I had my first Covid jab earlier this week. It was
everything you would expect from the NHS when given the resources to get on
with the job.
From the phone call from my GP practice the previous Friday
to the visit to the vaccination centre, it was all very well organised. Staff
were friendly, helpful and professional, offering information and reassurance
as needed. Clearly, some of the people at the centre were volunteers: you could
tell by their sense of enthusiasm at having the opportunity to help others. And
everyone there was working to a common purpose, so there was a clear sense of
team spirit in the air.
Including the mandatory 15 minute rest (and observation for any
adverse reaction) after the jab, the whole process took 20-25 minutes from
start to finish. A fine example of public service at its best.
Public Service Ethos
Back in 2016, I wrote a blog post called In
Praise of Public Service Values. In it, I explain how certain public
services should never be – or should never have been – privatised. The main reason
I gave then was the commonality of purpose all the way through the public
sector, from the top management through to the front-line staff. In a
privatised service, there is some discontinuity between profit-maximising leaders
and service-oriented junior staff. Priorities get blurred; messages get mixed.
I now recognise there is a second, powerful reason why
public services should remain in the public sector. I have recently watched the
2020 Reith Lectures given by former Bank of England chief Mark Carney. In his
first lecture, he speaks of the “moral hazard” of “commodification”.
Experiments show that, in carrying out an activity with a clear moral purpose,
people are disincentivised by financial gain. People are more effective
when morality, rather than money, drives their actions.
A further danger of commodification is what Carney calls “flattening”
of moral value or civic virtue. Once an activity is described solely in terms
of money, in profit or loss, something of real human value gets lost.
Good deeds become mere transactions; cynicism and boredom can creep in.
Government Failure to Learn
We should have learnt from the lessons of the 2012 London Olympics,
when Serco’s failure to recruit sufficient “Olympic greeters” led to the army
to be called in to help out. But this government didn’t learn. Perhaps the most
deadly of the consequences of the failure to learn from past mistakes are the
repeated failures over lockdowns: too late to impose, too soon to relax
restrictions. Johnson and his gang are far too ready to listen to the bayings
of the death squad of Tory backbenchers grotesquely misnamed the “Covid
It is extraordinary to think that, over 11 months into the
pandemic, the Government has still not properly implemented border controls for
people entering the UK. Failure to learn lessons from other countries’
approaches to quarantine and its enforcement is particularly ironic when “control
of borders” was a key rallying cry of the prominent Leavers now running the
Private Sector Failure
But a major government failure was to hand Test and Trace to the private sector, and specifically to friends of the Cabinet members – corruption on an eye-watering scale. Compare and contrast the spectacular failure of the £22bn privatised “NHS Test and Trace”. (The link in the last sentence leads to a page which lists 22, mainly private sector, companies involved: Serco and Sodexo are perhaps the most significant.) I’m not clear whether the list of 22 includes all the companies whom Serco and Sodexo have subcontracted work to.
I believe that one key underlying problem in using the private sector was the failure to use vital public health expertise in its design. The private sector dominated thinking was based upon the model of running call centres (for which the private sector has plenty of experience). What was overlooked was the public health expertise in the subtleties of the interpersonal relationships and sensitivities in cold calling people about health issues. Many of us see our health as an intensely personal matter and there was an understandable reluctance for “cold called” people to engage.
Finally, here’s the BMA’s
view from last September giving the medical professions view on the many
and varied shortcomings in over-reliance on the private sector.
Called to Account?
As for accountability, my best estimate currently is this.
Of the 110, 000 deaths to Covid so far, somewhere between 50,000 and 80,000
could have been avoided through better governance and decision-making. It would
be a betrayal to those who died and their grieving families if this stark
analysis were somehow forgotten. To govern is to be accountable.
As the country’s mood lifts, from fear and despair to hope and positive expectation of an end to the pandemic, I have a concern that that public opinion will fail to call to account the actions of this government over the past year. Repeated failure and disastrously poor decision-making vastly exceed the one thing we seem to have got right: vaccination, thanks to the “real” NHS. It would be grossly unfair for Johnson and co to be let off the hook over their lamentable performance overall.
For the benefit of the confused – and, frankly, who isn’t these days – the NHS Track and Trace “system” is no such thing. The CJJ “government” slapped the NHS logo on a privatised service run by various companies with no previous Public Health experience or expertise. Here are the villains of the piece:
Sitel is a US company, headquartered in Florida, which runs
the T&T call centre. They call their core business “Customer Experience
Management” which they seem to like to abbreviate to “CX”. They work across a
wide range of industry sectors and their expertise seems to be call management.
Their website is full of bullshit
management speak like “omnichannel customer service solution” and “incomplete
or stretched channel strategies”. Obviously, halfwit impressionable people like
Matt Hancock find this all very exciting.
So, how well are they performing? Assuming that the call centre
is the original point of contact for those with positive Covid test results,
activity since June has risen from around 4300 per week (73% of positive cases
given) to nearly 13,000 in early September (83%). Although they seem to be
learning on the job, Sitel are still failing in the relatively straightforward task
of making contact with one out of six of the people on a list.
Serco (of escaped prisoners and invoicing for dead people’s
security tags fame) manage the contact tracers. Here’s an example of one of
Serco’s earlier failures working for the Home Office on immigrant removal
centres such as the notorious Yarl’s Wood in Bedfordshire. To give a flavour:
one incident there in 2018 involved 100 women going on hunger strike in protest
at their detention and treatment by Serco staff. The company even denied that
the strike was happening. So, transparency not great then.
Serco have made their fortunes hoovering up former public
sector work privatised by successive Tory governments. Its CEO was paid £4.5m
in 2018 (the most recent I could find). No wonder Boris Johnson complains he
can’t manage on a measly £150,000 as Prime Minister!
So, how good a job are they doing at contact tracing? The
trend figures are as follows: in June, around 91% of positive cases’ contacts
were reached, this has fallen erratically to 74% in early September, having
been below 70% for much of September. So the overall system over the 3-month
period has found 62% (i.e. 78% of 80%) of potential contacts, well below the
target of 80% to be effective.
The other main player bringing the name of the NHS into disrepute is Deloittes, one of the Big Four auditor firms who, like their three competitors, suffer a massive conflict of interest by making most of their profits from consultancy work – much of it for the UK government. Their main task is to coordinate – don’t laugh – the so-called “pillar two” laboratories: the “Lighthouse Labs”. My observation of lighthouses over the years is that they provide a brief flash of light, then all is darkness for most of the time before the next flash. Seems an appropriate name.
The pillar two labs are run by a mixture of private companies
and universities. The ramp-up has been considerable: three labs initially,
currently five, with four more planned. The reality has been a fiasco. And,
sadly, all too predictable. Schoolchildren returned to school in early
September (in England), the government has been exhorting people to return to
work and to “Eat Out to Help Out”. All of these led to a lot more social mixing
and a lot more opportunities for the virus to spread. Just a few short weeks
ago, Hancock was advising everyone, if they had “any doubt”, to get tested. Then,
just a few days ago, the same Matt Hancock was blaming the public for too many
of them coming forward for tests. The press reports of people booking tests –
if they could get one – hundreds of miles away are well reported elsewhere.
Matching test sites with available slots to geographically close people who
need tests seems beyond the capability of the government’s chosen contractor.
The number tested has been increasing. On the government’s
own figures, the number of tests has increased by 57% since June. The official
figures mix up those tested for current virus infection with antibody tests
(which show past infection). So the volume figures must be treated with
caution. But, to be of any use, test results must be turned round quickly:
within 24 hours or even less. This is because people can pass on their infection
before any symptoms show: this has been the particularly dangerous feature of
Here, it all gets a bit complicated – presumably deliberately
– by a government keen to obfuscate things. We need to get into the world of
pillars. No, not pillocks, but you could be excused. Pillar 1, in the public
sector, is, roughly speaking done by NHS staff on NHS staff or key workers.
Here, there’s good news: around 90% of test results are returned within 24
hours. Pillar 2 is the private sector work done on the rest of us: the general
public. On speed, it’s mostly bad news. Using government figures, the proportion
of Pillar 2 test results received in 24 hours in early September was only 58%
at a “permanent” site and 69% at the mobile “pop-up” centres. Only 17% of home
tests get test results within the target 48 hours; for “Satellite” (basically
Care Homes) it’s a pathetic 8%, taking an average of 83 hours – half a week –
for Care Home managers to get test results. In mid-June, they were averaging 28
hours. No wonder Care Home managers and staff are complaining again!
Keir Starmer’s comment that the government has “lost control”
of testing seems entirely fair comment.
Public and Private
There’s worse. These figures actually flatter considerably the performance of the private sector companies. Wikipedia talks coyly of the privatised system working “in parallel” with experienced contact tracers working in local government for Directors of Public Health. These are the people who actually know what they’re doing with expertise built up in the public sector over many years, dealing with flu, AIDS and sexually transmitted diseases. The public sector figures are combined with the private companies in the performance statistics. And, surprise surprise, the public sector people do a much better job: 93% of contacts reached compared to only 61%.
I used the word “coyly” in the last paragraph. The truth is
that the centralised, privatised system set up by Hancock and co. has, for the
most part, treated the local PHE teams as their enemies, starving them of vital
information for them to do their job. Central government has had to be dragged
kicking and screaming into cooperation with local authority Public Health
staff. A local mayor told me of the extreme difficulty he had getting the
information his PH people needed to keep his local population safe.
A further example was
when the Deloittes logistics people sent, literally, an army of military staff
to set up a mobile testing centre in the middle of a West Midlands town. The
local Director of Public Health was given no prior warning, the exercise led to
pitifully few tests – there was even talk of soldiers accosting people in the
street to take a test, to boost the numbers reported by Hancock. The exercise
caused traffic havoc and the DPH spent much time and effort to get a more
In fact, my understanding is that the contract specifications
signed with the private companies were not even designed to feed actionable
data to local PHE teams. Dogma and a blinkered approach in Westminster led to serious
– and deadly – fragmentation.
Isle of Wight on the Night
Oh, and the NHS Track and Trace app worked well, didn’t it? Version 2, totally redesigned, is due for launch tomorrow, but it seems to be a secret for now. So, not world beating, then – again.
As you will see above, a system as fragmented as this is bound to fail. Compare, for example, Germany’s much more successful approach, building on an existing regional expertise in public health.
But there is another, more fundamental, way where there is a
discontinuity. Back in 2016, I wrote a blog post entitled In
Praise of Public Service Values. The main point I want to emphasise
from that post is this. When providing a public service in the public sector,
everyone in the organisation has broadly the same purpose: to provide the best
possible service to the public. If that service is privatised, those at the top
are more fixated on short-term profit and the company’s share price. Somewhere
between the bottom and the top, messages – and priorities – get mixed and
confused. No wonder that privatisation of “naturally” public services nearly always
leads to a worse service.
Dido, Queen of Carnage
And presiding over all this is Dido “Dodo” Harding, Tory peer and general waste of DNA. I’m deeply indebted to the brilliant Guardian journalist Marina Hyde for the above formulation in the paragraph header. For the less-well classically educated (which includes me), I have included a link here which explains the joke. (For good measure, Christopher Marlowe, one of Shakespeare’s contemporaries, wrote a play about her.)
But note this: don’t let the useless, incompetent buggers
like Dido/Dodo, Sitel, Serco, Deloittes and their army of sub- and sub-sub-contractors
sully the reputation of Our NHS.
During this Second Wave, it needs more than just our applause.
On Monday, medical advisers Chris Whitty and Patrick
Vallance had their own TV programme to explain to us all just how fucked we
were as a country and how careful we must be over the next 6 months. I confess
I did not have the stomach to watch Johnson confuse the whole thing the next
day with his incoherent babble. I’m up to HERE with mixed messages.
75 years after the end of World War II in Europe, the
Johnson government is inviting the people of Britain to “celebrate” the Allies’
victory over Nazi Germany. So, what kind of “victory” has that turned out to
I quote just one statistic at this point, coronavirus deaths
(as of yesterday): Germany 7277; UK 30,076. For comparison, population sizes
are Germany 80 million, UK 66 million. So, per capita, the death rate differences
are even larger. And Germany’s pandemic started a couple of weeks earlier than
So, if our Government had managed the outbreak as well as
the Germans’, pro rata, we would have
24,000 fewer deaths. So, who is to blame? I will argue below, the answer is
Tories, Tories and Tories.
The Spanish Flu pandemic (which, incidentally, wasn’t
Spanish) occurred in three distinct waves with the second worse than the first.
The graph above clearly illustrates this point. (NB: the figures along the lower axis are dates: shown, rather confusingly, in US “semi arse about face”
month/day format.) It is mainly because Wave 2 was biggest, reinforced by
current epidemiologists’ modelling, that the Government is being cautious about
lifting the current lockdown restrictions.
I argue below that, similarly, our present predicament comes
about as a result of Tory Governments’ mismanagement and bad policy making,
also in three distinct waves. As a result, the country was far less prepared
than it could – or should, in my view – have been.
Wave One: 1980s and Thatcher
My wife has just delivered a load of face masks and
headbands she has sewn for use by frontline staff in the fight against the
pandemic. This is all too reminiscent of the pre-Industrial Revolution period
in the late 18th and early 19th century. People spinning
and weaving cloth in their own cottages. So, what accounts for our apparent regression?
Wave One and the first betrayal were started forty years ago by Margaret Thatcher. She may be remembered for a number of things. For now, I will concentrate on three: monetarism, anti-Trade Union legislation and the City Big Bang deregulation.
The graph below shows the trend during the 18 years of
Thatcher and Major Government. The steep drop in the period 1979 to 1982 is
mainly associated with the Tories’ flirtation with monetarism. For a period,
this was treated almost like a religious belief within Tory ranks and was
responsible for the needless destruction of many jobs, particularly in
manufacturing. The second steep drop around 1990-91 was at the time Thatcher
was ousted and replaced by John Major. Although the primary causes of this recession were
global, civil unrest and rioting occurred in such diverse places as Birmingham,
Oxford, Tyneside, Cardiff and Bristol.
The second factor was the anti-Trade Union legislation
passed during the Thatcher period. A fairly neutral account is found here.
With the benefit of hindsight, it is clear that this started a long period of
change from relatively secure and well-paid manufacturing jobs to the insecure
zero hours and sham self-employment we see today. The people in this insecure
workforce are really at the sharp end of current lockdown policies. The “treat
them like shit” attitude, too prevalent in today’s employment practices, was an
inevitable result of weakening the countervailing power of the Trade Unions.
The third factor was the so-called Big Bang. In the
prevailing orthodoxy of the time – still largely present in today’s Johnson cabal
of True Believers – the financial centre in the City was “liberated” from the
old-fashioned practices of yore. As a result, financial services grew in
parasitic fashion into the monster we see today, with its abuse of power and
prevailing attitude of personal greed. I covered this topic in more detail in
my 2015 post The
City: Paragon or Parasite?Its general thesis is that what’s good for
the City is generally bad for the rest of us.
“The rest of us” includes those trying to make a living from manufacturing.
The upshot of all this is our over-reliance on imported
goods (such as panic-bought substandard PPE flown in from Turkey by the RAF). A
weakened manufacturing base has left us dangerously vulnerable in times of need
on items such as ventilators, PPE, testing kits: all the things that the
government is still playing catch-up on, 2 to 3 months after they should have
been aware of the seriousness of the threat from coronavirus.
This constitutes the Tories’ first betrayal of the people of
Britain: the 40-year weakening of our capacity to make the things we need in
times of crisis. (A possibly similar argument could be made about the food we
eat, but that’s another story.)
Wave Two: Decade of Austerity 2010-2020
Wave Two and the second betrayal cover the last 10 years of
Tory-led government and the Osborne-led religion of austerity. A nation was
persuaded to believe that the New Labour government was responsible for the
2008 global recession and the solution was austerity. Translated this means
punishing the weakest and poorest in society whilst letting those responsible –
organised finance – to escape scot free. Despite some eye-watering spending
announcements by Rishi Sunak, many of the tenets of austerity are still in
place in the mind set of Johnson and his gang.
What concerns us here is the cumulative effect of austerity
over the last 10 cruel years: the graph below shows the trend. The overall
figures disguise the fact that local government has been squeezed even harder
(by 40%) than public spending overall. And, of course, apart from the last few
desperate weeks, NHS spending was frozen (in real terms) for much of the
In the 2010s, the government split Public Health from the
NHS and then (as I said above) squeezed local government very hard. Casualties
would be care homes, public health resources and support services for
vulnerable and disabled people. Cuts in benefits, including for those with
disabilities, have weakened our collective resilience further.
A new and shocking example has emerged with the past 24
hours. During the years of austerity, Channel
4 News has revealed that 45% ofPPE stock was allowed to get out-of-date. This
includes 80% of respirators. In 2009, following an outbreak of swine flu, £500m
was spent building up a national pandemic stockpile. Channel 4 “has also
obtained evidence suggesting the stockpile had shrunk significantly over the
last ten years, while the UK’s population continued to grow.” In short, we were
less prepared for pandemic than at the end of the last Labour government.
To make matters worse, the government was forewarned. In
2016, Exercise Cygnus
simulated an influenza-type pandemic and predicted that the health service
would collapse through a lack of resources. The Daily Telegraph reported
one government source as saying that the results of the simulation were
“too terrifying” to be revealed. Eventually, the Guardian leaked the findings (redacted to exclude sensitive
personal information) on 7 May this year.
In summary, Tory led government policy decisions weakened
the UK’s preparedness for a corona-type pandemic systematically and repeatedly
over the last 10 years under the cover of austerity. Income and health
inequality widened over the same period, leaving the most vulnerable even more
This is the Tories second betrayal of its people.
Wave Three: Johnsonian Dogma 2020
And so we turn to the recent past with Johnson as Prime
Minister. The story doesn’t get any better.
All but the most stupid and the most ideologically zealous
supporters of Government policy – the two groups are not mutually exclusive –
have noticed by now that the government was asleep at the wheel in the weeks
before the pandemic took off. World
Health Organisation warnings as early as January were ignored. WHO advice
to do “testing, testing, testing” was similarly dismissed by a government that
was riding on a wave of hubris following the UK’s “departure” from the EU on 31st
Despite Ministers’ untruthful denials, it was UK Government policy right up to 20:00 on 23rd March that “herd immunity” was the best approach, making the UK an outlier in Governments’ approach to the pandemic around the world. Then we had the “screeching U-turn” and lockdown. By this time, of course, it was too late. It has been a game of catch-up ever since. Oh, and repeated instances of over-promise and under-deliver: on PPE, testing, contact tracing, whatever.
Conservative dogma had led to an over-reliance on the private sector and the bypassing of expertise in local government and other local arms of the public sector. A good, i.e. bad, example was last Thursday when Health Secretary Matt Hancock crowed that his “100,000 tests” target had been met. This was only achieved if you count test kits posted out (but clearly not yet used) on that day. Also the army was called in to set up “mobile testing centres”. In one instance for which I have an impeccable source, the local authority had not been forewarned of the army’s arrival and “caused chaos”. It seems that at one point, random people were approached in the street and offered at test. And all to meet a politically motivated target. Following the science, my arse! And, as we well know, in the days since, on at least 5 occasions, the number of actual daily tests have fallen well below 100,000.
Other countries have done better, and more consistently,
than the UK. And another thing. Local GPs and Public Health officials around
the country have NOT been given geographically-based test results numbers,
essential for the next phase of tracking clusters and tracing contacts. Perhaps
this is because the government handed the contract for manging testing to Deloittes
– yes, that Deloittes, one of the accountancy and consultancy big four who have
repeatedly failed, big time, to spot companies on the brink of going bust. The
system for getting feedback from Deloittes to key local expertise doesn’t exist
This illustrates a continuing weakness in the Government’s approach:
too much is attempted to be run from the centre and/or by private companies with
no relevant experience, rather than use expertise in local authorities. So,
even as I write, the Government continues to screw things up, avoidably.
The third wave of government betrayal continues,
unquestioned by a loyal and sycophantic press (with the honourable exception of
And so to today’s bread and circuses. We are invited by
those who govern us to celebrate an event which happened before 99% of us were
born. By inference, even to applaud our government’s “success” as Johnson
called it on Monday. Try telling that to the grieving families of the 24,000
individuals, disproportionately black, brown and poor, who have died too soon
thanks to Conservative government failures over the past half a century.
Last Monday, Michael Gove stood in for the self-isolating
Boris Johnson at the No. 10 pandemic briefing session. The country found itself
dependent on the most duplicitous, scheming Cabinet Minister to explain the
current situation and to tell us what the Government – collectively the most
incompetent in my lifetime – is doing to tackle the outbreak. And yet we have
no choice but to – sort of – believe he is speaking the truth.
Playing Catch Up
There’s wide agreement, including in some traditional Tory
supporting newspapers, that the government screwed up its handling of the crisis,
at least in the first few weeks. So the UK has been playing catch up since
Johnson’s U-turn on 23rd March. The lack of testing kits and
ventilators are the two most glaring examples. But the food supply industry, and
in particular the supermarkets, have not exactly bathed themselves in glory.
The government seems to be still too ideologically inclined to believe that the
private sector can do more to adapt than is actually the case.
We’re in the psychologically disturbing phase where all the
key numbers, and in particular deaths, are still rising daily. It helps me
personally not to over-obsess on them. I also look out for good news stories to
act as some kind of reassurance. As “MD” in the latest Private Eye points out,
since January 1st, 159,987 people have died in the UK, 158,759 from
causes other than the coronavirus – and therefore not newsworthy. (I guess the
article was written on Monday: the numbers have changed, but the broad point
still stands.) It’s clearly important that we keep a sense of proportion in all
this. I’m sure that’s a struggle for a lot of people, including me at times. I’m
hoping that the fear factor, which affects behaviour such as panic-buying, will
subside, once the numbers start to stabilise and then subside.
It’s a tragedy for the country that the Labour Party has boxed itself into a corner of irrelevance as a result of the extraordinarily extended self-indulgence – as it now feels – of a leadership contest. The result is due to be announced later today as I write. Everybody expects Keir Starmer to win. It would be great if he and other talented Labour Party leading figures were invited to join a government of national unity, at least until the crisis is over. Stranger things have already happened in the past two weeks, announced mainly from the lips of the new Chancellor, Rishi Sunak. He’s the only Cabinet member who has emerged in this crisis for whom I have any grain of respect. He has been clear in his announcements, bold in some decision making and shown a willingness to rethink as new information emerges – or there’s a strong backlash from sections of the community: small businesses, for example.
There’s a sense in which the people and the formerly hated “experts”
have pushed the government away from a disastrous policy stance up to 22nd
March into something more in line with what is needed. There’s a wish in the
air that somehow, sometime, we may all end up living in a kinder, fairer world
when this is all over. But any further thoughts on that must wait for another
I think we all agree that the key to getting out of this is testing. That’s both much more testing for live coronavirus cases, starting with all frontline NHS staff, and a reliable, easy-to-use antibodies test kit to retrospectively test those who’ve had symptoms but has not yet been positively tested owing the current lack of kits. Matt Hancock has promised 100,000 tests a day by the end of April. We, the people, aided and abetted by the right politicians and the media, must hold his feet to the fire to deliver on this one.