By: HANNAH CALLER and ROBERT CLOUGH
The decision by the Tory government to ease the lockdown from 11 May demonstrates both its contempt for working class lives and its lack of any consistent strategy for dealing with the coronavirus pandemic. The track and trace app with supporting contact staff, supposed to be in place at the beginning of June, will not be fully up and running until at least the end of the month. Supplies of personal protective equipment (PPE) are still inadequate; testing is a fraction of what it needs to be to suppress the virus. Britain has the most deaths in Europe and is second only to the US, the direct consequence of Tory government incompetence. Now, forcing people back to work merely risks a new spike in both infections and deaths. HANNAH CALLER and ROBERT CLOUGH report.
As at 28 May, the total number of government recorded Covid-19 deaths across England stood at 33,710, with a further 2,304 in Scotland and 1,307 in Wales. But these figures are incomplete: on the same day, NHS England stated that the number of hospital Covid-19 deaths stood at 26,235, while outside hospital, 12,120 care home residents died of Covid-19 between 11 April and 22 May alone (Care Quality Commission). The Office for National Statistics estimates that there have been up to 60,000 excess deaths over the period which may be attributed to the virus. During the pandemic peak between 8 and 11 April, 860 patients a day were dying in hospital (five-day rolling average); the figure on 11 May was still 192 (135 on 28 May). Despite the falling number of Covid-19 hospital patients, Intensive Care Units (ICU) are estimated to be running at up to 150% of their pre-pandemic levels.
When Prime Minister Johnson announced the lockdown changes, the so-called R ratio, the rate of infection spread, was still perilously close to one across England with the exception of London. Above one and the epidemic will resume its exponential spread. The figures for positive tests the government publishes on a daily basis do not reflect the true spread of the virus. For instance, an ONS pilot survey estimates an average 60,000 new infections a week over a 3-week period starting 27 April, double the official number of 85,000 positive cases for the same period. The Kings College mobile phone app, which claims 3.7 million users, is in broad agreement with the ONS survey, estimating that there are still 70,000 new infections a week.
Government incompetence
Dealing with this sort of pandemic is first and foremost a public health issue. The guidelines issued by the World Health Organisation for controlling communicable diseases are clear: it requires case finding, contact tracing and testing, isolation and quarantine where necessary. This demands clear government direction and meticulous work on the ground supported by adequate resources. At every point, the Tory government failed. By mid-January hospitalisation figures in China showed the seriousness of the virus, with a third of patients needing intensive care. But Prime Minister Johnson missed five Cobra emergency meetings between January and mid-February. On 25 February, the government said it was ‘very unlikely’ that the virus would spread to care homes; the next day Johnson announced a ‘herd immunity’ strategy. When it was shown that this would lead to up to 500,000 deaths, the government had to change course; nevertheless on 2 March Johnson boasted ‘we are very, very well prepared’. Two days later, the government suspended publication of daily infection rates but had to restore them after it was clear it was trying to cover up for the accelerating spread of the virus. Public events were allowed to continue with Johnson claiming that banning events such as the Cheltenham Festival on 16-19 March would have little effect on the spread of the virus; four days after it ended, the lockdown which he had fought to avoid started. Over a three-week period from 26 March the government missed four opportunities to join a joint EU procurement for PPE. On 1 April, the Evening Standard revealed that a mere 0.17% of NHS staff had received a coronavirus test; two days later, the hospital death toll exceeded that of China. On 21 April the government failed to reach its target for face masks for NHS staff as would-be manufacturers were met with silence in their application to join a government scheme. Two days later, the government announced testing kits for 10 million key workers; only 5,000 were available.
The decade-long assault on the NHS has made matters worse. The 2012 Health and Social Care Act removed public health management from the NHS in England and placed it under the direct control of the Department of Health. Much of the NHS’s public health resources were then divested to local authorities which became responsible for improving public health. Although public health funding was ring-fenced, the 2020/21 allocation of £3.3bn was £1bn short of what was needed to keep pace with inflation and population growth.
Testing shambles
On 12 March, without explanation, the Department of Health stopped the PHE programme of testing and contact tracing, although it was not difficult to fathom why – there were not enough tests available. By 5 May, Britain had the lowest testing rate in Europe, 10.13 tests per 1,000 people at which point Italy’s rate was 32.73, Ireland’s, 31 and Germany’s, 30.4. The government failed to meet its self-imposed target of 100,000 tests a day by the end of April and only met it nine times in the following 20 days. Numbers were inflated by counting the nasal and throat swabs on a single person as two tests rather than one. The government set up a privatised programme managed by Serco and Deloitte to run 50 testing centres and three new processing laboratories. The simpler solution, to use GP practices to do the tests and existing hospital laboratories to process the results was not considered. The result? 50,000 tests had to be sent secretly to the US for processing, making them clinically useless. There is no strategy: the system that the government has established is arbitrary and individualised, does not support any local contact tracing and does not target those most at risk, and is still insufficient for testing at-risk NHS staff.
Field day for private companies
The pandemic has been a bonanza for private companies. Since the start of the pandemic, state bodies have awarded at least 177 contracts worth £1.1bn to commercial firms. 115 of those were awarded under the fast-track rules bypassing competitive tenders. These private companies have got the contracts without the need to bid for work. Accountancy firms Deloitte, PricewaterhouseCoopers and Ernst&Young are among the beneficiaries. Health Secretary Matt Hancock has accelerated the transfer of public health duties to the private sector. Serco has now got the deal to supply 15,000 call handlers for the proposed tracking and tracing operation who are expected to work a six day, 42-hour week on the minimum hourly wage of £8.72. Staff on this poverty pay are nonetheless expected to be ‘passionate about…delivering an outstanding customer experience’ and ‘a great communicator…who wakes up every day wanting to exceed client and customer expectations.’ (Job advertisement in Preston)
Ministers have bypassed normal tendering processes and given contracts to private companies and management consultants without competition. Covid-19 drive-through testing centres, the purchasing of PPE and the building of the Nightingale Hospitals have all involved commissions to Deloitte, KPMG, Serco, Sodexo, Mitie, Boots and the US data mining group Palantir. The Department of Health has instructed NHS trusts to stop buying their own PPE and ventilators and use centralised procurement run by a private consortium. This has already hit problems, requiring the transfer of NHS procurement staff to make it work. Such lucrative deals, made with no public scrutiny, transparency or accountability, will inevitably mean public money is wasted on overpriced equipment or substandard services. Randox, a healthcare firm which employs Conservative MP Owen Paterson for £100,000 a year, was awarded a £133m contract by the Department of Health to produce Covid-19 testing kits.
The pandemic has revealed the parlous state of NHS hospitals, the result of chronic underfunding over the past decade of Tory-led governments. The outcome is the worst performance against the A&E 4-hour waiting time target (68.6% in January against 95%) with Secretary of State Matt Hancock suggesting it should be abolished; 4.5 million people waiting for routine elective care; just over 80% waiting less than 18 weeks for their first appointment (target 92%). These cuts mean that Britain has 2.8 doctors and 7.8 nurses per 1,000 people, compared with OECD averages of 3.5 and 8.8 respectively; there are 100,000 staff vacancies in the NHS in England including 45,000 nursing vacancies.
In 2011 the Influenza Pandemic Preparedness Strategy warned of the need ‘to increase capacity of these [critical care] services’, and the government was warned again in 2016 after Exercise Cygnus concluded that there was a severe shortage of PPE and ventilators and poor preparedness for a flu pandemic. This report was covered up. When the pandemic struck, hospitals had to effectively split themselves in half overnight by turning one part into a separate infectious disease hospital and more than double their high dependency (HDU) and critical care (ICU) capacity; reallocate a huge proportion of their staff, retraining nurses into HDU/ICU roles; obtain where possible extra respirators and ventilators as well as virtually non-existent PPE. Inevitably tragic mistakes were made: thousands of patients were hurriedly discharged into care homes, among them Covid-19 sufferers who had not been tested and thereby initiating the huge surge in care home cases and deaths; the completely inadequate testing of NHS staff meant that hospital-acquired infection became a serious problem, with unofficial reports suggesting that it may have amounted to between 5% and 20% of Covid-19 hospital patients.
Capitalism divides us
Covid-19 is not the great leveller as the Tories claimed. Lockdown of any degree is harder in small, overcrowded, badly-maintained housing. Food bank usage doubled in the first two weeks of lockdown with almost 40% of children in Britain living below the poverty line. Covid-19 and lockdown cause collateral damage affecting the most vulnerable, the young and the elderly, children and adults with learning difficulties and those with mental health problems. Men and women working in social care, including care workers and home carers, have significantly higher rates of death involving Covid-19 than those of the same age and sex in the general population (23.4 deaths per 100,000 for men care workers compared to 9.9 per 100,000 in the general male population). The highest death rates are among low-skilled workers such as security guards and taxi drivers (45.7 deaths per 100,000 men and 36.4 deaths per 100,000 men respectively). The risk of Covid-19-related death for BAME men and women is 1.9 times that of white men and women after taking into account age, other socio-demographic characteristics and measures of self-reported health and disability.
Test, test, test and trace
The Tory government is directly culpable for the deaths of tens of thousands. It has delayed decisions, it has demonstrated continual and almost unbelievable levels of incompetence in the management of testing, in the procurement and distribution of PPE kits, in its declaration that care homes would be adequately protected against the spread of the virus, in its total lack of planning in relaxing the lockdown, in its disregard of the lives of teachers and education staff as it drives to re-open primary schools. As it once again plays with the lives of working class people, we have to support any movement which demands the basic steps to protect our lives: universal planned, organised and systematic testing of the population; planned, organised and systematic contact tracing; maintenance of quarantine conditions where needed; requisitioning of food supplies to ensure the poor do not suffer from hunger; a planned system for producing and distributing PPE to all at risk workers; and full employment rights for all workers who refuse to work in unsafe conditions.