Parliament should vote monthly from March on ending the lockdown

23 Feb

Perhaps the most significant moment during Boris Johnson’s statement on the Government’s roadmap out of lockdown came when he was questioned by Paul Bristow.

The Peterborough MP asked the Prime Minister about the five week gap between each of the plan’s five stages.  In sum, his question was: if the date on which each stage is due to begin can be put back, why can’t it also be brought forward?  Why a rigid five week delay?

Johnson’s answer was that the five week gap is “crucial…For instance, we will need four weeks to see whether the opening of schools has caused an uncontrollable surge in the pandemic, and then a week to give advice and so on”.

This five week delay, which gives the plan its inflexible character, is in the Prime Minister’s view “dictated by the science” – and suggests that we were wrong yesterday to suggest that it might be relaxed if better progress than expected is made early.

Strange but true: lockdown sceptics (such as the 13 Conservative backbench MPs, including Bristow, who yesterday urged a faster restiction lift) have today been joined by none other than the high priest of shutdowns – Neil Ferguson of Imperial College.

“Hopefully what we’ll see when each step happens is a very limited resurgence of infections. In which case, there’s a chance we can accelerate the schedule,” he said on Times Radio.  Number Ten insists that this won’t happen.

The sum of the Government’s view will be informed by figures that won’t be in the 60-page roadmap document: its estimate of death numbers, cases and hospitalisations if restrictions are lifted earlier (and therefore of the threat to the NHS’s operability).

The Prime Minister, his top quad of Ministers and SAGE will be worried about how high vaccination failure rates, the number of those unvaccinated and potential new variants could push those figures.

That anxiety was the sum of his answer to the Chairman of the Covid Recovery Group, Mark Harper, who pointed out that groups one to nine in the Government’s scheme will have been vaccinated by the end of April.

These are everyone over 50 and those aged 16 to 64 with a health condition that makes them vulnerable to Covid.  “Those groups account for 99 per cent of deaths and around 80 per cent of hospitalisations,” Harper said.

“So for what reason, once they have been vaccinated and protected from Covid by the end of April at the latest, is there any need for restrictions to continue?”  Johnson reverted to his point that vaccination doesn’t necessarily equal protection.

You might argue that the vaccines need a bit of time to kick in, and that Harper’s date is say a fortnight premature.  Or you may believe that the Prime Minister is right.  Or that all restrictions should end now bar voluntary social distancing, masks and handwashing.

Or you may have a quarrel with details of the proposals.  For example, the restriction on outdoor sports activity until March 29 seems Cromwellian.

Or you may think that some are already honoured more in the breach than the observance – such as the restriction on meeting outdoors with more than one person.

Above all, you may go back to Bristow’s point, and ask why restrictions can’t be lifted more quickly than explained if hospital numbers fall faster than expected.

We lean towards thinking that the roadmap journey looks on the slow side, but acknowledge that the calculations are not easy, and may change: essentially, they boil down to lives v livelihoods, and lives v lives, as they always have: cancer deaths, say, versus Covid deaths.

That’s assuming in this last case, of course, that the NHS is operating as normal, more or less.  But the most pressing question isn’t who’s right or wrong.  It’s who should take the decision – and how often.

Johnson confirmed to Graham Brady yesterday that there will be a vote on the renewal of emergency powers before Easter, which falls this year on April 4.

The Commons should also vote on these at least twice thereafter: at the end of April – which would give the House a chance to test Harper’s view – and the end of May.

Our best guess is that the Commons wouldn’t vote at any point to speed up the Government’s plan, since more Conservative MPs would vote with Ministers than against them, and opposition MPs would abstain at the very least.

But this is beside the main point – which is that the Executive should propose, the Legislature dispose, and that in this case there should be regular opportunities to test the will of the house as the facts emerge.

In that way, life would be breathed into the Prime Minister’s slogan of “data, not dates”.  At the moment, we are being offered data – and dates maybe later than those given, but not earlier.

On one point, however, all can surely agree.  It is wonderful to see so large a proportion of our vulnerable people being vaccinated so fast, due to good Ministerial decisions, scientific prowess and effective management.

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.

Ryan Bourne: The lifting of lockdown. Yes to prudence but no to pessimism. The projections of these gloomy scientists seem absurd.

16 Feb

Ryan Bourne is the author of Economics In One Virus, a forthcoming book available for pre-order on Amazon UK. 

As Boris Johnson’s February 22 “roadmap out of lockdown” day draws closer, the Prime Minister faces sharply conflicting advice. The backbench Covid recovery group (CRG) demands that schools return on March 8, and that all lockdown restrictions are lifted by April’s end.

Scientists and Covid-19 modelers from Warwick University and Imperial College, on the other hand, say a gradual lifting of restrictions from March through July would see between 83,000 and 150,000 people perishing from a massive fourth wave death spike. They recommend “non-pharmaceutical interventions” remain intact through summer.

Who is right? Given what we know, the politicians appear slightly too bullish. The modelers, on the other hand, seem ridiculously pessimistic. But a great deal of uncertainty remains and value judgments abound.

Committing to the CRG’s timetable would leave the Prime Minister a hostage to disappointment if first vaccine doses prove less efficacious against death than widely believed. Precautionary prudence demands we wait to see clear trends in the data before delivering major policy change. Especially because a release, amplified by its signal, will inevitably raise the prevalence of the disease over time, including among those still susceptible who would be vaccinated soon.

Looking at the collapse of children’s infections during lockdowns suggests that school closures may have had a large impact on disease prevalence. So here, in particular, I’d be more cautious as first doses continue to be administered to groups 1-9. Yes, the societal damage of lost schooling is enormous. But is re-opening them entirely in early March, rather than a month or so later when prevalence is much lower, really so crucial to life chances, on the margin, to risk the lives of those for whom vaccinations will occur within weeks?

This is not to say that targeted relaxations cannot begin. Outdoor activity, certain sports, and indoor retail could be green-lighted relatively safely, with the usual social distancing protocols and stronger guidance on ventilation. If schools can do rapid surveillance testing, we could have targeted closures only if multiple cases arise. In the depressing absence of that, localised returns in rural low disease prevalence areas seems reasonable. But until the high first dose efficacy against death or severe disease is confirmed and we’ve vaccinated more people, I’d probably opt for slightly more caution.

For all that I might quibble with the CRG on timing, they appear to understand the coming trade-offs better than certain scientists. Pretty soon, almost all over-70s will have been vaccinated once. These demographics make up 88 per cent of deaths to date. Vaccinations should therefore slash deaths rates observably in March, in turn reducing lockdowns’ benefits.

Hospitalisations will prove stickier, because of the large numbers of middle-aged people susceptible to severe disease. The capacity of the hospital system will remain a binding constraint, hence why everyone is advocating a glidepath to normalisation, rather than a “big bang” reopening.

That said, the modelers’ pessimism for even gradual relaxations is jarring. The Warwick model predicts 2,000 deaths per day in August if we “fully reopen” by July, even if 95 per cent of care home residents and 85 percent of over 50s are vaccinated. That would mean more deaths this summer than the pandemic to date. Imperial’s model assumes an 85 per cent general population vaccine take-up, but similarly predicts 130,800 more deaths even if vaccines are administered at a sustained rate of three million per week.

The logic behind these shocking figures is that if 85 per cent of people get a first dose which is, say, 70 per cent effective against symptomatic disease, then 40.5 per cent of people remain “at risk.” Presuming normal Covid-19 death risks apply to those with symptomatic infection implies lots of people still susceptible to death. On the path to everyone getting vaccinated, then, they believe a gradual release of restrictions will see an increasingly unmitigated spread that kills many, even accounting for the higher efficacy Pfizer vaccine and second doses.

Yet these assumptions seem absurd. Vaccine take-up rates have been higher so far. Official data for England through 7 February suggests 93.5 per cent of those eligible in care homes have been jabbed once, as have 91 per cent of over 80s, 96 per cent of 75-79s, and 74 per cent of 70-74s already. The modeling, meanwhile, seems to ignore entirely the evidence that vaccines might mitigate against severe disease or death, even among those vaccinated who still catch Covid-19. If confirmed in data, that alone would invalidate these results.

What’s more, modelling restriction relaxation as if this is synonymous with unmitigated spread seems misguided. Those in vulnerable groups who cannot take vaccines will surely remain cautious. In fact, they would probably be even more careful in the knowledge others are mixing more. A host of voluntary social distancing, mask-wearing, and an ongoing preference for outdoor activity will surely remain for many younger people too ,as they seek to avoid disease in spring and summer before being vaccinated or boosted. Releasing government mandates, in other words, won’t return us to “normal” behaviour.

But even if we did a lot of normalisation, lockdown-like measures would still be disproportionate against the end risks. If severe disease and death rates will indeed plunge after one dose, the value of the health benefits of population-wide restrictions fall dramatically relative to their extraordinary costs too.

Some scientists advising Johnson use banalities such as “the lower the cases can get, the better.” But the idea that nationwide restrictions remain the most cost-effective policy in a world where the overall fatality and severe disease risks are low, and highly concentrated in a tiny slither of the population, is clearly absurd.

Once priority groups have had their vaccines, the Great Barrington Declaration will be essentially correct: “focused protection” for those still vulnerable will be the order of the day.  This will be all the more feasible given the smaller number of people still at risk. For a much lower social cost than lockdowns, we could send these people a healthy supply of N-95 masks, indoor ventilation machines, a year’s worth of rapid testing kits for any guests, and have taxpayers finance carer networks that minimize disease-spreading risks for them.

Such measures will obviously be far cheaper in mitigating the remaining risks than imposing massive restrictions on everyone indefinitely. And, of course, ongoing surveillance will continue to monitor new mutations and local clusters, just as many businesses will also maintain mask requirements that mitigate risks for vulnerable patrons.

What scientists must acknowledge, then, is that the same logic that said lockdowns’ benefits were huge when vaccinations were imminent says they could be tiny once vulnerable people are protected. If first dose efficacy proves as strong as we think, the Prime Minister will have to break with those overly cautious scientists who fail to think about the marginal costs and benefits of lockdowns as vaccinations proceed.

Kristian Niemietz: What difference does the size of the state make to how is deals with Covid? None.

9 Feb

Kristian Niemietz is Head of Political Economy at the Institute of Economic Affairs

We are not having a very good pandemic so far.

With over 1,500 deaths per million people, Britain has one of the highest Covid death rates in the world. You can quibble a bit with those figures, but only at the margins. The number of excess deaths – that is, the number of deaths over and above what we would expect in a normal year – matches the number of Covid deaths far too closely for this to be a statistical fluke.   

In addition to having a higher Covid death rate, we have also had a worse economic downturn than most comparable countries. The UK economy shrank by about 10 per cent in 2020, compared to a European average of seven per cent, and about five per cent in North America and Japan.

And it is not as if we had lighter or shorter lockdowns than others. Our only redeeming feature so far has been the very fast approval, procurement and rollout of the vaccine. But there can be no denying that at least until the end of 2020, the UK has been coping extremely badly with this pandemic. The question is why.  

Britain’s left-wing commentariat was quick to ascribe all this to “austerity”. For example, Polly Toynbee, the Guardian columnist, talks about “an incapacitated public realm, naked in the blast of this epidemic. It wasn’t just the NHS and social care […] but every service crippled by cuts: public health, police, local government, the army and Whitehall – all denuded.” 

Owen Jones, the arch-Corbynite writer, asserts: “a state hollowed out by austerity and market dogma is, in large part, to blame: it cannot be stressed enough that it is mostly because of these ideologically driven failures that Britain has been – is – one of the worst-hit countries on Earth.”

Michael Marmot, the “inequality czar”, wrote a Guardian article with the self-explanatory title “Why did England have Europe’s worst Covid figures? The answer starts with austerity.” 

I could easily find dozens of similar quotes, but you get the gist. It is a highly fashionable opinion. But as is usually the case with fashionable opinions, it is also completely baseless.

“Small-state Britain” is a myth. Despite all the waffle about “austerity”, in 2019, UK public spending still stood at about 40 per cent of GDP. This is a perfectly normal figure for an OECD economy, neither unusually high, nor unusually low.

But that is beside the point anyway. As I show in my new report Viral Myths: Why we risk learning the wrong lessons from the pandemic (published by the Institute of Economic Affairs), the size of the public sector is completely unrelated to how well, or how badly, different countries have been coping with the pandemic.

If the size of the state were the critical factor, Belgium, where government spending accounts for over half of GDP – one of the highest levels in the world – should have been superbly prepared for the pandemic. Alas, they were not. With a Covid death rate of over 1,800 per million, they did even worse than Britain, and their economy also shrank by over eight per cent.

In Italy, where public spending accounts for almost half of GDP, both the Covid death rate and the economic “growth” rate are about the same as Britain’s. France, which has perhaps the largest state in the world (unless you count North Korea and Cuba) fared somewhat better than Britain, but not by a huge margin.

Australia and New Zealand, on the other hand, fared better than most developed countries, with public spending levels that are (moderately) lower than the UK’s. South Korea, with public spending levels of less than a third of GDP, was one of the star performers, and so were Taiwan, Hong Kong and Singapore, where public spending stands at less than a quarter of GDP.

It was not government largesse that saved the best performers. It was specific policy packages, containing measures such as early travel restrictions, a rapid roll-out of mass testing, effective test-and-trace-and-isolate systems, and a rigorous enforcement of quarantining requirements (combined with financial support to make this economically viable).

This is, of course, Captain Hindsight speaking. Being right with the benefit of hindsight is, admittedly, not very impressive. But it is still better than being wrong despite that benefit.

Neil O’Brien: Imperfect vaccines, new variants, domestic mutations. Why there must be no rush out of lockdown.

8 Feb

Neil O’Brien is co-Chairman of the Conservative Party’s Policy Board, and is MP for Harborough.

At last, the happy ending.  As EU politicians squabble, we’re vaccinating faster than anywhere else in Europe. The Church of England is allowing cathedrals to be used as vaccination centres, and the footage of orderly queues in Salisbury and Lichfield made me feel like we were in the happy ending of Powell and Pressburger’s patriotic war movie, A Canterbury Tale.

But whenever a movie has a happy ending, I worry someone will make an awful sequel: 2020 the revenge. As the Prime Minister said, alluding to The Great Escape, it would be tragic to “tangle ourselves in the last barbed wire” just as we escape from the pandemic.

He’s right. Ministers face two uncertainties.

The first: how fast we can go in opening up without triggering an upsurge in conventional Covid.

The second: how to manage the risk of new, vaccine-resistant Covid strains being imported – or equally importantly, developing here.

Armour with holes in

Clearly, we can’t just open everything tomorrow. Until mid-February we’re vaccinating the over 70s. But half of Covid patients in intensive care are under 60. Even once we vaccinate younger groups, it takes up to three weeks to fully kick in.

And the vaccination programme is a suit of armour with holes in. Some older people won’t get jabbed, and no vaccine is 100 per cent effective. The Oxford vaccine showed a 59.5 per cebt reduction in the symptomatic cases in clinical trials. A more recent paper suggested a 67 per cent reduction.

Currently, older people are protected not just by growing vaccination rates, but national lockdown and their very high levels of social distancing. Only over time, as we open up, will we really find out how big the holes in our armour are. And we don’t yet know how long we’ll be in this tricky phase between vaccinating the most vulnerable, and getting to the full benefits of herd immunity.

We need to pace ourselves. We don’t want to go for a big bang reopening only to trigger a new wave and be forced backwards. In the coming weeks we’ll start to fully reopen schools – quite rightly – as the first step back to normality. Reopening schools will increase virus transmission. The uncertainty is by how much.

A study in Nature looked found closing educational settings was the second most effective intervention to reduce transmission. A study in The Lancet found school closures cut transmission. A study from the US showed statewide school closures reduced new cases. In December SAGE concluded that “overall, accumulating evidence is consistent with increased transmission occurring amongst school children when schools are open, particularly in children of secondary school age (high confidence)”.

The Nature paper found similar effects for both primary and secondary schools, and the number of school based outbreaks in the UK is similar for both, though ONS data (about to be updated) suggested older children were much more likely to be exposed to the virus. There’s options about how we reopen in areas where rates remain high: primary and secondary; different rotas or protective measures – there are lots of choices if needed.

Given the uncertainty about the effect of schools reopening, we should allow time between opening one thing (schools) and the next, so we can judge their effects.

It’s time for Burkean conservatism: As Burke wrote: “By a slow but well-sustained progress, the effect of each step is watched; the good or ill success of the first, gives light to us in the second; and so, from light to light, we are conducted with safety through the whole series”.

New variants

The harder question is how to manage the risk from new variants. We’re seeing lots of them around the world, but also within the UK. There was the Kent variant, now there’s Bristol and Liverpool variants. A variant from South Africa sadly made its way here, but one from Brazil seemingly hasn’t.

How big is the risk from vaccine-evading variants?  Evidence is emerging. The Kent variant has a less dangerous N501Y mutation, which makes it more infectious, but doesn’t let it dodge vaccines.

The South African variant has that plus the E484K mutation, which may reduce vaccine efficacy.

The Financial Times reported last week that in clinical trials Novavax’s new vaccine was found to be 89 per cent effective in its UK trial (where the E484K mutation is rare), but had just 49 per cent overall efficacy in South Africa.  Lab evidence also suggests it may make the holes in our armour much bigger. The paper also recently reported that the South African strain reduced the effectiveness of the Oxford / AstraZeneca strain too.

Concerningly, the Liverpool variant adds the E484K mutation to “old” Covid, while the Bristol variant combines the Kent variant with the E484K mutation, making it like a home grown version of the South African strain. We’re still learning how coronaviruses evolve to dodge immunityhow they do it, and how we should respond.

I support the measures the government is taking to tighten our borders for starters: requiring negative tests pre-travel, hotel quarantine from risky countries, making sure travellers do isolate. It’s a monumental task to set these systems up. But worth it. Covid is likely to bounce around the world mutating for some time. Once in place, we can steadily toughen these border controls as appropriate.

The prize of us getting back to normal life in the UK seems worth the price of inconvenience for travellers: if you hate lockdowns, you should back the toughening of borders.

Sadly, managing the risk from new variants isn’t only about borders, because we’re seeing new variants originating in the UK. As vaccinations rates go up, the evolutionary incentive to mutate and dodge them increases. It’s like anti-microbial resistance. The reason doctors tell us to finish antibiotics courses is that it is dangerous to wound but not kill bugs: that way you end up breeding superbugs.

The less of the virus we have in circulation, the fewer new variants we will see, and the lower the risk of a really bad vaccine-dodging variation emerging inside the UK.

Manaus in Brazil shows the dynamic in extreme form. The Covid-sceptic government failed to act so, in spring 2020, it became the Covid capital of the world. They buried huge numbers of people in vast mass graves, but never reached herd immunity. Instead, uncontrolled spread has made it a hothouse for new more dangerous strains: a new local variant has emerged to re-infect survivors.

So there’s a second consideration for ministers. It’s not just that we have to pace ourselves to avoid a new wave of “old” Covid.  Driving down infections more also reduces the uncertain risk of a vaccine-dodging variant which could set us back a really long way.  And small differences in the timing of opening measures can make big differences to infection rates.

The Prime Minister set out a clear timetable and set of criteria for making decisions on reopening, one of which is that nothing game-changing emerges to blow us off course. We should stick to the plan.  The other day, he said we were making progress but it’s too soon to “take your foot off the throat of the beast”.

As a classicist, the mutations of Covid-19 might remind the him of the mythical beast Hydra, which grew two new heads if you chopped one off.  Heracles eventually solved this problem by cutting them all off, burning the stumps, and burying the last head under a giant rock. We might not need to take quite such drastic measures.  But so close to a happy ending, it’s wise to keep controlling the virus while we gauge these emerging risks.

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.

David Gauke: The UK, the EU, vaccines – and future relations. Here, jingoistic politicians. There, Trumpian ones. Bodes badly.

29 Jan

David Gauke is a former Justice Secretary, and was an independent candidate in South-West Hertfordshire at the recent general election.

Will the new, post-Brexit relationship between the UK and the EU run smoothly? Will the Trade and Cooperation Agreement (TCA) provide a foundation on which a closer relationship is constructed (albeit still much more distant than the one we had), or will it provide the means by which the UK diverges from the EU?

The first few weeks after the transition period have confirmed many of the predicted difficulties of a hard Brexit. Businesses have struggled with red tape and trade with the EU is much reduced.

Whatever the Prime Minister claimed, the TCA does not address non-tariff barriers in the same way as the Single Market, and the erection of trade barriers will have a long-term economic impact. Northern Ireland is adjusting to a border in the Irish Sea, and it must finally be occurring even to the DUP that campaigning for Brexit and against a deal that kept Northern Ireland and Great Britain closely aligned has not served the Union well.

Given the obvious problems of Brexit and that, by the time the transition period ended polls showed that a clear majority of the public thought the country had made a mistake in 2016 in voting to leave, one might expect that, over time, we would begin to move to a more collaborative relationship. The likelihood, however, is that we will go the other way.

There are a number of political reasons for this. Perhaps most importantly of all, the political imperative for the Conservative Party is to maintain the support of those Leave-voting Red Wallers who delivered the Prime Minister his majority.

This week saw the Conservative Group for Europe relaunched as the Conservative European Forum. The CEF’s Chairman, David Lidington, delivered a characteristically thoughtful, well-informed and pragmatic speech setting the case for building a constructive relationship with the EU.

I hope the Government follows his advice, but I fear it won’t. If the Government’s approach to the EU is thoughtful, pragmatic and constructive, this is not going to get the patriotic juices of Workington Man flowing. There needs to be rows, conflicts and Brussels-bashing from Boris Johnson whilst portraying Labour as the party of ‘rejoiners’. ‘Keep Brexit Done’ will be something we could hear a lot in 2024.

To nullify this risk, there is every sign that Keir Starmer will want the next general election to be about almost anything other than the EU. The most straightforward way for Labour to win more seats is to win back the Brexit-voting Red Wall.

The absence of much opposition from Labour to a hard Brexit position might create an opportunity for the Liberal Democrats to articulate a pro-European one that will cut through to the public. But betting on a Lib Dem revival has not proved to be a profitable pursuit in recent years. In any event, pro-European votes have tended to be split amongst many parties and heavily concentrated in safe seats whilst Brexit votes are most efficiently distributed and, as long as Nigel Farage can be kept at bay, will vote Conservative.

The upshot of all this is that even, if the public continues to become more pro-European in the way that it has in the last five years (largely because of demography), the chances of an explicitly pro-European Government being elected in 2024 remain slim.

Nor should we discount the possibility that UK opinion becomes more hostile towards the EU in future. Even the day-to-day negotiations with the EU which we are now condemned to – endlessly having to make judgements as to how we balance ‘sovereignty’ with access to our most important market – can have a deleterious impact on how the EU is seen.

A bigger trading partner willing to leverage its strong negotiating position to protect its interests can be an unlovely sight, as the Swiss discovered after narrowly rejecting EU membership in 1992, since when support for joining the EU has fallen sharply.

Within weeks of the transition period coming to an end, we have faced more than the day-to-day challenges. The row between the European Commission and AstraZeneca is turning into a crisis that could have very serious implications for UK/EU relations.

Even before the recent difficulties with the AZ supplies, plenty of Brexit supporters were claiming that the UK’s success in rolling out the vaccine is a vindication of our departure from the EU. The reality is that at the relevant time, we were still required to comply with EU rules and everything we did on vaccines we could have done as EU members. Nonetheless, it is true to say that in these particular circumstances, going it alone has served us well. It is not surprising some are describing this as a benefit of Brexit.

The case, however, needs to be made that what worked in the very specific circumstances of finding vaccines in a pandemic applies elsewhere. It is not obvious that there is a read across from our approach to vaccines to other challenges we will face, not least because we are not yet capable of cloning Kate Bingham.

Not every decision that this country has taken during the pandemic has been quite so world-beating, and there is also a risk that we learn the wrong lessons from the vaccine issue and, in the pursuit of self-sufficiency in a whole host of areas, become increasingly protectionist.

But the immediate danger of protectionism comes from the EU in its export controls on vaccines. Understandably, EU citizens are concerned about the slow rollout of the vaccine and the response of the European Commission has been to panic, lash out and distract.

The news that AstraZeneca is unable to deliver the number of doses hoped for has resulted in demands that it diverts the product committed to the UK. Notwithstanding the statements made by EU Commissioners, the publication of the agreement between the EU and AZ reveals that the contractual basis of such demands is, at the very least, questionable.

So its next step is to control exports to the UK. Yesterday, this even involved triggering Article 16 of the Northern Ireland Protocol enabling the EU to block exports from the Republic of Ireland to Northern Ireland.  This is supposed to be a “last resort” mechanism, but its use was premature, provocative and sets a precedent that will be cited by those unwilling to accept the consequences of the Protocol.  The Commission has now seen sense and backed off.

There is an argument that, if the EU is throwing its weight around in order to prioritise the interests of the citizens of member states, this suggests that it is a good idea to be a member state. However, it is an unattractive argument that is, at best, ‘right but repulsive’.

Medicine supplies rely on internationalism and interdependence, and vaccine nationalism will mean that we all end up as losers. The UK’s response to the strident language coming out of the EU has been strikingly mature and measured. On this issue, at least, it has wisely sought to de-escalate tensions.

Let us hope that this is what happens, that the behaviour of the EU is performative and that the practical implications of yesterday’s announcement are limited. But it might not be.

The fundamentals of the UK’s need for a constructive relationship with the EU have not changed. It was not in our national interest to leave the EU; it is in our interests to create a new, special relationship. Such an outcome is not inevitable but the Trumpian behaviour of the EU in recent days makes that task all the harder.

Liam Fox: Are we really going to close down the global economy every time a new virus emerges?

24 Jan

Liam Fox is a former Secretary of State for International Trade, and is MP for North Somerset.

Over 71,000 more people died in 2020 than would have been expected in a normal year. Apart from a deluded and dangerous minority whose addiction to conspiracy theories leave them in denial about the impact (or even the existence) of Covid-19, most people recognise that these excess deaths are due directly or indirectly to the pandemic.

The UK has been recognised as one of the world leaders in the vaccination programme. Britain has made £548 million available to the Covid-19 Vaccines Global Access facility (COVAX), to support equitable and affordable access to new coronavirus vaccines and treatments around the world.

The rollout of the vaccine to the UK population has also been impressive, although there is growing concern about the decision to extend the period between doses of the Pfizer (but not the Oxford AstraZeneca) vaccine.

If we are to continue to lead globally on the issue – and this year’s G7 summit gives us an ideal opportunity to do so – we must be clear about the reality in which we find ourselves, and recognise that the data systems we currently have will be inadequate to deal with the challenges of global pandemic.

We need to understanding that, contrary to a great deal of assertion, this is unlikely to be a “once in a generation” event.

The first major, and deadly, coronavirus outbreak of the 21st century was SARS in 2002.  The second was MERS in 2012. So we are now in the third major global coronavirus outbreak in 20 years.

While the first two had higher death rates than Covid-19, it is the transmissibility of the latest viral variant that has caused such damage. There is, however, no guarantee that we will not get both a more deadly and more transmissible outbreak in the future.  It is likely that Coronavirus is here to stay, and that we will have to deal with potential new variants emerging from time to time around the world.  To have any chance of dealing with this effectively, we need to develop international protocols, and this means having standardised recording of data.

In the UK, there is no single measure to calculate the mortality rate for Covid-19 accurately . We use inferences from total excess death rates, the number of people who have died within 28 days of a positive Covid-19 test, and those who have had Covid-19 mentioned as a contributory cause on their death certificate.

None of these on their own can give us a truly accurate picture about the cost in lives of the virus.  There are three different types of patients who may fall within the excess mortality figures.

The first group is those who have died of Covid, i.e: where this was the main cause of death.

The Coronavirus Act 2020 made changes to death certification which may cloud the waters in this regard. While it is still intended that the doctor who attended the deceased during their last illness should, where possible, complete the death certificate, the Act also allows this to be completed if a patient was not seen by any medical practitioner during their last illness.

If that happens, a doctor would need to state to the best of their knowledge and belief the cause of death.  Covid-19 is now an acceptable ‘direct’ or ‘underlying’ cause of death for the purposes of the certificate but, although it is a notifiable disease, this does not mean that deaths from it must be reported to the coroner.

This may well result in fewer post-mortems being conducted, and a valuable source of data missed.  Some autopsy studies of patients who died of “influenza” during the 1918 Spanish flu pandemic showed that, while almost all patients had evidence of bacterial pneumonia, fewer than 50 per cent tested positive for influenza viral antigens or viral RNA. In other words, there was a significant overestimate of the numbers who had actually died of influenza itself.

The second group is those who died with Covid19, that is, those who had been diagnosed with a positive test ,but who may have died of other, unrelated causes.

It seems strange to many that someone who tested positive for the virus but was hit by a bus within a month is counted as a Covid-19 death.

The third group is those who have died as a consequence of Covid-19, including those who did not access medical care because of lockdown, or those who were unable to access the appropriate care because hospitals were overwhelmed with Covid-19 patients.

This will be of importance in determining how we run our healthcare services, especially if pandemic is likely to occur more frequently.  It has long been the practice in the NHS to run at very high bed occupancy rates.

We have to ask, if pandemic is going to be potentially a more frequent event, whether this is tilting the balance between efficiency and resilience in the wrong direction.  Given that we have spent billions of pounds trying to stop the capacity of our healthcare system being overwhelmed, would it not be more sensible (and potentially more financially prudent) in future to run the system with many more beds available than we expect to need at any one time?

Given the overall cost to our economy and the impact on the future of our public finances, perhaps we need to re-visit some of the assumptions that have underpinned policy under governments of all political colours. ,

Britain has a real opportunity to lead the global debate and the government can lead the way with the shakeup of Public Health England and the Resilience Unit within the Cabinet Office, both of which should have been better prepared for any pandemic.

I have supported the Government in all the lockdown measures they have taken in relation to Covid-19 but, in future, are we really going to close down the global economy every time a new virus emerges?

If not, what are the international protocols that we will need to develop as a global community and what are the metrics that we will require to make them work? Without proper information, how will we be able to determine the case fatality rate (the deaths from a disease compared to the total number of people diagnosed in a particular period) which will be one of the key measures that we will have to make in the event of a new outbreak?

We will also need enforceable global rules around transparency and notification. As we head for the G7, there can be no better example of “Global Britain” than for Britain to take a lead in pandemic preparedness and work towards global definitions that will enable us to avoid the uncoordinated global response that we have seen during Covid19.

Julian Brazier: A single allowance rate for Inheritance Tax – and five other proposals for making social care more resilient

23 Jan

Sir Julian Brazier is a former Defence Minister, and was MP for Canterbury from 1987-2017.

A great deal is currently being written about resilience – normally an underrated subject in politics. Building resilience should not just be about considering major national or global crises, but also involve asking questions about the likelihood of – and the solutions to – more frequent and more local crises. These range from NHS winter pressures to power cuts to cyber and terrorist attacks.

At the same time, there is an overwhelming view today that social care needs urgent reform and greater intervention from government. Yet there seems to be little appetite for considering these two great issues together:  the care of the elderly and its implications for national and local resilience.

This article seeks to show that incentives in current provision, for social care, benefits and tax, are reducing resilience. Some of the current proposals for social care ‘reform’ would worsen this.

The largest category of vulnerable people are those elderly people who cannot live without supporting care. Their domestic circumstances can be divided into four broad categories, listed in descending order of independence:

  • Those still in their original homes (whether owned or rented) with visiting carers,
  • the growing category of those in specially adapted sheltered accommodation
  • those living with family, in so called ‘inter-generational’ arrangements and, finally,
  • those in residential care.

How do these categories measure up for resilience?

At first sight, the least resilient group are those people living in their own, unmodified homes; they are reliant on visiting carers, who may not be able – or willing – to come in a crisis. They are also more likely to fall over or have an episode isolated in surroundings which have not been adapted, are most vulnerable in power cuts, for the same reason, and – crucially – they are often difficult to discharge from hospital.

But there are serious problems with the fourth category too. We have seen the problems with care homes in a pandemic. With their communal eating and recreation facilities, such homes have proved principal vectors of disease.

Equally, they have become a major cause of bed blocking, once the dangers of releasing patients to them was recognised. Britain’s higher-than-European-average concentration of people in residential homes has worsened our death rates and increased pressures on the NHS.

As Conservatives, we should also be concerned that residential care is not only the most expensive arrangement (whoever is picking up the bill). It also, for those fit enough to choose, offers the least independence.

This brings us to the two middle categories above.

Dwelling in adapted accommodation and living with younger family members are both comparatively resilient arrangements, and both are much less expensive than residential care.

They also have other features most Conservatives approve of. They offer a degree of independence absent in residential homes. There is also the potential for free childcare in inter-generational arrangements, or where nearby retirement accommodation has been chosen. Both categories offer an antidote to the loneliness of those still stranded with limited mobility in their original homes.

Any new system which aims to promote resilience should direct incentives towards rewarding, rather than penalising, these two middle categories: those who step down to retirement accommodation and those cared for by their descendants. That is how resilience is maximised.

Yet this is far from the case at present. Our commitment to ring-fencing the principal home for tax and benefit calculation purposes is a great policy, but one which has perverse unintended consequences when applied to transfers between generations. The state ends up penalising the heirs of those who aim for resilience, and rewarding many of those whose parents become most dependent.

For example, if an elderly person struggles on in their own home without much money, the state picks up the bill for their carers, and the potential strain on the NHS is maximised. Yet, if they own that home, their heirs will maximise the windfall when they die, compared to the alternatives. This has been exacerbated by the George Osborne tax break on Inheritance Tax, which greatly increases the exempt allowance, if and only if the inheritance is tied up in bricks and mortar.

On the other hand, suppose the same old person were to sell and move into purpose-built sheltered accommodation. They are less likely to have accidents where design has the frail in mind – and easier to release from hospital especially if there is warden assistance or such accommodation was selected to be close to relatives. Such people are also much less at risk in times of crisis – overall, a resilient arrangement.

Yet, from the point of view of their heirs, their estate diminishes, as the cash released from sale of the home is used to pay carers and service fees. If the original home was worth more than half a million pounds, thanks to the Osborne inheritance tax break, the heirs also face paying more tax than if the parent had soldiered on in the original house.

Similar points can be made about the position of families who look after elderly relatives at home, who have sold or moved out of their own houses. The one incentive such families currently get from the system for providing their loving care (and potentially relieving the state) is the carers’ allowance. Yet it is rumoured that there is a plan afoot to means test that. So, if the arriving parent or relative owns the proceeds of selling a property, that allowance would be lost.

It is time we built the promotion of resilience into our design of social care. My proposals are as follows:

  1. Abolish the Osborne bricks and mortar tax break by re-establishing a single allowance rate for Inheritance Tax.
  2. Extend that principle across the range of tax and benefit policies for the elderly to ensure that there is no financial incentive for potential recipients of inheritances to encourage their parents/relatives to stay in their homes, if they wish to move.
  3. Keep the carer’s allowance universal, so that those caring for relatives at home or in nearby accommodation can continue to draw it.
  4. Resist lobbying from the care sector and residents’ heirs for the taxpayer to take on more of the cost of residential fees to protect inheritances. Despite the political clamour, such proposals would be paid in part from by the taxes of those who are looking after relatives either at home or in neighbouring accommodation. That would doubly incentivise more people to move into residential homes, further increasing cost and – critically – still further reducing national resilience.
  5. Offer tax incentives to the elderly to move out of family homes into sheltered accommodation, including a permanent end to stamp duty on such properties. (Ironically, many councils pay ‘key money’ to release family accommodation but there is no scheme for owner occupiers). Gareth Lyon’s excellent article on this site pointed out how small this sector still is compared with Australia and new Zealand.

Shakespeare’s adage “sorrows … come not as single spies, but in battalions” is apt in the era of globalisation.  We simply do not know what shocks and challenges are just ahead. We must recognise that how we structure social care – and the associated tax and benefit framework for the elderly and their heirs – has profound consequences for resilience in major crises. It is also important for services under pressure in ‘peacetime’.

Resham Kotecha: Integrated community care is already here: it’s called the pharmacy

21 Jan

Resham Kotecha is a strategy consultant. She contested Coventry North West in last year’s General Election. She currently serves as the Head of Engagement for Women2Win, and is a Policy Ambassador for the Conservative Policy Forum, reaching out to BAME communities.

The Government has ambitious plans to vaccinate everyone in the four highest priority groups by mid-February. This equates to 15 million people, and while 4.61 million UK citizens had received their initial jab by the end of Tuesday, two million jabs a week are needed to reach the target.

Currently, the target would mean the bulk of the burden would fall to GPs. While they have been working valiantly, staffing numbers and an already monumental workload means they are unlikely to be able to deliver two million vaccines a week without significant support.

Hospital pharmacies are already involved in administering the Pfizer and Oxford vaccines, and community pharmacies are being brought in to join the vaccination programme. There are more than 11,000 community pharmacies in England; 1,200 in Scotland; and 700 in Wales. Two hundred pharmaceutical sites will be administering the Oxford / AstraZeneca vaccine next week, with Boots, Superdrug and Lloyds committed to delivering over 1,000 vaccines a week.

Simon Dukes, Chief Executive of the Pharmaceutical Negotiating Services Committee, said pharmacies have the capability to vaccinate about 1.3 million Brits each week. With community pharmacies joining the fight to dispense vaccinations, the Government is looking more and more likely to be able to meet its target to vaccinate people in the four most “at-risk” categories. It is absolutely right that we utilise all the skilled people we can during times of crisis, but it would be remiss to ignore the value that community pharmacists could add to tackling health inequalities and providing healthcare beyond the Covid-19 vaccines and medicine dispensation.

Community pharmacies are already involved in flu and travel vaccinations and have the knowledge and capability to diagnose minor health issues and support the delivery of health care for patients. Every day, about 1.6 million people visit a pharmacy in England and 37 per cent of people visit their pharmacy monthly. 89 per cent of England’s population has access to a community pharmacy within a 20 minute walk, and over 99 per cent of those in areas of high deprivation and low health outcomes are within this 20 minute walk of a community pharmacy.

An NHS study (pre-Covid) found that the average waiting time for a GP appointment was 19 days, placing additional pressures on stretched GP surgeries and hospital A&E departments. Pharmacists would make a great second line of defence to relieve pressures on GPs – and less than 20 per cent of pharmacy teams surveyed believe pharmacy is being fully utilised.

By expanding the services that pharmacies can offer, and empowering pharmacists, we could leverage a currently under-utilised pharmacy service, and reduce the burden on overwhelmed GPs, A&E departments and other parts of the NHS. To meet the increasing demands of an ageing population with rising rates of obesity, we need our cohort of 45,000+ pharmacists to be empowered to work alongside our GPs and to be appropriately and adequately financially rewarded for the services they deliver through NHS contracts.

An obvious opportunity is an enhanced vaccine programme. It is possible that the Covid-19 vaccine might need to be offered to vulnerable people every winter, or at regular intervals. Community pharmacists should be recruited to deliver the Covid-19 vaccine alongside the regular flu vaccine.

In addition to the Covid-19 vaccine, we should commission the provision of the National Childhood Vaccination Programme from pharmacies. Currently, community pharmacists provide a number of private vaccinations, including chicken pox, MMR, meningitis and HPV, but not NHS vaccines. By commissioning community pharmacies to deliver the NHS vaccination programme, a significant amount of work would be taken from overloaded GPs and would support cash-strapped pharmacies.

Finally, the Government should enable pharmacists to populate the patient record. Currently, community pharmacists can view Summary Care Records, but are unable to populate or update them. Many patients are unaware that when they get emergency medication from their pharmacy, their GP will not be informed via updated records. This means that GPs are unable to see “real time” updates and it is often left to the patient to update their GP when records are not accurate.

By enabling pharmacists to update patient records, GPs would have access to up to date records at all times, including around emergency meds provision, travel vaccinations and supervised methadone compliance. By making a few simple policy changes, we can extend the provision of healthcare into communities, tackle healthcare inequalities, reduce some work from overstretched GPs and ensure we utilise the full capabilities of our talented community pharmacists.

We may be seeing the light at the end of the Covid tunnel, but let’s ensure we take every step possible to strengthen our healthcare and empower community pharmacists to support people in their communities.