Andrew Gimson’s Commons sketch: Johnson’s former adviser gives us politics as a disaster movie

26 May

“We’re heading for total and utter catastrophe,” Dominic Cummings, the Prime Minister’s chief adviser, told his colleagues on the evening of Thursday 12th March 2020.

Or as Helen MacNamara, the Deputy Cabinet Secretary, put it when she burst into the meeting he was holding with two of his scientific advisers: “I think we are absolutely fucked.”

This is politics as a disaster movie. In his evidence today to MPs, Cummings made Downing Street sound like the control room of a space ship which is hurtling towards oblivion while most of the senior people on board go on convincing themselves, thanks to the operation of almost irresistible groupthink, that no course correction is required.

The captain, Boris Johnson, is “about one thousand times too obsessed with the media to do his job”, and has only become Prime Minister because the other candidate, Jeremy Corbyn, was even worse.

“A choice between two people like that,” Cummings said, “is obviously a system that’s gone extremely badly wrong.”

And as MacNamara has just announced: “There is no plan.”

Cummings proceeds to “press the panic button”, but will it be too late? For a long time it seems that it will be. Today’s dialogue, though often riveting, will have to be cut before this picture makes its way to a big screen near you.

The Department of Health pretended it had prepared for the pandemic, but instead collapsed under the strain, unable even to obtain sufficient supplies of Personal Protective Equipment.

By Cummings’ account, Matt Hancock, the Health Secretary, lied that “everything is fine on PPE,” and then lied again, blaming the shortages of PPE on Rishi Sunak, the Chancellor of the Exchequer, and Simon Stevens, the Chief Executive of the NHS.

How would he rate Hancock’s performance, Rosie Cooper (Lab, West Lancashire) wondered, somewhat superfluously.

Cummings: “I think the Secretary of State for Health should have been fired for at least 15 or 20 things.”

And Cummings did what he could to get this message across: “I said repeatedly to the Prime Minister he should be fired. So did the Cabinet Secretary. So did many other people.”

Meanwhile a small number of brilliant people wrestled to regain control of the stricken space ship. Cummings wishes he had been quicker to understand how bad things were: “If I’d acted earlier lots of people might still be alive.”

At the start of this long session, and several times during it, he said how sorry he was for his own mistakes.

But he also described the rescue mission which he and a few others mounted, once they realised “all the claims about brilliant preparations…were basically completely hollow.”

The behavioural scientists who advised the Government insisted the British public would not accept a lockdown, which is one reason why that essential measure was not introduced sooner.

Unfortunately, Cummings pointed out, “in the field of behavioural science there are a lot of charlatans”.

That is no doubt true, but as Edmund Burke once wrote, “The temper of the people amongst whom he presides ought…to be the first study of a statesman.”

It is the responsibility of ministers to judge what the people of this country will accept: whether in this instance we would accept being prisoners in our own homes, forbidden even to go to the pub, let alone to watch the races at Cheltenham or the football at Anfield.

A big call, but the buck stops with Johnson, not with his advisers, no matter how gifted they may be, and Cummings is clearly very gifted.

Spoiler alert. At the end of the movie, the space ship is saved, though only after an horrifically high number of those on board have died.

We have taken heavy casualties and had one hell of a fright, but as the credits roll, and the feel-good music plays, we are not, perhaps, quite as censorious as Cummings, played as usual by Dominic Cumberbatch, is about the manifold deficiencies of those who were supposed to be running the show.

Tracey Follows: Vaccine passports just the start of a digital identity revolution. Here’s what you need to know.

19 Mar

Tracey Follows is a Futurist and CEO of Futuremade.

This week MPs gathered, in a socially-distanced fashion, to debate the merits or otherwise of vaccination certificates. Steve Baker MP took to quoting The Prisoner in his attempt to dissuade his audience from even thinking about instituting a programme of certification designed to identify who and who has not received a vaccination against Covid-19.

As one after another contributor rose to make their point, the focus was very much on how the decisions that were going to be made today would turn out to have much more serious and long-term consequences in the future.

But this is to view the issue through the wrong end of the telescope. In order to better understand the benefits and drawbacks of such a verification system, we have to look at the future and work backwards to make the right decisions today. Looking at least ten years ahead, we can envision a world in which many countries, many citizens and also many consumers use some kind of digital identity system. Here’s why.

In 2015 the United Nations committed itself to achieving seventeen sustainable development goals by 2030. The sixteenth of those goals relates to justice and, more specifically, clause 16.9 commits nations to “provide legal identity for all“. This is an important goal and we should remember that over one billion people in the world have no official form of identification to prove who they are, and therefore cannot access essential health and financial services that most of us take for granted in every day life.

At the same time, more and more of those everyday services in modern life, are delivered digitally. Nations are acting like technology companies as they digitise public services, and technology companies are acting like nation states owning newspaper media, offering schools to disadvantaged children and increasingly operating in the field of telehealth. Someday soon, nearly all of our essential services will be digitised and therefore our access to them will require a digital authentication of some kind.

But we should not jump to the conclusion that a digital identity would necessarily be state-controlled. Plenty of countries do run centralised systems, linked to biometric data like a fingerprint, in the case of India; or an eighteen-digit code that combines everything from birth data to local authority data, in the case of China. The UK government has not in the past suggested any kind of centralised model for identity. In fact it has gone out of its way to operate what is known as a federated model.

This federation consists of trusted “identity assurance services” such as your bank, the tax office or the postal service who altogether provide a package of assurances, which gives citizens a sense of privacy and control. However it is a very complex system which needs updating and in 2020 the UK government announced it would be creating a Digital Identity Strategy Board to bring together numerous government departments from the Home Office to the Department of Health and Social Care, to avoid any one department developing a digital identity system in a silo of its own.

What is often forgotten is that there is a further model which is already taking place among a new generation and technology enthusiasts at large. More and more people are downloading identity apps onto their smartphones so they can manage their digital identity themselves. In Jersey, for example, more than half of 18-25 year olds have already downloaded the Yoti app which they can use to prove their age at retail or hospitality establishments and festivals.

The way these apps work is that the user can release whatever identifying attribute they wish to share without jeopardising all of their other personal information. In the past when an eighteen-year old wanted to prove they were of drinking age they might have shown a driving licence which states not only their age but birth date and full address too. A decentralised digital identity app such as Yoti, or Evernym or many others, will only release the identifying information that is relevant to the situation at the time.

Many of these companies are now working hard to deliver Coronavirus credentials, the digital proofs of vaccination. These are the gateway drug to a more complex digital wallet that one day will be full of credentials for university qualifications, travel passports and visas, business cards or work badges, and of course your NHS number and many health records besides.

The truth is that all nations are becoming digital nations, and their digital citizens will require access to digital services. Decentralised, downloadable apps will ensure the user always has control of their digital credentials in a digital wallet, and ultimately has sovereignty of their digital identity too.

After all, no-one seems to worry about the surveillance that an autonomous vehicle will bestow on each of us. These cars will be ordered online, arrive at our doorstep, they’ll know what time that was, who we picked up on the way and what time we arrived at our destination. Likewise, not many people seem concerned about the surveillance of the self in Amazon’s new cashier-less store in Ealing that uses “just walk out” technology consisting of QR codes, sensors and cameras.

The fact is there are many ways we are already monitored on the street, at work and in our homes. Our digital identity is already out there it’s just not evenly distributed. Some people are not waiting for their governments to give them a digital identity, they have already taken control and created one of their own.

The Future of You: Can Your Identity Survive 21st Century Technology by Tracey Follows is published by Elliott & Thompson, available from Bookshop.org now.

Ben Howlett: Hancock must seize this opportunity for health and social care reform

19 Feb

Before becoming MD of Public Policy Projects, Ben was Member of Parliament for Bath from 2015 to 2017 and Chair of the first Parliamentary Group for Rare, Genetic and Undiagnosed Conditions. He also Chaired the Stroke Group and supported the personalised medicines and data analytics groups. Prior to entering Parliament Ben worked alongside the NHS in management consultancy.

The recent announcement of a White Paper to formally integrate health and social care is ten years overdue. Given the widespread support the proposals have received from all corners of the healthcare sector, it is clear that no one has any appetite to repeat the same arguments that sucked the life out of a room with the infamous Health and Social Care Act of 2012.

However, before we get too excited, we should remind ourselves of some of the exhaustive debates surrounding the provision of health and social care in this country. In a country where the NHS is the closest thing to a national religion, this Government needs to be cautious about any “reforms”.

Andrew Lansley’s reforms were well intentioned: give more power to frontline clinicians to make the decisions themselves. How could this go wrong?

What ended up as the dog’s breakfast that we now call the Health and Social Care Act 2012 is not where his vision started. Most of us know that the Government is genuinely passionate about the formal integration of health and care – who isn’t?

But, and this is a big but, if this means that Ministers are now going to be responsible for 4000 people on waiting lists… and if this means that the relatively poor cancer outcomes of the pre-pandemic era are now the responsibility of Ministers rather than the NHS…I hope you can see where this is going. There may not only be charges of politicisation of our sacred NHS, but patients might start directly blaming Ministers rather than “the system”.

The White Paper is clear that these decisions should be led by local communities, with local government formally integrated into the decision-making process. This is good news: local accountability for locally-provided services.

However, what happens to national, more specialist services? We have not yet heard what will happen to NHS England when Sir Simon Stevens stands down. Is this the point where almost universal warmth towards these reforms begins to break down?

For those of you with the crystal ball, give it a rub to see what happens to the operations run out of Skipton House, the Canterbury Cathedral of the NHS. Will some of those policy making powers find their way to Victoria Street, the new home of the Department of Health and Social Care? Lansley’s reforms were designed to give the NHS more independence and if the reforms go the way some of us predict, then Sir Simon may be elevated to a status not seen since Thomas Becket.

The right time?

While the Opposition is asking whether this is the right time to “reform the NHS”, they flagrantly fail to recognise that these are reforms are intended to bring health and care together. For those of us who can remember a time before the pandemic, statutory health and care integration has been discussed at length.

Remember when Jeremy Hunt, as Secretary of State, decided to change the name from an Accountable Care System to an Integrated Care System? The Kings Fund, Nuffield Health, Public Policy Projects, The Health Foundation etc. have called on a formal system of integration for many years. Integrated Care Systems (ICSs) have been around for several years with varying degrees of success. There are those of us who have been calling on the Government to create a standardised system in law for a while.

However, parliamentary arithmetic to offer up new legislation has not existed until now. A significant proportion of the system already exists, so the Government should consider this a “tidying up exercise” to bring consistency and equity to the provision of joined-up health and care, as opposed to a proposal for something new and untested. In short, this is a very good opportunity to incorporate some of the lessons from the pandemic whilst we all await the formal public inquiry.

What is missing?

Digitisation. This is extremely surprising given the Secretary of State’s “Duracell Bunny” status as a cheerleader for digitisation. Matt Hancock was on the airwaves as soon as the White Paper landed, expressing his desire to reduce bureaucracy. I counted at least seven times on BBC Breakfast he made the point, yet he barely mentioned innovation.

For those of us who know just how passionate Hancock is about the subject, this seems like a missed opportunity. Public Policy Projects will be publishing our first State of the Nation report of 2021 on digitisation and medical technologies next week where we will hear from the Minister for Innovation, who is helpfully responsible for digitisation.

At one of our events last year, Hancock said that his proudest achievement as Secretary of State was the digitisation of health and care. The pandemic has seen rapid transformation of digital healthcare provision. When it was once a long wait in a GP waiting room, you can now download an app such as Babylon or Livi (other providers are available) and see a clinician within minutes. Does anyone want to see us go back to the dark ages where we have to book time off work to visit a doctor?

The forthcoming reforms must embrace digitisation to truly make this a 21st century system of universal healthcare provision. I have little doubt that the Secretary of State would receive extremely positive support from patients and clinicians alike if he were to make this his statutory legacy.

Building a country fit for heroes

The pandemic has been a disaster for the health of our population. With over 115,000 dead, tens of thousands left with the long-term challenges of Covid recovery, mutant virus strains and some of the longest waiting lists in a generation, this is going to be an extremely difficult time for any Government as they try to reset the agenda. The Secretary of State has shown tremendous leadership during this pandemic and I have no doubt that he will be able to set a vision for the long term, with integration being his legacy.

The country needs some optimism and, if we can be sure of one thing, it is that Hancock is definitely optimistic. He must focus on what is important and focus in on boosting the health of the nation, and not let ulterior motives impact upon his vision. As numerous former Secretaries of State have said to me over the years, beware the law of unintended consequences.

Iain Dale: Forget the theories around Frost’s appointment. What does it mean for Gove?

19 Feb

Iain Dale presents the evening show on LBC Radio and the For the Many podcast with Jacqui Smith.

There are so many theories about Lord Frost’s appointment to the Cabinet that it’s almost worth dismissing them all.

It’s a real “what did Boris mean by that” moment, one which Metternich might have been scratching his head at.

Having replaced Frost as National Security Adviser, a job he had precious few qualifications for, Johnson certainly owed him one.

And given the number of post-Brexit deal bumps in the road there have been, there’s certainly a need to up our game in unpicking some of the more outrageous consequences of what we signed up to.

For instance, one paper reported that it’s now impossible to export trees from Great Britain to Northern Ireland if they have soil on their roots. Yet it’s perfectly OK for Northern Ireland to take trees from Spain or Sicily. Work that one out if you can.

This is but one example of UK industries which have had to take a hit as a consequence of loose drafting or things which the UK side in the talks clearly didn’t understand.

Michael Gove has been trying to unpick this sort of thing with his European Commission counterpart, but now Frost will be taking over.

So what does this mean for Gove?

People are reading this two ways. Some see it as a humiliation for the Minister for the Cabinet Office and that he’s sliding down the greasy pole to be summarily despatched at the next reshuffle. For many that is wishful thinking.

I suspect the opposite is true and that the Cabinet’s only real transformational minister is heading back to run a department, and bring his powers of reform and regeneration to either the Department of Health or the Home Office.

However, any reshuffle isn’t likely to take place before the late Spring, or even late Autumn. So the jockeying for position will continue for a good few months yet.

– – – – – – – – –

On Sunday I read that Suzanne Heywood’s biography of her husband Jeremy had entered The Sunday Times top ten non-fiction bestsellers.

Jeremy Heywood was at the centre of UK government for 30 years, and was a fascinating character, rising through the ranks to become Cabinet Secretary under David Cameron and Theresa May. He very sadly died of cancer in November 2018.

I started reading the book on Saturday afternoon, as I was due to interview Suzanne on Monday morning.

I had little expectation of being able to finish it by then, as it is a massive 540 pages in length. However, I couldn’t put it down.

Far from being a dry civil service style memoir, it’s a real page turner. I eventually got to the last page at 2.15am on Monday morning, and then experienced that slight feeling of grief I always get when I finish a book I didn’t want to end.

I can’t imagine a single reader of this column not enjoying it. I highly recommend it.

My interview with Suzanne will be on my Book Club podcast next Friday.

– – – – – – – – –

It comes to something when a government agency stands accused of “misleading” a parliamentary committee, but this is just what HMRC is facing this week.

It’s over evidence it gave on the controversial loan charge, which has affected thousands of innocent independent contractors.

HMRC was more interested in saving its own reputation than telling the truth, the All Party Parliamentary Committee on the Loan Charge told The Guardian this week.

It has emerged that HMRC is using the very same contractors that it is attempting to penalise. Hypocrisy of the highest order.

The committee concluded that HMRC had “put management of their reputation and public relations ahead of telling the truth, including to the point of providing statements designed to give a misleading impression and withholding the truth when they discovered it. This is simply not acceptable for any governmental body and may… represent a breach of the civil service code”.

In addition to this the Government is implementing its IR35 legislation in April, which will further penalise independent contractors by ruining their cashflow and forcing them to be paid as employees but with none of the benefits of being employees.

Philip Hammond is entirely to blame for this attack on entrepreneurial people, most of whom are natural Conservative voters.

It is a scandal that a Conservative government should use Corbynista type anti-business prejudice in this way. Were I a Conservative party member I would have resigned over it long ago.

If Rishi Sunak wishes to ingratiate himself with small business people he would get a lot more than three cheers if he stood up on March 3 and announced in his budget that he was scrapping both the loan charge and IR35.

It’s what any proper Conservative chancellor would do.

George Freeman: The industrial strategy reforms I led helped to deliver Britain’s vaccine success. Now for the next phase.

1 Feb

George Freeman is a former Minister for Life Science and Chair of the Prime Minister’s Policy Board (2016-18). He is co-author and editor of the 2020 Conservatives book Britain Beyond Brexit.

The combination of Covid-19 and the Crash of 2008 have left this country facing the most serious crisis in our public finances since 1776. Unless we make the post-Brexit, post-Covid recovery a transformational renaissance of enterprise & innovation on a par with that unlocked by Thatcher Governments of the 1980s, we risk a decade of high debts, rising interest rates and slow growth.

We have a truly unique opportunity before us. As a science and innovation superpower, with the City of London now outside the EU’s rules for the first time in nearly fifty years, we can unlock a New Elizabethan era of growth – with Britain a world-leader in global commercialisation of science, technology and innovation. It is what our entrepreneurs have been crying out for. Now is the moment to make it happen.

That’s why I’m delighted to have been asked by the Prime Minister to help set up the new Taskforce for Innovation and Growth through Regulatory Reform (TIGRR) with Iain Duncan Smith and Theresa Villiers.

Reporting directly to the Prime Minister & the Chancellor’s Cabinet Committee on deregulation, and supported by a secretariat in the Cabinet Office, the Taskforce will consider and recommend “quick wins” to use our new regulatory sovereignty to unlock high growth sectors of the economy to drive post-Brexit post-Covid recovery.

Rest assured: there will also be no big report or a thousand pages of footnotes to wade through. We will be crowd-sourcing the best ideas from the business community and the entrepreneurs and innovators who are the engine of our economy.

The Prime Minister has asked me to bring my career experience in business starting & financing high growth bioscience technology companies as well as my experience as Minister in Health, BEIS and Transport leading our groundbreaking Industrial Strategy for Life Science which has paid such dividends this year.

The reforms I led in our Industrial Strategy – launching Genomics England, the Early Access to Medicines Scheme, MHRA and NICE reform, Accelerated Access procurement have been fundamental to our ability to lead the world in developing a Covid vaccine.

We now need to make Brexit & Covid the catalyst for bold reforms to unlock big UK opportunities for recovery & GlobalBritain across a range of high-growth sectors such as those I have worked on extensively as both entrepreneur and Minister:?

  • LifeScience: harnessing the potential of the NHS as a research engine for new medicines, unlocking digital health & innovative approaches to Accelerated Access, clinical trials & value-based pricing.
  • Nutraceuticals: health-promoting “superfoods”, cannabis medicines.
  • AgriTech: smart clean green twenty-first farming technology like the blight resistant potato banned by the EU.
  • CleanTech: new biofuels, Carbon Capture & Storage & digital “smart grids” to reward households & businesses for generating more and using less.
  • BioSecurity: harnessing the potential of Porton Down and UK vaccine science for plant, animal & human biosecurity.
  • Digital: removing barriers to UK digital leadership outside the EU GDPR framework.
  • Hydrogen: using the full power of Gov to lead in this key sector as we did in genomics.
  • Mobility: making the UK a global test-bed for new mobility technologies,

Before being elected to Parliament, I spent 15 years working in life sciences around the Cambridge cluster, financing innovation. I saw time and time again how the best British entrepreneurs and their companies struggled to build business to scale here in the UK.

So often we have invented the technologies of the future and failed to commercialise them effectively.

After several years working as the Government Life Science Adviser, I published my report for the Fresh Start Group on The EU impact on Life Sciences: Avoiding the Global Slow Lane.

Three years before Brexit, the report was the first to highlight the growing hostility of the EU to ‘biotech’ and the increasing tide of ‘anti- biotech’ legislation – driven by a combination of the German Green Party, Catholic anti-science and lowest commons denominator regulation by the “precautionary principle” which was having a damaging effect on the Bioscience Economy and risked condemning the EU – and by extension the UK – to the global slow lane in biotechnology.

The report set out how the genomic revolution was beginning to offer untold opportunities across medicine and agriculture to help generate huge economic, social and political dividends for mankind. Billions of people were being liberated from the scourge of insufficient food, medicine and energy. The main threat to that? The EU’s hostile regulatory framework.

This was seen clearly in numerous case studies. At the time, the EU’s hostility to GM led German-based BASF and major U.S firm Monsanto to announce their withdrawal from Europe in agricultural research and development. My report argued that unless something was done soon, other companies would follow suit, with dire consequences for the UK Life Science sector.

The report recommended a shift away from the increasingly widely used risk-based ‘precautionary Principle’ and greater freedoms around data protection, using public healthcare systems to help accelerate early access to medical innovations, and for the UK to be able to ‘go it alone’ in designing appropriate regulatory frameworks for GM crops.

The UK’s departure from the laws and requirements of the EU provides us with a once-in-a-generation chance to redesign and improve our approach.

This new Taskforce, therefore, is emphatically not another long-term Whitehall de-regulation ‘initiative’. Neither is this is about cutting workers’ or environmental rights that we rightly guaranteed in the 2019 election manifesto.

It is of vital importance that the UK maintains the high regulatory standards that we have consistently championed. In some of the fastest growing new sectors like Digital Health, Nutraceuticals and Autonomous Vehicle Tech, clear global regulatory standards are key to investment confidence. By setting the new global standards here in the UK we can play a key role in leading whole new sectors.

But we must think innovatively about supporting businesses to start and grow, and make the most of the cutting-edge technologies and sectors we nurture in our universities for global impact. For example, why don’t we use our freedom to pioneer new disease and drought- resistant crops, and use our aid budget and variable tariffs to help create new global markets for UK Technology Transfer?

We won’t unlock a new era of the UK as an Innovation Nation generating the technologies and companies of tomorrow with technocratic tinkering. We need bold leadership, clear commercial vision and reforms to support innovation and enterprise. The two go hand in hand. We won’t unlock an innovation economy without an enterprise society. So we will need to look at tax and regulatory incentives for high risk start/ups like the “New Deal for New Businesses” I proposed back in 2010 to drive recovery after the Crash.

This is a once-in-a-generation moment. Together we must seize it.

Robert Halfon: The levelling-up ladder risks being knocked away by Covid-inspired decisions on education

13 Jan

Robert Halfon is MP for Harlow, a former Conservative Party Deputy Chairman, Chair of the Education Select Committee and President of Conservative Workers and Trade Unionists.

Last week, having previously advised that schools would remain open – that the risk to children was low, that classrooms were safe and that closures had a marginal effect on transmission – the Government decided to reach a consensus with the education unions and shut school doors. At the same time, the decision to go ahead with exams was scrapped and pupils will now, for the second year in a row, be under a system of centre-assessed grades.

As pointed out by Department for Education (DfE) Ministers on a call with MPs just two weeks ago, one of the most senior CMO officials said:

“There is no evidence younger children transmit the new strain of the virus at the same rate as adults, and there is no evidence the new strain of the virus causes more serious illness in either children or adults” .

A statement on January 2 from the Royal College of Paediatricians and Child Health (RCPCH) noted:

“Children’s wards are usually busy in winter. As of now, we are not seeing significant pressure from Covid-19 in paediatrics across the UK. As cases in the community rise there will be a small increase in the number of children we see with Covid-19, but the overwhelming majority of children and young people have no symptoms or very mild illness only. The new variant appears to affect all ages and, as yet, we are not seeing any greater severity amongst children and young people.”

Conservative MPs were also told by the DfE about a recent study by Public Health England, which concluded that:

“School closures would have only a minor and temporary effect on transmission rates, and the wider impact of this on children’s social, physical, educational and emotional development would be significant.”

If the science has changed, and the new variant represents a serious threat to children, teachers and support staff, then the Chief Scientific Adviser and the Chief Medical Officer should, at the very least, set out the evidence explaining this, and why everything they had said about the need to keep schools open has now changed.

Whether or not a risk assessment was carried out as to the impact of school closures on pupils’ educational attainment, mental health and wellbeing is unknown. If it hasn’t, it should have been, and if it has, it should be published.

What we do know, according to a report by the IFS and Nuffield Foundation, is that education inequalities have been exacerbated by the pandemic, and the gap between disadvantaged pupils and their better-off peers has widened significantly. Since September, disadvantaged children have missed more school than others. They are also less likely to return to schooling, even when given the chance to do so. The IFS state that the pandemic will halt or reverse the closing of the attainment gap – undermining much of the work the Government has done since 2010.

The RCPCH and the Royal Society of Psychiatrists (RSoP) have also highlighted the damage to pupils’ mental health and well-being of school closures. A few months ago, 1,500 members of the RCPCH signed an open letter warning of the “scarring” harm to children’s life chances. Last week, Dr Karen Street, an Officer of the RSoP, wrote harrowingly about the 400 per cent increase in eating disorders amongst young people – partly due to social isolation. On Saturday, in The Daily Telegraph, Dr Bernadka Dubicka, Chair of the Royal College of Psychiatrists Child Faculty, reminded readers of the:

“NHS digital data published in October which found one in six five-to-16-year-olds living with a mental health problem, up from one in nine just three years ago.”

She warned that:

“Inequalities will widen, life chances will diminish, and the mental health crisis already running rife in our young people could plague this generation for years to come – that is unless the Government urgently prioritises children and young people and places them at the centre of policy making”

For our younger generation, it looks pretty bleak.

Of course, there is remote learning, but there are still hundreds of thousands of students on the wrong side of the digital divide. The Government is trying to address this, with one million laptops being provided and free mobile data, thanks to an agreement reached with phone operators. However, for all the laptops in the world, it still isn’t enough. We know that online learning can be extremely varied. Moreover, it requires a student to open the computer and to study independently or for parents to provide constant support. School closures put enormous pressures on parents, many of whom are balancing their own work commitments, while trying to help educate their children.

The Government has made its decision on schools and we are where we are. So what should happen now?

First, everything should be done to try and get schools open. If this means ensuring that teachers and support staff are a priority for vaccination (not because one group of workers are favoured over another – but to get pupils back into the classroom and learning again), then so be it. The end of half-term re-opening should be a reality, not just an aspiration.

Second, the DfE must rocket-boost the £1 billion catch-up tuition fund to focus it on disadvantaged areas so that extra assistance can be given to pupils at risk of being left-behind. Mental health support should be provided in schools so that children, parents and teachers who are struggling can access counselling and advice when they need it.

Above all, the Government needs to set out a long-term plan for education – focused on addressing the attainment chasm between the disadvantaged and the better-off and, perhaps, look at the role and effectiveness of the £2.5 billion pupil premium, for starters.

Children, parents, teachers and support staff need an educational route map out of the Covid-19 swamp. Without it, many could be stuck in the mire of an epidemic of educational poverty and a crisis of mental health, long after the pandemic has passed. The levelling-up ladder of opportunity for the coming generation, will have been knocked away.

Rob Sutton: Government needs advisers. But advisers need competition – not their present monopoly. As this pandemic has proved.

13 Dec

Rob Sutton is an incoming junior doctor in Wales and a former Parliamentary staffer. He is a recent graduate of the University of Oxford Medical School.

The combined effect of emergency measures which allow legislation to bypass parliamentary scrutiny, and a viral pandemic which requires the rapid interpretation of ever-changing and highly technical data, has exposed a troubling weakness at the heart of government: that our expert advisers, however talented and hard-working they might be as individuals, have left much to be desired.

This is not entirely due to the advisers themselves, but the internal structures and incentives which Number 10 relies upon to provide advice. Those organisations which Johnson’s administration turns to for expert opinion (SAGE, Public Health England, the Department of Health, and the Government Office for Science), hold effective monopolies within their own niches.

Despite the breadth of talent these groups pull from, and the impression of depth of available opinion, there is relatively little overlap of their briefs, and they are ultimately machines of consensus: built to produce a unified position, rather than competing proposals.

From a political communications perspective, this is ideal. Presenting a position drawn from the interpretation of ambiguous (and unstable) data as being scientific consensus gives some degree of protection from criticism.

Yet this is hardly a good approach to building policy. These problems, though longstanding, were dramatically exposed by the Covid-19 pandemic and the corresponding increase in the government’s reliance on expert advice. The natural monopoly of ideas held by these bodies of experts has led to a predictably narrow scope for policy debate.

This is a concern which has riled many in Parliament, who feel increasingly marginalised in favour of unelected experts who face no public scrutiny or internal competition. Steve Baker, ever the prolific organiser and influencer, has been among those leading calls for reform of expert advice in government, arguing that this should be addressed as a matter of priority in a letter to the Prime Minister.

A government which retreats from parliamentary scrutiny and has been defined by a vision of centralised control hardly encourages open discussion. Yet the importance of balancing contrasting advice has become, more than ever before, a critical requirement for effective policymaking. At the root of the problem is the question of what expert advisers should be doing. Is it their job to dispassionately report the available evidence? Or to interpret it in a broader societal and political context?

This uncertainty has been, in part, a problem of the Government’s own making. The unwavering fixation on the “following the science” assumes “the science” to be an immutable corpus of knowledge.

This is an untrue and unhelpful representation. The scientific method demands a narrow and well-defined hypothesis, from which it follows that any interpretation should have a narrow and well-defined applicability. To test that hypothesis, metrics will be proposed to observe and quantify the phenomenon under investigation.

These metrics, being a representation, not the phenomenon itself, moves us a degree away from reality (for instance, positive results does not mean number of infections; it is a proxy). Data analysis and statistical methods move us a further degree away, as does one’s ultimate interpretation of what, if anything, that analysis tells us.

The power of the scientific method is therefore also its weakness – that we get results with narrow applicability, have to apply human biases to interpret them and then apply those findings to real world situations, with all their intractable messiness.

Add predictive methods such as modelling, which are extremely sensitive to both initial parameters and the specific model used, and the problems are compounded. To assume that there is a single fountain of scientific knowledge from which the answers to all our policy queries must unambiguously flow is a political fiction. And it is designed, rather cynically, to place those answers beyond reproach from the scientific laity.

We therefore have two issues which combine to limit the effectiveness of expert advice in government: an exclusive inner circle of advisers who hold an effective monopoly on policy proposals (even to the exclusion of parliament itself), relying on research data which inevitably has a narrow scope of applicability and is subject to differing interpretations. Science can tell us much about the world as it is; it is a powerful means of answering “what,” but on questions of “should” it is silent.

Under normal conditions, Parliamentary scrutiny would serve as a means of tempering the most extreme of Government policy suggestions. But under the emergency legislation enacted in March, we no longer enjoy this luxury. This has exposed the fragility of the Government’s market on expert policy suggestions.

Without internally competitive processes to broaden the conversation and provide alternative options, there is a worrisome absence of incentives to encourage policymakers to stray from the consensus. With an effective monopoly on advice, there is little reason for ideas to be good, or even workable, as long as they are presented with an air of agreement.

This is the reason why interdisciplinary and intradisciplinary competition for policy proposals is so vital. Interdisciplinary competition would allow us to balance the public health implications of Covid-19 against broader considerations of, for instance, the economy and mental health. intradisciplinary competition would allow conflicting interpretations of data to be debated in a rigorous manner.

Yet capturing this kind of competition, which comes so naturally to the private sector, is notoriously difficult to embed within the public. There are ways this might be built into the current organisational structure. “Red teams,” groups whose primary purpose is to play devil’s advocate, and thereby exposing weaknesses and unforeseen complications would be a step in the right direction.

Baker and, ironically, Dominic Cummings (who has frequently been a source of frustration amongst those lamenting the Government’s overreliance on a small number of expert voices) are among those who have argued for their implementation.

There are few who would, I suspect, attempt to make the case that the expert advice this Government has so heavily relied upon during the Coronavirus pandemic has been an overwhelming success. But the current parliamentary term is young, and if reforms in the procurement of expert advice were implemented with determination, we should quickly see them paying off.

Edward Davies: Work and relationships are the core components of mental health. The lockdown has damaged both.

4 Nov

Edward Davies is Director of Policy at the Centre for Social Justice

The Coronavirus crisis will have many knock-on effects, but one of the biggest – the decline in the nation’s mental health – is already daily headline fodder.

Research published in the British Journal of Psychiatry found that recent suicidal thoughts had increased from one in 13 to one in 10 respondents since March: that’s the equivalent of an extra 830,000 adults thinking of ending their life.

A mega-survey conducted by Mind, the mental health charity, found that more than half the adult population reported a deterioration in their mental state during lockdown. Even six months on from telling us all to ‘stay at home’ ONS analysis finds almost four in 10 adults reporting high levels of anxiety in October.

The Department of Health in England has said, predictably, that it is increasing investment in mental health services in response. But maybe it shouldn’t. We need to learn from the last few months that addressing the mental health needs of the country is not about an ever-increasing spiral of public service spending.

Child and Adolescent Mental Health Services (CAMHS) are overwhelmed, and the knee-jerk response to expand them is understandable. But by the time a child gets there they are already likely to be suicidal. We must go much further upstream.

The last six months have reminded us that good public services, important though they are, are not at the root of mental wellbeing. In fact, the two core components have little to do with public services or government at all, and were profoundly undermined by the lockdown: our work and our relationships.

First, on work, there are few more important things to a person’s mental health than having a reason to get up in the morning. The Royal College of Psychiatrists is unequivocal about the importance of employment for people with mental health problems, they say it is “central to personal identity; provides structure and purpose to the day; gives opportunities for socialisation and friendship; and increases social networks – a core component of social capital”.

And secondly, on relationships, the evidence is even stronger. The Grant Study, a landmark 75-year longitudinal study of Harvard students, is utterly unequivocal about the importance of our relationships to mental and physical health:

“So what have we learned? What are the lessons that come from the tens of thousands of pages of information that we’ve generated on these lives? Well, the lessons aren’t about wealth or fame or working harder and harder. The clearest message that we get from this 75-year study is this: good relationships keep us happier and healthier. Period.”

The quality of our close relationships is fundamental to child mental health, too. Family instability is the single biggest reason that children report attending CAMHS. But, deeper than that, NHS data shows the very structure of our family relationships has a fundamental impact on the mental health of our children.

A primary school child with married parents has a six per cent chance of a mental disorder. It rises to 12 per cent for cohabiting parents and 18 per cent for lone parents.

This overwhelming evidence on work and relationships is reflected in the “happiness data” initiated by David Cameron and still quietly being collated by the ONS. After our health itself, the two most significant factors in an individual reporting that they are satisfied with their life is their marital status and employment status – way more important than other items we might assume, such as housing or income.

So what does that mean coming out of this crisis? It means that whenever policy talk turns to mental health, we need to remember the lessons of both this recent pandemic and thousands of years of history and evidence.

Public services are hugely important, but we will not prevent this problem by constantly pouring water on the fire.

If we want to truly tackle mental health problems in this country, we need to go deeper. We need to ask why, if close relationships are so important, we have allowed the most stable relationship form – marriage – to collapse to a quarter of the rate of a generation ago.

Why do our homes get smaller, our commutes get longer, and more people than ever live completely alone? As a start we should invest in greater relationship support in the early years of children’s lives and revive the Government’s Family Test to ensure housing and economic policy supports rather than hinders families’ wellbeing.

The Government has committed (but not spent) £2.5 million to conduct research into family hubs; this shouldn’t be a dry exercise, but should be done quickly enough to provide a road map to the delivery of family hubs in every part of the country.

Rev-up family support at pivotal moments like the birth of a first child. Birth registration should be a gateway into family support at the very moment parents need it most. Simply fire-fighting this problem with well-intentioned hoses of ever more school counsellors and spiralling public services will never prevent it in the first place.

John Redwood: Covid-19 – and the hard questions that must be asked about forecasts, numbers, data and treatments

3 Nov

Sir John Redwood is MP for Wokingham, and is a former Secretary of State for Wales.

Throughout this pandemic, I have been dismayed by the poor data and the misleading forecasts produced by some of  the official advisers to the government.

On Saturday evening, like many people, I was left trying to read graphs purporting to give the reasons to justify a major curtailment of personal and business freedom, only to be unable to see the varying scales, the sources of the data or the relevant dates. There were as often glaring omissions. Why, for example, are we never given up to date figures of bed occupancies for the NHS either nationally or regionally?

Over the last six months, we have been shown some gloomy forecasts that proved wrong, regular changes in the way figures like the numbers of deaths are computed, misleading international comparisons with countries that compile data differently and a refusal by the advisers to engage in public with legitimate professional concerns of other medical and scientific experts who take a different view.

We hear a stupid mantra that we must follow the science. There is no single agreed scientific view of this disease because it is new and talented scientists and medics are wrestling to understand  it and to work out how best to treat it. There are healthy disagreements between them as they seek  better knowledge.

It is the worst kind of talking down to tell us there is one perfect settled scientific view which leads to one simple policy prescription of lock down. When I asked about the forecast of four thousand future daily deaths and the huge range in estimates for both deaths and cases into December, there was no convincing answer. The truth is that the government advisers do not know how many cases or deaths there will be next week or month.

I fully accept that for a minority this is a dangerous and potentially lethal disease.  For most, it is at worst a flu-like illness; for others, there are no symptoms at all. I am seeking changes to the way that the fovernment responds to the pandemic. I wish them to do all that a government can to save lives, and to help the vulnerable find the protection they need and want from the disease.

I also wish to see the Government avoid measures which do substantial damage to jobs and livelihoods. As we saw,  the last national lockdown was unable to stop the virus spreading again come the autumn. The Government’s own advisers who think the lockdown itself brought down case numbers and deaths substantially accept that a tough national lockdown does not solve the problem. They recommend continuing with various lockdown measures as long as we have no cure or preventative vaccine. Others think the virus had peaked at the point where the lockdown was imposed, and maybe the weather and other factors played a part in its temporary demise.

I am urging the government to work closely with medics and pharmaceutical researchers to identify more treatments to cut the death rates. There are various steroids, anti-virals, clot busters and antibody treatments that have now been found to help, or may emerge from trials as useful additions to treatment.

Health professionals have also now discovered using non invasive ways of administering extra oxygen are often best. There are also issues about whether Vitamin D and zinc supplements can help. I have urged more emphasis on qualified people seeking new ways of treating and preventing. There is much medical and pharmaceutical talent in the UK, and it may well make more breakthroughs, as it did with the introduction of steroid treatment.

I have urged better data.  The basis of defining a death has been changed several times during the pandemic, and there are issues about whether Covid-19 deaths have been overstated whilst understating other lung infections and serious co morbidities in the mainly elderly people dying. In the early stages, the authorities boosted death numbers from Covid-19  by directing its inclusion on a death certificate even if there was no confirmatory test for its presence, based on reported symptoms.

There was also a wish to ascribe all deaths to Covid-19 where it was present, even though the elderly person concerned muay have died from one or more of several other bad conditions they had. Some of the most common tests for the disease may also report false positives, which needs to  be taken into account when examining  figures for deaths and cases.  The latest forecasts for cases and deaths take the form of very wide ranges where the upper figure is three times the lower figure, making them meaningless as planning forecasts.

There is an absence of reliable public data on hospital bed occupancy, which seems to be the main worry of NHS management and the scientific advisers. We must not close the economy down to save the NHS if it can now cope thanks to the building of the Nightingales, greatly expanding intensive care facilities and recruiting many more staff. Why are we not using some hospitals as isolation hospitals specialising in Covid-19, and leaving the rest of the system free of the disease to reassure patients needing many other treatments?

What we do know is a lockdown is very damaging to jobs and business. The first national lock down took around a quarter off our national income and output – an unprecedented fall. We cannot afford to do that again, as government rightly spent a fortune on subsidising public services and private sector employment to cushion the blow.

I am pressing for substantial changes to lockdown plans. I see no need to close outdoor sports facilities. I think a range of specialist retailers should stay open with suitable measures to cut risks of infection spreading. Pubs and restaurants should be allowed to sell drink as well as food for take away. Government should work with business and offer help to improve air extraction so more can function safely indoors.

I do support the schools staying open as this is important to the development and future prospects of children and teenagers. This disease is usually very mild in young people. I have urged the resumption of non Covid-19 work by the NHS as Ministers seek, as many more people die of causes other than Covid-19 every day.

In order to reduce, the spread of the virus everyone needs to reduce the number of social contacts they have in enclosed spaces with poor air. This requires buy-in by the public. There is no agreed set of laws and controls on our everyday movements that will guarantee success. Government needs to persuade people to reduce social contacts rather than try to find  a set of laws they can enforce against the wishes of a significant minority. It could also help by assisting more people and businesses to live with the virus for all the time we have no cures and vaccines.

Can we have more UV sanitising systems deployed in public places? Can we have more assistance to adapt air systems in commercial premises to extract dirty air promptly to make them safer? Can we have some better understanding from government that we need all the small businesses that serve us, and they are the ones that are in danger of being hounded out of work by clumsy generalised lockdowns.

We can adapt our lives to living with the virus by many small steps of a practical nature. This battle cannot be won by taking too many liberties away, and lecturing people to stop their social and business lives. My constituents want the government to work with them to help protect the vulnerable and make normal life safer for the rest. There is no silver bullet or single answer. We all need to help, and that requires a general spirit of collaboration, tolerance and commonsense.

David Davis: My prescription for a Covid Plan B? A strategic dose of vitamin D.

26 Oct

David Davis is a former Secretary of State for Exiting the European Union, and is MP for Haltemprice and Howden.

Remdesivir, the much-touted anti-Covid drug, has failed its tests, and has been shown not to prevent any deaths. Vaccines, touted for September, are now delayed at least until the second half of the winter, will be rationed, and are expected to be only partially effective.

Meanwhile, the various lockdown strategies tried by the government are of variable effectiveness, somewhere between partial and zero in their impact. The Government’s scientific advisers are recommending temporary lockdowns without hard evidence of their effectiveness. Only last week they admitted that the evidence base for the so called non-pharmaceutical strategies are “weak”, but that urgency requires their use.

Lockdowns have enormous economic cost, and have deadly side effects on the general health of the nation. Indeed if the lockdown strategy were a drug, it would have failed to meet the criteria that have now led to the rejection of remdesivir, hydrochlorquine, and countless other more or less promising medicines.

And the trouble with the “temporary” lockdown is that, without a very fast and effective test, track and trace system, backed up by a rapid isolation strategy, the lockdown will go on for months. The harm to lives and livelihoods will be enormous.

So what now? Is there an escape from this nightmare? Is there a game changer available to us that will allow us to create an effective plan B? I believe that there is.

In early May, I wrote to the Health Secretary pointing to two studies showing a strong association between the incidence and severity of Covid-19 with vitamin D deficiencies in the patients.

Vadim Backman, one of the authors of one of those studies, said about healthy levels of vitamin D that “Our analysis shows that it might be as high as cutting the mortality rate in half”.

Now I am a sceptic when it comes to vitamins and supplements. The supplements industry has a few too many salesmen too willing to make bogus or overblown claims for products that have are mostly harmless – but also mostly useless.

But this was a little different. The claims were, and are, coming from highly respected scientists, the vast majority of whom had no commercial interest. And the arguments were scientifically plausible.

Most of us learned in our GCSE science courses that vitamin D was important to calcium uptake for building healthy bones. Deficiency led to rickets and other bone diseases.

But less well known is that since the mid 1980s there have been a series of scientific discoveries that showed that the the role of vitamin D was massively greater than had previously been understood. Every cell in the body had a vitamin D receptor. At sufficient concentrations, the vitamin switches on thousands of genes.

In particular the immune system seemed to be hugely dependent on the availability of the vitamin. It enhances both innate immunity – the original primitive immune system that is the primary defence of young children – and adaptive immunity, the system that creates antibodies to kill pathogens.

Every year that passes sees more and more scientific insight into the role of vitamin D in resisting disease and controlling inflammation. There is hard evidence in particular in the role of vitamin D supplementation in resisting respiratory diseases. It can help suppress colds, influenza and pneumonia, which fact I also highlighted in my letter to Matt Hancock.

When the Secretary of State referred my letter to NICE, the Government’s body that assesses drug effectiveness, they essentially rejected it on the grounds of insufficient evidence. The evidence was, of course, stronger than for there so called “non-pharmaceutical strategies”, but that was not a matter for NICE. And since then, there has been a non-stop stream of supportive evidence.

Before we get to the hard science, there is already a vast amount of circumstantial evidence. Everyone is well aware that the risk of dying from Covid-19 is significantly increased if you are elderly, obese, come from a black or minority ethnic background or have a pre-existing health conditions such as diabetes.

A very large proportion of all those groups are people with Vitamin D deficiency. Of itself, that implies that vitamin D deficiency may be the common cause.

There are clear correlations with latitude and seasonality in the severity of the disease. Basically, the more sunshine, the more vitamin D, the fewer deaths. The exceptions are countries like Spain and Italy, whose cultural traditions (of covering up) lead to very low vitamin D levels, and to higher death rates. The example the other way is the Nordic countries, who are very northerly, but whose diet is either naturally or artificially rich in vitamin D.

So the physiology and biochemistry implies that there is an immunological effect. The evidence all around us implies that there is an effect. But for the scientists we need hard data.

When I wrote to the Health Secretary, I laid out observational studies that had shown a significant reduction in infections, and a dramatic drop in the death rate above a certain blood level of vitamin D.

Since then, the evidence showing that vitamin D might help prevent Covid turning serious in some people continues to grow.

The gold standard of medical research is the randomised control trial. At the start of the pandemic we did not have such evidence, and NICE highlighted this in their June review.

However, since the review, researchers in Spain have published the results of the world’s first randomised control trial on vitamin D and Covid.

The results are startling and clear-cut.

The trial, which took place at the Reina Sofía University Hospital in Cordoba, involved 76 patients suffering from Covid-19. 50 of those patients were given vitamin D. The remaining 26 were not. Half of those not given Vitamin D became so sick that they needed to be put on intensive care. By comparison, only one person who was given Vitamin D requiring ICU admission.

To put it another way, the use of Vitamin D reduced a patient’s risk of needing intensive care 25-fold.

Two patients who did not receive Vitamin D died. None of those on vitamin D died. While the sample size is too small to conclude that Vitamin D abolishes the risk of death in Covid patients, it is nonetheless an astonishing result. Again, it is consistent with earlier studies showing large reductions in mortality.

This is just one element of the growing body of evidence showing a link between Vitamin D and Covid-19 outcomes. Recent analysis by Ben Gurion University suggests supplementation can cut the risk of infection from Covid-19 in half in some of the most at-risk groups. This 1.3 million person study backed up the conclusions of a previous 190,000 person research project in America. The mass of evidence is building and building.

Thankfully, the Government at last appears to be acting on this.

Last week, the Health Secretary confirmed his Department would be looking again at the evidence. He also confirmed that the Government would be increasing the public messaging around Vitamin D supplements. Crucially, he confirmed there are no downsides to taking supplements.

The vitamin D levels in the blood of the British population halve over the winter, which is one reason we catch so many colds then. They started going down in September. So this announcement is long overdue. Nevertheless we still have just enough time to act on this.

Vitamin D is readily available and – at a penny per pill – it is incredibly cheap. Providing supplements to those at risk due to pre-existing conductions, such as diabetes, would cost £45 million: to these, plus to every ethnic minority citizen, about £200 million.

For a little more, we could do what the Nordic countries do, and fortify some basic foods with vitamin D. And for tiny amounts of money, we could repeat the Spanish experiment in every British hospital, elevating vitamin D levels in Covid patients on arrival, cutting down the demand for ICU treatments.

These expenditures are trivial amounts compared to the £12 billion spent on test and trace and the billions being pumped into the NHS to help it through the crisis.

Furthermore, providing supplements for those at most risk would also help reduce other pressures on the NHS through the winter months, as we know Vitamin D can reduce the likelihood and severity of other acute respiratory illnesses, which flare up annually around this time. Imagine the thousands of lives that could be saved even if we just made prescription mandatory for care homes?

If we were really ambitious, we could fortify our food with it. Sweden puts it in milk as a matter of course, as do some of their Nordic neighbours.

In summary, correcting vitamin D deficiency could halve the infection rates in vulnerable groups: in addition it could more than halve the death rate for those who do get infected. At a time when we are considering yet another lockdown, with all the damage that that could cause, this could be a game changer.

Add this to the better techniques in medical handling of serious cases, and the availability of dexamethasone for the most severe. These are already cutting death rates in ICU from about 50 per cent to nearer 30 per cent. Combine it with the better organisation of hospital care which is now underway, and perhaps reinforce that with use of the Nightingales to isolate more infected people (rather than just as overspill capacity).

The pandemic mortality rate, properly managed, would begin to approach the severity of a serious flu outbreak. At that level, we would no longer need the massive economic self harm of national lockdowns. And as that pressure comes off, there may be a chance of the track and trace getting ahead of the disease, and controlling it further with a hyper-localised strategy, similar to the successful German and South Korean ones.

So while the review of the evidence is underway the Government must take the first step towards addressing the issue.

The Government must at very least provide free supplementation to the at-risk groups. This will no doubt save thousands of lives across the winter months and, in Matt Hancock’s own words, supplementation has “no downsides”. The odds of success are seriously better than the government’s existing strategy. Accordingly, the precautionary principle makes this a no-brainer.