CPRE- Responding to the ‘new deal’, we call for greater green ambition and share our vision

‘With road building at its heart, the PM’s “new deal” makes a mockery of the government’s so-called green recovery. At this historic moment, the government must show real ambition and build back better, not worse, and in doing so balance our health and wellbeing, nature and countryside and the economic recovery.’

Responding to the ‘new deal’, we call for greater green ambition and share our vision – CPRE, the countryside charity

1st July 2020 www.cpre.org.uk 

CPRE today sets out our vision to regenerate the countryside and ourselves – and says the government’s plans make a mockery of its ‘so-called green recovery’.

The PM’s ‘new deal’ speech came just a day before CPRE, the countryside charity, launches our own detailed ‘manifesto’ for a green recovery that can support the regeneration of the economy, our wellbeing and the environment. This vision urges the government to use this post-coronavirus moment as an opportunity for real change, laying out recommendations for ways to stimulate the economy while making life greener and more resilient for the countryside and its communities.

Amongst other key proposals, Regenerate our countryside, regenerate ourselves: A manifesto for a resilient countryside after coronavirus emphasises that our Green Belts, the countryside next door for 30 million people, and other countryside around large towns and cities, should see funding significantly increased to make sure they’re used better for people and to help mitigate climate breakdown. It also presses for the support of greener farming techniques that could make our food supply more resilient.

The recommendations in the CPRE manifesto, with their emphasis on sustainable, community-led development and progress, are starkly at odds with Boris Johnson’s proposed approach. Tom Fyans, our campaigns and policy director, said:

‘With road building at its heart, the PM’s “new deal” makes a mockery of the government’s so-called green recovery. At this historic moment, the government must show real ambition and build back better, not worse, and in doing so balance our health and wellbeing, nature and countryside and the economic recovery.’

A greener future – for everyone

The CPRE’s manifesto for a regenerated countryside, future and population is being launched with a virtual debate. Leading countryside and political voices including Philip Dunne MP, chair of the Environmental Audit Committee, Mike Amesbury MP, shadow minister for housing and planning and Caroline Lucas MP, former leader of the Green Party, are speaking at the event.

The manifesto calls for steps towards a resilient countryside with thriving rural communities. But, given the regenerative power of green spaces that became so clear during lockdown, we’re stressing the need for the countryside to be open to everyone, whether visiting, living or working there. This is especially pertinent in the light of the deep inequalities around access to the countryside that coronavirus highlighted.

‘… given the regenerative power of green spaces that became so clear during lockdown, we’re especially calling for the countryside to be open to everyone, whether visiting, living or working there.’

Natural England’s figures show that children from Black, Asian and minority ethnic (BAME) backgrounds are 20% less likely than white children to visit the countryside. That’s why our manifesto includes a call for every child to be guaranteed a night in nature in a National Park or Area of Outstanding Natural Beauty, as recommended in last year’s Landscapes Review by Julian Glover OBE.

Rhiane Fatinikun, founder of Black Girls Hike and a panellist at the launch, spoke to this element of our work. She said:

‘Representing people of all backgrounds in the countryside really matters … For too long I didn’t even think about connecting with nature, as if the countryside wasn’t for me.

‘Black Girls Hike was set up to change this. Creating a safe space with people who share your experiences, is refreshing but also essential for our wellbeing. We’ll continue breaking down the barriers to nature and the countryside in the hope that more black girls and people of all backgrounds follow us into the great outdoors.’

A ‘once in a generation opportunity’

At the event, CPRE president Emma Bridgewater summarised what we feel this historic moment can offer, and what we want to see for a green and inclusive future:

‘We’re calling on the government to seize this once in a generation opportunity to put the countryside and access to green spaces at the heart of the recovery. That means putting the Green Belt ahead of developers’ profit margins, guaranteeing children’s education includes quality time in nature and breaking down the barriers to the countryside for groups previously excluded.

‘But we also need to make sure rural communities don’t bear the brunt of the economic fallout by supporting the rural economy and investing in rural social housing. Only then can the government claim to be learning the lessons of lockdown and building back better.’

What a resurgence of Covid-19 around the world tells us about the risk of a second wave

Several countries around the world are already seeing a resurgence of cases, some more severe than the first.

But are they second waves, spikes or simply a continuation of the first wave? And what do they tell us about the likelihood of a second wave hitting the UK this winter?

By Anne Gulland and Paul Nuki, Global Health Security Editor, London www.telegraph.co.uk 

When the Spanish flu pandemic hit the world after the First World War it came in three waves, with the second being the most deadly.

And this is not an oddity. Of the last 10 big respiratory disease outbreaks, five have had significant subsequent waves, and four came after a summer trough.

“Influenza pandemics tend to come in three waves; a spring wave, followed by a severe winter wave and another spring wave,” says Prof Francois Balloux, an epidemiologist and director of the UCL Genetics Institute in London.

Sars-Cov-2 is not an influenza virus but a coronavirus. Nevertheless, it is droplet spread and Prof Balloux is not optimistic for the coming winter.

“To me, the most likely scenario for the Covid-19 epidemic is that there will be a winter wave in the northern hemisphere, which I expect could be worse than the spring/summer waves we’ve [already] experienced”.

Several countries around the world are already seeing a resurgence of cases, some more severe than the first.

But are they second waves, spikes or simply a continuation of the first wave? And what do they tell us about the likelihood of a second wave hitting the UK this winter?

United States – a failure of political leadership

The curve of the US outbreak has been described as a ski slope, with the number of new cases first climbing before plateauing and then steeply rising again.

On Wednesday the number of cases passed the three million mark, confirming the assessment by the leader of the country’s coronavirus taskforce, Dr Anthony Fauci, that the US remains “knee deep in the first wave”.

It is hard to see the US epidemic as caused by anything other than poor leadership. The US is one of the world’s richest nations with a highly developed public health infrastructure but it was slow to react initially and then too quick to open up.

Confused messaging from the White House has left some of the 328 million population terrified and others wondering if the virus really exists at all. Violence and protest caused by the killing of George Floyd will not have helped.

As the chart shows, the latest surge in cases is being led by fast-growing outbreaks across the sun-belt states, stretching from Florida to California.

The outbreaks are thought to have been led by younger cohorts, via parties, bars and restaurants. Poor and black and minority ethnic populations have been hardest hit and are grossly over-represented in hospital admissions, which have been rising sharply for over a week.

Experts say the delay between new cases and deaths will be greater than at the start of the pandemic because mass testing now means younger age groups are being detected earlier.

Nevertheless, Covid deaths – while still falling for the country as a whole – are now rising again in Florida, Arizona, Tennessee, Texas, South Carolina and Nevada.

Having failed to control the first wave of the virus, the US is likely to be in a poor position going into winter.

“Respiratory pathogens tend to be highly seasonal with a peak in winter,” says Prof Balloux, echoing the warnings of the chief medical officer for England, Prof Chris Whitty.

“Transmission is facilitated by low temperature/humidity, and maybe less UV light. Crowding indoors likely plays a role. Worse general health of the population might also play a role,” he says.

Australia – the first true winter wave?

The city of Melbourne has now gone into a fresh six-week lockdown after a spike of coronavirus cases, with a further 191 infections reported on Tuesday.

Australia had been hailed as a global success story in suppressing the spread of Covid-19 and even at the height of the initial outbreak it only reported a little over 600 cases a day.

The virus did not take hold at first because of quick shutdown measures, including border closures and the mandatory quarantining of travellers. By the end of May the country was reporting just a handful of new infections every day.

However, since the end of June the number of cases has started to rise in Melbourne, in the southern state of Victoria where it is now winter. As the chart shows, the area is now suffering a peak that is worse than its first.

Professor Raina MacIntyre, an expert in influenza and emerging infectious diseases at the University of South New Wales, said the situation was more serious than in late March.

“It is possible there has been seeding of infection to other states, and silent epidemic growth which has not yet been detected. I would not be surprised to see epidemics detected in New South Wales and other states within the next few weeks,” she said.

Prof Balloux said rising case numbers in Victoria provided “putative evidence” for a seasonal influence on the virus. The “apparent ‘winter wave’” would be in line with the “dynamic for seasonal influenza and other respiratory pathogens in the southern hemisphere”, he added.

Israel – the danger of opening up too early

On Sunday Israel’s head of public health, Dr Siegal Sadetzki, said the country was experiencing a second wave of Covid-19 after more than 977 cases were registered.

On Tuesday she resigned and was scathing of the government’s response, saying it had opened up too early, against her advice.

“The achievements in dealing with the first wave [of infections] were cancelled out by the broad and swift opening of the economy,” said Dr Sadetzki shortly after announcing her resignation.

Israel responded rapidly and successfully to control the virus in March, quickly flattening the initial peak with a country-wide lockdown. But its lifting of restrictions in May was equally rapid, some would say crude. At the beginning of June, the Israeli government put the “emergency brake” on the re-opening measures after schools appeared to spark a rise in cases. But it was too late and now the country has been forced back to square one.

Prime minister Benjamin Netanyahu is known as a man of action but not patience – and perhaps that is part of the problem.

“The pandemic is spreading; it is as clear as the sun,” Mr Netanyahu said on Monday. The country, he added, was “at the height of a new corona offensive”.

Iran – poor adherence to social distancing

Iran was one of the first countries outside Asia to be hit hard by the coronavirus and in total has had more than 240,000 cases and 11,000 deaths – although many believe this is an underestimate.

The virus peaked at the end of March when there were just over 3,000 cases a day but then began to fall to under 1,000 by the end of April.

In late April the country began a phased easing of lockdown and by the end of May the country was back to normal, with Iranians packing into shops, restaurants and onto public transport.

This reopening coincided with an increase in the number of cases, which peaked in early June, fell but then started to rise again.

On Tuesday a health ministry spokeswoman, Sima Sadat Lari, blamed the resurgence on people not sticking to social distancing and gathering in large numbers at weddings and other ceremonies.

On Sunday the country belatedly introduced mandatory mask-wearing but there are fears it may be too little too late.

Saudi Arabia – migrant workers, poor living conditions

The oil-rich Middle Eastern country is experiencing a second peak, with the number of cases climbing steadily up until mid May when they appeared to top-out at just over 2,800 a day.

They then fell before starting to rise again and peaking at 4,700 in mid June, although they have hovered around the 3,000 to 4,000 mark since then.

It’s unclear what is behind the country’s unusual epidemic curve. The authorities instituted a strict lockdown but the virus spread throughout the dormitories housing the country’s many migrant workers, who, according to Amnesty International live in crowded and unsanitary conditions.

The authorities insist it will continue with this month’s Haj – the annual pilgrimage to Mecca undertaken by millions every year – although in a much reduced version.

Japan – cluster busting

Japan – a country of around 125 million people – appeared to have escaped the worst of the pandemic and as of July 6 it had registered just under 20,000 cases and 977 deaths.

However, a spike in infections in Tokyo over the weekend – not enough to be described as a second wave – has sparked concern. Authorities reported more than 100 new cases on three consecutive days.

The spike is linked to the city’s entertainment districts, whose bars and clubs have been packed. Some 70 per cent of the new diagnoses are among people in their 20s and 30s.

The national government insists that it is not planning to reintroduce a state of emergency for the capital, with the previous restrictions on bars, restaurants, sporting venues and other places where large groups of people gather lifted after a month on May 25.

For the moment, it looks like Japan is simply fighting new clusters – in much the same way as we are in the UK. And it will be interesting to see if the packed bars and pubs seen in the UK last weekend will lead to a similar spike in cases.

How successful Japan’s cluster busting is will almost certainly determine our success in battling a second wave should it come.

Romania – health or the economy?

Like much of Europe Romania was hit hard by the pandemic in March and April when a strict lockdown was imposed on the country.

Cases fell and in May the government introduced a softer state of alert which is set to run until the middle of this month.

However, at the beginning of June the number of daily infections began to rise again and on Wednesday it recorded the highest number of new cases during the pandemic – 555.

President Klaus Iohannis said if the numbers continue to rise he may be forced to put the country back under lockdown but is wary of hurting the economy – a dilemma that many countries, including the UK, may face in the coming months.

What happens when the Rich take over a small West Country Town

The rise in house prices, estimated by the high-street estate agent Hunter French to have increased by a third in five years, has also angered local people who cannot afford housing.

 “It’s all fancy restaurants we can’t afford and every other house is on Airbnb for silly money.”

 

‘This isn’t really Somerset’: how the rich took over Bruton

“This isn’t really Somerset,” Jock Mendoza-Wilson says as he looks through an estate agents window on the High Street of the small town of Bruton, a few miles away from the site of Glastonbury festival in Somerset. “This is a microcosm of the poshest parts of London transported to one of the most beautiful parts of the country.”

The town, which dates to at least the Domesday Book of 1086, is back in focus this week as George Osborne, the former chancellor and editor-in-chief of the Evening Standard, has become the latest celebrity to move in, buying a five-bedroom Grade II-listed Georgian pile for £1.6m.

“Even before ‘gorgeous George’ decided to pop down, rich people from London have built a microclimate down here, and caused a real spike in prices,” says Mendoza-Wilson as he reels off the names of the other well-known figures who have also made the move west.

Sir Cameron Mackintosh, the musical theatre producer behind Cats, Les Misérables and The Phantom of the Opera, lives in Grade I-listed former Augustinian prioryfrom the 13th century on the outskirts. The fashion designers Stella McCartney, Alice Temperley and Phoebe Philo live in the town or nearby, as does the war photographer Don McCullin, and the filmmaker Sam Taylor-Johnson with her actor husband, Aaron.

The actor Rhys Ifans lives in the centre of the town near Caroline Corr, of the Corrs, and Dominic Greensmith of the rock band Reef.

The influx has led the town, which boasts two private secondary schools and a state boarding secondary school, to be labelled the “next Chipping Norton” and British Vogue called it “the new Notting Hill”.

Iwan Wirth and Manuela Hauser, the founders of global art gallery network Hauser & Wirth who are regularly described as “the most powerful couple in the art world”, moved to Bruton in 2007, selling their former home in Holland Park, west London, to the Beckhams for £30m.

The couple now own a farm, vineyard and hotel in Bruton, and in 2014 they opened a branch of the Hauser & Wirth gallery in converted barns overlooking the town. The gallery’s restaurant was so busy for lunch this week that those turned away from its patio tables were asked to wait 45 minutes for £18 steak salads and £15 miso roast carrots to eat takeaway in the car park. Many obliged.

Mendoza-Wilson, the director of investor relations for System Capital Management, a huge conglomerate owned by Ukraine’s richest man, Rinat Akhmetov, says famous and creative people have attracted each other to the town and created a “real buzz and energy about the place” that has pulled in the wealthy and driven up his house price “massively”.

Mendoza-Wilson’s boss has not bought into Bruton yet, but he could afford to buy the whole town. Akhmetov, whose fortune is estimated at £5.2bn, recently bought a €200m (£180m) villa in Saint-Jean-Cap-Ferrat on the Côte d’Azur to add to his portfolio, which includes a £137m flat in London’s One Hyde Park and the Ukrainian football club FC Shakhtar Donetsk.

Another billionaire, however, has bought into Bruton. In 2013 the South African internet mogul Koos Bekker and his wife, Karen Roos, a former editor of Elle Decoration South Africa, bought the Grade II*-listed Hadspen House, the seat of the Hobhouse family since the late 18th century.

The £12m house, which was said to have also been eyed by Johnny Depp, has been transformed into a £475-a-night country hotel and spa. Those with a smaller budget can pay £20 for a ticket to tour the gardens, which are being returned to their Edwardian glory by a team of 18 full-time gardeners. (If you like apples, it might be worth it as there are 267 varieties of apple tree.) There are also three restaurants, taking the number catering for a town with a population of less than 3,000 to six.

The latest restaurant to open on the High Street is Osip, run by Merlin Labron-Johnson, who at 24 became the youngest chef to win a Michelin star at his former London restaurant Portland in 2015.

Labron-Johnson, who has just arrived back in Bruton from his girlfriend’s house in London as he prepares to reopen Osip, says he was on the lookout for a new project outside London but had not considered Bruton until his financial adviser suggested it.

He moved last year and Osip, which he describes as “a tiny farm-to-table restaurant” with no menu, opened in November. Food is grown on the restaurant’s allotment, bought from local farmers or foraged from neighbours’ gardens in return for free meals. (The strawberries are from Mendoza-Wilson’s vegetable patch). Dinner costs £65 per person.

“I came to visit, and I fell in love,” Labron-Johnson says. “This is home now. I was slightly nervous that the locals would say: ‘Oh God, not another person from London doing a fancy restaurant’, but people have been really welcoming.”

While those who have also relocated from London have been welcoming, families who have lived in Bruton for generations complain that the “influx of those people from London” has pushed out cheaper restaurants and shops to make space to cater for the wealthy.

The rise in house prices, estimated by the high-street estate agent Hunter French to have increased by a third in five years, has also angered local people who cannot afford housing.

“Bruton is not for locals any more,” says Deborah Eaton, who is taking her grandson Jack and dog Chaos for a walk along the River Brue. “It’s all fancy restaurants we can’t afford and every other house is on Airbnb for silly money.

“It has completely changed – you used to walk from one end of the town to the other and it was nothing but shops. Now the Londoners are buying up all the shops and turning them into houses. My son can’t get anywhere to live. He’s in a tiny rental. The prices have got ridiculous.”

England faces “serious risk of running out of water within 20 years” – News from Parliament

www.parliament.uk 

COMMONS

10 July 2020

In a report published today, Thursday 9 July 2020, the Public Accounts Committee says all the bodies responsible for the UK’s water supply – Defra, Ofwat and the Environment Agency – have “taken their eye off the ball” and must take urgent action now to ensure a reliable water supply in the years ahead. It concludes that the Department for Food, Environment and Rural Affairs (Defra) has shown a lack of leadership in getting to grips with all of the issues threatening our water supply.

There is a serious risk that some parts of England will run out of water within the next 20 years. Over 3 billion litres, a fifth of the volume used, is lost to leakage every day: a situation the Committee describes as “wholly unacceptable”.

The report says Government has failed to be clear with water companies, privatised in 1989, on how they should balance investment in infrastructure with reducing customer bills, and says “ponderous” water companies have made “no progress” in reducing leakage over the last 20 years.

The committee calls for Defra to produce annual performance league tables for water companies; step up on promoting water efficiency and deliver an effective campaign for water saving.

Industry action has failed, says the committee and government needs to step in and substantially step up efforts to coordinate increased awareness of the need to save water.

Chair’s comments

Meg Hillier MP, Chair of the Committee, said:

“It is very hard to imagine, in this country, turning the tap and not having enough clean, drinkable water come out – but that is exactly what we now face. Continued inaction by the water industry means we continue to lose one fifth of our daily supply to leaks.

“Empty words on climate commitments and unfunded public information campaigns will get us where we’ve got the last 20 years: nowhere. Defra has failed to lead and water companies have failed to act: we look now to the Department to step up, make up for lost time and see we get action before it’s too late.”

Further information

Image: Unsplash

More news on: Parliament, government and politicsParliamentHouse of Commons newsCommons newsCommittee news

What might Boris Johnson’s restructuring plan mean for the NHS?

A planned restructuring of NHS England could have a significant impact on its architecture, its relationship with government, which NHS bodies are responsible for which issues, and the role – and future – of its chief executive, Sir Simon Stevens.

Denis Campbell www.theguardian.com 

Foundation trust hospitals

In 2002, Tony Blair instigated the creation of foundation trust hospitals in England, sparking a row with his party. The plan was to liberate the best hospitals from central government control and encourage them to compete with each other to provide better care. There are 217 NHS trusts in England, of which 150 are foundation trusts.

They were handed unprecedented freedom to set their own financial plans and decide clinical priorities. For example, while they can incur a deficit, non-foundation NHS trusts have to break even. They also have different governance arrangements.

Abolishing foundation trust status could hand the Department of Health and Social Care (DHSC) the sort of controlit has over non-foundation trusts, allowing the health secretary to be more directive and interventionist over how hospitals spend their money and the action they take to tackle waiting lists, for example.

Integrated Care Systems

Since Stevens became chief executive of NHS England in 2014, he has sought to unwind the fragmentation of the service’s set-up that was a legacy of the coalition’s Health and Social Care Act 2012. He set up 44 sustainability and transformation partnerships (STPs), one for each area of England. They are voluntary, informal groupings of different NHS trusts – those providing acute, community, mental health, specialist and ambulance services – and sometimes local councils too.

Eighteen of these STPs have metamorphosed into integrated care systems (ICSs), and the plan is for the remainder to follow suit. ICS members collaborate closely but the bodies currently have no legal standing. However, under plans being studied by Boris Johnson’s new health and social care taskforce, all ICSs could become legal entities. They may be given the responsibility and budgets – possibly running into billions of pounds – for tackling workforce, financial and waiting time problems across their region, rather than individual trusts each doing their own thing.

However, this would disrupt the existing NHS financial and accountability regimes because, as one senior NHS official said, “they would be powerful new beasts in the NHS jungle that everyone else would have to work out their relationship with”. There would be new power flows between the ICSs and national NHS leaders and they would drive forward the integration of health services, and potentially health and social care, that ministers, Labour, NHS bosses and patient groups all want to see.

Payment by Results

Currently, NHS-funded healthcare providers in England receive much of their income under a system called Payment by Results. Providers receive a standard payment under the NHS “tariff system”, which is a set of fixed prices that it will pay for treatment, such as a visit to A&E or a surgical procedure.

There is concern that Payment by Results encourages hospitals to treat patients who may benefit from another form of care, such as physiotherapy rather than a knee replacement, and runs counter to working together in the patient’s interest.

The new taskforce is considering replacing it with a system under which care providers, or groups of care providers, would be paid for entire courses of care rather than individual episodes. While this would not affect district general hospitals’ income significantly, it may be harder to apply to specialist hospitals such as London’s Royal Marsden cancer hospital, which take patients from far outside their areas, and ambulance trusts, which operate across STP/ICS boundaries.

National NHS organisations

There is frustration in Downing Street, the DHSC and the Treasury that some NHS bodies have not performed well during the Covid-19 crisis and need reform. It is an open secret in Whitehall that Public Health England, an executive agency of the DHSC and thus already under its direct control, will not survive in its present form as ministers blame it for the poor implementation of coronavirus testing and tracing. There is also frustration that Health Education England, an arm’s-length body, has not done enough to tackle NHS staffing problems that have left it short of about 100,000 personnel. However, it is not clear what new arrangements would replace the current setup.

Simon Stevens

In his six years as NHS England’s chief executive, Stevens has exploited the operational independence of the role thanks to the last Conservative shakeup of the NHS in 2012. Previously, he won plaudits for telling MPs publicly that Theresa May was “stretching” the truth when talking about how much money her government was giving the NHS. He has used his position to push ministers to take action on obesity, the gambling industry and – last Sunday on the BBC – social care. However, some ministers and aides in Downing Street resent Stevens’ past tendency to speak out, what they see as his “invisibility” during the coronavirus crisis, the independence he enjoys and what they portray as his lack of accountability for rising waiting times and hospitals ending up in the red. If the proposals that emerge from the taskforce limit his power, Stevens may choose to consider his future.

Boris Johnson plans radical shake-up of NHS in bid to regain more direct control

The prime minister has set up a taskforce to devise plans for how ministers can regain much of the direct control over the NHS they lost in 2012 under a controversial shake-up masterminded by Andrew Lansley, the then coalition government health secretary.

Any radical overhaul of the NHS is also fraught with dangers….

Denis Campbell www.theguardian.com 

Boris Johnson is planning a radical and politically risky reorganisation of the NHS amid government frustration at the health service’s chief executive, Simon Stevens, the Guardian has learned.

The prime minister has set up a taskforce to devise plans for how ministers can regain much of the direct control over the NHS they lost in 2012 under a controversial shake-up masterminded by Andrew Lansley, the then coalition government health secretary.

The prime minister’s health and social care taskforce – made up of senior civil servants and advisers from Downing Street, the Treasury and the Department of Health and Social Care (DHSC) – is drawing up proposals that would restrict NHS England’s operational independence and the freedom Stevens has to run the service.

In the summer, the taskforce will present Johnson with a set of detailed options to achieve those goals, and that will be followed by a parliamentary bill to enact the proposals, it is understood.

“The options put forward to the prime minister will be about how the government can curb the powers of NHS England and increase the health secretary’s ‘powers of direction’ over it, so that he doesn’t have to try to persuade Simon Stevens to do something,” said a source with knowledge of the plans. “[The health secretary] Matt Hancock is frustrated [by] how limited his powers are and wants to get some of that back.”

The proposed NHS overhaul comes amid plans for other significant reforms, including to the universities system and the military.

The coronavirus crisis and an 80-seat majority have made Johnson determined to act. There is ministerial frustration at the role some health agencies have played during the pandemic, notably Public Health England (PHE), and a desire to make permanent some recent changes in NHS working, such as different NHS bodies working closely together, and the huge increase in patients seeing their GP or hospital specialist by video or telephone.

Ministers are also keen to “clip Simon Stevens’ wings”, sources said. There is a widely held view in the government that he enjoys too much independence, and frustration that his arms-length relationship with the DHSC means that Hancock has to ask rather than order him to act. The Treasury in particular is irritated that NHS treatment waiting times continue to worsen, and many hospitals remain unable to balance their budgets, despite the service receiving record funding.

Dominic Cummings, Johnson’s chief adviser, is not a member of the taskforce but William Warr, his health adviser, is. It is chaired by a senior mandarin from the DHSC. Its remit also includes delivery of the array of NHS promises the prime minister made during last year’s election campaign.

The taskforce’s creation last month follows tension between NHS England and the health department over issues that have caused Johnson’s administration persistent problems, including testing of patients and NHS staff, and shortages of personal protective equipment. Sources close to the health secretary say he believes that Stevens has been “invisible” and unhelpful during the pandemic and is not accountable enough for problems such as patients’ long waits for care.

Under one option being discussed, ministers would use new NHS legislation to abolish the foundation trust status introduced by Tony Blair in the early 2000s, under which many hospitals in England enjoy considerable autonomy from Whitehall, as part of a drive to give the DHSC more control over the day-to-day running of the health service.

The taskforce is also examining whether to turn integrated care systems, which are currently voluntary groupings of NHS organisations within an area of England, into legal entities with annual budgets of billions of pounds and responsibility for tackling staff shortages and ensuring that the finances of its care providers do not go into the red. That would add dozens of powerful new bodies into the NHS’s already-crowded organisational architecture and raise difficult questions about the powers and responsibilities of individual hospitals and NHS England leaders.

The prospect of a radical restructuring of the health service has prompted warnings from experts that renewed upheaval could damage the government and destabilise the NHS. Richard Murray, the chief executive of the King’s Fund thinktank, said problems created by the Health and Social Care Act 2012 should caution ministers against a major overhaul.

“Any large-scale reorganisation of the NHS comes at a high price as they distract and disrupt the service and risk paralysing the system. The last major reorganisation came in the 2012 Lansley reforms. These proved hugely controversial for the coalition government but perhaps worse, they have not stood the test of time,” said Murray.

“The changes we see in the NHS now – towards better integration and working across the health and care system – have come despite the 2012 act, not because of it. They stand as a warning against large-scale change that tips the entire NHS into reorganising the deckchairs.”

A shake-up could create problems for Johnson, who has made support for the NHS a key part of his programme for government, Murray added. “To date, many of the promises the government has made – more nurses, GPs and other staff, a new building campaign – do confront the real challenges facing the NHS. On the contrary, while there is a case for targeted changes to legislation, no one asked for large-scale reform.”

The Conservative MP Dr Dan Poulter, a health minister in the coalition, said the 2012 act caused more problems than it solved. “It has resulted in health ministers now wielding little real control over the functioning of the NHS, and the Covid pandemic has crystallised the failure of many of the health system’s arms-length bodies to properly coordinate a rapid national response at a time of great crisis.

“The current structures are not fit for purpose as they focus on competition and not enough on the integrated approach to health and social care that is so badly needed by patients. We need to return to a more streamlined command and control structure for the health system that is more in keeping with [Nye] Bevan’s original vision for the NHS.”

But, he added, “whilst it may be needed, a radical overhaul of the NHS is also fraught with dangers. A focus on structural reorganisation could well result in a worsening of operational performance in the short term and would be all the more challenging during the current pandemic.”

At the request of the then prime minister, Theresa May, NHS England last year brought forward proposals to modernise the way it works, which were due to form the basis of an NHS bill. However, Johnson wants to take a bolder approach to reform than that contemplated by his predecessor.

Downing Street declined to discuss the taskforce or its plans for NHS reform. A spokesperson said: “This is pure speculation. As has been the case throughout the pandemic, our focus is on protecting the public, controlling the spread of the virus, and saving lives.”

NHS England declined to comment.

Covid-19 Mortality Analyses John Hopkins University of Medicine

Boris Johnson achieves world beating status on both metrics – Owl

coronavirus.jhu.edu /data/mortality

How does mortality differ across countries?

One of the most important ways to measure the burden of COVID-19 is mortality. Countries throughout the world have reported very different case fatality ratios – the number of deaths divided by the number of confirmed cases. Differences in mortality numbers can be caused by:

  • Differences in the number of people tested: With more testing, more people with milder cases are identified. This lowers the case-fatality ratio.
  • Demographics: For example, mortality tends to be higher in older populations.
  • Characteristics of the healthcare system: For example, mortality may rise as hospitals become overwhelmed and have fewer resources.
  • Other factors, many of which remain unknown.

This page was last updated on Friday, July 10, 2020 at 08:42 PM EDT.

Mortality in the most affected countries

For the twenty countries currently most affected by COVID-19 worldwide, the bars in the chart below show the number of deaths either per 100 confirmed cases (observed case-fatality ratio) or per 100,000 population (this represents a country’s general population, with both confirmed cases and healthy people). Countries at the top of this figure have the most deaths proportionally to their COVID-19 cases or population, not necessarily the most deaths overall.