Don’t wait for virus cases to appear in Hospital – go out looking for it!

“Given that we still face months of potential chaos and damage, we have to understand why the government keeps ignoring well-established principles of good practice, and why it is willing to hand over contracts to companies such as Serco rather than involving local public health systems from the outset. This is not a case of mistakes being made. Instead, the government’s contact tracing shambles suggests something more troubling: a disdain for evidence, an obsession with centralised control, and the privileging of private over public interests.”

Why we got test and trace so very wrong

David McCoy is a professor of global public health and director of the Centre for Public Health at Queen Mary University of London www.theguardian.com 

Most people agree that England’s handling of the Covid-19 crisis has been slow and disorganised; a fact made worse by the government’s willingness to squander public trust by massaging data and spinning the facts to save face. Yet its shambolic approach to testing and contact tracing isn’t the result of mistakes, but a choice to ignore evidence and experience.

For months, public health specialists in England have asked the government to decentralise responsibility for testing and tracing to local authority public health teams, which can develop nimble and responsive plans that are specific to different contexts, and organise systems with clear lines of accountability. They have also asked the government to recognise the obvious fact that case detection and contact tracing are social and behavioural interventions, which rely on skilled personnel and trust.

Take the detection of coronavirus cases – a fundamental part of preventing the spread of the disease. Because speed is critical, we can’t passively wait for people to present themselves at a drive-in centre for testing. We need to actively look for people across the population who may be infectious and encourage them to be tested. The sooner cases are identified, the quicker they can be quarantined, and the fewer contacts there will be to trace. This is why countries such as Singapore and Taiwan implemented rigorous screening programmes in airports. They didn’t wait for the virus to appear in a clinic or hospital – they went looking for it.

Testing is particularly important with coronavirus, because many people have mild or no symptoms. Actively detecting new cases through testing also allows public health authorities to visibly demonstrate the importance of vigilance, and provides an opportunity for frontline health workers to engage with communities. Ideally you want to target communities or population groups who are at risk of either getting a severe infection, or transmitting the virus to others.

In Vietnam, screening programmes initially targeted incoming passengers at airports who had to agree to a temperature check, and fill in a form giving their contact details and travel and health history. These measures were then extended to anyone entering a major city, government building or hospital. Anyone with suspicious signs or symptoms, such as a temperature over 38C, was taken to a medical facility for thorough testing. Accessible testing stations were also set up across cities, while banks and apartment complexes established their own screening procedures. Likewise, Germany developed an aggressive case-detection strategy, testing anyone with symptoms and using a public information call centre to direct people to nearby local testing centres.

You also need a well-trained workforce, able to engage with people on a human-to-human basis, with some epidemiological and clinical knowledge. Because testing results aren’t always correct and can be delayed, sometimes a presumptive clinical diagnosis – of the sort a trained health worker can provide – is necessary. And when a case has been identified, information needs to be carefully gathered and assessed to determine the likely period of infectiousness, identify high-risk contacts (those who have had close and prolonged interaction, especially in a confined indoor space) and then formulate a tracing plan. Conversations need to be empathic and culturally sensitive, and conducted in the right language.

In Vietnam, teams of professional health workers, supported by civil servants and other recruits, delivered a programme of case detection, contact tracing and quarantine enforcement that was pivotal to bringing the virus under control. Kerala state in India is another success story: it acted quickly to minimise the spread of the virus by screening people in airports, seaports and railway stations. Kerala’s extensive community-based primary healthcare workforce helped to identify suspected cases and followed this up with nuanced conversations about the risk of spreading the infection to others. Because capacity was limited, testing was directed primarily at those with symptoms.

The workforce needs to be trusted, as well as skilled. Contact tracing involves sharing and divulging sensitive personal information about other people, some of whom will be subsequently inconvenienced by having to go into quarantine. People are more likely to cooperate and adhere to required behaviours if instructed by someone they trust who is clearly working in their interest. In Kerala, citizens trusted the state’s visible public health leadership and its decentralised health system (every town and village has a primary health centre, which has strong links to local communities).

For some reason, these basic principles eluded policymakers and public health professionals in England. Where Germany worked through a set of 400 decentralised teams, we decided to centralise our operations, a mistake that was compounded by decoupling testing from contact tracing, and then made worse by outsourcing both testing and contact tracing to private sector companies. The government also fixated on a mobile phone contact tracing app before properly establishing a human-driven and people-centred testing and contact tracing system.

Given that we still face months of potential chaos and damage, we have to understand why the government keeps ignoring well-established principles of good practice, and why it is willing to hand over contracts to companies such as Serco rather than involving local public health systems from the outset. This is not a case of mistakes being made. Instead, the government’s contact tracing shambles suggests something more troubling: a disdain for evidence, an obsession with centralised control, and the privileging of private over public interests.

 

Tory councils warn coronavirus second wave could bankrupt local authorities

A group of Conservative-run councils has told ministers that a second wave of coronavirus would leave them with a multibillion-pound budget shortfall, triggering a wave of insolvencies and forcing a fresh round of emergency cuts to local services.

Patrick Butler www.theguardian.com 

The County Councils Network (CCN), which acts for 39 of the biggest English authorities, said that even without a resurgence of Covid-19, they face “large scale reductions in services this year” unless ministers agree to a long-term bailout plan.

It called for a government-backed “income guarantee” to underpin council finances over the next five years, as well as short-term emergency funding to keep authorities afloat as they struggle with declining council tax income and rising social care costs.

The financial impact of Covid-19 pressures “may lead to a significant number of councils being forced to consider whether a S114 notice [a statement of effective bankruptcy] is required,” a CCN-commissioned report said.

The findings will increase pressure on ministers to agree to a further funding measures to stabilise English councils, which collectively estimate shortfalls of around £9bn this year as a result of pandemic costs and income losses from local taxes and charges.

Although the government injected £3.2bn of pandemic emergency funds into local authorities in two tranches in March and April, councils said that money has run out and that many are currently running on “fresh air”.

The CCN is said to carry weight in Whitehall because its members provide local council services in around two-thirds of all Tory-held constituencies, including in home counties heartlands such as Kent, Surrey, Buckinghamshire, and Hampshire.

Housing and local government minister Simon Clarke told MPs earlier this week he was “working closely with cabinet colleagues on a comprehensive plan to ensure councils’ financial sustainability over the financial year ahead”.

Asked by Labour MP Kate Osamor whether councils should prepare for a second wave of austerity cuts to enable them to balance their budgets, Clarke replied: “The answer to that question is unequivocally no, they should not.”

However, several councils have started to plan emergency cuts to stave off bankruptcy. Wiltshire county council last week said that a £50m shortfall caused by extra pandemic costs had put it at “significant risk and threat” of collapse, while Luton borough council has warned of £22m cuts.

Manchester city council is to hold an emergency budget next month after saying that a £133m shortfall leaves it with “difficult choices”. Stevenage borough council last week agreed an emergency budget to freeze short-term spending after estimating it faced a £6m shortfall.

The report by consultants Grant Thornton modelled three scenarios that leave the 39 CCN member councils with a collective shortfall of between £2.5bn and £4.5bn by April 2022, depending on whether a Covid-19 second wave leads to a second lockdown.

It found member authorities will have fully exhausted their financial reserves within 18 months under current projections, leaving many unable to fulfil their legal duty to balance their annual budget and vulnerable to insolvency.

Many councils would have little scope to find further cuts because a decade of real-terms funding reductions “has left most councils with significantly fewer options to drive out further efficiency or to make cuts to front line services”, the report said.

Cllr Carl Les, CCN finance spokesperson and leader of North Yorkshire county council, said: “This research shows the challenges facing county authorities and the severity of the potential impact on councils’ sustainability.”

Devon is waiting: our health and social care system at the mercy of national incompetence – a report from Health Scrutiny

A report by County Councillor Martin Shaw (from his blog)

Devon is waiting: our health and social care system at the mercy of national incompetence – a report from Health Scrutiny

Posted on  Updated on 

image-4

Exeter’s Nightingale Hospital – still on track for completion.

I attended (virtually) Devon’s Health and Adult Care Scrutiny Committee yesterday, the first meeting since the pandemic began.

The overall picture: things moving too slowly (which has cost lives), mainly because at every stage the local situation has been dependent on the deeply flawed national response.

Here are my key takeaways (and some of my inputs):

  • Devon’s overall death toll is lower than the national average – but we still have had more deaths in Devon than they’ve had in Australia and New Zealand combined.
  • The care home death toll (half of all deaths) is less would be expected given the community infections. This suggests that the County Council’s big operation to support care homes may have helped. But in March, Devon NHS still followed the infamous national directive to discharge hospital patients into care homes without testing. It is likely that this helped cause some outbreaks.
  • Only when I pressed was there any acknowledgement of possible failings in the early part of the pandemic. Due to technical problems, the committee failed to hear Dr Cathy Gardner’s contribution about care homes in the public consultation session, although it was read out late in the meeting. I have published it here.
  • Devon leaders have been arguing with other local government leaders for more local management of the crisis (as I and others were arguing in April) and this has influenced Government policy for the next phase of the pandemic.
  • Although Devon is a ‘beacon council’ for the new tracing system which was supposed to be running by June 1st, we are still waiting for it to kick in. It sounds more likely to be August than July before it is fully functional.
  • So although we now have very few cases of Covid-19 in Devon, and are at the stage where (in theory) we could effectively track, trace and isolate any new cases, we can’t actually do that – we are in limbo … .
  • The big takeaway of the pandemic for the CCG is the advantages of e-consultations with both GPs and hospital consultants. While recognising that they can indeed help all concerned, I questioned (in the light of complaints made by constituents) whether they might not also exclude some people, and said research was needed on how they affected access to services. I worry that the shift to e-consultation might have contributed to the drop in demand for urgent non-Covid services, which may cause people to miss out on crucial treatments.
  • I pressed on the need to separate care homes from clinical provision, and for regular testing of people coming into care homes, as well as staff and residents, to enable family visits to resume. I was assured that work on these issues is in progress … but yet again it depends considerably on national guidelines.
  • It is recognised that the provision of services (and the Devon NHS Local Plan) will need to be revised in the light of the pandemic experience and post-pandemic challenges. There was a lot of emphasis in the papers on doing things locally … we didn’t get to discuss this, but this will be a big issue over the coming months.

 

Latest news on Public prosecutor faces legal action over Cummings’ Durham trip

A judicial review is being sought over the failure of the director of public prosecutions, Max Hill, to investigate Dominic Cummings for alleged breaches of the coronavirus lockdown rules.

The complaint has been lodged on behalf of a member of the public, Martin Redston, who is concerned the DPP has shown insufficient independence from the government over the movements of Boris Johnson’s key adviser.

Matthew Weaver www.theguardian.com 

Redston’s legal team, headed by the barrister Michael Mansfield, gave Hill a deadline of last Thursday to state that the Crown Prosecution Service (CPS) was actively considering the case against Cummings.

On Tuesday, after the deadline had passed and Hill’s office said it was a police matter, Redston’s lawyers began proceedings in the high court to seek an urgent judicial review.

The grounds for the filing noted that the attorney general, Suella Braverman, had tweeted her support for the prime minister’s chief aide, without allowing due legal process to take place, on the day after the Guardian and Mirror revealed Cummings’ trip to Durham during lockdown, and before they reported his trip to Barnard Castle.

It said: “There is a lack of an appearance of independence to the decision-making of the DPP which arises from the scheme of subordination of the DPP to the attorney general.”

The grounds for the action also noted that Hill refused to disclose any communication he may have received from Johnson, his ministers or officials over the Cummings affair. It said: “The manoeuvres of the government and use of its powers behind the scenes is of obvious concern given the history of the this high-profile case.”

It said the DPP had a duty to take “active steps to ensure the maintenance of public confidence in accountability to, and enforcement of, the law that is designed to protect the public from the ongoing threat of Covid-19”.

A statement from Redston’s lawyers, Hackett & Dabbs, said: “The DPP has failed to exercise his discretion to refer the matter to the police on Mr Redston’s request. Consequently there has been a failure to engage with the need for public confidence to be restored: the law applies to everyone.”

Redston told the Guardian: “I feel this is a matter of public concern especially now that people are using the ‘Cummings defence’ to do whatever they like during the pandemic, after previously complying with the regulations. This is not a political action. It is about ensuring that the law is upheld.”

Redston, who runs a London-based civil and structural engineering business, added: “People will say: ‘You’re a Guardian reader you would do this’, but 71% of the population believe Cummings breached the regulations. And quite a number of Conservative MPs are also unhappy.”

Asked if he could afford the cost of a legal action, Redston said: “It is expensive but we can afford it.” He is also seeking crowdfunding for the challenge.

A CPS spokesman said: “Investigations into alleged criminal conduct are a matter for the relevant police force. This application for judicial review will be contested and in those circumstances we cannot comment further.”

Earlier this week, Nazir Afzal, a former regional chief prosecutor, announced he had joined a separate legal campaign for a new investigation into Cummings’ trips.

Afzal said that if the CPS and the police did not investigate he would consider launching a private prosecution on “behalf of every citizen whose goodwill and generosity led them to make painful sacrifices in order to comply with the law and protect their fellow citizens”.

Afzal’s older brother Umar died of coronavirus on 8 April while self-isolating at his home in Birmingham. At that time Cummings was in Durham, 264 miles from his London home.

A three-day investigation by Durham police into Cummings’ movements found he probably breached health protection regulations when he took a 52-mile round trip to the town of Barnard Castle, County Durham, with his wife and son on her birthday.

But the force decided to take no further action and made no finding in relation to “stay at home” government guidance over Cummings’ decision to leave London for Durham.

[Owl notes that Redstone’s funding campaign has not yet reached the levels of Dr Cathy Gardner’s, the level needed to go to go all the way]

“Changing of the Guard” at East Devon District Council – Act V – the final Act

(Or how the Conservatives with only one third of the Council seats tried to retain power for ever and ever. A comic tragedy in five parts.)

Extraordinary Virtual meeting of Council, Council – Wednesday, 24th June, 2020 6.00 pm

Readers may recall that Conservative Cllr and Council Chairman “We plan anywhere” Stuart Hughes took the opportunity provided by a change in legislation by the government to prematurely cancel the annual council meeting. This decision has created the need for five extraordinary general meetings at a time of crisis to do the same business (the five acts in this comic tragedy). 

Act I – where a meeting had to be held to decide to have a meeting to vote a new Leader.

Act II – where the meeting to elect a new Leader crashed when Conservative Cllr. “expletive deleted” Tom Wright swore on open mic causing You Tube to pull the plug with only a few votes left to be cast. (Someone has to play the role of wicked uncle).

Act III – where Cllr Paul Arnott and Cllr Eileen Wragg were elected Leader and Deputy Leader.

Act IV – where Cllr Cathy Gardner and Cllr Val Ranger were elected Council Chairman and Vice Chairman.

Act V – where the council will consider Governance Arrangements and committee appointments for the remainder of the Civic Year (2020/21) [The key appointments directing the way ahead]

‘Bleak future’ for council as funding fears mount

WARRINGTON Borough Council risks not being able to set a balanced budget next year – if the Government fails to reimburse it fully for coronavirus costs.

Owl doubts that any council has been allocated enough funds to cover local cost. A pandemic needs to be managed locally, not remotely from Whitehall. Is “Three homes” Jenrick tone deaf?

By Aran Dhillon, Local Democracy Reporter www.warringtonguardian.co.uk 2-3 minutes

It was allocated around £11.1 million out of the Government’s emergency £3.2 billion for local authorities.

However, the Labour-run authority expects costs and loss of income due to Covid-19 to total around £51.5 million.

The council’s cabinet noted the financial risks facing the town at its virtual meeting on Monday.

Deputy leader Cllr Cathy Mitchell said: “There are obviously risks to the setting of the budget for the next financial year.

“The full impact of Covid is not yet known and will be assessed in more detail in July’s cabinet report.

“Much of it will depend on if, when and how the Government responds to the funding gap which is being faced by local councils all across the country.”

Leader Cllr Russ Bowden also expressed fresh fears over the situation.

He said: “It is not just about increasing costs, it is also the impact that It is having on traditional sources of income, not least which is obviously business rates.

“The council faces a very bleak future, I think, as do councils across the country, if the Government doesn’t meet and match its word and commitment it gave to councils back in March.”

Last month, the Government unveiled plans to provide thousands of long-term, safe homes for vulnerable rough sleepers taken off the streets during the pandemic.

Robert Jenrick, secretary of state for housing, communities and local government, said that by accelerating plans for the £381 million announced for rough sleeping services in the budget – now extended to £433 million – that the funding will ensure that 6,000 new housing units will be put into the system, with 3,300 of these becoming available in the next 12 months.

On Monday, Mr Jenrick confirmed the Government was publishing new guidance for its £3.6 billion towns fund.

In a tweet, the Tory politician added: “My department is leading efforts to revitalise our local economies, with a collective determination to realise Britain’s enormous potential.”

East Devon ‘public health issue’ fears as council is urged to free clean-up cash & reopen more toilets

New Council facing baptism by fire (or even something worse) –  No doubt the Tories will forget the “Boris Blunders” and criticise any emergency expenditure from now on – Owl

“District council chiefs have been urged to unlock £62,000 of East Devon clean-up cash and reopen more public toilets – or face a ‘public health issue’.”

Virtual Cabinet Meets tomorrow, Thursday 18 June at 5.00 pm

East Devon Reporter eastdevonnews.co.uk 
The authority’s cabinet has been told that people are relieving themselves outside locked loos and in bushes following a ‘significant’ increase in visitor numbers.And a depleted workforce is struggling to empty overflowing bins and pick up litter, it has been warned.East Devon District Council’s (EDDC) cabinet is being asked to reinstate the StreetScene team’s agency budget for the summer when it meets on Thursday (June 18).

The seasonal sum for street cleaning was set to be saved as the authority faces a £5.3million deficit due to the coronavirus crisis.

Images of overflowing bins and rubbish strewn on Exmouth seafront are featured in the report to East Devon District Council's cabinet. Pictures: EDDC

Images of overflowing bins and rubbish strewn on Exmouth seafront are featured in the report to East Devon District Council’s cabinet. Pictures: EDDC

Images of overflowing bins and rubbish strewn on Exmouth seafront are featured in the report to East Devon District Council's cabinet. Pictures: EDDC

But in a report to cabinet members, service lead Andrew Hancock says: “It is now clear that we cannot maintain the required standards or keep bins emptied without using this budget.

“Using the agency resource will allow us to keep beaches, parks and streets clean in the face of increased demand, restoring staffing to our normal levels.”

Five options for reopening more East Devon public toilets – and their cost implications – have also been outlined.

Mr Hancock adds: “Not keeping up with levels of demand has been directly evident in recent weeks and we have witnessed a significant increase in visitors to our seafronts.

“The teams who are operating at 20 per cent less capacity due, to shielding and vulnerable workers being absent, are really struggling with the basics of emptying seafront bins, litter-picking the beaches and clearing up side waste – where people have kindly litter-picked.

“Without capacity and resource to clear side waste, we are experiencing the waste being attacked by seagulls, resulting in even more work for our depleted operatives.

“On a normal summer day during the school holidays, our operatives would empty the bins three times per day, with occasional evening bin runs when very busy.

“Visitor numbers over the past few weeks have meant that our operatives are emptying bins at least five times per day, and even this is not enough.”

Images of overflowing bins and rubbish strewn on Exmouth seafront are featured in the report to East Devon District Council's cabinet. Pictures: EDDC

Images of overflowing bins and rubbish strewn on Exmouth seafront are featured in the report to East Devon District Council’s cabinet. Pictures: EDDC

Images of overflowing bins and rubbish strewn on Exmouth seafront are featured in the report to East Devon District Council's cabinet. Pictures: EDDC

Ten East Devon public toilets – in Axminster, Budleigh Salterton, Beer, Exmouth, Honiton, Seaton, and Sidmouth – were reopened daily, from 8am to 4pm, in late May. The district’s 16 other loos reman shut.

Mr Hancock’s report adds: “The problem of public toilet availability is compounded by cafes and pubs not providing facilities.

“Even when hospitality reopens, it’s likely it will not be as simple as it was for people to access private sector toilet facilities.

“The risk of not opening the existing ten toilets longer, or opening more toilets, is one of public dissatisfaction as well as public health.

“People are relieving themselves outside of closed facilities and in bushes around our parks and beaches. If this persists or gets worse, it could create a public health issue.

“Not having enough public toilet facilities when high streets reopen will also create a reputational risk and a risk that people don’t have adequate toilet facilities when out.

“Both could have a detrimental impact on high streets re-opening safely and on our areas economic recovery.”

OPTIONS FOR EAST DEVON PUBLIC TOILETS
(With costs for the nine months until March 2021)

Option A

Increase the opening times for the existing ten public toilet sites from 8am to 8pm at a cost of £71,043.

Mr Hancock says that this is the ‘most affordable’ option and gives more access to loos than some neighbouring districts.

Option B

Reopen toilets at Cliff Path in Budleigh Salterton; the Magnolia Centre in Exmouth; Phear Park in Exmouth; and Market Place in Sidmouth.

This would see 14 public conveniences available from 8am to 4pm at a cost of £53,282.25.

Option C

Extend the opening hours of the existing ten toilet sites from 8am to 8pm and add the additional four conveniences mentioned in Option B at a cost of £124,325.

Mr Hancock says this is the ‘most sensible’ option, however, it would incur a ‘significant cost’.

An alternative whereby toilets are closed at 5pm in the winter would cost £76,962.

Option D

Open all of the public toilets that are currently closed from 8am to 4pm daily at a cost of £213,135.

Mr Hancock says in his report: “It is felt that Option D is financially unviable, given that the total public toilet budget is currently £732,320 excluding depreciation and the council’s in-year deficit is around £5.3million due to Covid-related impacts.”

Option E

Reopen all toilets but revert back to normal cleaning standards of one per day and top-up visits.

Mr Hancock says: “We have not gone into detail on this option as we believe it does not follow government guidance and does not take reasonable steps to protect the public and reduce the risk of viral transmission in our facilitates.”

 

EDDC [previous administration] had earmarked its StreetScene seasonal budgets – totalling £133,000 – as ‘not to be used’ this financial year to help plug a budget deficit caused by Covid-19. This includes £62,000 for ‘cleansing’ and £71,000 for ‘grounds’.

It has been recommended that cabinet members allow the £62,000 to now be used for StreetScene to ‘meet statutory responsibilities’ over street cleaning.

Members will also decide whether to pursue one of the options over the reopening of more toilets.

An ‘extensive communications effort’ is also proposed – where town and parish councils could be asked to contribute to the costs.

Councillors are also being asked to approve a long-term review of public toilets, ‘taking account of the new normal’.