Social Distancing?

Let’s start with Penny’s niece, ‘A’, the in-patient nurse working in a mental health ward for older people, who she wrote about in her last post.  You’ll remember that she and her colleagues were not deemed to need testing, despite intimate work with very vulnerable, elderly patients, one of whom had tested positive for Covid-19. So she took the matter into her own hands.

The home testing kit she ordered arrived broken and useless, so she made an 80-mile round trip to a drive-in. This, by the way, not in some remote area, but in an urban setting where the number of new cases remains high. Her results came back negative.  A day later, another patient she’d been working closely with tested positive.  Anxious not to expose anyone to the virus, she did the drive again on Thursday in her time off.  On Friday, her results arrived – positive.  So she has now to stay at home, miss her work, and her grandfather’s 95th close family ‘garden birthday party’. 

You’ll note that this already isolated, exhausted and stressed nurse had to do all this to-ing and fro-ing in her own time, at her own expense, out of her own conscientiousness.  If she hadn’t, colleagues, patients and the friends and family she’d hoped to see in some time off, would all have been at risk of infection.

Next, our home town, Leicester. Re-locked down.  You can understand this in a number of ways.  It could, of course, be a sign that the national easing of restrictions came too early, or was communicated in too blasé a fashion, encouraging unsafe behaviour generally. If Dido Harding is to be believed, it’s a sign of the success of test and trace.  If our mayor is to be believed, it was weeks after the first evidence of the resurgence of the virus that he and our Public Health department got the data from Government and the testing service about the demographics, age and postcodes of those infected who represented our spike. Informed by such data, an early, targeted response could have made all the difference, but no…. 

Then there is education. The strategy for helping young people to continue with some kind of schooling, especially for supporting vulnerable children and families, has promised much and delivered little.  The much-vaunted supply of laptops and routers to help poor youngsters get on-line has been (very) much more gesture than reality.  Saying that schools should continue to be open to the most vulnerable children looks as if it’s been a mere slogan, given the absence of the skilled resources needed to engage with such families to facilitate attendance. A predictable failure. Instructions or plans about how to re-open schools have shown a dire absence of knowledge of basic facts like space and resources available, the condition of buildings, staffing numbers, the scale of the task of preparation, and the lives and routines, and the anxieties, of the parents. How many of our leaders have the slightest understanding of what life in ordinary schools is really like?

These stories bear witness to a number of issues.  First, of course, we must recognise that the working and social conditions of many have been, at best, neglected for a long time.  Life, even before the virus, was hard, and frequently unhealthy, for many, including lots of health and social care workers, the disabled and vulnerable. Inequality has risen for years:  and the numbers living in poverty – ‘absolute’ and ‘relative’ – have continued to be shameful. Black and minority ethnic communities represent a disproportionate number of people in all of those categories. Funding shortages in the NHS have affected all services, but especially mental health. The physical state of many hospitals and schools is, in many places, poor. The dismantling of localised public health and NHS laboratory services has crippled capacity and capability to engage with and address local health problems intelligently and effectively. The effects on social care and other services of a decade of devastating cuts to local government resources have made it horribly difficult to offer support for the vulnerable, or engage effectively with toxic social problems. The lack of adequate social, and affordable, housing means living conditions for many have continued to be dire.

An inescapable theme, running through these examples, and many other aspects of the response to Covid-19, is of a chasm between decision makers and the lived lives of the population – real ‘social distancing’ if ever there was.  This displays itself in so many ways.  The centralisation and rigidity of strategy and management of so many things, rather than engagement with, learning from, and empowerment of local authorities and communities is emblematic. Poor, or non-existent collaboration with representative bodies such as the Association of Directors of Social Services and teaching unions, deepens the trench between government and the nation. Awarding contracts for key services like test and trace to companies with no local links, no understanding, let alone the engagement and communication skills required to make it work, exacerbates the gap.  The failure to tailor and focus communication to diverse communities – whether to do with ethnicity, language, age, culture, lifestyle or living conditions – demonstrates a complete ignorance, or wilful denial, of the realities of the nation we live in. Over and over again, policies and strictures are announced with apparent obliviousness to the complexities of implementation, or to the fact that they are hard, if not impossible, for many to follow.

All this can be read as strategic and leadership failure – but it is also political.  It can’t be a coincidence that our prime minister is advised by a centraliser, contemptuous of civil and public servants, someone who believes he, and a chosen few, are the only ones intelligent enough to plan and deliver things. But it goes deeper, into party politics.  As an example, let’s return to Penny’s niece’s predicament, and bring to mind Bob Carter’s comment on her last post, referring to protection (including testing) for healthcare staff:

“Labour leader Sir Keir Starmer, alongside Dr Rosena Allin-Khan, Jon Ashworth and Liz Kendall brought a motion to Parliament calling on greater protective measures to be rolled out in the health system. But it was voted down by more than 300 MPs, including Jeremy Hunt who had called for a weekly testing himself on the same day.”

Social distancing should be a tool for everybody’s safety. It should not be a means for leaders to deny, neglect, and keep at arm’s length, the people, and the reality of our lives. Nor to marginalise what so many could contribute to the national effort. Churchillian calls for solidarity, and (often self-) congratulatory rhetoric by our leaders do nothing to build the collaborative social contract, reaching out to, engaging and empowering everybody, that will really bring collective effort to bear on managing Covid-19.

John

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