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 David Vincent in Shrewsbury, UK: Six Giants

William Beveridge

June 24.  In the matter of identifying the aftermath of the pandemic, history has to be used with caution.

Peter Hennessy (see June 23) knows well that the Beveridge revolution was initially resisted by the war-time Conservatives.  Churchill believed that planning for a post-war future was simply a distraction in the middle of a conflict whose outcome was far from certain.  His attempt to bury the Beveridge report was defeated by its dry-as-dust author, who proved surprisingly adept at deploying the media of his time to publicise his document.  The report was full of practical detail, but by couching his target in terms of the five ‘giants’, Beveridge tapped into the moral subconscious of the British people, engaging with a tradition of social justice that stretched all the way back to Bunyan’s Pilgrim’s Progress.

The report became a best-seller.  My dog-eared copy once belonged to my father, who used it in the latter days of the war to lecture to his fellow sailors with whom he was serving in a naval outpost in Sierra Leone.   It was central to Labour’s landslide victory in 1945 (though Beveridge was himself a Liberal), and in turn the scale of that majority was critical to overcoming the opposition to many of the proposals, ranging from the Tory Party to a host of vested interests.

Starmer’s Labour Party will need another landslide, and another document to energise the electorate.  The Beveridge Plan offers only a partial model.  Lakes of ink have since been spilled over its recommendations.  Eligibility for relief was centred on the outdated figure of the male breadwinner with his dependants.  The ‘National’ in the NHS and other reforms reflected a passion to centralise every form of welfare, in most cases denying effective local participation in the provision of services.  There was no engagement with the environment by a Labour Government which spent its time in office burning every ton of coal it could get out of the ground.

There is a case for simply taking on the same giants and this time slaying them properly.  Anne Chappel has directed me to a recent article which points out in convincing detail how Beveridge’s agenda is still yet to be met.*  We still have work to do with poverty, health, education, unemployment and housing.  Nonetheless, three quarters of a century on, it is perhaps time to update the mission.

I would slightly re-shape Hennessy’s agenda.  The giant of Squalor remains a task in the form of social housing.  Idleness remains a task in the form of the vast numbers, barely visible in 1945, beyond working age and needing affordable social care as they grow old.  Ignorance remains a task in terms of acquiring the skills to combat and exploit technical change, including artificial intelligence.  Want has worsened since 2010, a permanent stain on the record of successive Conservative administrations.  There is a new giant of Pollution to be attacked.  And there is a new giant of Power, collected at the centre since the war by both parties, and now needing to be distributed to the localities in which the new sense of community is now flourishing, and more effectively devolved to the nations, where Labour urgently has to relaunch itself.

Above all we must revive and give purpose to the closing paragraph of the Beveridge Report: 

Freedom from want cannot be forced on a democracy or given to a democracy. It must be won by them. Winning it needs courage and faith and a sense of national unity : courage to face facts and difficulties and overcome them ; faith in our future and in the ideals of fair-play and freedom for which century after century our forefathers were prepared to die ; a sense of national unity overriding the interests of any class or section. The Plan for Social Security in this Report is submitted by one who believes that in this supreme crisis the British people will not be found wanting, of courage and faith and national unity, of material and spiritual power to play their part in achieving both social security and the victory of justice among nations upon which security depends.(para 461)

* https://www.theguardian.com/society/2017/oct/10/beveridge-five-evils-welfare-state

from David Vincent in Shrewsbury, UK: Staying alive

June 10.  If we are to learn the right lessons from the pandemic, it is crucial that we are careful with the meaning of words.

Monday’s Guardian carried a disturbing headline: ‘Epidemic of Loneliness’.*  This was a phrase much deployed in the public debate about loneliness in the years leading up to the present crisis.  It had two sets of meanings.

The first was a general metaphor.  It just meant that loneliness was a large and negative event.  If we say that someone received in an ‘avalanche of complaints’ we do not mean literally that they were covered in a mountain of rocks, just that they experienced a lot of trouble.

The second was more serious.  It was at the centre of an attempt to medicalise a social condition.  linking the experience to other crises such as smoking and obesity.  By this means the effect was dramatized, and campaigners hoped to appropriate longstanding concerns with major public health issues.

Critics were concerned about this use of language.  Whatever it is, loneliness cannot be caught by someone breathing on you.  It seemed an inappropriate descriptor before the present crisis, and now it would appear indefensible.

But in the Guardian, no less an authority than Professor Martin Marshall, President of the Royal College of General Practitioners, was cited as saying:  ‘The Covid-19 pandemic is also creating an epidemic of loneliness, not just for older people, and sadly there are some people who will fall through the net.’

The story was actually about the tragic discovery of individuals who had died alone, either of Covid 19 or of another condition for which in their lockdown they had failed to seek treatment.  A pathologist cheerfully described them as ‘decomps’, ‘people found dead at home after not being heard from for a couple of weeks.’

There are many ways in which ill health can be exacerbated by the experience of enforced and unwelcome solitude.  It is known that those living alone are less likely to seek medical assistance, even in normal times.  Associated forms of depression, or melancholy as it was once termed, can lower immune systems and increase vulnerability to a range of serious illnesses.  Conversely, various kinds of disability can have the effect of turning chosen solitude into an imprisoning loneliness. 

It might be expected that these interactions will increase the incidence and danger of loneliness in the present crisis, although there remains little quantitative evidence that this is happening on a significant scale.  The Office for National Statistics yesterday published its latest report on the experience of coronavirus in which it confirmed that the numbers ‘feeling lonely often / always’ in the lockdown remained at 5%.  As in earlier surveys, the old seemed more resistent to this condition than the young.**

With the total UK death rate now passing sixty thousand, lives will have been lost in every kind of social setting.  The evidence so far suggests that locked-down interiors, whether care homes or private residences, present the greater risk.  A recent Wall Street Journal analysis of the US population found that the virus had spread more widely in the most crowded households, irrespective of population density.***  .

When the final calculations are made, it is likely that those dying alone because they are alone will be far exceeded by those dying in company because they are in company.  Solitude has its compensations, and staying alive may be one of them

* Guardian, 8 June, 2020.

* Source: ONS survey of adults aged 16+, 3 April to 3 May.  https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/coronavirusandlonelinessgreatbritain/3aprilto3may2020

*** Ian Lovett, Dan Frosch and Paul Overberg, ‘Covid-19 Stalks Large Families in Rural America’, Wall Street Journal, June 7, 2022.

from David Vincent in Shrewsbury, UK: Lockdown Fortnight.

26 May. All of us are looking towards the future, seeking to understand how we can draw lessons from the crisis and build upon them.

This is my modest proposal.

From 2021 there shall be a legally-defined annual Lockdown Fortnight.

The Lockdown Fortnight will fall in the last week of June and the first week of July.  During that period, with exceptions listed below, every household will be required to observe full lockdown.

The Lockdown Fortnight will have four functions:

  • It will serve as a memorial for the tens of thousands who lost their lives in the 2020 UK pandemic, and for the health workers who risked their lives in supporting the afflicted.  Clapping is not enough;
  • It will serve as an annual reminder that we need to be prepared for the recurrence of a global pandemic. Countries, such as South Korea, that had an active memory of the SARS epidemic, were much better prepared for Covid19 than those without such a memory.  During the lockdown the government will be required to make an annual statement of preparedness;
  • It will create a pollution-free interval to remind us of what we have lost and have a right to regain;
  • It will provide a planned break from the distractions of late modernity in order that individuals recollect themselves and the importance of their immediate social networks (and also do the necessary home repairs that otherwise are left undone across the year).

Because it will be planned and of a fixed duration, the disorder and stress of the current crisis can be largely avoided. Before the Lockdown Fortnight, supplies can be purchased, encounters with family and friends can take place, hairdressers can be visited.  Any other practical difficulties can be borne for only fourteen days.

During Lockdown Fortnight, the only permitted movement will be such as can be conducted on foot, or on a bicycle (powered or otherwise).  The only long-distance travel will be pilgrimages to the shrine of St Cummings the Martyr in Durham (and/or Barnard Castle).

The Lockdown Fortnight will be timed for the period of maximum daylight in Britain. It will incorporate the May Bank Holidays which will be moved forward for this purpose. The school summer half terms will be extended to two weeks and also be moved to this period.

The event is partly based on the Potters Fortnight, which was still functioning when I started work at Keele University.  This was a relic of an industrial holiday, when the potbanks were shut for maintenance, and when, before the 1956 Clean Air Act, it was the only time when you could see across the city.

Exemptions to the Lockdown Fortnight will be:

  • Health and related workers, though A and E business may again decline if the pubs are shut.
  • Hospitality workers serving overseas visitors, who will be welcome to bring their currency to Britain and spend it at otherwise un-crowded hotels and bars (on production of a passport).   This will represent a temporary but annual reminder of what we have lost with Brexit-inspired hostility to all foreigners. Britons travelling abroad will have to leave and return before and after the lockdown.
  • Home-working will be permitted although no household will be allowed more than 10 hours video conferencing a week (5 work, 5 social).  Wherever possible factories should arrange their annual maintenance for this period (see Potters Fortnight above). 
  • Sporting fixtures will be closed (the football season will be over), except Wimbledon on the grounds that it provides televised entertainment for those in lockdown.

The Lockdown Fortnight would be disruptive, but perhaps we have learnt this year that unbroken continuity of event and practice can oppose wisdom and self-knowledge. There may be a small net hit on the national GDP, but everything now is a balance between cost and benefit. See above for the gains.

The regulations will be rigorously policed by the Priti Patel Compassionate Enforcement Agency.

from John in Brighton, UK: the debate of health v the economy

April16. As the debate of health v economy gathers pace I do support the current policy of maintaining the lockdown pro tem.  Maybe that reflects my background in health as opposed to business and economy which seems like a foreign land when people explain the intricacies of the economy. My level is that I have a certain income each month, certain outgoings and try to save a bit for the rainy day. Speaking of which, and I wouldn’t have said this a month ago when Covid first crossed The Channel, but perhaps our clap for carers could double as a rain dance for the weekend. But in the immediate notwithstanding my bias health would trump economy – every life saved spares families of the unthinkable grief, so well illustrated by some of the interviews we see on the news and we can always try and restore the economy to health in the months or years to come.

Nevertheless pent up in my South coast version of Wormwood Scrubs the recent warm afternoons have allowed my mind to drift into the sunlit uplands and reflect on whether we’ll be entering a different era. Above all will the pendulum that Margaret Thatcher swung away from the ethos of community and society swing back? It’s as if a genie has been let out of a bottle in the last few weeks and up and down the land people have grabbed the opportunity to do their bit – the Thursday clap, the NHS volunteers, communities looking after the old and vulnerable or the fundraising to name but four. Has there ever been a more extraordinary enterprise than 99 year old Captain Tom strolling in his garden aiming to raise a grand and this morning he crosses the twelve million mark and rising – all for the NHS?  It’s out of this World so with apologies to David Bowie perhaps I could plagiarise a few of his lines:

This is Captain Tom to Boris J

I’m stepping through the door

And I think my Zimmer knows what I must do

Tell the NHS I love it very much…

But here’s the crunch – is this a transient silver lining to a very black cloud or could it just be the beginning of a brave new world?  Will the moral compass swing along with Thatcher’s pendulum? Money will cease to be the benchmark of success and misguided lodestar towards bliss. Poverty brings misery but wealth won’t make you happy as my father taught me from a very young age. Instead we will focus on each other and the good of society now and the planet for the generations to come. Distinctly lacking in my view to date has been the role of politicians to lead by example – be it the dubious expense claims or the pay rises from which all other public servants are excluded there has been a degree of self interest and protection. So as primus inter pares we can look to Boris the bellwether – and perhaps his recent sojourn in intensive care might make him realise that the public services are a pillar of that society and deserve far more support than the Tories have offered to date. I don’t tend to gamble but I’ll stake a quid that he’ll be seen on the steps of Chequers this evening clapping away but more importantly will the tangible follow despite the enormous financial hit we are taking?  I’d love to be proved wrong but my glass is a little less than half full at present.

from David Vincent in Shrewsbury, UK: Borders

March 14. Every morning, I draw back the curtains in my bedroom and look across the Severn into Wales.  About six miles away, as the crow flies, there is a volcanic outcrop called The Breiddens in what was once Montgomeryshire and is now Powys.  On the summit of the hill sits Rodney’s Column, a forerunner of Nelson’s monument in Trafalgar Square.   It was erected in 1781-82 by the “Gentlemen of Montgomeryshire” to commemorate the victorious battles of Admiral Rodney.  The Admiral and I greet each other, and go about our day’s business.

The Welsh Border weaves through the Marches, the outcome not of rational planning but the bloody skirmishes fought in the Middle Ages.  If we drive north from our English home, we pass into Wales around Wrexham and then back into England as we approach Chester, once a Roman defensive outpost.  Shrewsbury is not only an English county town, but much the largest commercial centre between England and the Mid-Wales coast.  In the streets you hear Welsh accents, and from time to time a different language spoken by those who have travelled in for a day’s shopping.  The town’s railway station is the main hub for the otherwise fractured Welsh system.

People and cultures are irretrievably mixed.  I was therefore astonished to hear in last Wednesday’s government briefing a journalist ask the Minister whether the four nations of the United Kingdom would adopt different policies of social isolation when it came to relaxing the Coronavirus lockdown.  This would mean adjacent and interleaved communities pursuing different contact regimes.  The prospect seemed so insane that I expected an immediate denial.  None came.  This was presumably because earlier in the day the First Minister of Wales had been widely reported speculating on the policy he might adopt on this critical question, without any reference to what other devolved administrations might do.  He has the power to go his own way, and at present does not seem to be consulting with the English Government.  Today the Scottish First Minister, Nicola Sturgeon has announced that she may introduce her own scheme.   There is evidence that staff in the nations are now fighting each other for essential kit.  Welsh and Scottish care home managers have complained that their usual suppliers have told them that all their PPE stock was now earmarked for England.  Each administration has its own Chief Medical Officer (or did so until the Scottish official was forced to resign because she had twice visited her holiday home in defiance of the lock-down policy she herself had promulgated), and is running its own systems.  The NHS scheme for identifying the especially vulnerable that I discussed on April 6 I now discover applies only to England.  Were I living a few miles to the west, I would not be affected by it. 

Within England, the coronavirus has further exposed the incoherence of devolved power.  To the south of my home the newly created Mayor of the West Midlands has authority over regional transport but little else.  To the north the Mayor of Manchester actually has power over health provision, though it is too soon to know how well that is working.  The adjacent Mayor of Liverpool, on the other hand, is responsible merely for ‘leading the city, building investor confidence, and directing new resources to economic priorities.’  The new Mayor of Leeds, like the West Midlands, just does trains and buses. There is little sense of local ownership of medical services. The Strategic Health Authorities might have pulled an integrated regional policy together, but they were abolished in 2013.  It is now recognised that a reason why Germany has been so much better than Britain at developing coronavirus testing systems is that the Länder, whose identities in some cases pre-date Germany itself, had long built up effective networks linking public and private provision in their regions, which they were able to mobilise in ways in which Public Health England has conspicuously failed to do.  The ritual that has now been established of daily, London-based briefings merely accentuates the sense that everything that matters in terms of decision-making and public spending is based in the capital.

This crisis is placing all our systems under an unforgiving spotlight, not least the incoherent mix of centralisation and regional initiative that has built up in Britain.   This sense of impoverished local ownership and dislocated national devolution had much to do with Brexit, and is now being further exposed by the pandemic.