Bernard Jenkin: The threat of the virus to the NHS hasn’t gone away. How it could overwhelm hospitals – and intensive care.

13 Oct

Bernard Jenkin MP is Chair of the Liaison Committee, and MP for Harwich and North Essex.

The spring lockdown was necessary to avoid the NHS being overwhelmed by hundreds of thousands of seriously ill people. Today, infection rates are rising again.  So again, we must ask the question: what hospital capacity is required to keep pace with rates of infection?

Today, there is far more data, better understanding of the virus, and better treatments, so we no longer need to entertain the most apocalyptic predictions. Nevertheless, the figures are stark.

It is medical consensus that it takes an average of seven to ten days for someone infected with Coronavirus to develop severe symptoms which require hospitalisation. This affects a smaller proportion now, but ONS data suggests it is still significant.

In the week up to the 1st of October, 16,000 people per day were infected with coronavirus in England.  Hospitalisation data for this specific this specific period is still emerging, but already, seven to ten days later, the Government’s daily Coronavirus updates suggest that between 500 and 600 new hospitalisations are taking place daily in England.

This suggests that some three to four per cent of those newly infected with coronavirus will require hospitalisation. This is lower than earlier in the year (which was up to three times higher).

However, the epidemic is currently most prevalent among young adults.  They are far less likely to require hospitalisation.  This is the case in my own county, Essex, but low case rates are now doubling every ten days, as the virus spreads up the age range.  So rising case rates will lead to rising hospitalisations.

Intensive care units will also come under pressure.  Estimates from the spring suggest that up to 17 per cent of those in hospital with cthe Coronavirus required a move to the ICU.  Perhaps that will be lower too.  Let’s assume it will be only 10 per cent (and that optimism makes the sums easier).

The length of hospital stays also matters.  Those infected with Coronavirus can expect a length of stay in hospital of between five and 15 days, depending upon from where the data is drawn.

Here, a consensus has yet to emerge.  (The paucity of studies from outside China and the pandemic’s continuation means that medics are still feeling their way.)  In his presentation on Monday, Jonathan Van Tam, the Deputy Chief Medical Officer, showed a graphic with a range of nine to nineteen days: taking the middle point of that gives an average stay of 14 days. Similar evidence suggests that eight days is also the approximate length of stay for patients in ICU beds.

England has approximately 140,000 hospital beds, and 4,100 adult ICU beds. For this part of the year, we would expect around 85 per cent of beds to be full, which gives ‘spare’ capacity in England of around 20,000 hospital beds.

So what do all this statistical estimates mean, when asking how much hospital capacity will be needed if there is serious Coronavirus spread throughout the UK?

Let’s assume that we let the virus spread, so that, over the next three months, an additional quarter of the population of England becomes infected with coronavirus – an additional 14 million people. This is equivalent to just under five million infections per month, or 156,000 infections per day. 3.5 per cent of five million would become sick enough require hospitalisation.  That is equivalent to 5,500 daily hospitalisations.

We have to date ignored two factors which make things seem better than they would be. First, there would not be a flat rate of infections at 156,000 per day over three months. Instead, the daily infection rate would follow the familiar (and far more disastrous) bell-curve.

Second, we are assuming that the population which falls sick is relatively young and healthy, as now, and that we can protect the vulnerable.  Experience in this second wave already suggests this is most unlikely.

But let’s look again at what would be necessary to manage 5,500 daily hospitalisations. We know that hospitalisations last, on average, for 14 days. This means that we would need 77,000 extra beds on top of what we now have. So in addition to the 20,000 spare hospital beds that we currently have, we would need to find another 57,000 – equivalent to just over 16 new London-sized Nightingale hospitals.

In this (flat) scenario, these hospitals, as well as every hospital in the country, would have to be run at 100 per cent capacity, each and every single day for three months.

We have also assumed that we can perfectly match hospital capacity to the location of infection hotspots, which is not the experience.  Images we have seen of packed hospital corridors in Lombardy or New York demonstrate this task is very difficult, if not impossible.

For ICU capacity, the numbers are even more stark. If one in ten of those requiring hospitalisation require being moved to the ICU, then 5,500 daily hospitalisations becomes 550 daily ICU admissions. At an average length of stay of eight days, England alone would require 4,400 ICU beds, more than the entire capacity of ICU beds in the country.

And if the epidemic spreads to older and more vulnerable people, this shortage would become yet more acute.  In Essex, the NHS is not planning to stop doing anything but Coronavirus.  The aim is to keep the NHS open for as much normal business as possible, but there would be no possibility of achieving that in the scenario above.

This is the maths which is driving the conversation in government around the need for new Covid restrictions. If test and trace was working better, perhaps we would have been better able to keep the number of cases down.

But absent massive test and trace capacity, the Government has no option but to consider the second round of Covid restrictions to get us through this winter.

The reality of this virus is that it is not like ‘flu; something you get once and gives you immunity.  It is also very hard, perhaps impossible, to find a permanent vaccine.  There never was a vaccine for AIDS or for SARS (another coronavirus).

Time and science will improve the resilience of people, society and the economy.  We certainly should not plan to have varying degrees of lockdown every six or twelve months.  The Government should set up a long term strategic group, away from the daily pressures of Whitehall, to draft a strategic White Paper, Living with Coronavirus, which sets out how we can best manage Covid-19 while keeping the economy open.

John Fuller: This pandemic has shown that bigger local government does not mean better local government

14 Sep

Cllr John Fuller OBE is the Leader of South Norfolk District Council and the Chairman of the District Councils’ Network

The opportunity to take back control drove millions to the ballot box in June 2016. The country voted to take back greater powers to shape their own destiny, and against remote elite and expensive bureaucracies that take decisions to constrain our lives in ways that are hard to influence.

It doesn’t just apply to Europe: English local government is already the largest and most remote in the western world, with voters already the least well represented.

Yet the lessons of the pandemic have proved again what is fact: bigger local government is not better local government. While national command and control sometimes stumbled, our local district councils ensured that individuals, families, and businesses could keep calm and carry on.

In streets up and down our country, it was the local district council that ensured every fridge was filled, every bin collected, every evicted sofa-surfer had a roof placed over their head, and every small business had the financial help and regulatory forbearance to adapt and pivot towards a new normal.

And we were able to do this because we have the local connection, the local accountability, and the local knowledge, to customise our approach, one family at a time, one street at a time, and one place at a time.

Your local district and smaller unitary councils represent our market towns, our cathedral cities, coastal communities, new towns, and the countryside, across 60 per cent of England. Our agility at street level allowed national government to focus on the big issues whilst safe in the knowledge that the final mile was cared for.

But what’s this?

In the last few weeks there is a small group of people clamouring to put all of this at risk. Astonishingly, Conservative county councils are making the case for turning their backs on learning the lessons on what worked best in the depths of our Covid despair.  They are proposing to dismantle the final mile that delivers bespoke solutions for residents in every corner of our country.

They seek to recast local government into just two dozen county-based unitary councils in a reckless race to the bottom on cheapness. It is nothing less than putting their own organisations’ survival ahead of the best interests of residents and business – and will hamper our ability to grow the national economy, one local economy at a time.

Replacing nearly 200 predominantly Conservative authorities with just 25 county unitaries where control is much more finely balanced would be a suicide mission that would put see our associations and councillor base emasculated and take the voters even further away from those who represent us.

In so doing it, would destroy the local campaigning base of the Conservative Party and leave us at a structural disadvantage against Labour’s metropolitan heartlands who would remain unmolested.

The county councils’ plans would condemn Conservative local government to permanent opposition in the Local Government Association and all the other representative bodies that control nearly a third of public expenditure.

And with 33 councils in London and just 25 in the rest of shire England, what does that say about levelling up? It is already more difficult to get Conservatives elected on the bottom rung of our democracy. In the typical Labour-run London Borough or city-based metropolitan council, it takes about 3,000 electors for a Labour candidate to win. In our county councils, in Kent, Essex and Hampshire that number is 15,000. Labour enjoys a five-times electoral advantage over us. We should be challenging this arithmetic, not reinforcing it.

But it’s worse than that. Labour councils tend to be smaller: 50-60 seats, whereas Conservative counties often comprise 80 councillors or more. So it’s also easier for those councillors of other parties to become council leaders and thus play a leading role in national policy formation.

In the mid-2000s, our leader in local government, Sandy Bruce Lockhart, and the Leader of Kent County Council, cautioned us against conniving with Labour to decimate the Party in the Shires. How ironic that we now have Conservative collaborators pushing something that even Hazel Blears as Labour’s Secretary of State dared not deliver.

Now is the time for us to focus on recovery not reorganisation. Our government’s Devolution and Recovery White Paper must recognise that a council isn’t just a transactional entity. A council has the responsibility to exceed the aspirations of residents and business, recognising and celebrating the differences in our county, not centralising with an identikit approach.

We should be devolving down even more to those organisations like our district and small unitary councils who shone when the Covid chips were down; not using it as an excuse to centralise into distant mega-bureaucracies with a ‘Computer Says No’ attitude, that are so removed from street level that they are unable to connect with the towns and cities across their sprawling landscapes.

Making an argument for cheapness is a dismal one that cannot inspire anyone. The Conservative Party stands for aspiration and efficient services that they can be shaped locally, not cheap ones they can’t. We stand against centralisation rather than devolution. We stand for shaping shared prosperity at street level to build homes, infrastructure funding, and employment to deliver true levelling up for all.

So let’s have a pattern of local government that looks forward to the needs of 2066 rather than being bogged down by boundaries laid down in 1066.

That’s not just a statement of common sense. It’s also an aspirational one which allows the Conservative Party the best chance to shape the future in every corner of our land. Let’s celebrate our historical county boundaries, but not get tripped up by them.

Mo Metcalf-Fisher: “Pubs versus schools” doesn’t need to be an either-or scenario in reopening Britain

12 Aug

Mo Metcalf-Fisher is spokesman for the Countryside Alliance.

During lockdown, the closure of pubs was catastrophic for the countryside. Pubs form part of the backbone of rural communities up and down the land. They are not just places to see off a pint; they are public houses that provide a vital community space. They act as village hubs, often being one of the few places available for local people to meet, hold events and even operate as polling stations during elections.

When the go-ahead was given by the Government to reopen pubs from July 4, the nation collectively cheered. Meeting up with friends at my local on the first evening it reopened gave me immense joy. Seeing other families and friends enjoying themselves, laughing and exchanging stories all while putting money into the till of a local business was incredibly satisfying to see again. Despite this positive development, it seems pubs now face a further challenge to their long-term existence.

Throughout the Covid crisis, the Countryside Alliance has been keeping in regular contact with publicans across our extensive network of rural businesses. While most were incredibly grateful for the financial support and flexibility of the Government during the height of lockdown, many were incredibly eager to get going again, once restrictions were lifted.

Landlords and pub owners seldom have an easy day; working long hours and continuously coming up with innovative ways to drive up new business. Irrespective of vast complications caused by Covid, there are a multitude of pre-existing factors which make keeping pubs open a challenge. Supermarkets selling multi-buy offers which are not available to pubs, for example, make it much harder for pubs to compete. It’s no secret that the number of pubs has been decreasing steadily for several decades. According to the BBPA, from 2000 to 2018, pub numbers have declined by 22 per cent.

Then there has been an effort, by the Children’s Commissioner Anne Longfield, to push an unhelpful narrative that pubs should be the first establishments to close in order to prioritise keeping schools open. Her exact quote, was: “If the choice has to be made in a local area about whether to keep pubs or schools open, then schools must always take priority.”

Now, no one is seriously doubting the importance of children going back to school, as quickly as possible. Seeing certain teachers unions’ attempting to sabotage plans to reopen schools and playing politics with our children’s future has infuriated me to my core. However, why is the not-so subtle dig over the prioritisation of reopening being landed at the door of our hardworking publicans?

The issue I take with her remark is that she has provided little clarity as to why there needs to be an exclusive choice between the two. The reason the closure of pubs captivated so many in the nation is because of their importance both as an economic contributor; providing huge levels of employment as well trade for an array of other connected businesses like breweries and wholesalers, as well as their huge societal contribution, at heart of so many local communities.

Pubs have already invested large sums into bringing their establishments up to the strict standards of health and safety expected of them. Plastic protective screens have been set up, PPE bought, hand sanitiser stations made available and track & trace systems implemented.

It is clear publicans understand their duty to their collective communities to provide a safe and secure social space. Many of the pubs we speak to have reported that as time has gone on, footfall has gradually increased. Staff have been taken off furlough and new personnel have been hired to meet the demand.

However, that same network of pubs in villages and small towns across Britain are virtually universal in their view that if a second lockdown were introduced, requiring them to shut shop again, they would have to close for good.

The choice facing local authorities should not simply be an either-or scenario. Without pubs, our economy will take an ever greater hit and the long-term damage it will cause across local communities will be irreversible.

We are officially in a recession now and it should go without saying that if we are to even attempt to pick up the pieces when this awful pandemic ends, we need to have a functioning economy. Sniping at pubs from the sidelines and pushing to halt a trade which employs hundreds of thousands of people, will cause untold devastation. Once leaving school, children will need jobs to go to. Unless we are out in our communities earning and spending money, their future remains bleak.

Pubs need and want to continue trading safely, especially as there is no guarantee of further financial support in the event of a further lockdown. Where Covid-related incidents have popped up at pubs, swift action has followed suit.

Take for example the Crown & Anchor in Avely, Essex. Within hours of being notified that a patron had been taken ill with suspected Covid symptoms, the pub immediately notified the community and shut shop. They carried out an extensive deep clean of the premises and remained shut for 72 hours. After following the relevant guidelines, they were able to reopen and continue trading. Going forward, it seems obvious that this remains the most effective way of dealing with Covid cases, from both an economic and health & safety perspective.

Covid has obviously created great anxiety for many people and time will only tell how long it will take for the vast majority of us to go back to leading an ordinary life. But it remains clear that there is not a bottomless pit of money for the government to prop up the economy for the long term. We need sensible, practical solutions for living day to day while the virus remains. We can’t continue living in fear and we must not allow businesses, like those remaining pubs, to fall by the wayside.

Bernard Jenkin: The Government should not allow China a role in our nuclear industry without new safeguards

14 Jul

Bernard Jenkin MP is Chair of the Liaison Committee. He is MP for Harwich and North Essex.

There is no such thing as a truly independent Chinese company. Any involvement with Chinese companies comes with strings attached that lead all the way back to the Communist leadership in Beijing. We tried to ignore this with Huawei and the construction of our 5G network. But Chinese regime influence is an inevitable fact of any relationship with Chinese companies. And the Government still don’t seem to have learnt this lesson.

Near my constituency, a next generation nuclear power station is out to consultation at Bradwell on the Essex coast. Bradwell B is intended as a vital part of the UK’s future carbon-free base electricity supply. The British pretty well invented nuclear power, but we allowed BNFL to sell the n-power builder Westinghouse to Toshiba in 2005, so the UK has no indigenous n-power construction capability.

Dependent on foreign designs, the government agreed with China that CGN (China General Nuclear) should construct two Chinese designed reactors at Bradwell. CGN is entirely state-owned.

So the Government has agreed that the Chinese government should build a key part of our own critical national infrastructure (CNI). If this is to go ahead, the very least we should insist upon is a set of safeguards to protect our national security and CNI from malign foreign influence from a hostile government.

The Chinese government has demonstrated an established pattern of IP theft, nuclear espionage, political interference with private enterprise and cyber attacks on Western interests. Chinese companies are not the same as private companies based in Europe or the United States, or even state owned ones like the French EDF, which is building Hinkley Point.

Only three years ago, China passed a law granting itself the power to compel any Chinese citizen to cooperate with the government of China for national security purposes. CGN has itself been indicted by the US government, after US-based employees attempted to recruit American nuclear experts for projects in China.

Last year,  Dr Christopher Ashley-Ford, the US Assistant Secretary of State, said: “the Chinese nuclear industry is not a purely civilian industry, instead operating in close partnership with the People’s Liberation Army (PLA)…To cooperate with the Chinese nuclear business, in other words, is thus to some extent inescapably to cooperate with the PLA.”

If we don’t want the UK taxpayer to contribute to the strength of the Chinese military, or UK based technology to mysteriously end up in Beijing, we need to act swiftly and decisively, whilst also recognising that, at least for now, we still need Chinese financing and technical expertise in order to expand the UK’s civil nuclear infrastructure.

The only safeguards currently proposed for Bradwell B are the same as for any nuclear power station. They are wholly inadequate. At present, China will finance, build, own and operate Bradwell B. The Office of Nuclear Regulation states that parent companies may not “usurp [the company’s] authority”, but what does this mean would happen if it happened? How can China “usurp” the authority of a company it owns anyway? This is either more wishful thinking about China, or more wilful strategic blindness.

The Government is proposing a new National Security and Investment law, of course, but this focuses on ‘trigger events’ – granting ministers the power to prevent, for example, a foreign takeover. The Bradwell deal signs us up to the takeover in the first place.

Nuclear espionage is already illegal, but this hasn’t stopped China so far. If we are to prevent espionage creating new crimes is insufficient. We must place obstacles in the way of those wishing to carry out criminal activities against us in the first place.

So the Government must use the new law to introduce a special regime for all foreign-owned CNI: a UK plc with a government-owned ‘golden share’, giving the Government special powers, and placing obligations on directors to inform the government of non-UK threats to UK CNI or to national security. This arrangement is based on the ‘golden shares’ introduced by the Thatcher government in 1980s for newly privatised industries, such as the defence research company, Qinetiq.

Under this arrangement, the Government would get the power to prevent takeovers and to appoint board members Senior company executives would have special responsibilities to notify the Government if they believed certain events were about to take place, including the preparation of intellectual property for transfer or sale and the employees involved. After all, any conspiracy to steal nuclear secrets that doesn’t involve senior executives would at least be more difficult to carry off successfully, even if it can’t eliminate the risk entirely.

The Government must manage the risks of foreign investment in UK CNI if we are to both build an infrastructure to secure our future as well as to regain China’s respect for our system and our values. Its huge economy and our own are interlinked in so many ways, and we should have positive and reciprocal engagement, but we must end the decades of blindness to China’s long-term aim of creating Western dependency on it.