The government keeps telling us they are "guided by the science", but this mantra does not fit the facts. In truth, its policies have been characterised by callousness, greed and ineptitude. Here is Keep Our NHS Public’s 11-point guide to the shambles of our Government’s Covid-19 response.
1. Pandemic reports
Exercise Cygnus, a test of Britain's ability to handle a pandemic, took place in 2016 and reported to the Government in 2017. The secret report was leaked to the Guardian in May after threats of legal action to force disclosure. It modelled a worst-case flu with 400,000 excess deaths. One of the main conclusions reads “the UK’s preparedness and response… is currently not sufficient to cope with the extreme demands of a severe pandemic”. There were 22 “Lessons Identified”. Lesson 18 states, in part: “A methodology for assessing social care capacity and surge capacity during a pandemic… should be developed with Directors of Adult Social Services and colleagues in the Devolved Administrations.” It was not implemented, care leaders told the Guardian.
Local Resilience Forums had told Cygnus it was not possible to collate an accurate picture of social care capacity because much of it lies with private providers.
Then in 2019, the National Security Risk Assessment included the need to stockpile PPE, organise advanced purchase agreements for other essential kit, procedures for disease surveillance and contact tracing, and plans to manage a surge in excess deaths.
2. Public health capacity
When all community testing and contact tracing was stopped on 12 March, Public Health England had only contacted 3,500 people of whom 125 were confirmed positive. It had fewer than 300 staff to do contact tracing.
Public health was transferred to local authorities in 2013. In 2015, £200 million was cut from the budget, and pre-school public health was then also transferred in, using NHS funding. The 2017 spending review implied further cuts to public health of at least £600 million a year by 2020/21, despite population growth.
Obesity and Diabetes (both public health targets) increase the risk of dying from COVID-19, so cutting public health budgets meant more deaths.
On 14 March the World Health Organisation repeated calls for all countries to find and test every coronavirus case after the British government claimed the practice was “no longer necessary” and “people who are remaining at home do not need testing.”
Richard Horton wrote the Lancet editorial on 28 March. He pointed out that Ministers didn't follow WHO's advice to “test, test, test” every suspected case. They didn't isolate, quarantine or contact trace. The NHS is now wholly unprepared for the surge of severely and critically ill patients that will soon come, he predicted.
Experts in Hong Kong, writing in The Lancet, had warned of a global epidemic back in January: “preparedness plans should be readied for deployment at short notice, including securing supply chains of pharmaceuticals, personal protective equipment, hospital supplies, and the necessary human resources to deal with the consequences of a global outbreak of this magnitude.”
Horton argued that February should have been used to expand coronavirus testing capacity, ensure the distribution of WHO-approved PPE, and establish training programmes and guidelines to protect NHS staff. The government didn't take any of those actions. Patients and NHS staff will die unnecessarily. It is “a national scandal”, Horton concluded.
England's Deputy Chief Medical Officer, Jenny Harries, said on 20 March: “The country has a perfectly adequate supply of PPE.” She claimed that supply pressures had now been “completely resolved”. Completely untrue.
The NHS Supply Chain, responsible for procuring and delivering PPE, had itself been privatised. There are 11 key outsourced procurement contracts and profit is skimmed before equipment arrives at the hospital or care home. The main contracts involve DHL, Unipart, Deloitte, Movianto, and Clipper Logistics.
5. "Herd immunity"
On 13 March Chief Scientific Officer Patrick Vallance stated “Our aim is to try and reduce the peak, not suppress it completely; also, because the vast majority get a mild illness, to build up some kind of herd immunity and we reduce the transmission, at the same time we protect those who are most vulnerable.” Vallance suggested the target was to infect 60% of the population.
This assumes that anyone who recovers is immune and remains immune – two very big Ifs in the case of coronavirus – and it means 40m people would be infected. But international evidence is that 20% of cases progress to severe or critical stages, so they would need hospital care – that’s 8m inpatients. 5% of cases become critical so 2m would need ICU. 2% of cases die, which means 800,000 deaths. Even if it turns out to be just 1% dying and only 5% severe or critical, 400,000 would die and 2m would need hospitalisation, an unthinkable policy aim. Also, 60% infected would not achieve herd immunity – it would need 75% or more.
6. Dominic Cummings
The Sunday Times claimed that at one private event in late February, Cummings outlined the government’s strategy as “herd immunity, protect the economy, and if that means some pensioners die, too bad.” He changed his mind after a 12 March meeting to discuss new modelling by Imperial College. The newspaper quoted one anonymous senior Conservative as saying: “He’s gone from ‘herd immunity and let the old people die’ to ‘let’s shut down the country and the economy’.”
But as Prof Alan McNally said on 18 March, “We are hearing that the ‘science has shifted’. It has not. Scientists have been very clear on what is coming. You only have to look at Italy, Iran and China then extrapolate to what the situation will be in the UK. The virus hasn’t changed; the epidemiology hasn’t.”
7. Late lockdown
It was almost two weeks after the meeting on 12 March before the lockdown began on 24 March. The next day, Imperial College Prof Neil Ferguson, lead author of the report advocating lockdown, told the Select Committee on Science and Technology “fatalities would probably be unlikely to exceed about 20,000, and it could be substantially lower than that.” By 1 May, there were 36,591 deaths involving COVID-19.
I forecast that a 12 week lockdown from 24 March will result in 30,000 more deaths than the same lockdown starting 17 March. This is caused by a rapid expansion in case numbers in mid March, doubling every 2.7 days. With one week’s delay, cases increase nearly sixfold. I estimate there were over 200,000 cases on 18 March.
8. Care Homes
As the Independent SAGE report of 12 May states, care home residents are almost all high risk. Staff are often poorly paid, more likely to live in crowded housing, less able to self-isolate, more likely to be BAME, or living with underlying health conditions. Their COVID-19 death rates are also higher.
Patients discharged from hospital to care homes were not routinely tested before discharge until mid-April and routine testing in care homes only began from 29 April.
On 8 May, the Gov’t asked local directors of public health to take charge of COVID-19 testing in English care homes, after centralised attempts to run the programme failed. One senior director of public health said: “We’ve been pushing government to realise that we are best placed to organise things like testing, alongside directors of adult social services, because we know our patch.”
9. Bogus briefings
The Government's daily data on cases only reflects the extent of testing – not tested does not mean not infected.
Until recently, Government data on deaths excluded deaths outside hospital. The more reliable Office for National Statistics data counts all patients whose death certificate mentions COVID-19.
There are also excess illness and deaths from other causes as people stay home instead of calling an ambulance and all routine and elective care is cancelled. Over the seven weeks up to 15 May, deaths at home rose from the normal 16,300 to 28,600.
Community services have been cancelled and GP appointments are being replaced with telephone calls and video conferencing.
10. Advance Care Plans
If people who could benefit from hospital admission are being kept out of hospital, they may die at home or in care homes instead of being treated.
Hackney CCG advised GPs that COVID-19 patients with a Clinical Frailty Score of 6 (moderate frailty) or more, should be treated at home even if they seek hospital care, as they would not be suitable for ventilation if their condition deteriorates. But there's more to hospital than ICU, and it’s wrong to stop people being admitted just because their Frailty score indicates they might not be suitable for ventilation.
On 1 April the British Medical Association, Care Provider Alliance, Care Quality Commission, and Royal College of General Practice stated: "It is unacceptable for advance care plans, with or without DNAR form completion to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need."
11. Hostile Environment
Anyone can be infected, so any strategy to control the pandemic must aim to involve the entire community. Ireland, Portugal and South Korea declared publicly that immigration status would not be an issue during the pandemic and people should come forward for testing and treatment without fear. The UK made no such declaration, even after 60 MPs wrote to the Home Secretary and The Voice news editor raised pointed questions at the daily briefing on 18 April.
Although the government has suspended the immigration surcharge for health and care workers, this limited step does not apply to other migrants who face charges for NHS treatment and may be reported to the Home Office if they fail to pay. Exempting COVID-19 does not solve this problem, as the test may fail to detect the disease, and people may have other medical conditions whose treatment is not free.
The government has also involved Serco and G4S in testing and contact tracing, when both firms have a history of abuses in immigration detention centres and deportation, along with fraud in electronic tagging of prisoners.
It has suited the Government to declare endlessly that they are being "guided by the science". But the consequences of cutting public health were clear at the time, the specific warnings in 2016 and 2019 were not adequately heeded, two months were squandered this winter as the global pandemic spread. Advice from the WHO was ignored. Even after the "herd immunity" strategy collapsed, it took nearly two weeks while the virus was raging to impose a lockdown, a delay which has already needlessly cost tens of thousands of lives.
Greg Dropkin Merseyside Keep Our NHS Public