It’s getting darker

While worst case predictions suggest up to 120,000 more UK Covid deaths this winter, we face a dangerous co-morbidity: the virus and politics.  Of course politics has infected our response to the virus from the start, but a new mutation is fast spreading. When every effort should be being made to learn from the last six months and to support and prepare services, and the people who toil in them, for what’s ahead, our government has started playing a nasty game.

First, lest we forget, as news slips by so quickly, Boris Johnson recently suggested that care homes failed to follow procedures properly earlier in the pandemic, contributing to the very high death rate from Covid amongst their residents. His later ‘clarifications’ in the House of Commons were based on the idea that no one knew about the risk of asymptomatic infection for ages. In fact this is contradicted by the public record: right from the start in Wuhan, experts were raising the issue of asymptomatic transmission making a rapidly spreading pandemic more likely.  Nevertheless, however (un)convincing those clarifications, he had planted in the public mind the idea that those homes were responsible.

Then there are the suggestions coming from No 10 that a reorganisation of the NHS should happen.  Now, let’s be clear, the Cameron government’s reorganisation in 2013 (despite their promises that no such thing would happen) caused serious problems.  It fragmented key services, paved the way for less effective public health services, and dismantled the Health Protection Agency.  It injected even more damaging levels of competition, industrialisation and commodification to the system.  These, and many other harms, along with the savage cuts to local government funding, meant that the ‘austerity’ government seriously undermined the resilience, collaboration and efficacy of our public services.

To even think of making significant structural changes to services as we face such an uncertain and dangerous future is scandalous.  My work in public services over decades has amply confirmed the idea, well known in organisational theory, that major reorganisations lead to serious disturbance to the quality and efficiency of services for years before eventual recovery. The scale of the changes involved in the 2013 NHS reorganisation disrupted the system badly, distracting managers and staff from their real, and vitally important, work.  Are our current government ignorant and blasé, or do they actively wish to inject such instability into the system in our current situation?

The priority should be to support health and social care in dealing with the virus on an ongoing basis, and to ensure that these services can continue to provide treatment and care for the myriad other health and wellbeing needs in our society. The system needs funding and support, and, whatever its complexity, to be enabled and empowered to collaborate, nationally and locally.  It certainly needs to change in time, but for the right reasons, gradually, and when it is safe to do so. 

The Government are ruthlessly setting the scene for a reckoning. They are basically suggesting that the NHS and public health services, nationally and locally, are the ones to blame for shortcomings in England’s response to Covid.  Government sources have been quoted as suggesting that Simon Stevens, CEO of NHS England, has been ‘invisible’, that the complex structure has meant that Johnson and Hancock cannot effectively ‘command and control’ the system. As if you can just tell a system to ‘pull itself together’ and get on with it, a system that, over many years, has been shackled and severely disabled, and that faces the biggest challenge in its history. No, this is an ill-disguised set up:  it’s not us, it’s the health service, says Johnson.

Next, we are told that ministers, especially Priti Patel, are ‘outraged’ at the failure of Leicester City Council to eradicate the abusive employment practices, especially in the BAME communities in this city. These have, in some narratives, fuelled the recent spike in cases here – though the data doesn’t support that.  Patel even suggests that, ‘just as in Rotherham’, cultural sensitivities have prevented attention to these problems, not so subtly placing in the mind the idea that the city council might be yet another colluder with vile sexual abuse. 

There clearly are some dire employment practices in this city, and many of these practices are in factories owned by people of Asian heritage.  They all need firm remedial, legal and other action, and it is good that the city council set up a multi-agency taskforce to address this some time ago.  And if the Government hadn’t ignored the 2017 Special Committee report Penny referred to in her last post, if it hadn’t starved services dealing with labour laws, health and safety at work, and, especially, the Gangmasters and Labour Abuse Authority, things might have been different. Had Theresa May not introduced the nasty and self-defeating ‘hostile environment’, migrant workers across England and Wales might have felt able to alert the authorities to their conditions.  If successive governments had not demeaned and side-lined unionisation this might not have been such an individualised challenge.  Had local government not lost 60% of its funding over the last decade, it might be more effective in dealing with many problems. However much the dynamics generated in our racially and culturally unequal society interfere with action, a nation that addressed structural and systemic racism determinedly would be better able to navigate them and address the appalling conditions of migrant workers.  This is true for Leicester, but also for those many idyllic (Tory voting?) rural farming areas where it is hard to tell the difference between a factory farm and a labour camp. Strange that Priti Patel has been silent on that bigger picture.

There will, of course, be shortcomings in many parts of the system, not all of them the result of government policies and actions over the years. But the Government are, not subtly but dangerously, setting candidates up for the blame for their own response to Covid.  Care homes neglectful; NHS and PHE inefficient, slow and clumsy; Leicester’s renewed outbreak all down to the (Labour) Council…..  So watch out, all you other public servants, towns and cities, should Covid raise its head again – which, by all sane accounts, it will.

We cautioned against the blame game months ago. We now have a manual for how to play it.

• First, side-line people from the planning process;
• Then deprive them of the information they need to understand what is happening, and properly plan a response;
• Then continue to deny them the resources and power they require to address the problem;
• Then hurriedly and incompetently contract out centralised services to (fail to) provide services that the system should itself be able to deliver, or which it desperately relies on;
• Then patronise or publicly shame the neglected and side-lined people and bodies for not cooperating with your ill-informed, poorly communicated and unrealistic demands;
• Then blame those you have sidelined and neglected for the problem;
• Now wash your hands.

I’ve shared three examples of this game in this post, but I’m sure there are many more – not least in education.  We need to keep our eyes open, and keep our society – and our services – safe. Let’s not fall for this.

John