The PandemicA Toxic Mix of Political and Public Health Crises
The handling of the Coronavirus crisis by Boris Johnson’s Government is an egregious example of structural failings at the heart of the British state, argue Professor Gurch Randhawa and Mike Buckley
In the face of rapidly rising COVID-19 cases, hospitalisations and deaths, NHS leaders have called for the Government to introduce mitigations being used successfully in countries across Europe.
“Trust leaders are looking on anxiously as the number of COVID cases, hospital admission rates and patients on ventilators steadily increases,” said Saffron Cordery, deputy chief executive of NHS Providers. “It is vital that the Government and national NHS leaders act quickly and decisively to prevent any surge that could place overwhelming pressure on the NHS.”
Her words were echoed by Professor Stephen Reicher, one of the Government’s scientific advisors. “No one wants to reintroduce restrictions,” he said. “We will only be forced into restrictions if we fail to introduce the protections that other countries have used to control the Delta variant. More than ever, it is clear that the ‘do nothing’ advocates are the real lockdown party.”
Rising cases and deaths are entirely our choice, according to Ravi Gupta, Professor of Clinical Microbiology at Cambridge University. Numbers are rising, he said, “because we have fundamentally failed to control transmission, and that is because kids are vulnerable, they have not been vaccinated, they are back at school, they are spreading virus among themselves and they are feeding it into their families”.
The Scientific Advisory Group for Emergencies modelling sub-group, Spi-M, previously warned that new surges in the autumn could overwhelm the NHS and suggested that “a relatively light set of measures could be sufficient to curb sustained growth”. The Government has ignored this advice and continues to refuse to reintroduce even minimal protective measures.
It is a pattern those who have lived through the Coronavirus pandemic in England will recognise.
Scientists and medics have issued warnings in light of case numbers, trends in the data and projected scenarios. Case numbers, hospitalisations and deaths are tracking far higher than the European average. The Government nevertheless insists that it knows best and declines to heed expert advice or copy the best practice of other nations even when this has proven its worth in protecting health services and lives. The result of such a pattern is avoidable sickness and deaths numbered in their thousands.
This reality shines a harsh spotlight on deep problems in Britain’s governance and public health management. And, perhaps just as worryingly, the reality and depth of these problems are all but ignored by many politicians and most major media outlets.
We know from studies that nations that have badly managed public health also have worse economic outcomes. As proof of this is that our continued poor health outcomes are paralleled by a stalled recovery, made worse by Brexit-induced shortages of workers and resources.
It means too that the pre-existing inequalities of health, income and the ability to protect oneself and one’s family from harm that have been exposed during the pandemic are unlikely to be addressed.
A shocking six in 10 COVID-19 deaths in the UK have been among people living with disabilities. Many or most of these people had been living, and with better management of the pandemic could have continued to live, fulfilling and meaningful lives. Just as bad is that those dying are disproportionately black or Asian, regardless of pre-existing health conditions.
Widespread awareness ought to have spurred a debate about health inequality and the balance between preventative and reactionary healthcare in the UK, yet the opposite is true. Inequalities exposed by the pandemic have been all but forgotten.
The Government’s planned reorganisation of the NHS, which consolidates the market paradigm the Government has favoured during the pandemic, will do nothing to address them. The extra cash generated by the National Insurance tax increase will be swallowed up by existing demand instead of directed to areas of greatest need.
The think tank, The King’s Fund, has been scathing in its assessment of Government policy. “With increases in life expectancy significantly slowing, health inequalities widening and years of cuts to public health funding taking a toll on vital services, urgent action is needed to support public health services and improve health outcomes,” it has observed.
It argues that it is time to give the same priority to promoting wellbeing and preventing ill health as to diagnosing and treating illness. But, despite the urgent need for this to happen, there is no sign that the Government is willing to provide the resources required to achieve this end, despite previous commitments.
Government funding for local authority public health budgets has been substantially cut since 2010, leading to reductions in vital services such as health visiting, stop smoking support and sexual health clinics, putting people at risk of poorer health and storing up problems for the future. Key public health indicators, including life expectancy, are beginning to worsen.
Boris Johnson’s Government has retained the Conservatives’ antipathy towards local government and its unwillingness to reverse budget cuts. Until it does so, provision will fail to improve and inequalities will deepen.
The Government’s decision to dismantle Public Health England to establish a new UK Health Security Agency only adds uncertainty and disruption at a time when the public health community should be fully focused on the pandemic and vulnerable communities.
Ideology and Accountability
As with Brexit, Government failures around the Coronavirus crisis appear to have been the result of both incompetence and ideology.
While Brexit was built on longstanding anti-European sentiment and a series of poor assumptions about the likely outcomes of leaving the EU, the single market and customs union, the pandemic has exposed the flaws of dogmatic libertarian ideology and a failure to grasp the costs of going against expert advice.
The unwillingness to mandate non-pharmaceutical interventions including masks, ventilation and social distancing to keep cases low not only indicates a misunderstanding of their value – they are ‘restrictions’ on freedom only in the way that a seatbelt is in a car – but shows a failure to value human life above ideology.
Yet Britons have found that we have no means by which to hold Government to account – even when it is making mistakes costing the lives of many thousands of people. We have been poorly served by much of the mainstream media, which has too often taken or uncritically reported the Government line and has repeatedly accused public health experts of alarmism when they have simply been describing widely accepted and proven mitigations which could reduce infections and save lives.
Adding to this, opposition parties have often found it hard to make their mark.
Labour and the Liberal Democrats have at times rightly criticised the Government approach, but have for the most part not attempted to build public support for an alternative strategy such as zero COVID – as used successfully in nations including New Zealand, Australia and Vietnam – or the vaccines-plus-mitigations approach used in most of Europe. Some of the most successful opponents of Government strategy have been local leaders, including metro mayors and devolved administrations, but even they have been unable to alter the overall strategy in England.
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Many public health experts believe that it is insufficient to criticise the Government approach without offering tangible alternatives grounded in best practice and want opposition parties to speak out more strongly. Many believe that a closer alliance between opposition parties and public health experts could have changed the course of the pandemic, and that it still can.
There is also the relationship between the Government and companies involved in managing the UK’s response to the Coronavirus pandemic. A future public inquiry is likely to find that the close relationship between politics and business resulted in ill-equipped contractors being given access to large sums of public money to complete services that were beyond them. The failure of ‘Test and Trace’ – which formed the core of successful pandemic responses in many nations – is a case in point.
Rebuilding and Reform
Public health experts are now calling for transparency in Government decision-making. In the short-term, this is required so that it is clear how the risks of relatively high infection rates of COVID-19 and the prospect of increasing numbers of people with Long COVID are counter-balanced with the need to rebuild the economy. In the long-term, we need to build renewed confidence in our governance and public health systems.
Opposition parties and the media should now begin a public debate which considers Britain’s pandemic failures and is honest about our catastrophically high death rate, infection rates and Long COVID numbers.
They should highlight our lack of preparedness, long-term and unreversed cuts to public health and local government budgets, and the health inequalities made brutally clear at every stage of the crisis. They should make the case for a long-term COVID-19 recovery strategy that sets out how all sections of the UK public can best be protected from the virus and supported to rebuild their lives.
Opposition parties should call for a fundamental change in the way that healthcare is managed in this country. Boris Johnson’s National Insurance rise will provide some help to a struggling NHS but will do little, if anything, for social care and nothing for preventative public health. Yet, both of these are just as important as the NHS itself if the public’s health needs are to be addressed in the long-term.
The response to the Coronavirus pandemic and a hard Brexit are just two of the most egregious examples of failed governance. Britain needs a fairer electoral system, further devolution and greater media and public scrutiny, most urgently in health and social care provision, if we are to move beyond our current failures.
Gurch Randhawa is Professor of Diversity in Public Health at the University of Bedfordshire. Mike Buckley is a journalist and campaigner