From John in Brighton: Time to Kick Against the Pricks?

20 October


In case you hadn’t noticed I haven’t eulogised to date for the Government’s Covid strategies or more precisely Boris and Matt – at least I’m far from alone on that. But I’m going biblical and take you to Acts 9:5 where Saul is on the road to Damascus and suddenly a bright light appears from Heaven and Jesus acknowledges Saul’s persecuting him and that it is hard for him to kick against the pricks. I wonder if the Cambridge dictionary had Boris and Matt in mind when they defined the meaning as “to argue and fight against people in authority”.  Meanwhile Oxford gives the meaning as “to hurt oneself by persisting in useless resistance or protest”.

Up until now I’ve strongly supported a strategy of social isolation, masks, test and trace, possible lockdown of varying extent and degree etc etc. But we’re in a rapidly escalating second wave, test and trace is a shambles, no vaccine on the horizon, morale is tanking nearly as fast as the economy and civil war is festering with a North-South divide, local versus central government and even Tory versus Tory. Maybe it is time for a rethink, a road to Damascus moment. The seeds were first sown for me not by the scientists or government ministers but by John Caudwell, the wealthy founder of Phones 4 u, speaking convincingly on Question Time recently. Hearing that he was a Tory donor triggered an instant Pavlovian response to rubbish all that he said which essentially revolved around a rethink of our strategy to Covid. A key factor was still unproven but some early evidence that the virus was losing potency compared to the spring, we had better knowledge of the virus and significant improvements in treatment strategies. The antiviral Remdesivir is effective and dexamethasone (a steroid) lowers mortality for the very sick. Ignore the Tory links and maybe, just maybe, he has a point. Quotidian health issues, physical and mental,  continue to play second fiddle with dire consequences to the wellbeing of the Nation and the economy sinks into an even deeper depression and that’s before Brexit really kicks in. Now is the winter of our discontent for sure but how best to mitigate that? Perhaps we should revisit herd immunity and focus on who constitutes the herd. Clearly sending the old and vulnerable into the frontline of viral attack back in the spring had predictable consequences and should never have been sanctioned. But we know the high risk group – those previously shielding, the elderly and those with various complex health issues . Most of my contacts of that ilk still remain very circumspect. Could it be that we now maintain and enhance support to the vulnerable but relax, rather than tighten, restrictions on the rest of the population allowing life, education, business, retail to continue in a more normal vein? This has been discussed but rejected as a policy but has a proper options appraisal been undertaken? It is not a case of which policy is the better but a Morton’s Fork and which is the least damaging. A more liberal approach for the majority does carry risk, still depends on the public maintaining precautions like social distancing and masks as best possible and will incur casualties and deaths but could it be that we look to the utilitarianism of Bentham and Mill – which decisions and actions will bring the greatest advantages to the highest number of people?

As one of the vulnerable I’ve been maintaining extreme care to protect myself irrespective of Government guidelines and I suspect that most others have done the same. I don’t envisage doing anything different for the next six months but would suggest that we need enhanced support as needed on an individual basis. Despite the Government mantra I found access to supermarket delivery spaces hard to come by in the spring and suggest they should be available as a given and free of charge. Food parcels only for those that are financially challenged – most of us don’t need these and indeed never accepted them. Access to technology for those who don’t have it and can’t afford it, free taxis in lieu of the bus pass when family and friends are unavailable, an occasional haircut at home  and other support as needed. I suspect most of us would ask for little seeing health protection as the overriding consideration.

As we increasingly reconcile ourselves to the fact that the Covid virus is to be a part of our lives for the foreseeable future and probably beyond – even if a vaccine does arrive next year – then perhaps we also need to constantly review strategies and policies for how we all live those lives for maximum safety, wellbeing, education and economic viability. I don’t know the answers but advocate avoiding a tunnel-visioned approach.

From John in Brighton: Had Enough of Experts? Not for Test and Trace

25 September

I see the sporting world as a vignette of the wider world and in many ways with lessons to teach us. One is that at the highest level mediocrity will not triumph and we should all strive for the very highest standards that we can. Which tenuously links to one association with Covid and also one of Matt Hancock’s numerous own goals when he called on the extortionately paid Premiership footballers to donate to support good causes in the crisis. Well they did Matt but we didn’t hear of any MPs, many of whom are extremely wealthy, doing the same. Ironically in the sporting world we’d have been spared his little homily as his performance in a “results business” means he’d have been sacked by April Fool’s day.

It’s no coincidence that many football managers have a track record of playing the game because it means they understand the way it all works, the skills, the psychology, man management. In a nutshell they are experts, But it’s not just in football of which I have not partaken but medicine in which I have. I recall Andrew Marr interviewing Professor Sarah Gilbert who leads the Oxford Covid vaccine research team and ending the interview “Professors do give you very clear answers”. Too many pat answers from politicians Andrew but it’s not just professors  – people who really know their subject are authoritative. The nub of medical knowledge and advice is that it is “evidence based” and I’m sure the same must apply in all other fields. Clearly that is deficient with a new disease like Covid but that should not serve as an excuse for incompetent management. I’d happily advise on childhood diseases and safety but not on road planning (even though I drive), A level exams (it’s too long since I partook) or pest control in agriculture (despite my enjoyment of nature). And if I’m on a flight I’d prefer the pilot to be an expert, in an inferno a well-trained fireman, repairing the roof an experienced tiler or defending me in court (might be best if Matt and Boris don’t read this) a knowledgeable lawyer. In fact whatever the trade or skill then good training, experience and honed judgement are prerequisites for the best outcome. I don’t understand the Tory’s’ beef over Britain having had enough of experts. Presumably when you’ve got a multi-talented polymath like Dominic Cummings as BJ’s chief adviser there’s no place for experts.

And has the flaw ever been more crudely exposed than in the Test and Trace system? Since Adam was a boy health care has tracked down infections, chased and managed epidemics and provided advice to protect individuals and communities. Since the end of the 19th century there has been a legal requirement to inform the authorities about certain infections albeit the list has evolved and currently stands at 31 (including Covid of course). Or there may be esoteric viruses which are fortunately sufficiently rare to be listed in their own right like lassa and ebola. Then, and I claim no expertise in this, there are animal diseases which also carry statutory notification rules. All that a doctor needs is clinical suspicion of a notifiable disease and they must inform the so-called “proper officer” or health protection team in writing or by phone if it’s urgent. As a backup laboratories identifying a notifiable organism are obliged to notify Public Health England. Either way PHE are currently charged with the lead in identifying possible outbreaks and epidemics as swiftly as possible with local experts taking a lead role. As a result there is a long history of experts up and down the land with well-honed  skills in disease notification and management. A Godsend, you’d think, as the basis for a Covid test and trace service. For the sake of argument take a dozen or so of these public health doctors perhaps working in their own region but coming together as a National team, relieve them of some other duties and let them focus on developing a national test and trace service. And after years of NHS “efficiency savings” (cuts to you and me) I’m sure they’d do it for a lot less than the £10 billion on offer. But Boris and Matt invite Dido Harding to lead the 15 strong NHS Test & Trace Committee which contains just one public health doctor with the appropriate expertise. “I can’t think of anyone better than Dido” said Hancock when she was appointed. I can think of plenty Matt if you’re interested but I might be deemed a bit too expert to proffer an opinion. Was that another of Matt’s own goals or does he still feel that after her astounding statement to Parliament that nobody was expecting to see a sizeable increase in demands for tests. Really? Only the best part of 66.64 million of us. Even BJ, the Tory version of Wilkins Macawber as opposed to an expert soothsayer said on the BBC just a day after Dido that he’d been saying for weeks that a second wave was inevitable in this country. Why have such a centralised arrangement if they don’t talk or does she just dismiss a lot of Boris’ hot air? And Hancock goes to nil-3 by now stressing that only those with symptoms should go for a test and maybe rationing is needed but just two months ago in July he was urging everyone with any doubt about infection to get tested. In the absence of any credentials of value I can only assume that Baroness Harding has coughed up another Tory donation because it’s hardly on merit that she’s been promoted to head the new National Institute of Health Protection which replaces PHE. To me this seems so ridiculous that if it weren’t so serious it would be laughable. Back to the football and Dominic’s pre-empted the one about the ref needing to go to Specsavers …even if he had to go 250 miles for his eye test which equates to many people’s trip for a Covid swab. So it’s back to the other old favourite and a chant for Boris and Matt “You don’t know what yer doin’  “. There’s been a string of U-turns so one more wouldn’t go amiss – that whatever the field expert advice and leadership is integral to the best advice and support to the Government.

From John in Brighton: Prioritising Protection – Health or Self?

3 September

What were you doing on 30 April 2018? No, me neither but I know what Amber Rudd was doing – she was clearing her desk as Home Secretary having tendered her resignation. She had misled Parliament over Windrush deportation targets and despite her being misinformed by Home Office officials she took ultimate responsibility and acted with integrity. Isn’t that what you do as an MP? Make a significant error and you fall on your sword or get invited to revisit the job centre? 

Not any more it seems. Take failing Grayling who firstly demonstrated an inhumane streak and incompetence as Justice Secretary banning prisoners from receiving books – overturned by the courts. Then his coup de grace as Transport Secretary was to award a £13.8 million contract for a ferry service to a company with no ships. But all is forgiven by Boris if you support Brexit and Grayling was all but offered the opportunity of a hat trick of blunders being lined up as the new chair of the intelligence and security committee but fortunately a  modicum of democracy was restored when colleagues decided otherwise. Then there’s conduct and example – Dominic Cummings visit to Barnard Castle for an eye test is well documented but less is made of Robert Jenrick’s earlier breech of lockdown travel restrictions in order to deliver his parents’ medications – really? Every pharmacy I know will deliver to those who are in need. Not to mention his rather dubious / illegal fast-tracking of Richard Desmond’s planning application – a £45 million saving for a £12,000 donation to the Tories amounts to good business for Desmond but questionable judgement by Jenrick. But all is well ‘cos he supports Brexit. Then more recently Gavin Williamson as Education Secretary whose only experience in the field was in his upbringing (but don’t worry, the country’s had enough of experts) made such a pig’s ear of the exams that it was less a matter of if but more of when he’d resign….or not. Surely Boris will show him the door – except that Brexit support overrules crass inability. And fortunately there’s a let -out clause called Ofqual. Despite Williamson’s directive that grade inflation was a red line no-no and Ofqual producing an algorithm to ensure that applies Gavin ducks responsibility. It’s left to Sally Collier the CEO of Ofqual to resign and for Boris Johnson to sack Jonathan Slater who was the most senior civil servant at the Department of Education stating a need for “fresh leadership” – right idea Boris, wrong man I’d say. Do you spot a theme – it’s not about ability, experience or integrity but more a matter of passing the Tory Toady Test. Get behind BJ, speak up for Brexit and nothing else matters.

But what about Covid which is our primary focus? In fairness to the Government they have been dealing with an unprecedented (surely that will be word of the year) situation. Some things have gone well – the speed of knocking up Nightingale Hospitals was very impressive albeit they were underutilised, Rishi’s furlough scheme has been a lifeline to so many people (the sting in the tail of paying for it is yet to come) and…..and…Boris was a regular Thursday clapper. But there are serious questions over other aspects – the shortage of PPE for NHS staff and others at varied frontlines was disgraceful, the late institution of lockdown whilst initially opting for “herd immunity” undoubtedly cost lives, the disdain for the elderly serving them a death sentence by discharging to care homes without so much as a diagnostic test, the grossly inadequate number of tests performed and the  pratfall of the “world beating test and trace” app to name but a few. In a nutshell we have a dubious twosome – no, even worse than Johnson and Cummings – of the highest number of excess deaths of a given time period compared to that expected and the largest recession of any G7 country. Calls for an independent enquiry have been accepted but mothballed until the pandemic is over. The Government can point to a ready-made lightning rod claiming that they have always simply followed the science notably the SAGE committee or Chief Medical Officer Chris Whitty. 

But last week Matt Hancock added an additional protective shell against criticism by abolishing Public Health England citing failures in PHE’s testing and tracing as a focus of BJ’s disappointment. It is to be replaced by the National Institute for Health Protection which will bring together health protection with a primary focus of infection, biosecurity and NHS test and trace under unified leadership and with an immediate goal of tackling Covid. Bearing in mind Germany’s more favourable outcome it is to be modelled on the Robert Koch Institute but I’m left wondering whether we wouldn’t achieve more if we cloned our leader on the Angela Merkel prototype. The slight irony is that Baroness Dido Harding has been the lead on test and trace since early May (along with a Government allocation of £10 billion) and she is to be the initial executive chair of the new body. I don’t get it – the Government can’t pursue the much needed Public Enquiry into the management of Covid whilst the pandemic remains active but they can make significant changes to the healthcare strategy. Actually I think I do get it – MH and BJ recognise that errors have been made including more U-bends than a plumbing superstore and they are trying to detract from Government responsibility as much as they can. The last significant pandemic in the UK was swine flu in the summer of 2009 and of course we should learn lessons from Covid as there’ll surely be another in the years ahead. But the new Institute drops all the PHE responsibilities for the quotidian conditions – reducing smoking, sexual health, drug and alcohol misuse and obesity which a mere six weeks ago BJ told us was a priority issue. In a parliamentary Q&A session on Tuesday Alex Norris, Shadow Health and Social Care Minister, asked Hancock about these more generic health issues. His answer was that it would all be embedded fully across the health system including the NHS and they will ensure the best and right organisational structure to deliver this. That all seems very nebulous to me and with the demands on the NHS my suspicion is that without clear national leadership it just won’t happen. Jo Churchill, Tory Health and Social Care Minister, went on to call our current obesity strategy “world beating” which I find risible and it begs two questions  – who says?  and so why change it? I acknowledge that managing pandemics is important but prevention is better than cure in healthcare and I suspect more lives could be saved in the long run with better management of the common conditions. It feels to me that BJ and MH are attempting to cover their own backs by passing the buck at the expense of the Nation’s health and if they agree with my interpretation then I would hope that the large national bodies – BMA, RCN and Colleges for example would take the politicians to task.

The imminent winter could be both challenging and interesting in equal measure. If we’re back to normal by Christmas then BJ isn’t quite the turkey he currently seems.

From John in Brighton: More Lock-up and Lock-down

19 August

Bonjour mes amis! Relief abounds for the thousands who have successfully retreated across the Channel before the quarantine deadline. Self-isolation in the UK means not leaving a place of your choice which is likely one’s own home but could be friends or family. Is that vigilantly policed? Sky News suggested last week that nine people had been fined at the Border but only one beyond this since its introduction on 8th June. Employers may sometimes make concessions but are under no obligation to do so. My sister is now an Aussie national and is currently over in the UK. Although she lives a little North of Brisbane which is relatively spared of Covid on her return in early September two weeks of quarantine will be mandatory. That’s assuming you get in – some states set strict weekly caps on the number of international travellers. Self-isolation is literally a lock-up spent in a hotel room, no visitors, eat in the room and to boot you pay for it. Employers have no obligation to pay you. There’s no government bail out. Strict but on the face of it logical and importantly effectively saying that the virus is still with us and any complacency is misplaced.

Some returning British travellers are requesting Government compensation where they have lost out following sudden changes in the quarantine rules. Some travel insurance policies booked before 1st March did not exclude Covid but most of those after that date did. Hence travellers would have been informed of this and must have been aware that the virus is capricious, it is a pandemic ie very widespread and possibly worldwide and so pending further outbreaks travel arrangements, restrictions and regulations could change in parallel. It is surely the individual’s decision whether they deem the risk worth taking or not and I’d challenge whether it is the Government’s responsibility to pay compensation even where the rules have unfortunately changed whilst they were on foreign shores. Sure it’s tough. Lockdown has been difficult. People are desperate for a break, a change, a summer vacation before the winter creeps up on us and, God forbid, the possible second wave. But it is still a personal choice where you opt to take that break. This is different to the situation with employment where people were asked by Government to work at home if possible and if not and there was health risk then to abstain with the support of the furlough scheme. The economy is in a dire state, furlough has been relatively generous and is now extended to October and surely we can ill afford adding numerous payouts as a variant of travel insurance. Surely preference  should go to paying those identified by track and trace to isolate, many of whom can’t afford to and hence the low pickup rate.

If there is any Government responsibility I’d point the finger at Boris Johnson who conflates a libertarian ideology with an attitude so positive that it makes Wilkins Micawber look gloomy. He perceives himself as a modern-day Churchill rallying the troops but fails to tick a single box. Do you recall that speech at the end of April when he talked of wrestling the virus to the floor and pressing home our advantage?  We were deemed on track to prevail in Phase 1 of the virus and were moving on to winning Phase 2 like battles en route to winning a war.  Nearly three months later on July 17 you could hear the champagne corks popping up and down the land. Gyms and leisure settings could imminently reopen, by September all schools and colleges will reopen full time, from October sports stadia and conferences and hey pretty much back to normal by Christmas. Music to our ears! I wonder how many people booked a break in celebration.  On the other hand how many Cassandras like me felt this was too much too fast? Then there’s the mixed messages with the ongoing importance of staying alert and maintaining social distancing but the gradual relaxation of lockdown continues …except that from August 8 masks became mandatory in some places notably museums, galleries, cinemas and libraries. On the other hand masks are not mandatory in pubs and restaurants although social distancing is. The Eat Out to Help Out Scheme was used for over 10.5 million meals in its first week and it is hard to think that there would not have been some risk of social interaction as a consequence.

My concern, and I hope I’m wrong is that there is potential sophistry at play. 1. New cases of corona virus and deaths are gradually falling, 2. the pandemic is passing and therefore 3. we can progressively relax the restrictions. The flaw is that the fall is largely due to the restrictions and not despite them. An analogy in my speciality would be to say that many diseases are all but non-existent and so we don’t need immunisations any more – the resurgence of measles with a small drop in MMR uptake shows just how careful one needs to be in distinguishing the chicken from the egg. In the same way Blackburn and Leicester should  be seen as warning shots (to continue BJ’s ridiculous analogy of the virus and warfare) when our guard drops and not as unfortunate isolated blips. 

A firm line, no ambiguity and consistent policies may be more painful in the short term but could reap benefit in the long run.

From John in Brighton

9 August

Whose sage? Which SAGE?

Well I’ve just had a flashback to my salad days. Flicking thro’ the Observer recently I recognised  a physiognomy from yesteryear – the rugged features unchanged but the black hair now all but grey throughout. Some July that year – the Toxteth riots in Liverpool and Princess Di married Charles. Lest that’s not enough then this should clinch it – cricketing history was made as England became the first team this century to win a test match after following on as soon-to-be-Lord Botham and the late Bob Willis did for the Aussies at Headingley. It speaks for our extraordinary times that Sir Ian gets his upgrade not for the  worthiness of cricketing prowess, his wine label (bit pricey even in Tesco)  or charity walks but for backing Brexit. Does it get rescinded should that all go pear-shaped?
So whose face could be so powerfully redolent of my younger day? Tony Costello my erstwhile SHO (aka dog’s body) colleague at the Childrens’ Hospital in the Hackney Road. Mutual support as the East End children poured into the Casualty (the term A&E was still not widely used) like a tsunami. He was passionate about cricket and our only breaks were very brief test match updates on Tony’s crackly trannie. He was clearly very bright, quite opinionated considering our relatively callow status but with a much-needed sense of humour. SHO’s are like stem cells in the blood – common origins and the potential to develop in multiple different directions. For Tony the stellar heights of Professor of International Child Health at UCL and a Director at the WHO. Meanwhile I was happy to spend 25 rather more prosaic years at the busy coal face on the South coast. Either way we had a perfect training ground for both – . plenty of patient contact and the pre-gentrified Hackney was a melting pot, so perfect for an initial dabble on the international front. We’d occasionally splash out on a curry from Brick Lane, just around the corner, which had yet to become a household name following Monica Ali’s 2003 novel.  
Tony is a member of Independent SAGE, a name which I find confusing and would suggest is ill-advised. It is a self-selected group of experts created with a view to encouraging more open presentation and discussion of the scientific facts around Covid. The group is independent of the Government (unlike the Scientific Advisory Group for Emergencies [SAGE]) and does not answer to it but is chaired by Sir David King, a former Government Chief Scientific Adviser. It shares its work with the Government and the public but whether the former listens may be another matter. They recently wrote to Chris Whitty advising that we pursue a Covid-zero elimination policy before any further easing of lockdown and Whitty publicly then said we’d relaxed as far as we could but will the politicians be of a piece? An effective Test and Trace scheme is key to this – £10 billion for a “world beating” system that misses 25% of cases surely begs some questions. The recent little pockets of escalating cases might be interpreted as a bellwether of a potential second wave and give backing to the harder line. It’s easier to pass judgement and opinion when you have no responsibility for matters fiscal but on the other hand a second wave might well shut the economy down again – surely it’s better to pre-empt that. In his Observer interview Costello was open in some of his criticisms and two comments of note were a suggestion that some of Matt Hancock’s decisions verged on the criminally negligent and  that about 50,000 of our current excess 65,000 deaths were preventable with more competent management .
My reflections move on to how different is the NHS now. Progress in treatment in all specialties has been phenomenal. But it’s not all been rosy. A year after Hackney Roy Griffiths, Deputy Chairman of Sainsburys produced a report and so another-Lord-to-be Ken Clark began the insidious mushrooming of NHS management along with a move towards a more business- based service. It has always been a dilemma in my mind as to how much financial implications should dictate care. Clearly money must be used judiciously but the new world of purchasing and commissioning, business plans, contracts and efficiency savings (euphemism for cutbacks) was one that at times felt like a foreign land to some of us. The Patients Charter gave power to the elbow for patients but some are much better at speaking up and making demands and it encouraged a litigation culture. The introduction of targets seemed to further distort priorities at times and especially in areas which are harder to measure and may explain why mental health really doesn’t have parity with the physical despite repeated governments purportedly making it a priority. The NHS has increasingly become a political football which is detrimental to the service, the staff and the patients.
Notwithstanding all this the septuagenarian NHS remains to my mind one of the jewels in the crown of this country and one which we should respect and cherish if it is to survive.  One thing that undoubtedly hasn’t changed is the enormous commitment of the staff many of whom are seriously underpaid and go well beyond their contracted  hours of employment driven by a sense of duty and desire to do the best for patients. The pandemic has shone a light on this as rainbows have appeared in windows and the Thursday clap became a weekly ritual. The pandemic is going to leave many scars but hopefully there will be the shimmer of a silver lining as well. A weekly clap and supermarket priority slots are welcome but don’t pay the rent or bills and we need to ensure that all public service workers are appropriately rewarded for their skills and commitment. I await with interest whether Boris Johnson does do the right thing and tangibly rewards the service that saved his life.

Oh, it was 1981 by the way.

From John in Brighton: DNA

28 July

Potentially an existential issue – but not the double helix and its crucial role to life but rather the future of the restaurant industry. Within a fortnight of the hospitality services resuming, albeit with reduced numbers and other restrictions, restaurant hosts up and down the land bemoan those who book and then don’t materialise at the appointed time. I suspect this is not a new issue but more sharply focussed in these straitened and challenging times. The most outspoken was Tom Kerridge who had 27 no shows at his bar and grill restaurant on a single Saturday night. He emphasised that such selfishness could be the tipping point for the industry which is “already on the verge of collapse”.

Welcome to our world Tom. DNA’s, Did Not Attend, have been a perennial problem in the NHS for as long as I can remember. An outpatient clinic appointment is booked for a certain date and time but the patient is conspicuous only by their absence. Figures vary from place to place and between specialities but on average 8% of appointments (just under 8 million in 2017-8) are not honoured. With each missed appointment typically costing approximately £120 that represents around £1 billion to be coughed up. Not to be sneezed at (even with a mask on). Speaking on Question Time exactly five years ago Health Secretary Jeremy Hunt expressed a personal preference for charging patients for missed appointments. The complexity of administering this and, I suspect, political unpopularity led by the other Jeremy meant it went no further. At the same sitting he also denounced patients who simply failed to take their prescribed medications which is another chronic wastage – so be grateful Tom, at least people swallow your food. The year after Hunt’s rant the body termed NHS Improvement was set up and in a report on “Reducing DNA’s” cited clerical errors and patients forgetting as the commonest reasons amongst several. To counteract these factors many clinics asked patients to ring in and book an appointment personally and then followed later with a reminder text a day or two before the consultation….but sadly not a panacea and still appointments go to waste.

Another ploy in the NHS is to book one or two extra patients in expectation of the absentees – bad news if it’s neither raining nor the World Cup and everyone turns up. But that’s less practical in the restaurant trade and especially with enforced social distancing. And the NHS is not a business whereas a restaurant’s bottom line and staff livelihoods depend on maintaining income. The current white hope for NHS appointments is to give patients the option of booking and changing appointments online. If it works in hospitals then perhaps it could be an option in hospitality as well. But until then a more immediate potential solution is to ask for a deposit at booking with a full refund should cancellation occur at least forty eight hours prior to the meal. To no show with impunity is ignorant and rude – maybe a forfeit would concentrate the mind. Interestingly, but perhaps unsurprising, is that psychologists have demonstrated that people value things more if they have had to pay towards them. The only difficulty I can envisage is the client taken genuinely ill on the day of the booking.
At the end of the day surely a key factor is that both action and inaction have consequences and we all have a personal responsibility for “doing the right thing” as the Tory mantra so often tells us. The NHS may be free at the point of delivery but that doesn’t mean that financial considerations are irrelevant and we all need to use the service responsibly and judiciously. Equally the patrons of restaurants have a duty to respect those providing them with a service and whose livelihoods depend on it.

From John in Brighton: Shielding – To be or not to be?

20 June

How do you link “shielding”, a packet of biscuits and a sharp rebuke? The obvious answer is too much comfort eating but you’d be wrong. My daughter spotted gluten-free biscuits on the shopping list I gave her last week and leaving no stone unturned a third degree ensued on why (I’m not gluten-intolerant), who was coming over, indoors or out, how many people…? Definitely won’t be in the house I reassured her but had to hedge a bit that there might be two people. Cue for a reprimand and brief homily on safest option being total abstinence of any social contact. Floundering on the ropes I point out that since 5 June shielders can spend time outside with someone from another household. A bit of Socratic irony from my son “Do you trust everything the government says?” “Well no actually” and that’s as good as a knockout punch. Case won in favour of the prosecution.
Strictly speaking they are right and what is clear is that their sentiments are entirely well-meaning and out of concern for my health and welfare. But equally after nearly three months the shielding does take its toll and that’s despite my going out on my bike (with social distancing) to maintain my sanity. I’m blessed with a garden but even so the glorious weather exacerbates the frustration. And to rub a bit of salt into the wounds we see progressive relaxation of lockdown for swathes of people up and down the land. But perhaps that reinforces the importance of ongoing shielding – a second wave is always potentially waiting to pounce like an angry cat.
Some shielders and indeed some support groups talk of an increasing two-tier society and the shielders’ desire to return to some sort of normal life. There is speculation this week that imminent changes could include the abolition of the need for shielders to isolate at home from the end of July and based entirely on clinical evidence.. But let’s remind ourselves we are the “extremely vulnerable” (sic). I’m a pensioner with additional health risks and an article in The Guardian a month ago starkly demonstrated how age was a key risk factor. The over-65’s are 34 times more likely to die from Covid than those of working age and 88% of the deaths were in the over-65s. 
So I acknowledge my offspring’s concern and that extreme vigilance is still the only guarantee of safety. The down-tick of cases and deaths should not induce any feelings of security and the case is made for ongoing shielding – short term pain for long term gain one hopes. I haven’t claimed the food parcels nor the prioritisation at supermarkets – it’s much more fundamental than the “perks”, it’s trying to minimise risk and maximise survival. Prolonged isolation can impact mood and mental health and if I were following Socrates I might be seeking out the hemlock by now. Instead I’ll turn to the meditations of Marcus (Aurelius not Rashford although the latter is clearly wiser and more proactive than BJ) and I think his advice would be similar to the offspring. Better to be the also-rans in a two tier society and it’s the utmost caution for the foreseeable future – “Carry on Shielding” is the one they never made so where’s Kenneth Williams when you need him?

From John in Brighton: What a Load of Rubbish!

Rubbish on a remote Indonesian island

12 June. It was instilled into me at a young age that you don’t leave litter. I don’t recall so many public bins back in the 60’s and the message was clear – pack up your rubbish, take it home and bin it. On the face of it not difficult to understand or to execute so why has litter been a thorn in our side for as long as I can remember?.
Yesterday evening in a local park was an overflowing bin and litter strewn all around – a small vignette of a much bigger problem. One hot weekend last summer 23 tons of rubbish were collected off the Brighton and Hove beaches and the Council planned for a further 300 new bins over a stretch of about eight miles along the sea front. This included recycling so blue for plastic bottles and cans, maroon for glass and black for ordinary rubbish. Again I’d ask, what could be simpler? But there’s a sense of deja vu with the recent burst of hot weather and the beach near the pier had an ugly coating of nappies, wipes, takeaway items, cans and drinks bottles aplenty. Enough in fact for volunteers to fill twenty five bags of 5 Litre volume over about a three mile stretch. 
And it’s not just the beaches but also the parks. Preston Park, Brighton’s largest, might take park attendant Bill at least a couple of hours to clear after a hot day he tells us on the local radio. And last spring 500 bags of rubbish were collected from two of the main roads in Sussex the A27 and A23 – some may have blown in but the majority probably expelled from drivers’ windows. Yet go up on the nearby Downs and litter is practically non-existent as witnessed by a ten mile cycle this week and spotting one item. Perhaps this simply reflects a far lower number of people but I suspect also a different mentality. And maybe if you see no rubbish it induces you to follow suit, positive reinforcement even if there is no tangible reward..
I try to understand why people leave so much rubbish. Is it simply laziness or lack of facilities? Often bins are overflowing but isn’t the appropriate response to find another even if that means taking it home? Is it a perception that it’s somebody else’s responsibility to sort – “that’s what they’re paid for”, except that they aren’t and a lot of the clearing rests with volunteers? A lack of any civic pride – maybe it’s the band of London day-trippers who are solely responsible but I doubt it. Or just a lack of self-discipline, perhaps exacerbated by the restrictions of lockdown and the new-found freedoms nurturing a low-level anomie? But last summer’s findings predate Covid and imply a more chronic problem. Or maybe it’s quite simply the absence of any consequence – identifying culprits is practically impossible. Politicians repeatedly praise the adherence of the general public to the lockdown so the principles of self-discipline are well understood but regardless of rules and directives from on high arguably the biggest incentive there is avoiding a potentially life-threatening disease. No one dies from leaving a bit of litter………but fauna might. The plastic pollution of the oceans and its consequences have been highlighted in the last couple of years. Recently there have been reports of micro-plastics in rivers and affecting the bird life, not all of it from litter but it may contribute. And better still for the miscreant is the difficulty of policing litter louts – last year Brighton introduced a team of “litter cops” and the threat of a £300 fine but how can they effectively patrol a large area 24/7 although the threat might be a subliminal deterrent to some? After a leave of absence the enforcement officers re-emerged last week so I’m hoping for a cleaner city as the summer progresses but won’t hold my breath and I still question why such a measure is needed.
Education and Public Information Films have been tried – going back to the 60’s Roy Hudd did one. Then there was that catchy slogan “Find a Bin To Put It In” so I fear this may be as difficult to unravel as the Gordian knot and will remain an issue in another fifty years time. But it’s not all bad. Back to the 60’s and the footpaths were littered with faeces (usually canine)  but no longer.  An eighty quid fine surely helps to focus the attention but again I suspect the mindset and understanding the rationale is the most important thing. Again it begs the question as to how people generally comply with this but not so well with garbage disposal.

From John in Brighton: A Little Bit of Sugar ….May Damage Your Health

4 June

I felt some angst when BJ announced initial relaxation of lock-down two or three weeks back – the disease was still very active and surely the decline was because of lock-down and not coincidental. Immunisation has largely extinguished many serious infectious diseases but that is because of and not despite the vaccines. Brighton’s slightly alternative population means a lower uptake than in many areas and a few years back there was a little cluster of measles cases showing that the lid can burst open given half a chance.Nevertheless the government mantra was that all decisions were based on scientific advice and SAGE and its subgroups has some wise and well informed members so that was reassuring.
I thought I was shielding until the end of June….until last weekend when it was suddenly announced that even the two million or so of us deemed at high risk of severe illness can take the latch off the front door and venture out once a day albeit adhering to the guidelines. I can wash my hands, wear a mask etc but it takes two to tango and also to socially distance so there’s the first potential flaw. And there are still around 2000 new cases reported daily in the UK – almost certainly a significant underestimate as some are asymptomatic and others simply don’t get tested. So why the sudden change?
Maybe it’s a sympathy move as the mood music from the shielded was of feeling forgotten and ignored and so BJ et al felt an olive branch of a daily toddle and a bit of human contact would soothe our pain. You don’t need to be on SAGE to realise that’s no grounds for a decision. And here’s the rub – members of SAGE have expressed doubts about aspects of the relaxation policy. Here’s a taster of three: Professor Sir Jeremy Farrar, Director of the Wellcome Trust “Covid-19 is spreading too fast to lift the lockdown in England”, Professor Peter Openshaw of Imperial College “near unanimity among scientists in unlocking carrying real risks”. Professor John Edmunds of the London School of Hygiene and Tropical Medicine stated that this was a political and not a scientific decision. And all four UK Chief Medical Officers rejected BJs line of decreased viral threat and Chris Witty, the England CMO, said he’d vetoed the Government dropping the risk level from 4 to 3. I’m relieved that my anxieties are not unfounded and don’t reflect lockdown induced paranoia but equally even more concerned that once again the Government have “had enough of experts” and opted for their own route map.
Indeed it was quite entertaining to watch Dominic Raab ducking and weaving more than Frank Bruno ever did as Andrew Marr had him on the ropes. We are at Level 4 on the Governments’s own chart said Marr but we start relaxation at Level 3 – DR gets up on the count of eight explaining that we are transitioning from 4 to 3 so it’s OK to start. Mmmmm? And interestingly he didn’t specifically say they were following the science but took “independent advice” – who from – maybe that well-informed addendum to SAGE aka Dominic Cummings? But the gall – asked how many have so far been tracked and traced he had no answer but still stated that our system was world-beating!! Good job I took the toilet break before the programme started or I might have been wetting myself by now. Marr then asks him to spell out the special exclusion clauses in the guidelines as per DC lest we need to pursue these and guess what – nothing is proffered. Dominic’s trainer would surely throw in the towel at this stage. 
Excuse my cynicism but I perceive a DC effect. There has been great worry that the general public will simply follow his example and do their own thing regardless of government guidelines. I suspect that this is a BJ pre-empt, a sweetener partly to detract from DC as a headline but also to assuage the public wrath. There has been increasing concern in medical circles that sugar and not fat is the arch criminal in cardiovascular disease. Perhaps BJ needs to be warned that too much metaphorical sweetener can potentially damage your health as well.
And what will this mean for the future of this government which is already under serious scrutiny as having mismanaged many aspects of the corona outbreak? If ploughing their own furrow in the face of medical and scientific advice should result in a significant resurgence of cases and deaths and even a second lockdown then could there be irreversible loss of public confidence in the competence of BJ and his team?

From John in Brighton: Don’t think its all over!

31 May

Through the winter my cycling has been confined to the undercliff passage along the sea front but a few days ago I took my first ride of the year up on the Downs from the Jack and Jill windmills over to Blackcap just outside Lewes. The countryside is the summer schedule when the ground is dry and the wheels unclogged by mud. A bit later than usual following the floods of spring and the uncertainty over the Lockdown rules as it does involve putting the bike in the car for a short drive. The driest May for 176 years has sorted the first issue and Dominic Cummings the second. In the unlikely event of a challenge from the Fuzz – “Sorry Officer but my vision was a little blurry this morning and I’m testing it out”. The only potential flaw in my DIY optometry argument is that I’m not risking a 4 year old on the back seat. What odds I wonder would I have got from Betfred last October that by the time I returned to the summer routine the World would be engulfed in a pandemic? 5000 to 1 mate, worf a quid surely! No thanks, no chance, I’ll stick with the tangible – another bag of chocolate buttons.
The  car park is full but the Downs expansive enough and social distancing is not an issue. First skylark of the summer for me and sounding very blithe, clearly oblivious of the troubles of the World below. It was June 1820 that Shelley wrote his wonderful tribute to the “Bird thou never wert” and that was only fifty five years after the Great Plague killed about 100,000 including an estimated 15% of the population of London. About eight miles each way up hill, down dale with the highest point about halfway at Ditchling Beacon. A couple of landmarks are the i360 in the distance and the Amex glistening in the sunlight a mere mile or so away. I can make out the seagull pattern on the seats but without my binocs the cobwebs of the furloughed stadium are indistinct. Should I clarify with DC whether this means I’ve failed the eye test? It’s 87 days and counting since the last home game. Another 87 will be the 21st August and the new season should be kicking off – what odds will they give me for that? Do we update the jibe about the ref going to Specsavers  – “you need a drive to Barnard Castle”. Up on the Downs nearly everyone exchanges a pleasantry, usually just a “good day” and everyone seems cheerful but who knows if any of them has suffered personal pain and even loss in the last three months? Nearly everyone has some problem of varying degree in their lives so are they dissembling? We have been repeatedly told that we have turned to Nature to lift our spirits in the dark times and perhaps we’re all benefactors of this pastoral opium of “England’s green and pleasant land” to borrow the description of another of the great romantics. The return trip had an unscripted adjournment as  a short stone’s throw away is a kestrel hovering and I watch him pounce twice but to no avail but the third time I half make out something in his beak – I just hope it wasn’t a baby skylark. Do birds pine I wonder?  A little further away is a buzzard surveying the landscape in search of a slightly belated lunch. Harsh reminders that the wonders of Nature are counterbalanced by being red in tooth and claw…and beak….and with a touch of poetic licence at least for the time being Covid. The grim reaper can pounce in varied formats. 
Thursday it was back on the sea front and what a contrast. The beaches and esplanades were packed and cafes well patronised. People strolled along in groups and many seemed to make no attempt to adhere to the two meter ruling. The traffic is undoubtedly escalating week by week. It gave the impression that as relaxations are introduced there is already a perception to many that the virus is beaten and normality is restored. Perhaps the really good weather is paradoxically showing it’s downside and although we are encouraged to be outside that only applies if the rest of the guidelines are in lockstep. Perhaps if it were chillier or wetter many more would find it easier to stay at home. Stopping off at a shop on the return trip serves a sharp reminder of the ongoing risk – a ten minute queue to enter and a one way system round the store. These reality checks may have additional benefits to the raison d’etre of acquiring goods.
The reminder is rubber-stamped when I get home to watch the news – an additional 412 deaths recorded over the last 24 hours. You think it’s all over ? Certainly not.