From David Vincent in Shrewsbury UK: Going Local

Matt Hancock

July 14. Here’s an idea.  The health of an area is a complex matter, interacting with a wide range of public services and private behaviours.  Why not appoint a senior figure in each local authority who can work across the three connected fields of protection, improvement and health care.  The role would advise elected members and senior officers and liaise with national bodies such as Public Health England and NHS England.

It has taken a long time for Matt Hancock, the Minister of Health, finally to accept that 134 such figures already exist.  The post of Director of Public Health (DPH) was created as part of the Lansley reforms of the Cameron government in a creative attempt to compensate for the damage caused by the abolition of regional health authorities.  According to NHS England, “Directors are responsible for ensuring that public health is at the heart of their local authority’s agenda. Using the best and most appropriate evidence, they determine the overall vision and aims for public health in their locality. They then manage the delivery of those objectives and report annually on their activities.”  As the Department of Health’s own website puts it, their role embraces both long-term issues such as obesity and health inequalities and short-term reactions to “outbreaks of disease and emergency community and emergency preparedness.”

The turning point in the deployment of the DPH’s in came in the second week of May, two months after the country began to grapple with the coronavirus outbreak.  The scandal of the infection and mortality rates in care homes forced central government to recognise that it simply did not have the capacity to determine how to prioritise a testing programme.  It turned to the DPHs because of their familiarity with provisions for the elderly in their areas, and their connections with other community agencies.  A DPH was quoted at the time as saying, “We’ve been pushing and pushing government to realise that we exist and that we are best placed to organise things like testing, alongside directors of adult social services, because we know our patch.”

Now, in an article in the Telegraph last Sunday, with the official UK death rate approaching 45,000, Hancock finally recognised that the coronavirus was a local event requiring interventions tailored to local circumstances.   He wrote that “now we can take more targeted local action and less national lockdown, to restore the freedom of the majority while controlling the virus wherever we can find it.”  The much delayed track and trace system can only work if the Directors of Public Health are supplied with all the so-called ‘Pillar 1’ and ‘Pillar 2’ returns so they can fully understand the conditions in communities or workplaces that are giving rise to anomalies, and develop tailored actions for dealing with them. 

With power comes responsibility.  Central government has not lost its appetite for intervention and it was reported over the weekend as threatening to take over running Leicester council if it failed to deal with the crisis in the city.  The Directors of Public Health are finding that their new powers are bringing with them an immense body of work, and an unwelcome exposure to the media.  The Herefordshire Director did not appear at all comfortable yesterday answering questions about the outbreak in a farm, particularly why three of the workers had managed to abscond from the lockdown she had imposed.

Nothing will be easy, and it remains to be seen how permanent is the shift of authority from the centre to the periphery.  But after so much confusion, wasted resources and unnecessary deaths, the belated change in policy can only be welcomed.   

As the far-seeing Dominic Cummings almost said, ‘Take back local control!’  Just now I live not in the United Kingdom, nor in England, but in Shropshire.   Home rule cannot come too soon. 

from Anne in Adelaide, Australia: older

June 30.

That is no country for old men. The young
In one another’s arms, birds in the trees,
—Those dying generations—at their son

I have aged beyond the normal passage of time during these last 4 months. Way beyond.  No question in my mind. I did not preface that statement with, ‘I feel I have aged …’. I find it hard to work out exactly why this is so. After all, living in South Australia we have been extremely fortunate. Our busy lives have been curtailed, but not drastically. There was an early panic evident in the rush to hoard food supplies and we learnt the Australians were particularly active in stocking up their larders. During those early days, the dread for me related to the fact that we did not know how bad the virus would be for us, what nature it would take. Stories abounded. The collapse in our stock market in February emphasised the approaching storm: health and wealth threatened!

But the issue has more to do with the nature of our lives as retired people. Maybe before 2020 we were living in a fool’s paradise, ignoring old age and the waning of our abilities. But now we are labelled as a group as vulnerable, many with ‘comorbidities‘ The percentages are widely discussed – an ultra-high death rate is assured for our age group. A retired friend was told by his doctor son that he must be serious about isolation because if he ended up in hospital it was unlikely that a ventilator would be assigned to him. Triage would be in operation.

So, the story is out: we are at the end of our lives and nothing new, nothing amazing, nothing significant remains for us. Together, my husband and I had planned travel to Indonesia – an interesting bird-watching trip through remote islands and I had organised a visit to Seattle to see our daughter and to travel with her to Yellowstone National Park. We have always been travellers and being able to pursue our hobbies of birding and photography in new places has enriched our lives. In December 2019, we felt that we still had the energy and enthusiasm to do this. I am not so sure anymore.

But my premature aging cannot be just this! It has more to do with optimism, or the lack thereof. I looked up the synonyms for ‘optimism’. They are: hope, confidence, sanguinity, buoyancy, cheerfulness. And those words hit home. I don’t think they describe my world at the moment. It’s closing down. Being so in touch with the persistent bad news, watching the numbers, does not make me happier. Maybe the way forward is to deliberately NOT immerse myself in the news. Ignore it all.

‘Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
’ as Dylan Thomas wrote.

That’s a bit dramatic for me and my angst.

I came across this article from the HBR. ‘That Discomfort You’re Feeling Is Grief.’

Is this the word for this sense? Grief? Perhaps that is closer to my aging idea. Grief – looking backwards at my life and at the confusion of our present times. And maybe I just have to deal with this. I have never been a person with depressive tendencies. If you survive boarding school you develop a certain resilience! And I can look to my father’s example, how he conducted himself in his old age: never sorry for himself, never without kindness, always interested in the world, always generous.

When he died, my father left a letter for my brother and me; it contained this poem. An ancient Sanskrit poem.

‘Look to this day
for it is life
the very life of life.
In its brief course lie all
the realities and truths of existence:
the joy of growth
the splendour of action
the glory of power.
For yesterday is but a memory
And tomorrow is only a vision.
But today well lived
makes every yesterday a memory of happiness
and every tomorrow a vision of hope.
Look well, therefore, to this day.’

A gift. Surely, that is enough.

*WB. Yeats, Sailing to Byzantium