‘Chumocracy’: how Covid revealed the new shape of the Tory establishment

Guardian November 15th 2020

Appointments made and contracts awarded during the pandemic have uncovered a web of connections

by David Conn, David Pegg, Rob Evans, Juliette Garside and Felicity Lawrence

The great global hope raised this week by news of successful trials for a Covid-19 vaccine interrupted a very British row about the head of the UK’s own vaccine efforts, who was appointed in May and reports directly to Boris Johnson.

As Kate Bingham, chair of the vaccine taskforce, came under sustained scrutiny over the £670,000 budget she had allocated for public relations consultants, attention switched from her suitability for the role to her connections to the Conservative government.

Managing partner of a private equity firm, SV Health Investors, involved for 30 years in pharmaceutical investment, she is also married to a Tory MP, Jesse Norman, who was at Eton at the same time as Johnson, and she went to private school with Rachel Johnson, the prime minister’s sister.

The pandemic’s devastating hold over British life has shone an unsparing light on the country’s defining features: the divide between north and south, the wealthy and less well-off, the vulnerability of black and minority ethnic communities.

The anti-establishment claims of a government led by Johnson and Dominic Cummings were always audacious, and in the appointments and contracts awarded during the pandemic, the shape of a Tory establishment has come into focus. Critics are calling it a “chumocracy”.

Companies benefiting from government contracts awarded during the pandemic have links, among others, to the Cabinet Office minister Michael Gove and Cummings, the prime minister’s chief adviser. Cummings shock departure from Downing Street following the resignation of his close ally Lee Cain, who was head of communications, now signal a realignment of power in No 10, but the web of connections drawing complaints of “cronyism” extend beyond any single Tory faction.

Bingham’s appointment shares similarities with that of Dido Harding, to head the NHS test and trace operation in May. She was made chair of NHS Improvement in 2017 after an open recruitment process, her CV gleams with executive experience, and also opens a window to a small world of Conservative connectedness. Married to the Tory MP John Penrose, she was given a peerage in 2014 by David Cameron, a friend, and sits in the House of Lords as a Conservative.

Neither Bingham nor Harding are being paid for their roles, but critics complain that two central pillars of the pandemic response, vaccines and testing, are being led by two well-connected executives appointed without an evident formal process.

A racehorse owner and keen rider, Harding was in 2004 appointed as a member of the Jockey Club, which gave the local Newmarket MP and current health secretary, Matt Hancock, another horseracing enthusiast, honorary membership of its prestigious rooms, shortly after he was first elected, in 2010.

The racing and Tory connections extend to Randox Laboratories, the Northern Irish healthcare company that was given a £133m contract in May by Hancock’s department to produce testing kits, recently extended by six months for a further £347m. Owen Paterson, Conservative MP for North Shropshire since 1997, is paid £8,333 per month for 16 hours work as a consultant for Randox. The company is the official healthcare partner of the Jockey Club, and has sponsored the Grand National since 2016.

Both the initial Randox deal for tests, and its recent extension, were awarded under the emergency Covid-19 regulations that waive standard rules requiring competitive tenders for public contracts, enabling Johnson’s government to directly hire chosen firms at speed. Neither Randox nor Paterson responded to requests for comment.

n the latest twist to the controversy over appointments, the Sunday Times reported that George Pascoe–Watson, UK chairman of lobbying firm Portland Communications, was made an unpaid adviser to a health minister during the first wave of the pandemic without any public process or announcement. Pascoe–Watson told the newspaper that information he and Portland passed to private clients in October about the government’s stance on future lockdowns was “in no way connected” to calls he had access to in his advisory work for the government.

Contracts

Amid the billions spent, some multimillion-pound contracts for the supply of personal protective equipment have been criticised by campaigners, including the not-for-profit Good Law Project (GLP), which has highlighted several Tory links.

While the emergency regulations could be expected to enable urgent commissioning of tests, PPE and other medical supplies, the government’s contracting of data, policy and communications companies has perhaps come as more of a surprise.

Four of the companies engaged for such consultancy services on contracts not put out to tender have political links either to the government, Conservative party, Cummings himself or the Vote Leave campaign he ran during the Brexit referendum.

In June the Cabinet Office, whose minister is Michael Gove, published details of a contract that had been running under the emergency regulations since March with the policy consultancy Public First, to research public opinion about the government’s Covid-19 communications. The company is owned by the husband-and-wife team James Frayne, previously a long-term political associate of Cummings, and Rachel Wolf, a former adviser to Gove who co-wrote the Conservative party manifesto for last year’s election.

Frayne and Cummings first worked together approximately 20 years ago on Business for Sterling, the Eurosceptic campaign against Britain joining the euro, and then in 2004 at the rightwing thinktank, the New Frontiers Foundation.

After Gove became education secretary following the 2010 election – with Cummings as his chief adviser – Frayne was from 2011-12 the Department for Education’s (DfE) director of communications, a civil service appointment. Frayne told the Guardian that after leaving the DfE in 2013 he worked in commercial consulting, setting up Public First in 2016. He said he has not been personally in contact with Cummings or Gove for some years.

Despite his wife’s recent work on the Tory manifesto, he insisted their company was engaged by the Cabinet Office because it is known for high-quality focus group and policy work, not because of its connections. The upper limit for the Cabinet Office contract was £840,000, but Frayne said they had billed about £550,000 in total, and that the work had a “low margin” of profit.

Public First was also contracted to advise the exams regulator Ofqual on its communications before and after the summer debacle over the awarding of A-level and GCSE grades, and had a £116,000 contract with the Department for Health and Social Care (DHSC) to advise on joining up health and social care. The value of these contracts was below the level at which a competitive tender is required.

Another very well-connected company that has profited from directly awarded contracts during the pandemic is Hanbury Strategy. A policy and lobbying consultancy, Hanbury has been paid £648,000 under two contracts, one under the emergency regulations to research “public attitudes and behaviours” in relation to the pandemic, the other, at a level that did not require a tender, to conduct weekly polling.

The company was co-founded by Paul Stephenson, who was director of communications for the Vote Leave campaign, working with Cummings. Stephenson is now among the names tipped as potential new chief of staff for the prime minister. In March last year, Hanbury was given responsibility for assessing job applications for Conservative party special advisers.

Tory–linked appointments and firms

 Illustration: Guardian Design

When its government contracts were first reported, Hanbury said its “leading experts” had worked with different political parties and governments internationally, and it was proud of its work for the British government during the Covid-19 crisis.

On 17 March, six days before Johnson finally imposed the first lockdown, the Cabinet Office gave the political communications company Topham Guerin a £3m contract under the new emergency regulations. Run by two New Zealanders, Sean Topham and Ben Guerin, the company had produced social media content for a number of rightwing political parties, including the Conservative party’s 2019 election campaign.

It was Topham Guerin that was behind two notorious Tory stunts during the election: renaming the official Conservative party Twitter account “factcheckUK” during the leaders’ debate, and setting up a website presented as Labour’s manifesto.

The £3m Covid-19 work was to sharpen the government’s messaging, and Topham Guerin is reported to have suggested on a call with Stephenson and Lee Cain, that the “stay home, save lives” slogan had worked in some other countries. The government adopted that with “protect the NHS”, reportedly suggested by Cain.

Topham Guerin’s £3m contract concluded in September; the Cabinet Office says it has exercised the option to extend the company’s work for a further six months.

Meanwhile, the artificial intelligence and data analytics company Faculty Science Ltd, which worked with Cummings for Vote Leave in the referendum, has been awarded a string of government contracts since 2018. After Johnson became prime minister, a former Faculty employee who worked on Vote Leave, Ben Warner, was recruited by Cummings to work alongside him in Downing Street.

Warner, who is the brother of Faculty’s chief executive, Marc Warner, is reported to have run the data modelling for the Conservative party’s general election campaign in 2019. A close Cummings ally, he regularly attends the Scientific Advisory Group for Emergencies (Sage) on behalf of No 10, although he is one of several aides who reportedly may now exit amid a changing of the guard at Downing Street.

Under the emergency pandemic regulations, Faculty has been engaged on a £400,000 contract with the Ministry of Housing, Communities and Local Government, and two contracts totalling approximately £350,000 with the Department for Business, Energy and Industrial Strategy.

That government work was in addition to a £930,000 contract with the DHSC to be the AI lab partner for NHSX, the digital arm of the NHS, which began on 2 February and was awarded following a competitive tender. That contract was extended to include work on the Covid-19 datastore, an “unprecedented” data project also involving Palantir, a US firm founded by the libertarian billionaire Peter Thiel.

A Faculty spokesperson told the Guardian that the work for Vote Leave in 2016 was to provide polling analysis and advice on reducing advertising costs. “This was a commercial contract,” she said. “Faculty would equally have worked with Remain, had they asked.” The spokesperson stressed Faculty’s expertise, and said all of its government work was “won through a fit and proper process”.

Connections

The Good Law Project has challenged some government contract awards to companies with Tory connections, and is increasingly focused on those for PPE. The case of Ayanda Capital, an investment firm that won a £252m contract in April to supply face masks, was raised with Johnson by the Labour leader, Keir Starmer, in parliament this week. Ayanda’s chief executive, the financier Tim Horlick, has strongly denied allegations that millions of its masks were unusable, saying the issue was the Cabinet Office requesting the final consignments to be headband style rather than with ear loops. The government appeared to support that view in its response to the GLP, saying “a wider issue” emerged as to whether ear-loops provide “an adequate fixing”.

The GLP drew attention to the involvement for Ayanda at the bidding stage of Andrew Mills, at the time an adviser to the Board of Trade, an arm of the Department for International Trade (DIT), where Liz Truss is the minister. Horlick has said that Mills was “told to go to the public portal” for procurement “like everybody else”, and the DIT said neither it nor the Board of Trade was involved in the Ayanda deal. Mills has since been replaced on the Board of Trade when it was “refreshed” in September.

The prime minister has repeatedly rejected accusations of “cronyism” made by the Labour opposition in the award of contracts, and in an exchange with Starmer at the dispatch box he hailed the contributions made by commercial companies in the pandemic. The government maintains that both Harding and Bingham are very well qualified and have made great successes of their roles.

However, Liz David-Barrett of the University of Sussex, an adviser to the Cabinet Office on the UK’s anti-corruption strategy, argues there are “red flags” when the competitive tendering process for government contracts is suspended and contracts are awarded to companies with connections.

“Competition and transparency for government contracts are hard-won processes, very important if the public are to have confidence that the best people are providing public services,” she said. “If the processes are suspended for a long time, there is a risk that it becomes the norm, and confidence is undermined.”

On Thursday the government in effect agreed; Julia Lopez, a Cabinet Office minister, said an internal review would be held into the awarding of private contracts during the pandemic, so ministers could be sure there was “no basis” for claims of favouritism to Tory supporters or donors. The National Audit Office is also carrying out its own review into procurement.

Throughout, as concerns have grown about the networks of Tory-linked relationships highlighted by the business done during the pandemic, it might be of some reassurance that the UK has an official anti-corruption champion. Perhaps less reassuring is that the champion is John Penrose, Conservative MP and husband of Dido Harding.

• The Scott Trust, the ultimate owner of the Guardian, is the sole investor in GMG Ventures, which is a minority shareholder in Faculty.
• Additional reporting by Joseph Smith

Revealed: Boris Johnson’s controversial policy chief leading secretive NHS task force

Munira Mirza heading up group meeting ‘daily or weekly’ to plan ‘radical NHS shakeup’.

Caroline Molloy OpenDemocracy 19 November 2020

Boris Johnson’s government has for the first time confirmed the existence of a prime ministerial task force which is reportedly planning a “radical shake-up of the NHS”.

Freedom of Information disclosures to openDemocracy show the new “No.10 Health and Social Care Taskforce” reports to a Steering Group chaired by Munira Mirza, the influential head of Boris Johnson’s policy unit, and that it “met weekly” from July to September with a further meeting in October.

Mirza, a political appointee who previously worked for Johnson when he was London mayor, has no background or policy experience in health.

The disclosures also reveal that whilst some Department of Health officials do attend the task force, it is led by four senior civil servants based at the Treasury, and none of whom are from the Department of Health.

The government has not published any information about the task force’s existence, work, terms of reference or membership – and has refused to answer questions about the nature of its work.

However in July, The Guardian reported that Boris Johnson was planning a “radical and politically risky reorganisation of the NHS” – in response to “frustration” with the NHS’s performance during the COVID crisis.

And in September, the Financial Times reported that inside sources had revealed an interdepartmental health task force with a wide remit, “determining what the health service’s goals should be”.

The government has previously claimed that rumours regarding the work of the task force are “pure speculation,” and did not even formally confirm its existence, insisting that instead: “As has been the case throughout the pandemic, our focus is on protecting the public, controlling the spread of the virus, and saving lives.”

Not only is the group now confirmed to exist, but Mirza’s leading role and the lack of leaders from the Department of Health suggest that its work is politically focused.

Jackie Applebee, Chair of Doctors in Unite, told openDemocracy, “It is shocking that people with no background in health are meeting regularly to determine the future of health and social care. COVID-19 has surely shown us that putting people with no health experience in charge of the NHS is a disaster.”

Meanwhile Tamasin Cave, a lobbying expert, has called Mirza “a political hire who is unqualified to mess around with the NHS”. She also questioned the timing: “Why are they doing this now, given how much the NHS – and the country – has on its plate already?”

The revelations come as concerns are mounting about post-COVID pressures on the NHS.

Kailash Chand, former deputy chair of the British Medical Association, told openDemocracy. “The waiting lists have built up to an awful level, and they’ll use that as an excuse to bring the private sector in, as they did under the previous Labour government.”

He described Boris Johnson as “dangerous” and having “no faith in public services.”

Secrecy ‘the worst possible way’ to do NHS reform

In their Freedom of Information responses, the Department of Health, the Treasury and Number 10 have all denied having a full record of who has been attending the task force and steering group meetings.

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, has criticised the government’s secretive approach as “the worst possible way to design a major reform.”

“Secrecy encourages groupthink. The government rightly stresses the importance of public and patient involvement and co-production with users when designing new models of care. It is bizarre to reject these ideas for the really big decisions.”

What today’s disclosures do show is that the task force’s civil service policy lead is Adrian Masters. An alumnus of the management consultancy McKinsey, Masters played a key role in shaping the last major piece of NHS legislation, the 2012 Health and Social Care Act.

McKinsey was reported to have drafted large parts of that bill, which was criticised as enabling increased fragmentation and private sector outsourcing of large parts of the NHS.

The task force also includes William Warr: Johnson’s health advisor and a former lobbyist at the firm of Lynton Crosby, who masterminded numerous Conservative Party election campaigns and Johnson’s successful 2008 London mayoral bid.

Warr described the NHS as “outdated” in a Telegraph article penned shortly before he and Johnson entered Downing Street last year, suggesting that the incoming prime minister should ask himself: “If I created the NHS today from scratch, what would it look like?” Warr answered: “Nothing like the monolith we have today.”

Boris Johnson’s first Queen’s Speech in December last year promised to “bring forward detailed proposals” and “draft legislation” to “accelerate the Long Term Plan for the NHS, transforming patient care and future-proofing our NHS.”

The British Medical Association (BMA) has characterised this Long Term Plan as a “plan for a market-driven healthcare system”.

Kailash Chand, the former BMA deputy chair, told openDemocracy he believed the purpose of the task force was part of a wider effort to drive forward more NHS privatisation: “These people are really clever at bringing these things in disguise. This is essentially about getting us towards… big pickings for private companies. It’s not going to happen overnight but this is the road map.”

Referring to McKinsey’s regular NHS recommendations that were implemented under the Cameron government, he said: “McKinsey were brought in previously to recommend financial savings. The easiest way for hospitals to achieve those targets was to cut beds, cut nurses and the salary bill. And we’re still suffering today.”

Political appointments

Boris Johnson has faced criticism for appointing political allies with no health experience to key roles in the COVID-19 response. Test and Trace head Dido Harding, another former McKinsey employee and Tory peer, is in the process of taking over a large portion of the soon-to-be-abolished Public Health England’s remit, the government announced in August. She has also been tipped as favourite to take over as chief executive of the English NHS from the current incumbent, Simon Stevens, next year.

Stevens’ own proposals for major NHS reform last year attempted to allay fears about further privatisation, though campaigners raised concerns that they could make outsourcing less transparent.

Both the Department of Health and the NHS now appear to be taking a back seat in policymaking. Stevens is not on the task force, and none of the four top senior servants in charge comes from the department.

openDemocracy approached Munira Mirza, Adrian Masters, Number 10 and the Treasury for comment, but all have declined to respond by the time of publication.

Is the pandemic changing attitudes towards migration?

Director of beleaguered Test and Trace replaced by trust CEO

Health Service Journal November 8th 2020

• Haroona Franklin was brought into NHS T&T on a temporary basis from HM Revenue and Customs
• HSJ has learned she has now been replaced by trust chief executive Steve McManus
• Programme has failed to reach target of 80 per cent of close contacts of covid cases since its inception

A director of the beleaguered coronavirus test and trace programme has been replaced by a trust chief executive, HSJ has learned.

Haroona Franklin was brought into the programme on a temporary basis from HM Revenue and Customs to run the contact tracing component, which has consistently failed to meet targets set by the government’s scientific advisors.

Haroona Franklin

She will be replaced by Steve McManus, chief executive of the Royal Berkshire Foundation Trust, who is part-way through a six-month secondment to NHS Test and Trace and has been in an operational role in the “contain” part of the programme.

Ms Franklin is understood to be moving to an as-yet-unspecified new role in the Department of Health and Social Care.

The national tracing effort has consistently failed to reach more than 64 per cent of the close contacts of people who have tested positive for covid, if you exclude the dwindling proportion of the contact tracing effort run by Public Health England’s local health protection teams.

Government advisors have said the programme must reach at least 80 per cent of close contacts to be effective.

A DHSC spokesperson said: “Haroona Franklin joined NHS Test & Trace in July on a temporary basis to lead on contact tracing and we are grateful for her tireless work and determination in helping to build this service.

“Steve McManus, who has been working in the programme since August, will be taking over the role going forwards and brings with him a wealth of experience from a thirty-year career in the NHS.”

Around a fifth of people identified as close contacts of a covid case are transferred to NHSTT without any contact details. But even after excluding these from the data, NHST&T has failed to surpass the 80 per cent threshold. Its best performance was 79 per cent in the week ending 23 September.

Tracing by local health protection teams, by contrast, has reported over 96 per cent of contacts reached and told to self-isolate, on average, between the end of May and the end of October. Local teams are handling tracing contacts related to outbreaks in specific settings such as in a hospital or care home, a prison, or a school. They have managed, on average, less than 20,000 contacts a week since May and been in charge of a declining proportion of contacts. By the last week of October this was down to 3.5 per cent.

Baroness Dido Harding, the executive chair of NHST&T, has faces calls that she should resign over the organisation’s shortcomings.

Typhoid Dido proves fluent in management bollocks and contradiction

John Crace

Guardian 10th November

Harding has the appearance of someone prepared to put the hours in, even if they aren’t put to much obvious use

Towards the end of his interview on the Today programme, Matt Hancock was asked if Kate Bingham, the head of the UK vaccines taskforce, was right to hand out £670,000 in PR contracts to some of her old muckers. Of course, the health secretary insisted, because she had done a great job in procuring possible vaccines. Then Matt doubled down. “I would go out of my way to thank Kate Bingham,” he said. The £670,000 in unnecessary media advisers was just a sideshow. A political distraction.

“She has given up six months of her life to help the government,” he concluded with a flourish. It would be nice if everyone received such gratitude from a government minister just for doing their job. But I guess you win some and you lose some. And to be fair, not many people have gone out of their way to praise Hancock for the job he has done. There again he hasn’t always done it that well.

Which brings us nicely on to Dido Harding, the chief exec of the misnamed NHS test and trace, given that most contracts have been outsourced to private companies. Fair to say that test and trace has failed on even the mediocre metrics it has set itself under Harding’s leadership. And yet she is somehow untouchable.

If anyone else had presided over this mess they would have been on a last warning at the very least, but Typhoid Dido continues on serenely. It probably helps that, like Bingham, she is married to a Tory MP – there must be a lot of Conservative partners upset to have missed out on this avenue for preferment – but what most counts in her favour is that she at least is doing it for nothing. Call it charity work. And it’s hard to moan too much if someone is useless when they are paid nothing to be useless.

Nevertheless, Typhoid Dido still finds herself accountable for what is one of the most important strategies for controlling the spread of coronavirus and she today found herself giving evidence to the health and science select committees on progress so far. Or rather the lack of it. To her credit, Harding is at least a trier. She has the appearance of someone prepared to put the hours in, even if they aren’t always put to much obvious use.

The session started with some quibbles over numbers. How much of the test and trace was done nationally and how much locally, asked Greg Clark. “We have a team of teams,” replied Harding, “and are locally led but nationally supported”. If nothing else Typhoid Dido is fluent in management bollocks. Clark tried to press her on the exact figures. “I’m afraid I don’t have the exact numbers to hand,” she shrugged. This was to become a constant refrain throughout the two hours she was before the committee.

Jeremy Hunt was next to press Harding on the details. By his estimates, test and trace ought to be making contact with 177,000 people per day but was scrabbling around near the 5,000 mark. This was success rate of just 3%. Typhoid Dido thought this was a little unfair – people would be more inclined to isolate if they were paid to do so – and that her organisation was achieving a hit rate of between 10-20%. Hunt pointed out that even this was nothing much to boast about and could explain why Sage had described test and trace as having a marginal effect back in September.

For most of the rest of the time Typhoid Dido seemed to do her best to contradict herself. Yes, they had known a second wave was coming but it had been impossible to predict how severe it would be even though every person and their dog had foreseen mayhem when the schools and universities went back. She also tried to lower the expectations of test and trace – “we’re only a small part in the national effort” – before claiming she had built an organisation bigger than Asda. The difference being that Asda does deliver. If the supermarket had been run like test and trace it would have gone out of business years ago.

Labour’s Graham Stringer was one of the few to attempt to point out the obvious flaws in Harding’s answers. If it was taking three days to get test results back then the system was dead in the water. Even Harding’s claim that more than 60% of results came back in two days was hardly anything to crow about. Typhoid Dido went silent. “If you want to be effective then you have to provide some answers,” Stringer observed. Though that rather assumed that Harding had ever remembered to ask the questions in the first place. Predictably, the meeting ended with no one much the wiser about anything. Was test and trace an inherently flawed, badly designed system or was Harding just a hopeless chief exec? Or both?

Over in the Commons, Hancock was in an unusually good mood. But then he often is when he’s come to the chamber with nothing much to say, as there’s not much that can go wrong. He swore on his life that not one Danish mink would infect a single Brit, before repeating the news about the vaccine that the prime minister and others had released the day before and ending by re-announcing that the quick result lateral flow test being piloted in Liverpool was going to be extended to 67 other regions.

Not even the shadow health secretary, Jon Ashworth, could quibble with that and basically just gave Door Matt the thumbs up. As did everyone else. After months of nothing but bad news, MPs from all sides could do with something vaguely positive. No one knew if the vaccine would work or if the lateral flow tests would be of much value, but just for today they were going to take time off from the shit hitting the fan and allow themselves a moment of hope. However slender.

Devi Sridhar: How the UK can avoid an endless cycle of lockdowns

BY GEORGE EATON

The Edinburgh professor on why the government’s strategy failed and what it must learn from other countries to avoid future catastrophes.

New Statesman November 2^nd 2020

https://www.newstatesman.com/politics/health/2020/11/devi-sridhar-how-uk-can-avoid-endless-cycle-lockdowns

When I first interviewed Devi Sridhar on 22 October, she told me that England’s rising hospitalisation rate made a new national lockdown “inevitable”. Nine days later (31 October), in a remarkable volte-face, Boris Johnson duly announced a second lockdown. Following the Prime Minister’s announcement, I spoke once more to Sridhar (professor and chair of global public health at the University of Edinburgh) to get her response.

Were you surprised by how quickly the government U-turned? 

I wasn’t really surprised, I’ve been puzzled since September because you could see the pick-up starting then and it was just getting worse every day. It seemed like none of the softer interventions – such as asking people to work from home – were working and so the longer you delayed, the worse it was going to become, so for me it was inevitable. Now my worry is that people are going to be fatigued about going into such a harsh lockdown.

Do you think a lockdown until 2 December will work? 

I don’t think it’s long enough, unless they really build the testing and tracing. Germany’s quite interesting, they didn’t go into such a harsh lockdown, they just shut their restaurants and bars. But they’re already seeing a downward trend in cases and I think that’s because they’re doing the testing and the tracing, they’re using the lockdown to buy time, which means you can enter and exit quickly. The question for England is how fast can they build their testing and tracing and get it up and running. That will help you shorten the lockdown period, just as it will help you avoid going into a lockdown.

And obviously no one is in favour of lockdowns – the key is to have a strategy to avoid them. 

Exactly. And in some ways, the people pushing for “herd immunity” are forcing us into these lockdown-release cycles because you end up in a reactive position by underestimating the spread of the virus and the hospitalisation rate.

Why do you think the tiered approch failed? 

I think because they [England] had such a high level of infection going into it. I think compliance overall is a problem, I think we underestimate the impact, from a public health perspective, that the Dominic Cummings episode had. And people thinking “actually this isn’t that serious and we’re being taken for a ride” and also the emphasis on “he protected his family because of his circumstances, it was permissible”. 

And I think what we have now is a lot of people bending the rules because they think, in their circumstances, they’ve made the best call for their family. And all of a sudden we’ve turned from “we’re doing this for all of us” to “what’s best for my situation and my family”. I think that’s a problem throughout the UK, the whole of the UK was watching and the message clearly sent by the government was “if your circumstances mean that you want to be a good parent or good to your family then you can break the rules”. And that of course means compliance is an issue now.

I think what’s really been devastating in the UK has been these pseudo-scientific debates around “is Covid like the flu?” Do we really need to debate that again? Obviously we’ve never had society paralysed in every country across the world over flu and Wuhan wouldn’t have locked down over flu, we knew clearly from mid-January that this was not the flu.

The next issue is PCR tests – are they all false positives? No, they’re not. We have a lot of Covid around. Next thing, are all the death certificates being forged for Covid-19? No they’re not, people are dying of Covid, this is real. I feel like in the UK all of the airing of these debates by the mainstream media has led to widespread confusion and people picking and choosing, rather than the very clear message we’ve heard in other countries: “this is a dangerous virus, you don’t want to get it, you don’t want to pass it on, even if you’re young. And these are the ways you can avoid getting it and still live your life.” 

And in the summer, to try and get the economy going, they [the UK government] needed to underplay the virus to unscare people, to get them back into restaurants. But you can’t scare people and then tell them “you don’t need to be scared” and then say “you need to be scared”. Then people just lose interest. We don’t want to tell people “you need to be scared”, we want to tell people “this is a virus you don’t want to get, this is how we’re going to manage it” and just be factual rather than all of the spin.

What’s your response to those who call for the government to focus more on non-Covid deaths and job losses?

This is a complete false dichotomy, it’s like people who say “oh, the choice is do we choose the cancer patient or the Covid patient” when health services are for all, they’re trying to cope with both. And same thing here, we can publish it, it’s good to have the data on job losses and other harms but they’re not caused by the restrictions, they’re caused by the virus. Non-Covid harms are probably going to increase with Covid going up, that’s what they’ve seen in every country. The path they’re [government critics] proposing will lead to more non-Covid harm.

What does the UK need to do to avoid an endless cycle of unlocking and locking down? 

You need a testing and tracing system and to support isolation. You need better benefits for isolation by paying people to stay home so that it becomes their full-time job. Scotland tried this and it seemed to work, “you’ll get your wages but you’ve got to stay home, that’s your job”. People say that costs a lot but given what we’re spending on test and trace [£12bn], it’s probably cheaper if you do the cost-benefit calculations. 

The next thing is border restrictions, real border restrictions, actually testing people at airports, asking them to quarantine for a few days and then testing them again. I know they’re doing this in India at airports as well, they’ve been doing this at African airports for months, so I don’t know why we’re not doing it and you have to make it free. People getting tested are a benefit to others – you can’t tell people you have to pay £80. Or you can ask them to have a negative test result 72 hours before they fly.

The third is getting back to core messages. We need real engagement with people about this virus, combating misinformation over why this is a serious virus, why you don’t want to get it. I think the press briefing was so complex that many people couldn’t follow, with all the graphs, we’ve really got to simplify it. 

The other thing I’m increasingly convinced of is that Europe isn’t co-ordinating well enough. If we look at East Asia and the Pacific countries, they’ve been really good at co-ordinating their responses, the African Union has been co-ordinating Sub-Saharan Africa responses and across the continent to make sure they’re aligned, whether it’s travel policies, movement policies, restrictions. Europe has been a free-for-all, every country is doing its own thing… We need to work with Europe on a broader plan for how countries co-ordinate, or all we’re going to keep seeing is this domino effect in Europe, which is not happening in other places because they are co-ordinating and communicating and trying to get ahead of the virus.

GPs handed access to COVID-19 swab tests for staff and patients

GPonline November 3rd 2020

GP practices in England will be offered COVID-19 swab testing kits to speed up access to testing for staff and patients with symptoms of the virus, NHS England has said.

GPs will be offered supplies of COVID-19 swab testing kits ‘on a voluntary opt-in basis’ – with swabs intended to be for self administration only.

Practices choosing to take part will be able to hand out tests to patients presenting in GP practices with symptoms of COVID-19, or to ‘symptomatic GPs, practice staff and their symptomatic household members’.

The move comes after repeated calls from GPs for better access to testing in primary care – and criticism of the failure to involve primary care in the test and trace programme.

Test and trace

GPonline reported last week on BMA polling that found 60% of GPs reported a colleague off sick or self-isolating in the previous fortnight, with many isolating while awaiting test results.

A leading global health expert told an RCGP event last month that the failure to involve general practice in test and trace had been ‘a disaster and a national shame’ – and a group of doctors wrote in the Journal of the Royal Society of Medicine last week that the millions of pounds spent on outsourcing the service should be diverted to primary care and local public health services.

NHS England’s latest primary care bulletin confirms that while there is no plan for a radical rethink on the test and trace service, practices will now be able to request supplies of testing kits.

To date during the pandemic, only a handful of ‘hot sites’ set up by GP practices have been able to administer swab testing.

COVID-19 swab

The bulletin confirms: ‘This will be a supplementary option for practices and does not replace any of the existing routes to access testing. Members of the public will continue to be directed to regional testing centres or home testing kits in the first instance.

‘These tests can be offered to patients who present with COVID symptoms in general practice settings, to streamline patient care and increase access to testing for patients who would otherwise be unlikely to get a test via the primary testing routes.

‘For example, due to barriers around language, disability or digital inclusion. Practices can use their discretion to offer the swabs where they deem it to be clinically appropriate.

‘Following requests from GPs to have increased access to testing, these tests will also be available for symptomatic GPs, practice staff and their symptomatic household members to support general practice settings remaining operational. Test results for anyone using these swabs will be sent to patients and flow into GP records, in the same manner as other pillar 2 test results.’

GP practices are set to receive further information via email from NHS England on how to opt in.

Software bungle meant NHS Covid app failed to warn users to self-isolate

Sunday Times November 1st 2020

The “world-beating” NHS Covid app, downloaded by 19 million people, has systematically failed to send alerts telling people to self-isolate after they came into contact with infected people.

Thousands were not contacted by the Test and Trace app, developed under Baroness (Dido) Harding, because it was set at the wrong sensitivity, the government has admitted.

For a month, the Department of Health and Social Care failed to use software developed to make the app work properly. Users whose “risk score” should have triggered an alert were not contacted. As a result, a government source said, “shockingly low” numbers of users had been sent warnings since the app was released on September 24.

The source added that people who owned Android devices were among the worst hit. The mobile operating system accounts for more than half of UK phone users and is also disproportionately used by the less well-off, who are most at risk from the virus.

It took officials five weeks to fix the problem and make a voluntary software update available last Thursday.

The latest disclosure may explain why government scientific advisers on Sage recently warned that the £12bn test and trace system, of which the app is an integral part, has had only a “marginal” impact on Covid-19 transmission.

Last week, developers admitted the error in a blog post, which explained that software engineers had created more effective technology ahead of the app’s national launch, meaning it could have been upgraded from the version tested in the Isle of Wight.

“The ‘risk threshold’ was due to be lowered,” wrote Randeep Sidhu and Gaby Appleton, who are leading figures behind the app. However, they continued, “this change did not take place at that time”.

Although 19 million people use the app, officials have refused to say how many people have been told to isolate through it.

In contrast, Scotland and Northern Ireland have made data for their systems available, with the devolved administrations’ apps contacting 10,000 and 16,000 respectively.

Matt Hancock, the health secretary, has previously hailed the app as “an important step forward in our fight against this invisible killer”.

The app has suffered from problems since its launch. An urgent fix was needed two days after the national roll-out when it emerged that 61,000 NHS tests could not be linked to it.

Last month, the app was updated to stop users from receiving “phantom” alerts telling them they had had a “possible Covid-19 exposure” but without any follow-up.

Professor Muttukrishnan Rajarajan, director of the cyber-security institute at City University in London, said that “lowering” the risk benchmark for notifying users should make the app more effective.

Unlike people reached by a contact tracer, those on lower incomes who are told to stay at home by the app do not get a £500 payment.

A health department spokesman said: “The NHS Covid-19 app is the only app in the world using the latest Google/Apple technology to better gauge distance to identify those most at risk, and is deemed ‘excellent’ by international standards.”