In Downing Street, the prime minister has trashed the UK public health strategy, with his repulsive defence of his senior adviser making up his own rules. Elsewhere, health workers, teachers and communities are organising to protect people from the coronavirus more effectively. Here PHIL EDWARDS, Joint Secretary of Newham Save Our NHS, writing in a personal capacity, reflects on how the virus is changing the politics of health.
The Mayor of Newham, Rokhsana Fiaz, has announced that along with the London boroughs of Camden, Barnet and Hackney, our borough will be part of a local test and track (or trace) initiative.
The government in turn announced that local areas were to submit plans for carrying out local test track initiatives across the country. The Newham initiative, on 22 May, was the result of
weeks of pressure nationally from public health experts, local authorities, medical practitioners, and of campaigns like our own.
This came days after the release of evidence that the national test and track scheme launched by the health secretary Matt Hancock’s friends in Serco, the private contractor, and recruitment agencies sub-contracted to contact people using the government-approved mobile app, was collapsing in disarray.
As the Newham Health and Wellbeing Board met this week, to respond to questions on the local test trace scheme from local residents, it was pointed out that the government would finally launch its app this week after several false starts.
We have to approach this “victory” with some careful qualifications. It is not yet clear what the relationship is between these “local” tests and the national effort run by Serco. The scheme in Sheffield (see “Testing times” below) is run and operated by local health professionals. In Newham, our campaign has yet to establish whether the scheme will simply be a subordinate part of a national testing scheme, in which case this is not going to be the answer for anyone. As they say, “La lucha continua”!
This week’s national testing-and-tracing launch comes after a litany of disastrous policies, U-turns and indecisive pronouncements – a fragmented, chaotic and numbingly blind response to a pandemic that should have been contained much earlier.
Why the incompetence and coverup of mistakes? Why the incapacity or wanton deafness in the face of so many better examples of how to deal with this pandemic?
The answer lies in the ideological and self interested singlemindedness of a regime which from the very start had another agenda, to them more important than finding any rational solution to this mortal crisis.
That agenda – involving the breakup of the NHS, the politicisation of public bodies supposed to act in the “public interest”, and the vicious pursuit of corporate self interest – could never be compatible with dealing in any rational way with the problems which have cost us so many lives.
“Leave the unproductive to die”
There are 400,000 care homes in England , and deaths in these reached 11,000 by mid May. Many of these resulted from hospitals discharging patients into care homes, even though those hospitals were unexpectedly operating below capacity, with the newly opened Nightingale hospitals lying empty.
Eventually, some managers refused to accept patients discharged from hospitals with Covid-19, because they could not be safely isolated.
Care home deaths have been excluded from figures – not, as the government claimed, because data was not available, but because the uncomfortable truth was that the care homes sector was a hidden front line, where, after privatisation, homes were owned by a multiplicity of individuals and companies, poorly regulated and often not fit for purpose.
Care workers have historically been underpaid, often dependent on benefits to supplement their income, and deemed in the government’s eyes to be “unskilled”.
Any migrant workers in NHS or private care homes – and there are vast numbers of them – earned less than £26,500 per annum, and so had to struggle to obtain visas, and were then crippled by the government surcharge (increased this year from £400 to £650), which penalised families by charging each member individually.
During the pandemic, a victory was won by campaigners, when pressure finally brought the government to concede that nurses and other healthworkers should not be subject to the surcharge. Boris Johnson reversed what he had said the night before about the necessary revenue raised by this discriminatory tax, to say that NHS workers would no longer be subject to the charge, whatever their background. (See also linked article – The hostile environment. Who needs a virus?)
Teachers in the firing line
It has been left to local community campaigns and the Keep Our NHS Public (KONP) campaign to organise to expose the weaknesses of the government’s response and to call for a reversal of their most damaging policies.
When the government announced it would reopen some classes in schools on 1 June, teachers of reception classes in particular bemoaned the fact that social distancing alone, even if it could be actuated, would not protect staff and pupils.
Membership of the National Education Union (NEU) rocketed – as teachers became aware that they could be isolated against bullying managerial regimes, in academies in particular – and these could only be resisted collectively.
Nevertheless, local authorities were again given powers of oversight over all schools, academies or not, during the pandemic. This gives them a huge responsibility – in light of the proposed reopening of some schools on 1 June and 15 June – to pronounce against such government orders. Many local authorities, needless to say, have not risen to the task.
In Newham, the Mayor announced at the Health and Wellbeing Board meeting on 27 May, in response to questions about schools opening from concerned parents, that she would challenge any school, academy or not, if they sought to ignore her advice not to open on 1 June.
The legal position is confused, but the Mayor pointed out that in legal cases against private companies who had endangered public health through, for example, oil spillages, the health issue was enough to get them fined.
The real issue, though, is that it has been mounting pressure from parents and teachers, and union advice, that has convinced many schools to declare that they may not be opening.
The NEU recruited 6250 new members following the government announcement, and 560 new school representatives were elected. The petition to leave schools closed for the duration got 400,000 signatures.
Meanwhile the alternative Scientific Advisory Group on Emergencies (SAGE) – organised by scientists dissatisfied at the work of the official group – on 22 May provided evidence that keeping schools closed for an additional two weeks after 1 June would halve the risk, and leaving them closed till September would reduce the risk still further.
Many teachers though still felt alone and isolated, working in schools which had been open throughout anyway, teaching pupils of key workers.
Perhaps they may have felt strengthened by the alternative SAGE’s unprecedented support for trade union demands. It quoted the NEU’s five preconditions for reopening, which include having a properly coordinated test trace system in place in every school and community.
Even the Department for Education, which had failed to even provide updated guidance to school heads, faced with so much opposition from parents, admitted that opening schools might lead to a spread of the virus. They even said “there is a low degree of confidence” that children might transmit the virus less than adults.
Community campaigns organise
During the lockdown, campaign groups have found new ways to organise, meeting virtually on zoom, organising national conferences online, setting up WhatsApp groups, and using virtual networks to counter government misinformation with scientific evidence and calls for action.
In Newham, one Parents Action Group had 100 attendees at its zoom meeting, with over 100 in the “waiting room”, and there was a discussion which presented all sides to a debate concerning whether or not is was safe to send children back to school. This resulted in a statement being sent to the mayor, who then argued that a return to schools would be inadvisable.
Such online movements hopefully will form the embryo of resistance to any post-pandemic imposition of austerity on schools, the NHS and other public services.
In response to these actions by teachers and parents, the Daily Mail and others then launched disgusting front page stories attacking “callous teachers’ unions”.
Middlesbrough, Liverpool and Hartlepool councils were among those who defied the government’s announcement that all primary schools (later amended to “not all” primary schools), as well as Years 10 and 12 in secondary schools, would open.
Another group of workers on the frontline were in transport. As the government announced “business as usual” for construction workers, it has been clear that, while workers were
expected to put their lives at risk to keep the economy moving, others, like Dominic Cummings had different rules. The class divide couldn’t have been any clearer.
The rail workers union RMT has announced the death of 42 transport workers, including bus drivers who had not been provided with personal protective equipment (PPE) in London, the country’s richest city. This included 15 minicab drivers.
At least one mini cab driver, and a rail platform worker, were spat at by knowingly infected members of the public. The latter’s managers had ignored her pleas not to go back onto the platform where she feared for her safety.
As the number of deaths among frontline workers grew, local groups began calling for local testing, following the examples in other countries where this had been successfully implemented. (See People & Nature article from 18 May.)
The government’s own testing scheme was stopped unaccountably on 12 March. The result was that the virus, instead of being contained in areas where it could have been traced and then isolated – which would have been possible in the Midlands and the north even as figures in London and the south began to rocket – spread with accelerating intensity.
In May, when Office of National Statistics figures showed Newham to have had the highest death rate in the country, with 144.3 deaths per 100,000, we launched a petition in Newham calling for local testing.
Deaths included one of many GPs sacrificing themselves on the government’s frontline.
Why so many health worker deaths? In contrast, 45,000 volunteers equipped with proper PPE were sent into Wuhan province, in China, without a single infection, let alone death.
Further, why not follow the examples set in Germany, where death rates were lower, and where the country had been divided into 400 communities for the purposes of testing? Why not follow the good examples set by South Korea, Taiwan and elsewhere?
The answer lies partly in the government’s blind recognition of an opportunity – and Hancock never misses any – to contract out further sectors of the NHS to private companies.
The government announced that it was recruiting 18,000 contact tracers. But test centres controlled by Serco failed to achieve the 100,000 tests per day that Hancock had promised. The figures produced included 40,000+ tests lying in envelopes waiting to be delivered by Amazon. And the number of deaths kept rising.
The government promised to increase testing capacity, as if capacity alone was sufficient to ensure the delivery of the appropriate scale of testing.
The British Medical Journal said: “These headline grabbing scenes should be replaced by locality led strategies rooted in communicable disease control.” Jonathan Ashworth, shadow
health secretary, said in a letter to Johnson: “It is crucial primary care is integrated into a locally led test, trace and isolate regime”.
On 21 May Newsnight reported on the initiative by retired GPs and other doctors to set up their own test-trace scheme in Sheffield. Dr Bing Jones and six volunteers set up their own scheme showing that communities could organise themselves using the help of existing medical expertise. Following this, the movement for such schemes to be set up locally gathered pace. (See also Channel 4 report here.)
PPE: supply and demand
The shortage of PPE, the other big issue alongside the testing controversy, was rooted in that other sacred cow beloved of the Tories and assisted by the Blair government: the privatisation of the NHS.
In essence this is being pursued at pace whilst no-one is looking.
The Integrated Care Systems (ICSs) which in their infancy in 2016 were called Sustainability and Transformation Plans/Partnerships (STPs) were asked in May to hold meetings to forge ahead with regional plans and budgets in line with the Central Long Term Plan, announced shortly before the pandemic broke out.
These unaccountable systems form the heart of proto-partnerships which will work with Primary Care Networks (PCNs), to circumvent the groups established through the 2012 legislation – the Clinical Care Groups (CCGs), Health and Wellbeing Boards, scrutiny
committees and hospital Trusts – to put in place the beginnings of what must eventually metamorphose into partnerships with private corporate interests.
Privatisation, though, has been an ongoing process since the 1980s, when Thatcher first made possible the contracting out of catering, portering and other services to private contracts.
The PPE shortage is closely linked to privatisation, through the privatisation of procurement, which has taken place on Hancock’s watch.
This is explained in a well researched report published by We Own It, a campaign against privatisation of public services and for their renationalisation, with the University of Greenwich and John Lister (a seasoned campaigner and blogger on the Lowdown).
The idea that the PPE shortage is due to a global shortage, which could never have been avoided (even if they had had the foresight to place their orders when that misplaced email from the EU accidentally fell under the table) is a government lie.
The history reveals a process which has at its core the aim of further fragmenting services for exploitation by private profiteers, whilst the control of local NHS budgets are centralised, and decisions taken out of the hands of public health experts and medical professionals.
In 2018, the privatisation of procurement made a great leap forward, with the creation of the NHS Supply Chain.
This immediately outsourced IT and logistics and put DHL in charge of consumables (including PPE). In the interests of “efficiency savings” this was subdivided between 11 different contracts with Unipart in control overall.
This began a process of placing more and more distance and red tape between doctors, nurses and Hospital Trusts and the companies supposedly providing them with essential equipment.
Eventually, through a process of fragmentation and continual outsourcing to a multiplicity of inappropriately equipped companies, what emerged created “perverse incentives” to encourage rationing of demand, instead of gearing up supply to meet existing demand during the pandemic.
At the end of March, a lavish £400,000 consultancy contract to make “efficiency savings” was awarded to Deloitte, an accountancy firm. They then oversaw a testing disaster. The existing pool of expertise located in the public sector, in this case the Healthcare Supply Association was completely ignored.
Deloitte had already taken over procurement in 2016. Its CEO, Jim Sahota, who had no experience whatsoever with healthcare, regarded it as “equivalent to a FTSE250 business with approximately £3.2bn turnover”.
How can such a profiteering mindset ever serve the interests of public health?
The resulting fiasco is well known. Sixteen million goggles were recalled after failing safety tests. The pattern was repeated in the case of the well publicised delivery of gowns from Turkey which never met expectations either in terms of quality or quantity.
DHL meanwhile awarded subcontracts to numerous beneficiaries. The so-called Pandemic Preparedness Programme was handed out in 2018 to Movianto. A new PPE supply channel was awarded to Clipper Logistics, whose CEO is a Tory donor and attendee at the prime minister’s special dinners.
Cronyism was the defining feature of how contracts were awarded with no accountability to anyone, least of all the NHS.
When Deloitte outsourced contracts to Serco, G4S, Mitie, Sodexo and Boots there was no public scrutiny. And so we saw 50,000 test results sent to the US following the loss of testing data, and the incapacity of existing bodies in the UK to process it – and why we have seen critical shortages of PPE.
Many workers set up their own production units of PPE, but never on the scale required. Companies offering to help in the UK were ignored by Deloitte. Calls by Unite, the British Medical Association (that represents doctors), Unison and the Royal College of Nursing for UK-based PPE production centres fell on deaf ears.
Instead, everything to do with procurement of PPE was divided between a number of profiteering companies. These included:
■ Foodbuy (The Companies Group) which had repeated strikes from its poorly treated workers and served horsemeat burgers to its market in Northern Ireland, and free school meals of crisps and butter costing £11 each/ (“Privatised and Unprepared” We Own It);
■ DHL (which boasted about privatising parts of the NHS);
■ Unipart (which stole 2000 workers from the NHS and which owes its survival to 20% of its turnover linked to the NHS);
■ DXE Technology (investigated for accountancy fraud);
■ CSC (sued for misconduct for numerous contracts)
■ Clipper Logistics;
■ Deloitte (which rewarded one Health Care Official who gave them the contract with a job);
■ Serco (responsible for 270 women not called for breast scans because the callers had 1 hour training);
■ Sitel, whose contact tracing recruitment drive and 1:100 trainer caller ratio described by trainees as “shambolic”.
These are all examples of how degenerate this aspect of capitalist exploitation of the NHS and its component parts has become.
Nowhere can it be evidenced that this process serves any need but private profit.
It is this which, along with the restructuring of the NHS and of the state’s relationship with public health, is at root of the catastrophe which has led to the unjustifiable loss of life.
Meanwhile … the government’s real agenda
Throughout the pandemic, the government has continued to pursue its real agenda without accountability and behind closed doors. The inheritance of Brexit was the trade deal being negotiated by Liz Truss, the trade secretary, and a team determined to crash through a deal with the US – at the expense of offering up the NHS like a sacrificial goat to corporate buyers.
This, with a regime led by a president who called for using an untested malarial drug or even bleach against the virus, whilst busily encouraging Republicans to open up business as usual as the US death toll exceeded all other countries. The other agenda was to continue restructuring the NHS even as deaths continued to rise.
Adjusting the balance between public health professionals and politicians
Alongside the privatisation drive, the government has undermined the systems through which public health professionals can discuss and influence policy.
The Scientific Pandemic Influenza Group on Modelling (SPI-M), which models future epidemics, advises SAGE (the government’s official advisory group on emergencies).
Both are dominated by modellers and epidemiologists, and attended by the prime minister’s chief adviser, the well travelled Dominic Cummings (Vote Leave campaign coordinator and enemy of the state’s supposedly independent civil service), who is currently facing criticism for multiple breaches of the lockdown he helped to impose.
The British Medical Journal says: “None of the members [of SPI-M] were experts in developing and implementing a public health response, and other relevant groups such as communicable disease experts, women and ethnic minorities are under represented.”
Government briefings during the lockdown have deliberately played down problems created by their intransigent lurch into an ever deeper quagmire of ineptitude.
John Ashton, a former regional director of health, interviewed on NHS Staff Voices online, spoke of the way in which scientists were deliberately excluded from public briefings so that difficult questions could be avoided.
The government attempted to cut down on media time by asking local authority leaders to ask questions at the daily press briefing in the wake of promised increased funding.
This backfired, as the leader of Middlesbrough Council opened with a salvo attacking the Government for ten years of austerity, which had led to extremes of hardship in communities in the north.
No surprise then that the “R” number is high, at 0.85, in Middlesbrough, where the virus has hit hard-pressed working class communities.
Tory policies have also weakened medical expertise within the NHS itself.
The restructuring of public health bodies since 2012 – when the Health and Social Care Act was introduced, following a World Economic Forum conference in Davos, which was busy modelling how to privatise health services across the globe – led to a critical loss of senior posts and staff.
Critically, regional health teams and public health bodies were abolished and subsumed into Public Health England.
Today, only one of the four countries comprising the UK had a trained health physician as Chief Medical Officer. With responsibilities for overseeing Public Healthcare devolved to local government, central government then imposed crippling cuts amounting to £1 billion up to the present day.
Much of the illness and death during the pandemic is attributable to this government and to the historic fragmentation and privatisation of the NHS. 29 May 2020.