NHS begins 2021 facing perpetual crisis 18 December 2020 Think 2020 has been awful for the NHS? Next year is shaping up to be far worse – and most of the huge hole it’s in was dug long before Covid. The virus has merely finished off the job. The health service does not have the beds, staff or equipment to recover the ground it lost during the first two waves of the coronavirus pandemic, but the government is blocking desperately needed improvements, and another round of organisational upheaval is on its way. Roughly one in 11 clinical posts are vacant, and it would hardly be a surprise to see many staff rush for the retirement door once the worst of the pandemic is behind us. The NHS can’t solve the problem without long-term certainty over funding for staff. Around 140,000 patients in England have been waiting more than a year for surgeries such as a hip replacements, up a hundredfold from a year ago. With the whole system beset by delays long before we had even heard of coronavirus, the lack of spare capacity means it will take years to help many patients. Unprecedented interruptions and delays to cancer tests and treatments have been exacerbated by the pitiful state of diagnostic equipment. Read the full article at Guardian Society __________________________________________________ Overseas lessons on social care reform 4 December 2020 The coronavirus pandemic has brutally exposed the impact of years of underfunding adult social care in England, with almost a third of the country’s Covid-19-related deaths happening in care homes. With the UK government under intensifying pressure to reform a failing system, what lessons can be learnt from other countries?Richard Humphries, senior fellow at the King’s Fund health charity, says: “Covid-19 has exposed all the weaknesses we knew about – fragmentation, underfunding, zero-hours contracts, reliance on agency staff moving about transmitting the infection from home to home, so [the outcome is] no great surprise. We have a bargain basement care system.”While many countries have tackled the challenges of an ageing population and underfunding, UK governments have repeatedly stalled reform for 25 years despite – as charity Age UK points out – two consultations, two official commissions, five green or white papers and one act of parliament. Labour rejected proposals in 1999 for free personal care and a more generous means test. In 2010, the coalition government established a commission under Sir Andrew Dilnot, which proposed a lifetime cap on social care charges and a more generous means test. The Conservative government dumped the subsequent legislation in 2015, promising options for reform in 2017. We are still waiting for action. Read the full article at Public Finance __________________________________________________ Sunak’s spending review will cost lives 27 November 2020 Rishi Sunak’s spending review will cost lives and cause yet more cuts in local services. But he still found the cash for a red wall bung. If there were any lessons about spending priorities during the pandemic it is that investing in public health services saves lives, but Sunak offered nothing. The core public health grant – this year at £2.4bn – has been slashed by a fifth in five years. The hollowing out of this vital public service has been a central factor in the UK having a Covid-related death rate worse than the US and Brazil and five times that of Germany. Covid-19 suppression and preparing for future pandemics will remain a core task, and the failure to give councils the resources to do the job will drive up the death toll. When billions can be found for the NHS it almost feels like a calculated insult. No wonder a despairing Jeanelle de Gruchy, president of the Association of Directors of Public Health, described Sunak’s refusal to increase the public health grant as “completely incomprehensible”. Read the full article at Guardian Society __________________________________________________ Life and death of Public Health England 20 November 2020 Public Health England was born from the most controversial reforms in NHS history—and it’s been killed off just seven years later, the first casualty of a blame game over tens of thousands of deaths from covid-19. Under the Health and Social Care Act 2012 as championed by the then health secretary Andrew Lansley, Public Health England (PHE) was established as an executive agency of the Department of Health, meaning that it had operational independence but took instructions from ministers. In contrast, the Health Protection Agency, which PHE replaced, had had independence as a non-departmental public agency. This lack of autonomy would undermine PHE’s relations with parliament, would stoke criticism from public health specialists, and would eventually prevent it from defending its reputation when the covid pandemic took hold. As well as taking up the Health Protection Agency’s role of protecting the public from infectious diseases and environmental hazards, PHE absorbed numerous other organisations including the National Treatment Agency for Substance Misuse, the public health observatories, cancer registries, and national screening programmes. The Rare and Imported Pathogens Laboratory, at the government science facility in Porton Down, also came with the Health Protection Agency. Read the full article at BMJ __________________________________________________ Rotten culture permeates government 13 November 2020 There is something rotten in the government’s culture. Less than a year after Boris Johnson led his party to an 80-seat majority, ethical standards are routinely compromised and the principle of transparency is under attack. The mishandling by the communities secretary, Robert Jenrick, of the £3.6bn towns fund typifies this casual abuse of power – a shoddy piece of work that barely pays lip service to basic principles of openness and objectivity. Established in July 2019 to support the economies of struggling towns, the fund selected 101 places, 40 based on need and the other 61 chosen by ministers. Tory seats and targets were the big beneficiaries, leading to Labour concerns that the money was used to win votes. An excoriating report by the cross-party Commons public accounts select committee accuses the Ministry of Housing, Communities and Local Government of dishing out billions based on vague justifications, scant evidence and sweeping assumptions. One town, Cheadle in Greater Manchester (Conservative, majority 2,336), was given cash despite being ranked by officials as the 535th priority out of 541 towns. The department refused to disclose its reasons for selecting or excluding towns, offering risible excuses that have fuelled accusations of political bias and that has, according to the report, risked the civil service’s reputation for integrity and impartiality. Read the full article at Guardian Society __________________________________________________ Building back starts with public services 2 October 2020 Boris Johnson has promised to “build back better” after the pandemic. But to stand any chance of improving public services, the government has to understand the significance of the wreckage around us. Covid-19 has laid bare the destruction caused by a decade of austerity. Everywhere there is a lack of capacity, from too few respirators to threadbare public health teams in local authorities. Every part of the system was running hot, so when the virus hit, one of the wealthiest countries on Earth was quickly tipped into crisis. Tens of thousands of deaths from disrupted healthcare could follow. With local government reduced to little more than a skeleton operation, towns and cities were entirely dependent on government handouts to cope. The folly of running our social care system on minimum wages and zero-hours contracts was cruelly exposed as underpaid staff moved between homes to make ends meet, unwittingly taking the infection with them. Meanwhile, decades of underinvestment in social housing ensured the virus ripped through our most deprived communities, with overcrowded homes and shared facilities providing the perfect breeding ground for the infection. Read the full article at Guardian Society __________________________________________________