Julie Wintrup (Policy Officer, and Co-Campaign Coordinator with Mark Beach) said of the consultation process: “It’s been very different this year. In 2018, our submission ‘Tackling Health Inequalities’ was the result of meeting in groups, debating health policy, and challenging each other’s ideas. This year, we’ve been unable to meet, and online forums aren’t everyone’s cup of tea. It’s been a frightening and emotional time; we know many members have struggled and remain worried about work insecurity and family needs. Sadly some have been bereaved”.
So as an Executive Committee, we decided to put our energies into addressing the question: What lessons can we learn from the Covid19 crisis to ensure our health and social care services are better prepared for the pressures they will face in the future?
Why is this so important to us?
Labour is the party of the NHS. Yet during coronavirus we have had to stand by while the effects of a decade of neglect in health services became painfully obvious, and while social care was sacrificed for political expediency. We have had to witness the mistakes made by Boris Johnson’s government, and see the UK experience the highest death rate in the world. So far we have seen more of our health and social care workforce lose their lives at work than any other country in the world except Russia, according to Amnesty International.
Containment of the pandemic is becoming the responsibility of Local Authorities and local lockdowns are taking place daily. Government’s ‘world-beating’ Test and Trace system is failing, having been outsourced to private companies, and many local authorities have been forced to begin their own programmes. Keir Starmer has said government must up its game urgently, warning there are only five weeks left to prevent a second wave.
“Our Conservative-dominated Council’s enthusiastic embrace of austerity means local services are already pared to the bone”, Julie said. Having been on the receiving end, she is particularly concerned about its defensiveness and partisanship when challenged: “It’s difficult in a safe Tory seat to know how to make a difference. But local authorities have been vested with powers and responsibilities unimaginable a few months ago, and we know West Berkshire Council well. Many long-serving councillors have recently made costly errors and destroyed local amenities – only to wash their hands of responsibility and move on. As Labour members we must work together, and use all the means available to us to hold our councillors to account”.
We consider the Covid19 crisis to have shown us:
1. That investment in the nation’s health and care is not only a moral obligation but good economics.
Outsourcing essential care to the voluntary and charitable sector while defunding the NHS and slashing central government grants to Local Authorities, is both harmful to the health and wellbeing of the population and bad economics. Austerity opened to the door to the normalisation of food banks, inescapable poverty, rough sleeping and exclusion from work and society. The Covid19 crisis provides government with another opportunity to remove entire treatments or services from the public sector, as the NHS is reframed as a Covid-service. We must be ready and organised locally to prevent a race to the bottom, further outsourcing of jobs and services to often inept private companies, and the inevitable cuts to less visible/non-emergency health/social care services.
We are concerned in particular about Local Authorities and their ability to cope, already chronically underfunded and in debt. Already most have pared to the bone funding for the residential care sector, children’s services, domestic violence units, addiction services and mental health provision and other grants to local charities that support the most at risk. In its letter to the Commons Health and Social Care Select Committee, some weeks ago, the Kings Fund reported that as well as across the board suspension of non-Covid health services, “seven local authorities have triggered emergency powers under the Coronavirus Act to scale back their legal duties to provide care, faced with unimaginable increases in demand and workforce shortages” (Kings Fund, 14 May 2020). As a party we should be ready to articulate and evidence the degradation of local public services and welfare, and the resulting long-term human and economic costs.
We have also learned that our health and care professionals and support workforce can work fast, safely, creatively and expertly to reorganise entire admission and treatment processes, to create new care pathways, to utilise equipment in new ways etc, to treat a new disease, alleviate symptoms and to save lives. We must not allow oppressive cultures that have been reported in the past in health services to stifle the ingenuity and interdisciplinary collaborations of our health and social care workforce. As well as liberating their potential and valuing their skills, ensuring the long-term health and wellbeing of an exhausted and traumatised workforce must be our priority.
2. That trust and respect urgently need to be rebuilt between government, politicians and citizens.
Public health has been defined as society’s efforts as a whole to improve the health of the population and prevent illness (Nuffield Council on Bioethics, 2007). To do so, and in particular to limit the spread of infectious diseases, local public health teams depend on public trust and cooperation. This means trust in government’s intentions, its competence, its health information messages, fair application of its rules, and its use of our sensitive personal data. The Association of Directors of Public Health UK said on 18 May 2020: “that honest and open dialogue with their communities is integral to effectively containing COVID-19 and managing outbreaks”.
In opposition, alongside challenging and exposing government when it falls short, we need to rebuild trust in all these same ways: through our Labour Councillors where possible and through active engagement with health communities, providers, commissioners, local authorities and quality monitors.
3. That those most at risk from Covid19 require higher levels of support to stay in employment safely.
Whether because of ethnicity, a long-term health condition, disability, age, occupation or living arrangements (etc.), or a combination of factors, some people are at a greater risk of death or long-term health impairments from Covid19 infection. We cannot wait to discover the reasons for the heightened risks and often extended health complications facing these groups and individuals, although doing so is also a priority. We need to prioritise protecting their ability to stay in work, and urge government to respond quickly and in a variety of ways to do so; for example, to enable prolonged shielding, self-isolation, working from home, furloughing, help with practicalities outside of the home etc. This is vital as the Resolution Foundation found that loss of work hours and job losses are “much more common” for those already earning the least (Resolution Foundation, 16 May 2020).
4. That being at risk requires well-researched risk assessment for participation, not exclusion from society.
Covid19 has exposed the deep inequalities in our society. Social sciences research is needed alongside the biomedical, psychological, epidemiological and statistical research being foregrounded if risks related to ethnicity, occupation, housing, gender, class and income (etc.) are to be properly interrogated, understood, and in time mitigated by new practices in the community, welfare services and workplaces. The Independent Sage committee is structured to reflect this broad interdisciplinary research approach and has offered a much more compelling vision of the scientific contribution.
Focusing only on acute physical illness and hospital services, while necessary during the height of the pandemic, risks ignoring the intersectional and structural nature of poor health and reduced life expectancy. We are particularly concerned about the new needs of people with long term conditions and existing mental health conditions, including those who will develop serious problems related to the pandemic, fear of infection, lockdown and isolation.
5. That General Practice and Local Authority Public Health Departments should be leading on local Test, Trace, Isolate and Support implementation.
Local health systems should not be replaced by private companies and we must expose government’s appalling waste of public money on failed contracts. In the absence of a vaccine, we must learn how to live with a level of health surveillance we are unused to and that will remain unwelcome. The least unwelcome and most trusted will be our local general practices and Public Health teams, who should be central to finding, testing, tracing, isolating and supporting individuals. They already have the skills and information, know our health and possibly our social circumstances. We trust them with our personal data already and are more likely to trust an extended local team who would follow up during the necessary isolation. The principle of stewardship in public health offers a holistic, sustainable approach to protecting the health of the most vulnerable in society while seeking to close the gap between the most and least healthy in society (Nuffield Council on Bioethics, 2007). Investing in our local general practices and public health teams would also see wider health gains. Yet we understand local teams are not even receiving the correct data and information from government.
We must learn how to do Test, Trace, Isolate and Support programmes properly. Government says 80% of those infected must be found and isolated if the infection is not to spread, yet 75% of all infections are currently missing from government reported figures (Independent Sage committee, 9 June 2020).
‘Call-centre’ track and trace staff employed by a private companies are less likely to be trusted with our personal data and those companies are less well-placed to report accurate data than our existing NHS and local authority Public Health teams. Private contracting flies in the face of the stewardship approach and will inevitably waste public resources.
6. That health and social care are open and interdependent systems, and as such must work cooperatively to control the spread of infection.
The safety and care standards of each, rely on the safety and care standards delivered by the other. We therefore need excellent local coordination and the highest standards of infection control – including cleanliness, reliable sources for PPE, effective education and training, and adequate time built into working hours – resourced and implemented routinely, across health and social care, wherever people attend, are cared for, or receive treatment. This includes community/home-visiting practices and pharmacies, and some educational and recreational services.
Competition and short-termism prevent such cooperation and introduce risk, leading to lower standards, shortages and further outbreaks. The pandemic has shown that working across agencies need not be as difficult as we have made it in the past. Richard Humphries said that the pandemic had seen “superb examples of joined-up working across the NHS and local government, with imaginative efforts to support the workforce  suddenly  able to quickly remove obstacles in areas such as information governance that for years have bedevilled integration” (The Kings Fund, 3 April 2020). Good governance remains essential – but we must learn from these positive lessons that old habits and unhelpful divisions have no place post-Covid19 if the health and wellbeing of all citizens is our priority.
Submitted to the NPF on June 30 2020 by Julie Wintrup