I’m left wanting to pick up a difficult issue in Chris and John’s blog on the harmful effects of Blame. Of course I understand that Covid-19 is beyond anyone’s control, that people were going to die however prepared and competent our leaders. I understand that our need to blame someone in these circumstances can make things even worse, that the short term sense of emotional release can stop us seeing that we are not always being as objective as we like to think, and that self-righteousness is deeply unattractive. I understand that blame can have a disabling effect, and that it is dangerous to disable our leaders in the middle of a crisis. But what do I do with my anger?
It would be easier if we had leaders who were capable of making a fulsome apology as Macron did in France, acknowledging that he had not been prepared enough. But just to shrug shoulders and suggest it’s easy to judge in retrospect, as UK ministers tend to do, is not sufficient. Assessing risk and taking appropriate measures to pre-empt and minimise the consequences of potential crises, is an important responsibility of government. The revelation this weekend that Government ministers had been warned only last year in a confidential Cabinet Office meeting that the UK needed a robust plan to deal with a pandemic virus, doesn’t come as a surprise because we have got tired of being shocked. The 2019 National Security Risk Assessment (NSRA) outlined several potential threats facing the UK and made recommendations on how to prepare for them: an influenza-type pandemic was top of the list. The report was signed off by Sir Patrick Vallance, the government’s chief scientific advisor but was, it would seem, largely ignored by ministers – so much for ‘following the science’. A report on the simulation exercise on coping with a serious virus pandemic in 2016 (known as Cygnus) has also never been published. Parts of it have been leaked and it is clear that recommendations were made about the need for more ventilators, protective equipment for staff and additional mortuary facilities.
It hasn’t always been like this. Throughout the noughties, when I was a clinical director, I was involved in both pandemic and terrorism local contingency planning meetings – and I was a mere psychiatrist! Apparently, such planning meetings have not been held for years. If austerity didn’t put an end to them, it was presumably Lansley’s 2012 Health and Social Care Act, which took Public Health out of the NHS and massively reduced its voice and resources. I remember those multi-disciplinary, multi-organisational meetings being surprisingly lively. A document would be drafted and presumably fed into a regional plan; but it was the process of bouncing ideas around that seemed particularly helpful. It is not so easy to have creative, emergent discussion in the heat of a real crisis when everyone is anxious. But these planning meetings meant that if a pandemic had hit ten years earlier, we would have had ideas at the ready and known who to contact in the various organisations across the city.
One important focus was how to make the most of local resources. The two issues that people are most angry about – and have been for weeks – are the lack of protective clothing for health and social care workers and the paucity of testing. The Government defend their poor record by pointing out that there are shortages across the globe. But like many people, I struggle to understand why it has been so difficult to sort out these problems more quickly, even given the UK’s unpreparedness. I live in Leicester, where there is a textile factory on every other street, many of them, I know, willing and eager to start manufacturing scrubs and gowns. I cannot begin to understand what the Government were doing making dubious deals with Turkey? And there are scientists in our universities, who offered to switch their labs over to testing for Covid-19 but received a bureaucratic response that went nowhere. Then we hear that the Department of Health (the Health Minister, Matt Hancock, is an economist by background) have put Deloitte, a private firm that specialise in management consultancy, tax and accountancy, in charge of scaling-up testing, which makes no sense at all – as hospital leaders have bitterly complained.
Like many doctors of my generation, it took this crisis to bring home just how profoundly re-structuring and cuts have down-graded Public Health and the career path for medics within this specialty. Chief Medical Officers (CMOs) in the past were usually drawn from people at the top of the public health profession – unlike the present incumbent. As a student, I was taught, enthused and inspired by Liam Donaldson, who was a lecturer in Public health in Leicester at the time. He went on to be CMO until 2010 and before that was Regional Director of Public Health in NE England. Public Health experts learn a broad mix of disciplines, including – I remember Donaldson telling us – the art of persuading Government what needs to be done.
These issues make me angry. And I’m only getting started! There are so many things to be angry about. In principle I’m as much for banding together in a crisis and dropping snarky party political point scoring, as the next person. But the level of incompetence shown by our leaders has been baffling at times. I can only hope the media, and the new leader of the opposition, continue to hold them to account and help me with some of the anger I’m feeling…….
But stepping back a bit: this morning I listened to a Talking Politics podcast where David Runciman interviewed Lucia Rubinelli, a Cambridge political scientist, talking about the situation in Italy where she is locked-down. The pandemic crisis in Italy is amplifying divisions – between north and south, rich and poor, and national and regional governments, for a start – and creating ideal conditions for a resurgence of the Mafia. On top of an already weak political and economic system, things could turn very ugly.
However angry, we need to remain civilised.
As a psychotherapist, I work daily with people’s anger, trying to foster a conversation where anger can be expressed safely. I know that anger cannot be short-cut. I know that putting pressure on people to repress or supress their anger can be damaging. I also know that anger can feed on itself and can become a defence against even more painful emotions.
Unfortunately, there is a fine line between justified, constructive and challenging criticism and dumping the blame; but a line there is and we need to try to stay on the right side of it.