UK Covid deaths: Why the 100,000 toll is so bad

The language of Never Again resonates – we should not have to mobilise to Save the NHS – that was only necessary because it has been underfunded and successive governments had failed to prepare for the pandemic – although a pandemic was at the top of the UK’s risk register.  Scientists in one group were surprised to be told that they would not be meeting at all during August despite the ongoing pandemic.

Daily Telegraph 07 January 2021
“Even after hearing about mutations elsewhere, the UK never really attempted to assess whether people entering the country were infected. The new strain of the virus now leaves us in a situation graver than even last spring.

For sure, we must question how much control governments can truly assert over complex human interactions and viruses. But few would doubt most of those decisions outlined were errors, and ones that owe little to inadequacies in state capacity.

Some reflect a failure of robust economic reasoning. Little thought was given, for example, to people’s financial incentive to engage with track-and-trace, or to how on-off lockdowns and urging normality in late summer would affect perceptions of risk.

Some reflect simply bad decisions or dithering. Eat Out to Help Out – subsidising indoor dining during a respiratory pandemic – was baffling. And the major mistake with the most recent lockdown stemmed not from an inability to implement it, but in delaying its announcement. With rapid growth in the numbers of infected, delay even by days costs lives.”

LONDON — When the pandemic exploded in March, British officials embarked on a desperate scramble to procure the personal protective equipment, ventilators, coronavirus tests and other supplies critical to containing the surge. In the months following those fevered days, the government handed out thousands of contracts to fight the virus, some of them in a secretive “V.I.P. lane” to a select few companies with connections to the governing Conservative Party.

To shine a light on one of the greatest spending sprees in Britain’s postwar era, The New York Times analyzed a large segment of it, the roughly 1,200 central government contracts that have been made public, together worth nearly $22 billion. Of that, about $11 billion went to companies either run by friends and associates of politicians in the Conservative Party, or with no prior experience or a history of controversy. Meanwhile, smaller firms without political clout got nowhere.   more

24 December: The Huffington Post has identified 11 Times Ministers Weren’t Guided By The Science.  The government has made a big deal about following scientists’ advice while fighting Covid-19. So what went wrong?

23 December: Anthony Costello Professor of Global Health and Sustainable Development at University College London explains that the UK government’s failure to pursue a “maximum suppression” strategy has enabled the virus to spread and mutate.
As late as 13 March, Scientific Advisory Group for Emergencies (Sage) minutes recorded that “measures seeking to completely suppress [the] spread of Covid-19 will cause a second peak”. Advisers warned that countries such as China, where heavy suppression was already underway “will experience a second peak once measures are relaxed”. Instead of eliminating coronavirus, the logic seemed to be, Britain would learn to live with it.
Nine months later, China and South Korea have recorded three and 12 deaths per million people respectively. By contrast, based on the government data for deaths occurring within 28 days of a positive Covid test, the UK has recorded 970 deaths from Covid per million people.
Scientists only expected the virus that causes Covid-19 to undergo one to two mutations each month – but with an estimated 2 million people now infected with Covid in the UK, there are many more opportunities for the virus to mutate. more The Guardian

6 December Majority of Britons distrust government Covid response for first time
57% of the public say they do not trust the UK government to control the spread of coronavirus – the first time in a series of studies running since April that distrust has become the majority view in the country. In  April it was 28%. Evidence: new research by King’s College London and Ipsos MORI, based on 2,244 interviews with UK residents aged 16-75, carried out online between 20 and 24 November.

• Half the population (51%) think the UK government’s handling of the coronavirus crisis has been a national humiliation – twice as many as those who disagree (26%).
• Half (50%) also say they’re angry with the government because of how it’s handled the crisis, compared with a quarter (25%) who do not feel this way.

The handling of certain aspects of the crisis may go further in explaining this sentiment:
> Nearly two-thirds (64%) think the UK government failed to prepare properly for a second wave of coronavirus infections.
> 47% think the government has prioritised some parts of the country over others in
its response to the crisis – more than double the 19% who think it hasn’t.
> 45% think the government has done a bad job of protecting young people’s futures during the pandemic – almost twice as many as the 23% who think it has done a good job.
> 46% think the government has done a bad job of protecting elderly or vulnerable people’s health during the crisis, compared with 28% who say the opposite.

From those critical seven days that were wasted before a clearly inevitable national lockdown was imposed in March – a delay that Prof Neil Ferguson, then on the Sage committee, estimates to have cost 20,000 lives – to the multimillion-pound contracts handed to pals to supply PPE that turned out to be useless against Covid, Johnson and his team have blundered at every turn. The result is that the UK has managed to score a rare double: notching up the highest death toll in Europe along with the severest economic slump in the world. more

This needs to subjected to independent scrutiny

21st October George Monbiot in The Guardian The government’s secretive Covid contracts are heaping misery on Britain. Bypassing the NHS and handing crucial services to corporate executives has led to the catastrophic failure of test and trace. more

Deals worth billions have been granted by a government willing to brazen out disgrace until outrage subsides. This is the kind of thing usually seen in corrupt countries, can it be true?
There is more on the Good Law Project website

Cover-up?

11 October: Trust in the government to handle the pandemic, say local leaders who monitor the crisis daily, has been shot to pieces. “I would say that trust in authority has completely gone,” said one senior official at the heart of the fight against Covid-19 in the north of England on Saturday. That crisis of confidence in central government is borne out in the latest Opinium poll for the Observer on Sunday. It shows that just 31% approve of the way the government has handled Covid-19. At the end of March, the approval rate was above 60%. National targets on testing have not been met. False expectations have been set. Rules have changed at dizzying speed. “One day people are told one thing, the next another to the point where they have stopped even trying to follow,” said one public health director. This weekend, when uni is needed, the cabinet is split. Tory MPs are split. The media is split. Public opinion is split. And council and public health leaders in some of the biggest cities of the north and Midlands are in revolt. So what can be done? The Guardian 

11 October: The Department of Health is refusing to release key figures used to measure the effectiveness of NHS Test and Trace after a senior official previously suggested that the rate of success in July left the system unable to prevent a second wave. In a briefing reported by The Telegraph, Alex Cooper, the “senior responsible owner” for two of the five pillars of the Government’s testing programme, said the system was only identifying 37 per cent of the people “we really should be finding”.

At last: “Officials are drawing up plans to add a South Korea-inspired layer of contact tracing designed to pinpoint “super spreader” events or locations at which small numbers of individuals have unwittingly infected many others. Whitehall sources said preparations to introduce so-called “backward tracing” when current infection rates drop to lower levels were underway”.  Professor Chris Whitty, the chief medical officer, has told ministers that Covid-19 is being transmitted in “clusters”, which have been successfully tracked in countries such as South Korea using the “backward tracing” tactic. A Whitehall source confirmed that preparations to incorporate “backward”, or retrospective, contact tracing into the current system were underway.  “That is our plan,” the source said. “We just can’t do it while prevalence is as high as it is now.”  Addressing MPs in July, Prof Whitty said: “Backward contact tracing is, we think, an increasingly important thing to do … One thing that is now much clearer, but was not clear at the beginning of the epidemic, is that the disease is passed on in clusters. The Koreans and the Chinese have demonstrated that really well.

10 October: Covid rates in university towns are over 40 per cent higher than the rest of the UK, an analysis by The Telegraph has revealed. Virus hotspots are emerging in student areas around the country with the number of new cases up to 38 times higher following freshers’ week, official data shows. It comes as a leading public health expert warns that students must not be blamed for fuelling outbreaks in their local areas as he says it is “inevitable” that a lot of young people will catch the virus. On September 1 the average daily rate of infections per 100,000 people in areas with universities was 29.4 per cent higher than areas with no students – likely as those areas tend to be larger cities and urban areas with dense populations.But since the return of almost 2.5m students across the UK, average infection rates have climbed to 42.4 per cent higher among major university towns and cities, an increase of 13 percentage points. DT

6 October Ministers have blamed technical blunders after almost 16,000 confirmed coronavirus cases became lost in their various aged computer systems. The fiasco occurred when an Excel spreadsheet, used in outdated software being employed by Public Health England (PHE), was unable to cope with high numbers of cases. As a result – and as infection numbers soared – thousands of positive cases were automatically thrown off the database when they should have been passed to the Test and Trace system. Labour said as many as 48,000 contacts of positive cases may not have been traced, with “thousands blissfully unaware” that they had been exposed to Covid-19 and could now be spreading it. Efforts to reach the missed contacts were further hampered on Monday when the phone system used by NHS test and trace call handlers crashed yesterday, according to The Times. The failings mean the daily data published since September 24 did not track the rise in infection rates.  DT

5 October More than 15,000 positive Covid cases have become “lost” in Britain’s tracking systems, resulting in long delays being passed on to Test and Trace handlers. It means that tens of thousands of people who should have been told to self-isolate after coming into close contact with an infected case are only now being contacted – in some cases 10 days after transmission occurred. The Government blamed “computer issues” for a blunder that saw the number of daily cases appear to double overnight. Last night, they announced another 22,961 new cases – bringing the total number to more than half a million since the pandemic began. Health Editor Laura Donnelly explains the impact of the “technical glitch”.

Meanwhile, every patient on NHS hospital waiting lists will be reassessed under a national review – with many who have already endured long waits sent to the back of the queue. We can reveal that doctors have been told to brace themselves for “anger and distress” when they contact more than four million patients waiting for surgery in an effort to ensure that the most urgent cases are prioritised. DT

30 September Care homes are having to wait up to three weeks for coronavirus test results, putting staff and elderly residents at “serious risk”, an investigation by The Telegraph has found. The Government’s pledge to test care home staff every week and residents every 28 days has sparked a backlog, meaning many care providers are waiting more than seven days for results. It comes after the Government was heavily criticised for failing to protect care homes at the height of the Covid-19 pandemic DT

27 September Officials were forced to urgently remove a major blindspot in the Government’s Covid-19 app on Saturday which meant that more than a third of daily tests were being excluded from the system.  On Saturday morning, it emerged that those who tested positive for the virus in NHS hospitals and Public Health England (PHE) labs were unable to share their result using the official contact-tracing app for the first 48 hours after its introduction on Thursday. DT

26 September Contact-tracing app: First version worked on more phones. The new app doesn’t work with a variety of older phones, including iPhones made before 2015, and Android phones not running the Android 6.0 operating system or above. BBC It can also generate false readings of close contacts in a third of cases.

24 September Finally the Test and Trace App promised at beginning of June is available
Test and Trace app: users will be able to delete records of pub and restaurant visits Also, the app will only work on iPhones built on or after 2015, and Android devices built on or after 2017 The new NHS Test and Trace app will allow people to delete records of their visits to pubs and restaurants, and will only function on the more modern smartphones.  Launched Thursday, the app will rely heavily on QR code technology (recently trialled in a drive-through centre in Catford, see video below) which users will be expected to scan on their way into hospitality and other public venues, creating a digital record of where they have been, to be stored on their phone.  However, it has emerged that this will only work on iPhones built on or after 2015, and Android devices built on or after 2017. Charities warned that it risks harming older people, who are more likely to use less up-to-date phones and are already more vulnerable to Covid-19. It came amid reports from Newham, one of the areas where the new app had been tried, suggesting that just one in five customers to local pubs had scanned the QR code, a camera function that recognises a unique location code that is stored on the users phone. The function enables the app to alert people that they should self-isolate if another visitor to that venue tests positive for the virus. But senior officials in NHS Test and Trace system have confirmed that, due to privacy concerns, users will be free to delete the record of their movements from the app, but they will still be alerted if a contact tests positive. DT

18 September Secret plans have revealed the country’s failing coronavirus test and trace system is to be outsourced to a giant delivery firm, such as Amazon. The logistics giant is likely to be in the running for the lucrative contract as part of efforts to deliver 500,000 tests a day. Baroness Harding, the head of NHS Test and Trace, prompted incredulity after she told MPs that no one was expecting to see the “really sizeable increase in demand”.  New figures show that just one in three people who turned up for a coronavirus test in England are getting the result within 24 hours – half the levels achieved the week before.  DT

17 September
Coronavirus testing: What’s going wrong?  BBC  poor management
Daily Telegraph headline: “Only select few to get rationed Covid tests”
Swathes of public to be refused coronavirus tests under rationing plans
Prioritisation list suggests testing would be restricted to hospital patients, care homes, certain key workers and schools more in DT

16 September:  … children face being turned away from coronavirus testing centres after Matt Hancock introduced rationing. The Health Secretary said there would be “prioritisation” of tests for people with acute clinical needs – such as hospital patients – and those in social care. Yesterday, staff at a Covid testing site in London told the public they can jump the queue for a local swab by pretending they live 400 miles away in Aberdeen DT

Is this Deloitte’s incompetence? Deloitte gets another huge COVID contract – for ‘crazy’ plan to test millions each day. Operation Moonshot could be the biggest NHS privatisation in history, and civil servants are shaking their heads in disbelief. more

15 September: The crisis over coronavirus testing is deepening. Health chiefs have warned that NHS hospitals are cancelling operations and turning away patients because so many doctors and nurses are stuck at home – unable to obtain Covid-19 tests for themselves or their families. Council leaders described the failings as “unacceptable”, with the country’s 10 worst hotspots running out of tests. It has been obvious for the best part of a fortnight that all was far from well in England’s Covid testing system. Health Correspondent Henry Bodkin examines in detail what has gone wrong. It came as medics threatened strike action over pay amid fears that the Covid crisis could lead to a winter of discontent. DT

18 August: PHE abolished. Its health protection functions are to be taken on by the new National Institute for Health Protection headed by Dido Harding.
Can’t the government find someone better to lead its successor body, the Institute for Health Protection, than the woman who set up the government’s dysfunctional test and trace system?   Harding,  was CEO of TalkTalk in 2015 when 157,000 of its customers had their data stolen – including names, addresses, telephone numbers and bank account details.
What better candidate, then, to run a test and trace system which relies on cutting edge phone technology and 25,000 call centre staff? Her first effort, a phone app which was supposed to tell us if we had come into close contact with an infected individual, disappeared without trace after a trial on the Isle of Wight. People in the technology industry had warned that the system was flawed, but Harding ploughed ahead anyway. Harding was then charged with creating a manual test and trace system, which has proved no less farcical. A report by the Independent Sage Committee last week revealed that between the end of May and the end of July those staff succeeded in contacting 51,524 close contacts of people who had been diagnosed with Covid 19. That is a grand total of one call per month – and there is no guarantee than any of them actually did what they were told and self-isolated for 14 days. DT

15 August  Will Public Health England be scapegoated?  Whitehall’s systemic failure exposed: why this was a disaster ten years in the making. The austerity overseen by former chancellor George Osborne saw the NHS protected but the capacity of its sister public health services cut. In its defence, Duncan Selbie, PHE’s chief executive, told The Telegraph “the Department of Health and Social Care leads on all aspects of pandemic planning and preparedness, not Public Health England”. He added it was “never at any stage our role to set the national testing strategy for the pandemic. This ­responsibility [also] rested with DHSC. “Any suggestion that PHE ­monopolised, centralised and controlled pandemic testing, and even stopped others from developing tests or conducting them is not true.”Matthew Lesh, head of research at the Adam Smith Institute, is one of several calling for PHE’s responsibilities in the area of infectious diseases to be hived off into a dedicated agency – a UK centres for disease control or, as government sources propose today, a new National Institute for Health Protection.” Nick Davies, programme director at the Institute of Government said it was “a nonsense” to say PHE was beyond the control of ministers. As an executive agency of the DHSC, it has “direct accountability to Matt Hancock,”   “I think it’s fair to say the crisis hasn’t exactly been a good advert for what happens for services directly under government control. If you look at, for example, NHS test and trace – directly under the control of ministers – that’s clearly been a bit of a disaster.” DT

11 August Ayanda was awarded a £252.5m contract to provide 50m FFP2 masks and 150m IIR-type masks to the Department for Health at the end of April. Almost all of these have now been supplied and been paid for. It is among several companies with little to no public track record in providing PPE that were awarded lucrative contracts as global demand rocketed in March and April and hospitals came close to running out of stock. The contract to Ayanda has sparked particular questions because the company’s advisor Andrew Mills is also an advisor to the UK Board of Trade. Andrew Mills’ contract as an adviser to the Board of Trade was due to run until September ceased to be an adviser in late July. DT

11 August New analysis reveals that test and trace staff are successfully reaching just one contact each a month. A report by the Independent Sage group of scientists has criticised the new centralised system for its “fundamentally wrong design”, which it says sees thousands of operatives “doing almost nothing for weeks on end”. The group said the army of up to 25,000 staff each reached an average of two successful contacts of people who tested positive for coronavirus between the end of May and the end of July. One staff member, a trained clinician, said the job was akin to being “paid to watch Netflix”. Health Correspondent Henry Bodkin reports how others were members of a WhatsApp group called the Mouse Movers Club – to remind each other to move their computer mouse every 15 minutes to avoid being locked out of the system. The national scheme is now being scaled back, with some call centre workers replaced with council staff knocking on doors. DT

10 August Dido joins the war on reality. The performance of NHS TAT can be contrasted with that of the public health team in Blackburn with Darwen. They created their own local tracing system from scratch which has achieved 90 per cent success in contact tracing – beating the NHS TAT record into a cocked hat. After one week of operation. Baroness Harding is chair of NHS Improvement. The Commons Health Select Committee’s reported on her appointment: “we noted Baroness Harding’s own admission of a lack of professional experience in health and social care. We recommend that both before taking up the role of Chair of NHS Improvement and after commencing, Baroness Harding gain the widest possible experience of listening to both staff and service users at all levels and in a wide variety of settings on the front line of NHS service provision.”!
“The point of NHS TAT is in its actual name – to test and trace. It is not great at the testing, and it’s absolutely empirically poor at the tracing. This is highlighted by a victory for campaigners in Manchester (led by the redoubtable Jennifer Williams of Manchester Evening News) in getting the government to provide with local authorities the near-real-time data they need to understand what is going on in their localities.”  Andy Cowper writing in the Health Service Journal 

05 August As other nations imposed quarantine restrictions, the UK allowed in up to one million passengers leading to spread of Covid pandemic. Failure to introduce quarantine at the start of the outbreak saw up to 10,000 infected people enter the UK, accelerating the spread of disease, an investigation by MPs have said. This was confirmed by Sir Patrick Vallance, the Government’s chief scientific officer, who pointed to evidence that hundreds of different strains of Covid-19 were brought into the UK after the Government abandoned special measures for international arrivals on March 13. DT

04 August: Reopening schools without an improvement in test and trace could result in a second coronavirus wave more than twice the size of the first, a Lancet study suggests.

Researchers said pubs may have to be closed or millions of people urged to work from home if significant progress in tracking the spread of the virus is not made in the next month.

The study, by University College London and the London School of Hygiene and Tropical Medicine, simulated how the virus might spread when schools open at the start of September. It found that, if test and trace was more successful – so that 68 per cent of the contacts of positive cases were traced – the spread could be held in check.

Researchers warned that just 50 per cent of contacts of positive cases are currently reached. They said only one in seven infections in the country is being detected by the programme when its results are compared with surveillance sampling. DT

04 August: Dozens of leading virus experts have complained that UK testing contracts have gone on ideological grounds to private sector companies rather than being based on expertise. The government has announced new 90-minute tests – but the experts from the UK Clinical Virology Network say such tests were already available, whereas the types chosen by the government are not well known. Guardian

30 July: England had more extra deaths during the first few months of the coronavirus pandemic than any other European country, new analysis has revealed. Although Spain experienced the biggest peak of excess deaths as cases soared across the continent, cases then fell faster there than in England. This is the first time the Office for National Statistics has compared excess mortality rates in different countries to measure the impact of the Covid-19 pandemic.  DT

19 July:  As Johnson speaks to the Telegraph about how the government can effectively prevent a second wave,  in the same edition the Sunday Telegraph reports that Government’s test and trace system would currently fail to prevent a second wave of Covid-19 infections because it is only identifying a third of people it needs to track down, a senior official has admitted.” ” Last week the Government said NHS Test and Trace was reaching 77 per cent of those who had tested positive in order to seek details of their contacts and ask them to isolate. But Mr Cooper’s remarks raise concerns that many more who may be infected with the virus are not being tested.” DT

16 July The UK Office for Statistics Regulation has written to NHST&T questioned the value of data being produced by the programme. It said the statistics should support understanding of the pandemic, of the management of the test and trace programme, and inform people about the implementation and effectiveness of the programme, “and enable them to hold government to account”. However, the data “may not serve any of these three aims as well as it should” without “greater clarity on the purposes of the publication and clearer information on how data in the publication fit with other statistics or research.” This is not the first time the UK statistics authority has upbraided the government for the quality of its covid data. In May it raised fundamental concerns about the government’s reporting of covid-19 test numbers and called for greater transparency on how they present the data. Source HSJ

10 July Covid-19: Government is criticised for “scandalous” £10bn spent on test and trace programme BMJ
The UK government has spent £10bn (€11.2bn; $12.7bn) on its much derided covid-19 test and trace programme and £15bn on personal protective equipment for frontline healthcare staff, the Treasury disclosed this week. Allyson Pollock, co-director of the Newcastle University Centre for Excellence in Regulatory Science and a member of the Independent Scientific Advisory Group for Emergencies, described the £10bn figure as “scandalous expenditure.”She added, “There are really serious questions to be asked about the way these contracts were set up and about their performance. Ten billion pounds spent, and we don’t even have an effective test and trace strategy. Not all cases are being detected, half of cases are not giving contacts, and those which do are largely doing it through traditional public health teams, while the commercial call handlers have got little to do.

o9 July Sage  is to meet less often, with its sub-groups asked to provide advice directly to the Government.  The work of the Joint Biosecurity Centre was “shrouded in secrecy”. DT
09 July “The taxpayer has stumped up £10 billion for the Government’s bungled test and trace system, “The taxpayer has also spent an “eye-watering” £15 billion on PPE amid scrutiny of the Government’s procurement process”  £25bn is equivalent to the entire transport budget and 15 per cent of health spending. DT

Today is the 72nd anniversary of the founding of the NHS in 1948 as part of the post-war consensus.  For 10 weeks on Thursday evenings large numbers of people have stood at their front doors or on balconies to applaud the NHS expressing their appreciation for the people who deliver the medical care. During the lockdown many people “noticed”, many for the first time, the efforts of those whose work enables our society to function. The clapping has been for the NHS staff who worked tirelessly to deliver the health service we and they care for. Today is a day for celebration and remembrance. Clapping is not enough NHS wages for many staff are low and the service, in which the country takes such pride, is underfunded. Dangerously underfunded in its unpreparedness to tackle the Covid-19 pandemic. As we shall see it knew that it was unprepared. There is no realistic prospect of pay rises for NHS staff from porters and security staff to consultants.

In many windows in Faversham children’s art work displays their understanding of whom their lives depend on.

As Maurice Glasman has pointed out  one of the consequence of the pandemic has been “the visibility and necessity of the working class.” Those who stack shelves, collect the rubbish, maintain the sewers, deliver the post – these workers so often ‘invisible’  have been at work throughout the pandemic. They are the working class, the workers who cannot work from home. “Covid-19 has reminded us of the “importance of the working class to our well-being and survival is recognised as it has not been for decades, and labour value has been reaffirmed” writes Glasman.

“People working in elementary jobs faced the greatest risk. Of those, there were more security guard deaths than in any other profession at 74.0 per 100,000, or 104 deaths.” Telegraph 

How soon will we forget? It seems likely that we shall forget very quickly. As Edmund Burke, a founding father of Conservatism. pointed out “Those who don’t know history are doomed to repeat it.” If we fail to learn from past mistakes we shall repeat them.

The government pledged to give the NHS whatever it needs to tackle the pandemic. The Chancellor will on Wednesday spell out his plans for public spending. NHS England says that it needs and additional £10bn. The annual NHS budget is £140bn, if provided that would be an increase of 7%.  £10bn is the NHS’s estimate of the cost of fighting the virus and reopening the normal services. The money would mean the NHS could create extra beds in hospitals, keep the Nightingale facilities on standby, send patients to private hospitals for surgery and provide protective equipment for frontline staff. The sticking point in the negotiations between the NHS/Department of Health and Social Care and the Treasury is reported to be the NHS’s insistence that the Treasury continues to underwrite the £400m-a-month cost of the contract the Department agreed with private hospitals in March to treat NHS patients. The Treasury is insisting that the temporary contract with the private hospitals be maintained for fear of waiting list hitting 10m by Christmas. more

At some point in the future there will doubtless be an inquiry into the government’s handling of the pandemic and the preparations for epidemics made by successive governments. However, preparations need to be made now.  There is a significant risk that Covid-19 will return and and that the NHS will again risk being overwhelmed. Much of what follows is based on the Daily Telegraph (DT), widely referred to in the UK as the “Torygraph,” the daily paper of the Conservative Party.

There have been many mistakes:

• The Cygnus Report in 2017 and the Silver Swan exercise in Scotland in 2015, both revealed that Britain was ill-prepared to cope with a pandemic. The problems of staffing, PPE and care homes were amongst the issues identified in these exercises. Track, trace and isolate was abandoned in the early stages of the pandemic because of a lack of resources and preparation.
• “Britain prepared for a herd immunity strategy to contain Covid-19, while other countries focused on enhanced testing capacity. The assumption a new virus could not be contained is also explicitly stated in the governments pandemic strategy documents. “We discussed the levels of herd immunity as part of that scenario,” a Whitehall source said.” The “government formally refused a request for the release of the findings of the 2016 pandemic drill, code-named Exercise Cygnus, under the terms of the Freedom of Information Act.”
  “A senior Whitehall official involved in drawing up Cygnus, a major test of this country’s pandemic preparations held in October 2016, admitted lessons from other countries had been “entirely ignored”.  “Everything we planned for was based on the idea that a disease would kill lots and lots of people,” the official told the Telegraph. “We didn’t spend a lot of time exploring how we could prevent it in the first place. Instead we looked at how we could build up mortuary space and intensive care beds after it had already spread. “I can’t remember that we ever discussed what they were doing in South Korea and places like that. It simply wasn’t on our radar. We were sort of ploughing our own furrow. “Given the current lack of testing capacity and PPE, you could say that was a mistake.””While nations in the Asia Pacific region make up 9 percent of the world’s population, they have only experienced 1 percent of the cases, and less than 1 percent of the deaths. Britain, meanwhile, is expected to suffer the highest death rate in Europe. Many Asian nations had already drawn up plans for mass testing using networks of public laboratories to chart the spread of disease, and prevent it spreading, according to documents seen by the Telegraph. DT 18 April 2020
• PPE: “Last week five million surgical masks and more than a million respirators were packed on to EU-registered lorries by one UK wholesaler.” DT
  Andrew Pear chief executive of Reliance Medical, a Staffordshire-based PPE supplier which imports from Shanghai, said tighter customs inspections were holding up shipments to Britain. Pear said: “Britain needs to take a long hard look at this and ask whether we can afford to leave our PPE manufacturing supply in the hands of other countries. Shipbuilding, munitions and armaments are almost exempt from free-trade rules because nation-states take precautions in case they need them in the time of war. Britain needs to fight a war against a virus, restarting old industries that make aprons and masks. That’s the only real long-term solution.” DT
• John Edmunds, Professor of Infectious Disease Modelling at the London School of Hygiene & Tropical Medicine, is the first member of Sage to state openly that failing to implement restrictions earlier was a potentially lethal decision. Testing for coronavirus was severely limited at the beginning of the crisis as Public Health England (PHE) struggled to ramp up capacity, and on March 13 community testing stopped entirely, leaving scientists in the dark about levels of infection outside of hospitals. Prof Edmunds also appeared to criticise lack of community testing saying ‘situational awareness’ had been inadequate to gain a better understanding of the epidemic. Speaking at the Science Technology Select Committee, Prof Kay, who has called the decision to stop community testing “the greatest scandal of the epidemic” said: “If we had that data much earlier in the crisis we would have been able to make much better forecasts.  “I think that would be a major subject for investigation. My strong sense is there was an insistence on centralisation of the process of testing and monitoring testing. “There were many university labs that had the capacity to do this work if they were allowed to do it and would have allowed us to ramp up testing.” DT
• “Cleaners, porters and office staff working for the NHS were “super-spreaders” of coronavirus within hospitals, according to initial results from a national screening drive. The discovery has prompted health bosses to examine how lower-paid workers can be better protected from the virus in the event of a second coronavirus wave, he said. It comes amid growing suspicion that a large proportion of virus cases were spread by medical workers rather than in the community.”  “…  “surprising” initial figures suggesting that the main vectors of the virus were not necessarily front line medics on intensive care wards but porters, cleaners and backroom office staff.” DT
• “In May, NHS England said a fifth of patients with Covid-19 in some hospitals were thought to have contracted the disease while already being treated there for other illnesses. Some of the infections were passed on by hospital staff unaware they had the virus and displaying no symptoms, health bosses said.” DT 
• Matt Hancock, the Health Secretary, said hospital patients who tested positive for Covid-19 would continue to be discharged into care homes despite growing evidence that the policy is fuelling outbreaks and deaths.  Mr Hancock claimed no care home residents had “died unnecessarily” from coronavirus despite figures suggesting care home could account for at least a quarter of total virus deaths in the UK. DT
• A paper by the Care Homes Sub group which was submitted to the Scientific Advisory Group for Emergencies (Sage) on May 12th, warned that the new disease cases were linked to the connection between care homes and hospitals. Discharging hospital patients back into care homes was an ‘important source’ of infection, government experts have admitted, as new figures show that more than half of care homes have had a confirmed case of Covid-19. The ONS separately released data showing that nearly 20,000 residents in England and Wales have died with coronavirus in their care home. DT 
• “Ministers and Public Health England were warned in early April that staff working in multiple care homes could be unwittingly spreading coronavirus among the elderly – five weeks before the Government finally issued guidance restricting workers to one institution.” “An official study conducted in mid-April found that symptomatic staff were self-isolating and being replaced by “bank” staff who worked at multiple homes.” “Scientists also recommended effectively quarantining elderly patients in “intermediate” Nightingale-type facilities before transferring them back to care homes, but the idea was never taken up nationally. Government advisers later concluded that discharging hospital patients back into care homes was an “important source” of infection.” “the deputy chief medical officer privately warned ministers of the concerns following a meeting on April 9.”…call[s] into question Matt Hancock’s claim that “right from the start we’ve tried to throw a protective ring around our care homes”. “DHSC’s guidance on controlling the spread of infection in care homes, published on April 16, made no mention of restricting the movement of staff.””At least 19,394 residents died with coronavirus in care homes between March 2 and June 12. ” On 15 May [DHSC] published [their] care home support package which followed the latest evidence from PHE and recommended a range of measures care homes could take to limit the spread of the virus. This included limiting the movement of staff.” DT
• The government must have know that Test, Track and Isolate would be an essential part of moving out of lockdown papers from the Scientific Advisory Group on Emergencies show routine testing and tracing of contacts was stopped because Public Health England’s systems were struggling to deal with a handful of cases. At a meeting on Feb 18, advisors said PHE could only cope with testing and tracing contacts of five Covid-19 cases a week, with modelling suggesting it might only be possible to increase this to 50 cases. Advisors then agreed it was “sensible” to shift to stopping routine testing – despite acknowledging that such a decision would “generate a public reaction”. The decision to give up on testing those with symptoms of coronavirus is now seen as the key reason the UK has the highest death toll in Europe. DT
  3 July 2020 “Test and Trace is failing to identify 25 per cent of contacts” DT
• Deloitte was proud to secure the contact for Covid-19 testing. Despite a string of major accounting scandals leading to fines and regulatory investigations, the Big Four accounting firms – Deloitte, EY, KPMG and PwC – are among the most high-profile winners of outsourcing contracts. Deloitte has come under fire from doctors for its work on increasing coronavirus testing capacity for frontline workers and delays in getting results to people who have been tested. Hospital bosses wanted to oust the firm last month because they felt it was doing a poor job. The firm is also working on procurement of personal protective equipment (PPE) by reviewing new manufacturers that may be able to post supplies. DT
• Department of Health  figures report that between 28 May and 17 June 128,566 ‘close contacts’ of people tested positive had been identified. Of these 15,812 were classified as non-complex and contacted through the “wider online and call centre capacity” run by Serco. 112,754 contacts were traced by “local health protection teams[managing] complex cases linked to outbreaks.” So the Serco system traced just 12.3% and only the simpler cases.   Serco deployed a 21,000 strong army of tracers funded by a contract worth £45m. There are 3,000 or so public health officials 50 times more productive than the Serco tracers. (Source Private Eye 16 July 2020) “Newly recruited “contact tracers”, who have been hired by outsourced call centre giants Serco and Sitel on behalf of the Department of Health and Social Care, have reported spending hours trying to log into online systems, having no work to do, and experiencing technical and quality issues with the training they received.” Personnel Today
• Incredibly Nadine Dorries Minister of State (Department of Health and Social Care) replying to a question in the House of Commons said that ” The contract with Deloitte does not require the company to report positive cases to Public Health England and local authorities.”  No wonder nobody in Leicester knew what was going on.

Successive governments, including the current one, have said that they will solve the social care problem. Without a solution, the NHS will continue to suffer from bed blocking.

Timeline of Failure

Through a deadly combination of arrogance and incompetence, Boris Johnson’s government ignored international warnings and allowed Covid-19 to spread largely unchecked in the UK. Today the UK is one of the worst-hit countries in the world.  January 1st to June 18

The Daily Express on June 3rd published the results of a poll it funded: “A damning survey for the Daily Express reveals two-thirds of those aged 55-plus support the increase. And 41 per cent across all age groups agree that a ring-fenced general tax increase is the best way forward. They want an end to the scandal of pensioners handing over their savings and selling their homes to pay for care. The system’s failings have been cruelly exposed by the coronavirus pandemic……Our poll found more than half of the 2,094 adults aged 55-plus (58 per cent) believe it is unacceptable to force the older generation to sell their family homes to pay care home bills. And 49 per cent of all ages agreed. Almost the same number (54 per cent) believe it is unfair to put property or a hard-saved nest egg into a means test to qualify for financial help.

The Covid-19 crisis has raised serious concerns about governance and the preparatory planning for pandemics and decision making during this one. Awareness of the crisis in health and social care is now very clear. Although some have presented this as a source of intergenerational conflict, the elderly who have died are the parents and grandparents of people now concerned about their own care in old age.

Never again

There is an urgent need to develop a consensus to tackle some of the fundamental challenges that the UK faces and which require a consistent approach over several parliaments if the UK is to thrive. The collective expression of support for NHS and Social Care staff expressed in clapping on Thursdays at 8 pm for 10 weeks is indicative of public support and love of the service. There is strong public support for the NHS combined with mounting concern for its future.

Failures by successive governments to ensure adequate preparations for a pandemic resulted in the government priority to defend the NHS, just when we should have been able to rely on the NHS to defend us. In the front line, the doctors, nurses, porters and cleaners did defend us, despite the lack of preparation and of the PPE to do it. This was achieved by discharging elderly patients, untested for Covid-19, into Social Care.  One-third of all UK fatalities form Covid-19 were in care homes, 16,000.

Much of the NHS is managed by the developed assemblies in Scotland, Wales and Northern Ireland leaving the UK government to oversee England.

Britain needs to ensure that the NHS is adequately funded and is resilient to cope with pandemics. The scientists expect that there will be further epidemics and pandemics. The next one may be more or less aggressive and deadly. It would be prudent to assume that the next one will be worse and plan for it. Successive governments has failed to reform social care, was unable to ensure the maintenance of adequate stock piles of PPE and ventilators, and failed to provide robust Public Health services, including having a track and trace system in place to scale up in the face of a pandemic. There should have been an app in place prior to the pandemic to facilitate track, trace and isolate.

Covid-19 has revealed significant weakness in the UK’s ability to deal with a pandemic. This has raised some fundamental questions about the competence of government, civil service, Public Health England, local government and the NHS. Funding for resilience is always easy to cut, the important displaced by the urgent.  A system-level review is required to ensure that the UK is prepared for the next epidemic or pandemic.

Between 2011 and 2018, the WHO tracked 1483 epidemic events in 172 countries. The World Bank (09/2019) published A World at Risk, the graphic below comes from page12.  It would be foolish to think that Covid-19 is the last event of its kind. The World Bank concludes that we are entering a “new era of high-impact, potentially fast-spreading outbreaks that are more frequently detected and increasingly difficult to manage.”

As of late May there had been a very significant fall in people’s confidence in the government’s handling of the pandemic.  Guardian 

LATEST

• A new external provider is being sought to “harden” the management of covid-19 home testing, to make it “fully resilient, scalable and automated”, in a £7m national deal. More than 20 unnamed companies are bidding for the job, which involves supporting the distribution of 30,000 covid-19 swab testing kits and – potentially — antibody tests to people’s homes. It has been tendered by NHS Digital. Procurement documents The current manual tracing system was launched rapidly at the end of May to help manage the spread of covid-19, but it is not yet able to get information from every person who tests positive for covid-19. NHS Digital said the current system was not designed to run over a long period of time, and hope to have their system in place by this winter.