Army, councils and Whitehall all given August deadline for new contingency plan, as ministers try not to be caught out

The head of the Ministry of Defence’s strategy and operations revealed that Downing Street has asked for tabletop exercises, simulating a combination of emergencies, to be carried out by army chiefs, Whitehall departments and local authorities by the end of August in order to prepare for the possible winter disaster.

The revelation underscores the strenuous efforts going on behind the scenes in Whitehall and in civil resilience forums across the country to prepare the UK for a second peak of Covid-19 infections and prevent the NHS from being overwhelmed.

It is in stark contrast to the Prime Minister’s public comments at his Downing Street press conference last week, in which he said it was possible the country could get back to normality by Christmas.

While local authorities have been given new powers to isolate sporadic outbreaks of Covid-19 and avoid a second nationwide peak in infections, the tabletop exercises involve planning for a reemergence of the disease across the country, together with the normal winter flu season which puts a strain on the NHS, the end of the transition period for Brexit on 31 December, which could lead to food shortages and queues at ports if there is no trade deal in place, as well as serious flooding.

Devastating floods hit the UK last winter, as well as in 2015/16 and 2013/14, and six of the 10 wettest years on record have taken place in the last 20 years.

Worst case scenarios

In evidence to the House of Lords public services committee, which is conducting an inquiry into lessons to be learned from the pandemic, Lieutenant General Douglas Chalmers, the head of military strategy and operations at the MoD, said the army was working with the new Joint Biosecurity Centre and Whitehall chiefs on planning for the worst case scenarios.

He said: “The [Covid-19] crisis is still very firmly with us, and definitely as we look towards the winter now, we know about the normal flu season … we’re obviously transitioning out of the EU, and we have our normal floods etc that come on.

“So we are looking at very heavily at how we do winter preparedness and we will support, because we run tabletop [TT] exercises very routinely, we will support some of the departmental tabletop exercising… in Whitehall and local resilience forums.

“No10 has been very clear those TT exercises need to be done by the end of August in order that we can learn from them and then act on some of those elements that have been brought forward.”

Lt Gen Chalmers said he hoped that the civil servants involved in those exercises would be kept in place for the winter because it was essential to “sustain the neural network”.

‘Terrible health outcomes’

In his evidence to the committee, former head of the Civil Service and Cabinet Secretary Lord Gus O’Donnell criticised the Government’s response to the pandemic, saying that there had been plenty of data but not enough analysis of that data.

He told peers: “I don’t think anyone can hide away from the fact that our health outcomes are terrible compared to the rest of the world. Part of the problem has been that we haven’t got the right people around the table at the right time.

“The Cabinet Office is very large compared to my day – if people think throwing people at this is the answer, then that clearly hasn’t worked.”

Lord O’Donnell said he was “really worried” that when the key decisions were made by ministers and scientists at Cobra “they only had half the story”. Ministers had a “fundamental problem” in that they “got the science but didn’t get the social science” and that the government introduced “one of the biggest changes to behaviour ever been brought about” in the lockdown without really understanding behavioural science, the crossbench peer said.

He said there was also a lack of “clear messages – if anyone knows what the clear message on masks is, please tell me”.

Lord O’Donnell added: “All those [Downing Street] press briefings with deaths in hospitals, they biased the whole thing towards hospitals, not care homes.”

Quadruple threat — The four potential crisis points

1. Second wave of Covid-19. The worst case scenario is that infections reach epidemic levels again across the country, putting serious strain on the NHS.
2. Serious winter flu outbreak. Each winter hospitals experience their busiest period because of flu, despite a nationwide vaccine programme. Flu kills around 8,000 people in the UK each year, but there were more serious flu seasons in the winters of 2010-11 and 2017-18.
3. Brexit. If no trade deal with the EU is in place by New Year’s Day, there could be food shortages, panic buying and queues at ports for goods coming into the UK.
4. Floods. Devastating floods hit the UK last winter, as well as in 2015-16 and 2013-14, and six of the 10 wettest years on record have occurred in the past 20 years. Last winter the military was brought in to help evacuate people from deluged homes and deliver food to stranded households, and at least 11 people died.

The committee also heard from Tracy Daszkiewicz, who was head of public health for Wiltshire during the Salisbury poisonings and was portrayed in the recent BBC drama on that crisis.

Ms Daszkiewicz, who is now deputy director of population health and wellbeing at Public Health England, told peers that she and her colleagues believed the novichok attack in 2018 would be the “biggest [crisis] of our career” adding: “Little did we know what 2020 had in store.”

Local Tories channel Trump in attempt to bamboozle over cuts to Devon’s NHS

A rather Trumpist email (sent to me by a concerned resident) appears to be a stock response being circulated to people contacting their conservative councillors about the service cuts being made to the NHS in Devon, as part of a government instruction to save over £400m by 2024.

The annual budget is £2.6bn.

It comes after a previous attempt to make significant savings to Devon’s NHS failed, partly because the government forced a £30bn ‘efficiency savings’ programme on the NHS nationally and reduced the annual increment from around six per cent in 2010, to around one per cent during the past decade.

The email from conservative councillors to concerned residents appears to be both an attempt to confound residents and at the same time disparage me.

The situation has arisen following a meeting of Devon County Council’s Health and Adult Care Scrutiny Committee on 12 March, where councillors received a presentation from Philippa Slinger, chief executive of Devon Together, on the county’s NHS’s precarious financial position and what measures were being taken to reduce spending, in order to break even by 2024.

I made a proposal at the meeting to suspend this requirement during the Covid19 pandemic to make these cuts, which was met with derision by conservative councillors.  Mrs Slinger herself also claimed there were no cuts proposed.

I replied that this was semantics and that most people would regard the list below as evidence of cuts.

My proposal was seconded by Martin Shaw but received no other backers, so it was lost. Instead, a proposal from the chair to bring the subject back to a later meeting, was supported.

At the meeting, Mrs Slinger made the following points in relation to what work (cuts!) needed to be done to get Devon’s NHS back on financial track:

• A reduction in agency staff
• More efficiency relating to the number of surgical procedures
• Reducing hospital lengths of stay
• Fewer admissions
• Reducing overnight stays after surgery
• Capping referrals
• Trying to source less expensive pharmaceuticals
• Reducing the cost of procurement, such as replacement hips
• Reducing the number of outpatient appointments by between 60 and 70 per cent
• Doing less work in the independent sector
• Reducing overseas recruitment
• Improving staff retention
• E-consultations in primary care (GP surgeries)

The presentation in the agenda papers also outlines the broad areas for action as the following:

• Address the challenges of increasing demand of hospital beds
• Transforming out of hospital care and integrating community services
• Reducing outpatient appointments by 30 per cent
• Consideration of creation of a major diagnostic centre in Devon
• Travelling further for planned care, such as a hip operation
• Widening access to online GP consultations
• New technology monitoring equipment supporting people to live independently in their own homes
• Support more people in their home and community and avoid urgent admissions to hospital
• Improving cancer outcomes
• Improving mental health services through a ring-fenced investment fund
• Shorter waits for planned care through protected capacity (capping referrals)
• Reducing health inequalities
• Setting minimum requirements for community based care to reduce pressure on emergency hospital services

……………………………………………………………………………………………………………………….

Here’s the email:

Dear

The CCG did not put forward any proposals to cut their budget by £400 million. The total NHS Budget in Devon is £2 billion. However, as made clear in their Committee documents, they are currently forecast to overspend that Budget by approximately £100 million a year if they take no action. What the CCG outlined to the Committee were indicative measures to try to contain that overspend and balance their books. That is totally different from cutting your budget by £400 million – THEY ARE NOT REDUCING THEIR BUDGET NOR HAVE THEY ANNOUNCED ANY PLANS TO DO SO.

 Philippa Slinger said very clearly – in plain English – at the meeting “there are not cuts.” Neither the Labour or Liberal Democrat members of the Committee supported Cllr Wright’s poorly worded and financially inaccurate and illiterate motion and if the concerns of xxxxx were true, then the Labour Party is in support of ‘£400 million of NHS cuts’ too!

 Actually the fact is, that during this pandemic the NHS and Devon County Council secured an additional 194 beds in Devon. There will be a further 120 beds in the new Nightingale Hospital, which the Government have confirmed will be used to help routine tests and scans, along with Winter Pressures this coming season and will be an enormous benefit to our NHS here in Devon. None of these improvements sound like cuts to me.

……………………………………………………………………………………………………………………

Here’s the speaker itemised webcast of the meeting. Item 7 – https://devoncc.public-i.tv/core/portal/webcast_interactive/455423/start_time/3226000

Here is the relevant agenda paper. Item 7: https://democracy.devon.gov.uk/documents/s30199/long%20term%20plan.pdf

And here’s the additional paper. Item 7: https://democracy.devon.gov.uk/documents/b12111/Long%20Term%20Plan%20Presentation%2012th-Mar-2020%2014.15%20Health%20and%20Adult%20Care%20Scrutiny%20Committee.pdf?T=9

Here’s my blog post following the meeting: https://claire-wright.org/devon-scrutiny-councillors-vote-down-proposal-to-suspend-nhs-cuts-requirement/

Local leaders and directors of public health are demanding more control over the tracing operation amid concerns that their ability to contain the virus is being put at risk.

Data obtained by the Guardian shows that in areas with the highest infection rates in England, the proportion of close contacts of infected people being reached is far below 80%, the level the government’s scientific advisers say is required for test and trace to be effective.

In Luton, which has the sixth highest infection rate in England, only 47% of at-risk people were contacted by test and trace. In Leicester, which remains under a partial lockdown, the rate was 65%, meaning more than 3,300 people were not reached by the programme.

Directors of public health have expressed frustration that local expertise has been sidelined under the centralised test-and-trace system, which has been handed to private firms such as Serco and Sitel.

More than 5,500 people in four areas with the highest infection rates in England were not contacted when they should have been told to self-isolate, the Guardian has learned. These included 3,340 people in Leicester, 984 in Kirklees, 759 in Rochdale and 448 in Blackburn with Darwen.

The government’s Scientific Advisory Group for Emergencies (Sage) has said that 80% of an infected person’s close contacts must be contacted and told to self-isolate within 48 to 72 hours for the national programme to be effective.

In Blackburn with Darwen the figure was 54%; in Leicester 65%, in Rochdale 66% and in Kirklees 77%.

Bradford council, which has the fourth-highest infection rate in England, declined to provide a figure but said “a high number of contacts” in the city were not traced by the national system.

A council spokeswoman said it was asking the government “to allow us to set up a local extension to the national test-and-trace system which would enable us to follow up uncontacted data with door-to-door visits, something which no national system can really do.”

Gerry Taylor, Luton borough council’s director of public health, said she was “very concerned” at the low rate in the Bedfordshire town. She said the centralised system was “too remote” to be able to reach all of its communities.

“Clearly 47% is too low. The bulk of the contact tracing feels somewhat distant from us and working more closely together with the national system I think would be a huge advantage,” she said.

Local leaders say they have the community links and relationships to hunt down the virus at street level, thereby plugging holes in the centralised system.

Factors including language barriers, distrust of unknown callers and missed emails could explain the low contact completion rate in the worst-affected towns, where in some cases the virus is disproportionately affecting people of south Asian heritage.

Under the current system, contact tracers attempt to reach close contacts of an infected person by text, email or up to 10 times by phone call.

Kate Hollern, the Labour MP for Blackburn, said the national test-and-trace system had failed. “People are out there spreading the virus unknowingly due to this government failure. The responsibility and resources for this should have been with local government, who have the local knowledge. It’s a complete shambles and we really need to get control of it.”

Lisa McNally, the director of public health at Sandwell Council in the West Midlands, which has the ninth highest infection rate in the country, said that last week only 40% of positive coronavirus cases in her area had been contacted by the national system. She said she asked the government for more data so those people could be traced locally but was told it was not possible.

A Department of Health and Social Care spokesperson said: “NHS test and trace has already helped test and isolate more than 180,000 cases – helping us control the spread of the virus, prevent a second wave and save lives. This represents 81% of close contacts identified by those who test positive.

“The service is working closely with local authorities across England to help manage local outbreaks. High quality data is critical to providing good public services and we’ve been providing increasingly detailed data to local directors of public health, helping them tackle local outbreaks and control this virus.”

Since launching on 6 July, the Covid Tracker app was downloaded 1.3m times in eight days – the fastest-downloaded app per capita in Europe – and has started picking up cases of infection.

“We’ve been delighted by the take-up rate. It’s gone beyond the initial hopes,” said Colm Harte, the technical director of NearForm, the company that made the app for the Health Service Executive (HSE).

The app uses a phone’s Bluetooth signal to exchange a digital handshake with another device also running the app when users come within 2 metres of each other for more than 15 minutes. The anonymous keys are stored in a log on the phone, which health authorities may ask users to upload if they are diagnosed with Covid-19. The log can then be used to track unnamed contacts, who are alerted about possible infection.

NearForm made a similar app for Gibraltar, which launched last month, and one for Northern Ireland, due to launch within weeks. “It’s the same core platform. It’s built on the Irish solution,” said Harte.

“An Irish solution to an Irish problem” is a derisive term in Ireland for attempted fixes that are daft or quixotic. In this case, though, there seems no need for self-deprecation.

Ireland has made a tool against the pandemic not only for Ireland but for part of the UK and for a British overseas territory – while Britain flounders in its own attempt to produce an app.

The NHS Covid-19 app was meant to roll out in England in May. That slipped to June. Last month, officials ditched the app in its original form and backed an alternative designed by Apple and Google. The government said it might launch in winter.

The Irish are not crowing. Authorities originally hoped to launch the app in March, only to encounter complications. And its effectiveness remains unclear. “It still has to prove its mettle,” said Seán L’Estrange, a social scientist at University College Dublin who has studied tracing.

Even so, the take-up rate is impressive, said L’Estrange. “What that shows is the credibility of the app, the confidence in the initiative, and the enthusiasm for participating in the collective project to contain the virus.”

The €850,000 (£773,000) price tag is “dirt cheap” given that the average cost of identifying each case of infection is €42,000, said L’Estrange. “Even if it fails to produce the goods, little has been lost.”

This suggests Ireland’s health system, plagued in normal times by bloated management, turf battles and duplication, can do well in a crisis.

“The whole of the organisation attuned itself and focused on coronavirus,” said Fran Thompson, a HSE spokesperson. The pandemic allowed the HSE to shortcut the regular tender process and select NearForm in mid-March. “It probably saved six to eight weeks,” said Thompson.

NearForm employs 150 people and builds software mostly for private clients. It is based in a former council office in Tramore, a seaside town in County Waterford, but has international pedigree, with developers scattered across 21 countries. Clients include Condé Nast, Intel and Microsoft.

Following Singapore’s lead, NearForm’s developers raced to build a centralised app that used smartphones’ Bluetooth connectivity to trace people who come into close contact with infected people.

By April, they had a version but were struggling with Bluetooth. It worked with Android but Apple’s iPhone operating system sent apps to sleep when unused and Bluetooth could not activate them.

“We quickly hit the same problems as other countries,” said Harte. A centralised system also raised alarms about storing data and breaching privacy.

Then Apple and Google came together and offered an app that would support public health apps and let Android and iOS phones connect even while locked. Their decentralised version held no data in a single official database, alleviating privacy concerns.

The Irish were among the first to grasp Silicon Valley’s offer in late April. “We got in early and it was full steam ahead. It allowed us to move on,” said Harte.

Britain, meanwhile, persisted with attempts to make a customised app until last month when it made a U-turn and embraced the model preferred by Apple and Google.

NearForm claims to be the only company to have built apps with interoperability across borders and jurisdictions – Northern Ireland and the Republic of Ireland, and Gibraltar and Spain.

Using the same source code and supplier should facilitate a coherent all-Ireland response to the pandemic – a decision that raised no political problems at the Stormont assembly.

Thompson credits Ireland’s fast take-up rate to the population’s trust in government, desire to do the right thing and good user experience based on consultation and behavioural research.

Big questions hang over the app. How many people are using it correctly? Will downloads hit 2.2m to reach 60% of the target demographic? Will public transport and other settings sabotage Bluetooth’s accuracy? How many people will be notified and tested that otherwise would have been missed?

Stephen Farrell, a computer scientist at Trinity College Dublin who has studied contact-tracing technology, said the app’s impact on the pandemic may remain unclear. “I’d not be surprised if we never end up with a definitive answer to that.”