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Wed 12 August 2020
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Byline Times’ chief medical officer, Dr John Ashton, looks at the lost opportunity to create a ‘new normal’ that would result in a real redefining of our public realm

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Our 4 July Independence Day came and went. Whilst COVID-19 continues to circulate at unknown levels, because of the Government’s failure to deliver mass testing at the levels promised and effective contact tracing – both of which were delivered by Deloitte and Serco respectively – we are now being asked to behave as if it’s ‘business as usual’.

Meanwhile, the decline in the death curve shows signs of levelling off but there are reports of the rate of transmission – the ‘R’ value – increasing past 1.0 in London and other cities. Leicester is back in lockdown, along with numerous pubs where customers turned out to be COVID-19 positive.

People turned out on Saturday to ‘drink, drink, drink’, as an alternative to ‘shop, shop, shop’ to get the economy rebooted.

At least the publicans are showing the Government how to contact trace, even if it does mean that the confidentiality issues – held up as the explanation for Public Health England (PHE) not sharing results for tests conducted commercially for the general public outside of hospital staff and patients via the Test and Trace system – with local directors of public health, conveniently don’t apply when commercial interests are involved.


Progress On Five Pillars

The ending of the lockdown was predicated on the Health and Social Care Secretary Matt Hancock’s ‘five pillars’ being met. But, in the event, that wasn’t the case.

Pillar 1 is the scaling up of NHS testing for those with a medical need and, where possible, the most critical frontline health workers. This has turned out to be by far the most successful part of the effort, under the control and direction of the NHS in concert with PHE.

Pillar 2 is testing for the wider population – commissioned to Deloitte – which has been a disaster, with logistical failures involving the tests themselves, their reliability and the reporting and the sharing of incomplete data with local teams.

Government data released yesterday shows that only 39,382 Pillar 2 tests were carried out on 6 July, versus a capacity for many times this. Indeed, this is only slightly more than Pillar 1 testing on the same day – 37,602, even though general population tests should be much higher. The Pillar 2 testing has been declining every day since 2 July when it was 168,921. This is a serious failing and inhibiting identification of any rise in infection.

It is at this local level where the intelligence is most needed. It is the failure of this that lies behind the chaos and new lockdown in Leicester last week, where the Government ran roughshod over local political and public health leaders who had been kept in the dark over the true state of the local epidemic.

This lack of granular data covering postcodes, ethnicity and other neighbourhood level intelligence is what may well have prevented the local public health, health and safety and trading standards personnel from honing in on dysfunctional cottage industry textile operations – with exploitation of the workforce in conditions tailor-made for incubating the virus.

As for Pillars 3 and 4, which relate to mass antibody testing and population surveillance, it is very difficult to know where things have got to, in view of the contradictory messages about antibody tests and the paucity of transparent information.

Pillar 5 is the “spearheading of a diagnostic national effort to build a mass testing capacity at a completely new scale”. Apart from the fact that only one of the five pillars was achieved before the Government embarked on an easing of the lockdown, it is the lack of progress on this fifth pillar that should perhaps give us most cause for concern.


Opportunity Missed

Even though the private sector contacts in this area don’t seem to have been very successful, the Government is preparing to award COVID-19 testing contracts – worth an estimated £5 billion – to private contractors, equivalent to the entire annual spend on English NHS laboratories.

The performance issues with the Pillar 2 testing to date do not inspire any confidence in the private sector delivering against the procurement requirements. Currently, the NHS and PHE are proving the public sector can do a far better job.

Taken together with the revelation that the Government is planning to renege on its promise of the £10 billion promised to cover the NHS COVID-19 overspend, this should bring about a sense of foreboding about the future.

At a time when waiting lists for important routine work including cancer treatment are soaring as a result of the diversion during the emergency, without additional resources, the likelihood is that this will be a significant boost to the private sector for those who can afford it, and long waits with collateral health consequences for those who can’t.

Rather than taking the ‘new normal’ as an opportunity to rebuild the diminished public health services that lie at the heart of the Government’s failure to respond effectively to COVID-19, we may be looking at ‘business as usual’ paving the way for the Boris Johnson administration’s opportunistic ambition to shrink the state and privatise health, including public health.

Over the past weeks and months, there has been much talk of this ‘new normal’ that might emerge after the greatest national crisis for a century. Faced with a unique opportunity to reset and recalibrate our national life to one based on a fairer and more sustainable way of life, these straws in the wind show us that the rush to ‘business as usual’ is being led by those whose vision of the ‘new normal’ is more of the same.

Dr John Ashton is a former director of public health and a leading international authority on public health. He is a member of the Crown Prince of Bahrain’s Corona Task Force


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