Byline Times‘ CMO, former director of public health John Ashton, praises the recommendations of the independent report convened by Sir David King
Four months into the COVID-19 pandemic and with the total of deaths in hospital, care home and community settings heading north of 50,000, we have at last had the benefit of a coherent and transparent analysis of the challenge the country faces with clear guidance as to the road ahead.
Published on 12 May, the Independent SAGE Report identified the priorities for action to support the gradual release from social distancing by means of a sustainable response, until such time as effective treatments or vaccines become available. The authors of the report chose not to focus on the structural and procedural weaknesses that have contributed to the UK’s dire failure to measure up to the response of other countries of similar size and demographics, rather leaving these matters for the judicial enquiry that must inevitably follow sometime in the future.
In the midst of chaos, the Independent Sage has given us a glimpse of a brighter future as we emerge from these difficult times
The many criticisms of the government response to the biggest public health emergency have identified the impact of ten years of austerity on the resilience of health and social care made worse by a chaotic reorganisation in 2013 and the establishment of a highly centralising national public health agency, Public Health England.
This was compounded by a failure to learn the lessons of poor emergency preparedness that came out of Operation Cygnus in 2016 and for the Prime Minister to get a grip of the parameters of the crisis early in February with a cascade of consequences particularly with regard to adequate capacity for Coronavirus testing, for Personal Protective Equipment and for preparing the public for eventualities that subsequently became inevitable, not least the wholesale national lockdown and grinding to a halt of the economy. It is against this backdrop that the inability of the Scientific Advisory Group to Government to deliver on its remit must be assessed.
From early on in the government press conferences the SAGE was pushed into the foreground behind a mantra of an administration ‘following the science’ but what science exactly was unclear in the absence of transparency down to membership of the advisers and publication of the minutes of their meetings. Over time arcane, mysterious and contradictory statements came to be clouded in a fog of poor communication.
As put by Professor Brian Cox says “There’s no such thing as ‘ the science’” which is a key lesson. If you hear a politician say we’re following the science, then what that means is they don’t really understand what science is. There isn’t such a thing as ‘the science’. Science is a mindse.” What we were left with was a form of the Emperor’s new clothes in which politicians believing their own rhetoric wrapped it up in a cloak of mumbo jumbo quasi-scientific deference.
In contrast to this SAGE committee with its undue deference to a dogmatic political agenda of neglect, dominated by a narrowly drawn group of Home Counties academics, the Independent SAGE, convened by a former Chief Scientific Adviser to the UK government, Sir David King, included a suite of highly experienced practical-minded public health consultants together with credible and complementary colleagues.
Their offering, born of the heat of a failing battle against the virus, is reminiscent in its comprehensive overview, of the 1942 Beveridge Report, that provided the blueprint for social reconstruction and the creation of the welfare state after World War 11.
The eighteen recommendations of the panel report tackle head-on the bizarre interlude in which for several days it seemed that the epidemic would be allowed to ‘run hot’ with a goal of achieving a spurious ‘herd immunity’ on the back of countless avoidable extra deaths of the most vulnerable. Backing the goal of ‘suppression’ rather than managed spread, the team laid bare the dangers posed by the discharge of untested hospital patients harbouring the virus to care homes, bringing with it a resurgence or seeding of a second epidemic.
Rather, as repeated throughout these months by the Director-General of WHO, it is essential to build the capacity to identify, isolate, test and treat, trace and quarantine all those infected with a standard of 14 days isolation rather than the 7 days that had somehow slipped in from leftfield.
Real-time, quality data, conforming to national data standards was found to be essential to inform a wider range of modelling techniques.
Proper attention needed to be paid to the development of whole population, safe habit formation with regard to hygiene and bio-security with reference to the whole range of potentially vulnerable groups and settings, including care homes, prisons, other closed institutions, ports, disadvantaged and BAME communities. In future, arrangements should be made to take over hotels and other suitable places for isolation and quarantine purposes in support of these interventions and during any easing off of the lockdown.
Other important issues identified were the reform of procurement processes, ensuring that all children had personal access to technology and computing facilities in support of their continued education as a human right, strengthening health and social care planning with the provision of adequate bed numbers to ensure resilience, and the recognition of the complex and emerging clinical patterns of disease caused by the virus, including multi-system and organ damage requiring extensive after-care and rehabilitation.
In the medium and longer-term, and with a clear eye to the legacy of this ongoing public health disaster, Sir David’s team called for;
- a strengthening of the social safety net for a range of groups including older people, those on a low income, Black and Ethnic Minority groups; the proper co-ordination of emergency preparedness and response across government at national, devolved administration and local government levels;
- the building up of a long term integrated and sustainable public health infrastructure, rooted in the community in contrast to the present top-down approach;
- and the establishment of an integrated National Health and Social Care System for England.
In the midst of chaos, the Independent Sage has given us a glimpse of a brighter future as we emerge from these difficult times.