway ASAP. At least he didn’t try to dodge it, but the Cummings saga would have made that impossible to get away with. It was surprising to learn that over 660,000 Brits were on holiday in Spain at this time – no wonder the Spanish authorities were upset and anxious at this spanner being thrown into their economic works. The main criticisms around this change were its sudden announcement halfway through Saturday evening (25 July), too late for many to change plans; its indiscriminate approach (ie the whole of Spain was in the frame rather than just the flare up areas such as Catalonia); but primarily that this was used as a distraction from the government’s mismanagement, projecting its incompetence into another country. Since then, Luxembourg has been added to the quarantine list and the PM has warned that any country could suddenly find itself on the list.

An interesting thing about all this is the increasing amount of disapproval and judgement of those travelling abroad for their holiday: at one time those having ‘staycations’ could be looked down upon, but now those going abroad are being stigmatised. It’s worrying, though, that some air travellers have reported no health and safety procedures at the UK airport, such as taking of details, mandatory face mask use, hand sanitisers and social distancing protocols, when all of these were in place at the airport they’ve returned from. It seems another example of government chaos and reactivity, setting out policies without the strategy and resources to implement them.

The government came in for similar flak regarding the sudden decision to restrict indoor gatherings in some northern areas, preventing large numbers from celebrating Eid.  Again, this was announced well into the evening and initially on Twitter. Of course it’s understandable that ministers have to respond to changing circumstances, but their macho description of ‘swift’ has been called panicking by some commentators, such important messages needing far more skilled communication. An exasperated Radio 4 listener tweeted: ‘Tory MPs and government apologists dance on the head of a pin to sound ok with ill-considered policies and their knee-jerk roll-out’.

Amid suggestions that in order for schools to reopen in September other openings such as pubs may have to be restricted, there’s also concern that the further COVID19 outbreaks won’t just lead to more local ‘whackamoles’ but another 100% lockdown. Commentators are already expressing doubt that such a drastic step would be complied with because a large percentage of the public lost trust in the government some time ago. We have to wonder if these are yet more attempts to trail potential policies, in order to assess their acceptability, only to deny any intention of whatever it is if there’s a bad response.

Regarding Independent SAGE (‘the independent group of scientists providing transparent advice during the COVID crisis’) one member, Professor Allyson Pollock, has long argued for much more local control in track and trace, as well as for the pandemic strategy as a whole. In an article subtitled ‘NHS services have been sidelined in favour of private giants with a poor track record – and billions are unaccounted for’, she details how this life-threatening situation has evolved. ‘We all know that an effective and integrated find, test, track and trace system is hugely important in tackling the coronavirus outbreak. It’s crucial if we’re going to come out of lockdown safely, prevent a second wave of suffering and see our loved ones again. Yet Britain’s test and trace programme – lauded by the government as “world-beating” – is about as far from integrated or effective as you can get’. It’s a wonder that despite the government’s doctrinaire policy of centralised control, favouring the private sector and suspension of normal contract tendering procedures, local public health teams are still stepping up although they’re hampered by lack of access to real-time data.

The official version of events is that 80% of contacts are being traced, regarded as sufficient, but leaked data has revealed that the national tracing service is managing only 52% in some areas. It seems shocking in itself (as they’re not cheap) that the government has felt the need to appoint McKinsey management consultants to review this national service, but it still hasn’t published a list of contracts issued, amounting to £10 billion of public money. Over 100 public figures including Professor Pollock have now written to Matt Hancock to demand that he publishes this information – we’d better not hold our breath.

More interesting news this week concerns the long neglected social care area: successive governments have ducked this worsening time bomb for years but COVID19 has proved it can no longer be ignored. We now hear that a former Cameron adviser, Camilla Cavendish, is working with social care minister Helen Whately (the one of car crash media interviews) on plans enabling the NHS to take over social care’s work and budget. Local authorities are apparently fighting such a move, partly because removal of the social care funding would hugely reduce their overall budgets, but might it be good for care recipients and their families? It could remove the damaging postcode lotteries which currently affect the quality of care people receive, but these may still persist because the plan is for care to be commissioned locally via NHS bodies called Integrated Care Systems. We’re told this change would need legislation – if it comes to pass legislators would be well-advised to get rid of the absurd NHS internal market introduced by the 2012 Health and Social Care Act. Apparently the PM is determined to fulfil his promise to ‘tackle the injustice of social care’. Where have you heard something similar before? Yes, Theresa May and her ‘determination’ to tackle the ‘burning injustice’ of mental ill-health, and look what happened there.

The Guardian’s John Crace has excelled himself yet again with his portrayal of the many versions of Matt Hancock, describing his speech to the Royal College of Physicians on the future of the NHS. ‘There’s been the energetic Tigger enthusiast determined that everyone must have the best experience possible as they are kept on hold for 30 minutes on the NHS 111 helpline. There’s been the tetchy, defensive Hancock, who has just realised he’s been set up by the PM to take most of the blame for the government’s failings over its handling of the coronavirus pandemic and can’t understand why Labour aren’t more supportive of what he’s done. The clue might be in the word opposition….’, then it’s management consultant Matt, eg ‘the important thing about a system is that it should work as a system…There are seven major cultural lessons to be learned…The first is that we must value our people.’ Crace observed: ‘Something every health secretary over the past 10 years has said, before imposing a whole range of cost-cutting measures to systematically undermine the entire profession’. Apparently the atmosphere in the room was ‘comatose’ and no one had any serious questions, because at present ‘most people in the NHS aren’t worrying about long-term reform so much as getting through the next 12 months’.

The government’s obesity strategy continues to dominate the news, and, while some aspects were welcomed by experts, it was felt lacking in others, including a lack of detail and the need for personal support. There’s also a disconnect with the Eat Out to Help Out campaign, which features many fast food restaurants. Such strategies are often too biomedical and fail to understand and address the underlying psychological causes of overeating, not to mention the wider socioeconomic factors such as social deprivation. Renowned psychotherapist Susie Orbach, who has long taken an active interest in the complex relationship between our bodies, food and our emotional wellbeing, gave her views in the Guardian. ‘Rather than counting calories and stigmatising fat, we need to take on the food and weight-loss industries…..the rate of recidivism with all diets is an estimated 97%. That figure should give the government pause for thought. Of every 100 people who diet, an estimated three will manage to keep the weight off in the long term. Why is the government ignoring this evidence?’

What’s key is our relationship with food, which begins at birth, associating food with love and safety. Babies turn away from the breast when they’re no longer hungry but many later lose the capacity to do this, for a variety of reasons. ‘We should be encouraging people to be healthy and fit. But a better and more viable place to start would be to help people understand what food means to them, both individually and culturally. We need messaging that encourages people to eat when they are hungry and to savour every mouthful so they can stop when they are full’. When will governments and experts understand the need for attention to the underlying psychology of food and eating? Until they do, solutions to the obesity crisis are likely to be superficial and short-lived.

It was scarcely credible to learn that the PM has made 36 nominations for new peerages (including the PM’s brother, Jo Johnson), a blatant example of cronyism which would bring the already top-heavy House of Lords to over 800 members, more than the House of Commons. It’s surely a travesty of democracy when the membership of an unelected chamber exceeds that of the elected chamber. We have to wonder whether the ploy of appeasing the sacked Remainers and others will even work: may be in the short term but in the longer term? House of Lords speaker Lord Fowler has already clearly signalled his disapproval, citing the previous intention to reduce numbers in the Lords and the fact that many are ‘passengers’, who do not speak or contribute to the work of the Lords. Peers can claim £300 a day for attendance, so this is a significant burden for the taxpayer.

Finally, for some light relief, you may like two BBC4 documentaries. One is about the history of gospel music, presented by British soul singer Mica Paris.

The other focuses on the changing flora and fauna of the Fens, including the re-introduction after centuries of European cranes.