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Sun 25 October 2020
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Byline Times’ chief medical officer John Ashton looks at how England has been on the back foot in fighting the COVID-19 pandemic since the first cases were recorded at the end of January

A decade of austerity took a huge toll on the resilience of both the NHS and public health.

This was especially the case in England, where the then Health Secretary Andrew Lansley’s disastrous reforms of 2013 produced a dysfunctional and over-centralised national public health agency and a fragmentation and weakening of the local public health system that had been in place for almost 200 years.

The failure of Boris Johnson to act quickly when COVID-19 arrived in the UK, through the convening and chairing of regular COBRA meetings in January and February, meant that the Government didn’t have a grip on the emerging crisis and was subsequently always running to catch-up – over-promising and under-delivering, resulting in the worst excess death rate attributable to the Coronavirus in Europe.

However blameworthy the Johnson administration might be, it is not alone in bearing responsibility for the worst public health failure in a century. The Government’s advisors must too take responsibility for delivering an ineffectual response, for tolerating governance arrangements that were not fit for purpose, and for not truly ‘speaking truth to power’ when it really mattered.

One issue in particular that is worthy of consideration is whether the narrowly drawn, predominantly male and London-based coterie of advisors are too close to those who must be held accountable – and perhaps too influenced by the prospect of glittering prizes and honours.


No Open Scrutiny

The inadequate start to tackling the Coronavirus in the UK began at the end of January, when England’s Chief Medical Officer Professor Chris Whitty restricted NHS and community testing for COVID-19 – a decision that was not subject to open scrutiny at the time and for which the evidence was withheld from the public and professional peers.

In February, the competing teams of quantitative modellers kept their homework to themselves producing widely varying projections based on what we now know to have been deeply flawed input data. If their workings out had been in the public domain, open scrutiny would surely have led to their being found wanting and sent back.

The result was an expensive and tragic dysfunctional Government waltz with a progressive loss of trust by the public in those whose responsibility was to protect them.

Today, after eight months, we are back to square one. Tracking, tracing and isolating those at risk of spreading the Coronavirus – the bread and butter of public health – are still in disarray. A handful of national private consultancies, having been plied with funds, have failed to deliver effective action where it really matters: in neighbourhoods, communities and workplaces.

The recent attempts by the Chief Scientific Advisor Sir Patrick Vallance and Whitty to distance themselves from the aim of achieving ‘herd immunity’ earlier in the pandemic represent a desire to rewrite history. Strangely, these two senior men charged with leading the country’s response to the virus are now attacking academic criticism of their earlier support for the idea – when they themselves have been far too academic in their approach to the crisis.


Questionable Credentials

The credentials of the advisors in charge must also be seriously questioned.

Of the four regional Chief Medical Officers (CMOs) in post at the beginning of the pandemic, only one, Frank Atherton in Wales, had undergone comprehensive public health training with the necessary range of experience to deal effectively with the challenge.

The then Scottish CMO, Catherine Calderwood, was an obstetrician and both of the CMOs for Northern Ireland and England are clinical epidemiologists primarily concerned with the clinical care of patients with infectious disease.

Professor Chris Whitty has a Master’s degree in Epidemiology from the London School of Hygiene and Tropical Medicine, which is a much narrower degree course than most Directors of Public Health will have completed. In contrast to the predominant emphasis on quantitative methods to be found in the epidemiology Master’s curriculum, a Master’s degree in public health is very practically focused, covering areas including the political aspects of health and social administration, social science, community engagement and public health communications.

A proper training in public health covering five post-graduate years involves dealing with complex issues at a community and local authority level, rather than the arcane world of research grants and Oxbridge and Imperial College networks.

Sir Patrick Vallance is a clinical pharmacologist with a background in the pharmaceutical industry. By no means can he claim to have competence in public health. The recent revelation that he holds £600,000 worth of shares in one of the companies competing to produce a COVID-19 vaccine for the Government does little to reassure us of his adherence to Nolan’s Seven Principles of Public Life and suitability for the public leadership role he currently occupies.

While Whitty is an honorary fellow of the Faculty of Public Health this would not qualify him to apply to be a local Director of Public Health any more than my honorary fellowships of the Royal Colleges of Medicine of London, Edinburgh and Glasgow – having completed neither the set training nor passed the examinations – equip me to be appointed as a medical consultant in a hospital, not least in an intensive care unit.


The Fundamental Rethink Required

The recent devastating intervention by the former head of the Civil Service, Sir Gus O’Donnell, is clear evidence that these criticisms must be taken seriously.

He honed in on weaknesses of strategy and leadership as contributing to the excess deaths from COVID-19 and the economic impact of the pandemic, arguing for the establishment of a COVID-19 Council – modelled on the National Security Council, which would allow ministers and officials to consider, rather than simply defer to, the opinions received from the Government’s Scientific Advisory Group for Emergencies (SAGE).

Although this might be the essential next step to manage a second wave of the Coronavirus, a fundamental rethink of the arrangements for public health and the essential skill-set for senior positions must surely follow.

John Ashton is the author of ‘Blinded by Corona: How the Pandemic Ruined Britain’s Health and Wealth’ published by Gibson Square Press


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