health

Wider opening of schools during covid-19

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Cllr. Ketan Sheth 

Education impacts society and is a measure and driver of our progress as a community.  A good education keeps us physically and mentally strong and plays a key role in the betterment of our socio-economic environment and the communities in which we live. Education is the ultimate pathway of success, providing the support that enables each and everyone of us to keep growing our knowledge and ourselves across the whole of our lives.  That is why education is given the highest status in today’s world. The delivery of our education service, however, has been heavenly impacted at all levels by Covid-19.

We are now starting discussions on easing the Covid-19 lockdown by reopening schools in a bid to restart our economy. The concern is that this might become a breeding ground for a second wave of Covid-19 cases.  Indeed, many parents may decide to keep their children at home, as it is possible that the rate at which the virus spreads may increase when schools open. It is therefore possible that the decline in the number of people infected may be affected. I say ‘possible’ because analysis of international trends suggest there are no definitive indications that opening schools accelerates infection. Schools have not yet been shown to push the reproduction rate (R) above one.

Many of our families and the communities in which we live have actively helped reduce (R) over the last 5 to 6 weeks. As a result the number of hospital admissions of Covid-19, in some communities, has now stabilised. Because of that, the reduction of the reproduction rate has slowed since mid-April, but it is still under 1. This has led to the debate on balancing the needs of the economy and the safety of our communities. In this case, that means our children.

The role of local government is to know and understand its communities and their children. Local government delivers services to local residents every day and is the vital ingredient to finding the best community solution.

As Covid-19 shows, pandemics are not technocratic. They are complex, creating social and behavioural challenges. Parents, teachers, and children are grappling with the threat of contracting the infection, often while dealing with personal loss. Effective management mechanisms between national and local government are therefore critical. We need to strengthen local responses and systems, and respect and build the capacity of local government to manage the policy response from health to the economy, to social protection. Investment in local government will be key to successful recovery and long-term resilience.

Thinking and acting locally will help to ensure that the spread of Covid-19 is curtailed and our communities protected. As far as opening schools goes: this needs to be managed locally and to be responsive to local concerns and needs. A locally crafted step-by-step approach is demanded, setting a code-of-conduct that ensures the highest standards of hygiene, and ensuring all school operations, break times, and classroom divisions meet carefully set social distancing guidelines.

For government to work effectively in the worst of times, it needs to have well-oiled systems, practices and resource flows.  We need to reflect on, and respond to, our population’s needs and changing realities quickly, intelligently, and always with the wellbeing of our communities at the forefront. Anxiety will linger over infection rates, but if we work together at a local level in the communities where we live, we can be agile, and creative, in our services. Together we can do it locally.

 

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Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. Ketan is a lawyer by profession and sits on a number of public bodies, including as the Lead Governor of Central and North West London NHS Foundation Trust.

England’s over-centralisation isn’t just a governance issue now – it’s a public health emergency

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Jessica Studdert

The concentration of power at Westminster and Whitehall has long frustrated those of us who engage closely with the structures of governance and compare it to decentralised norms across much of Europe. Now, as with so many facets of the Covid-19 crisis, the pandemic has exposed national vulnerabilities and left us grappling with the consequences. The grip on initiative that rests in SW1 is one such weakness, which is impacting how our system is responding to the virus, in turn perpetuating the public health emergency we find ourselves in.

A degree of national direction is clearly needed in the midst of a serious pandemic. People look to the Government for leadership and reassurance. Those in positions of power certainly feel personal responsibility for leading the response. Measures to implement service strategy nationally, such as through the NHS, or to use national heft for international procurement buying power, are certainly necessary. But time after time during the unfolding crisis, the centralised instinct has clouded decision-making, with terrible results.

The structures for the top-down approach to the pandemic were set early on, when the Government chose not to deploy the existing Civil Contingencies Act which set out clear roles, responsibilities and resources for all local and national public bodies. They instead rushed the Coronavirus Act through Parliament, which gave the Executive a greater level of unchecked power and no defined local role. This has had ongoing consequences for the coordination of an effective response. Leaked findings from an internal Whitehall review found that local emergency planning teams believe their abilities have been compromised by a controlling and uncommunicative approach from the central government machine, which persistently withholds data and intelligence.

The centralised response isn’t just structural, at times it has felt deeply instinctive. There has been a repeated preference for big, bold flashy schemes over smaller, sustained but potentially more impactful measures. In the early weeks of the crisis much media attention focussed on the new Nightingale hospitals, yet we are now seeing tragically how that time and resource could have been better invested in the more targeted shielding of hundreds of care homes. When faced with the need to quickly implement testing for Covid-19, the Secretary of State for Health reached for a high-profile 100,000 target and set up new large processing sites. This triumph of tactics over strategy directed the systemic response to focus on numbers over priority need and overlooked existing networks of local lab capacity. Even as attempts are made to set up contact tracing at scale to support the easing of lockdown restrictions, the Government seems to have more confidence in a new mobile app than it does existing local public health teams. This is despite the latter’s expertise in tracing the contacts of people who have highly infectious diseases and clear evidence from countries who have successfully managed their lockdown transition.

The formal power exercised at the centre is in direct contrast to the informal role for local authorities, which is having devastating consequences for their very viability. Because councils’ response has no statutory footing in the context of an emergency, they are left exposed to the whims of a few individuals making decisions in Westminster. At the start of the crisis, the Secretary of State for Local Government told local authorities to spend “whatever it takes” to protect their residents. Councils had immediately set about providing relief to shielded groups, protecting wider vulnerable groups and implementing public safety measures, all while ensuring essential services continued as usual. Rather than support these efforts, Government then rescinded this early clear backing, querying councils’ honesty over their cost assessments and leaving many facing a financial black hole.

The double standards central government imposes on its local counterparts is nowhere more apparent than when it comes to local government finance. An emergency on the scale of a global pandemic has required state-led responses on a scale inconceivable only months ago, and with widespread public approval. Central government spending has snowballed to accommodate unprecedented employee furlough schemes, emergency business support measures, not to mention the enormous costs to the NHS. The Chancellor has the leeway to respond to this through a number of different measures – incurring public debt, raising taxes, freezing public sector wages and reducing public spending, a combination of which he is reportedly considering.

Local government has no such room for fiscal manoeuvre. Councils are legally required to balance annual budgets and have only narrow revenue-raising powers through council tax and business rates which are themselves subject to centrally imposed controls. With a shock to their budgets of this scale they are at the mercy of decisions made by a few in Westminster. These have so far resulted in a couple of ad hoc cash injections of £1.6bn each, and a bit extra cobbled together earmarked for social care and rough sleepers – so far massively short of the estimated £10-13 billon shortfall councils collectively face.

It is no way to run a country. It never was, but in the context of the crisis the contradictions of our top-heavy system of governance are laid bare. The rumblings of discontent from Mayors in the north of England at their regions being side-lined, and from councils over plans to fully reopen schools in the absence of clear local test, track and trace infrastructure, suggest the popular tide is beginning to turn against blanket centrally-imposed measures. As local government is increasingly being seen as better placed to protect their residents, particularly in the context of a Government that is increasingly mis-stepping, there may now be an opportunity for a deeper discussion about how our country should be run in the interests of everyone.

Jessica Studdert is deputy director of the New Local Government Network (NLGN), a Londonbased think-tank. She leads NLGN’s thought leadership and research, and contributes strategic oversight of the organisation. Prior to joining NLGN, Jessica was political adviser to the Labour Group at the LGA. She led policy there, working closely on public service reform and devolution. Previously she worked in policy roles in the voluntary sector for a street homelessness and a childcare charity, and she began her career at the Fabian Society.

The disparities in housing and public health within the BAME community and the pandemic crisis

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Cllr. Ketan Sheth

Public Health is important: it prolongs life. A fundamental quality of Public Health is its preventative nature; prevention is far more effective and far less expensive than cure. Public Health is important because we are constantly striving to close the inequality gap between people and encourage equal opportunities for children, all ethnicities and genders. Health is a human right and we should be ensuring no one is disadvantaged, regardless of their background, their ethnicity or where they live. Becoming the voice for people who have no voice is our collective duty. Simply put, our influence on the improvement of someone’s health is a fundamental act of kindness.

Poor housing and living environments cause or contribute to many preventable diseases, such as respiratory, nervous system and cardiovascular diseases and cancer. An unsatisfactory home environment, with air and noise pollution, lack of green spaces, lack of personal space, poor ventilation and mobility options, all pose health risks, and in part have contributed to the spread of Covid-19. The disparities in housing and public health within the BAME community have persisted for decades cannot be doubted, and is underscored by a raft of research over the past six decades as well as highlighted by the recent analysis of the impact of Covid -19. The death rate among British black Africans and British Pakistanis from coronavirus in English hospitals is more than 2.5 times that of the white population.

What are the possible reasons? A third of all working-age Black Africans are employed in key worker roles, much more than the share of the White British population. Additionally Pakistani, Indian and Black African men are respectively 90%, 150% and 310% more likely to work in healthcare than white British men. While cultural practices and genetics have been mooted as possible explanations for the disparities, higher levels of social deprivation, particularly poor housing may be part of the cause, and that some ethnic groups look more likely than others to suffer economically from the lockdown.

Homelessness has grown in BAME communities, from 18% to 36% over the last two decades – double the presence of ethnic minorities in the population. BAME households are also far more likely to live in overcrowded, inadequate or fuel poor housing. What’s more, around a quarter of BAME households live in the oldest pre-1919 built homes. And their homes less often include safety features such as fire alarms, which is striking given the recent Grenfell Tower tragedy. Over-concentration of BAME households in the

neighbourhoods in London, linked to poor housing conditions and lower economic status all ensure negative impacts on health, all of which means lower life expectancy. The roll-out of Universal Credit is having greater effects on the living standards of BAME people since a larger percentage experience poverty, receive benefits and tax credits, and live in large families.
Larger household size also means that ethnic minorities are far more vulnerable to housing displacement because of the Bedroom Tax or subject to financial penalties if they do not move to a smaller home.
These stark facts, sharply bring to our attention the health, social and economic inequalities among our minority ethnic community, all of which are critical to understanding why some ethnic minority groups are bearing the brunt of Covid-19. In this time of reflection, it is not enough to observe; we must think about what more we can do, right now, to reduce the health, housing and economic vulnerabilities that our BAME communities are much more exposed to in these fragile times. Let’s act and prolong life together, as a flourishing community.

Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. Ketan is a lawyer by profession and sits on a number of public bodies, including as the Lead Governor of Central and North West London NHS Foundation Trust.

The national political tremors have settled. Let’s re-focus on local health scrutiny

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Cllr. Ketan Sheth

There was a lot of national media commentary and coverage about the role of the NHS at the recent General Election, which was unsurprising given all the commitments major political parties were making: boosting NHS funding, more doctors and extra GP appointments, rebuilding hospitals, and so on.

However, I think that members of overview and scrutiny committees – of all political parties – know that the NHS in particular and health in general are always a major issue in their areas regardless, not just because of the casework we receive from constituents or because health and the NHS tend to fill up a lot of the space on the work plans of our scrutiny committees.

Firstly, local government is part and parcel of the structure of the NHS in many localities, with Directors of Public Health and Directors of Adult Social Care sitting on the executives of Clinical Commissioning Groups. And, let’s not forget that many elected councillors are involved outside the local authority in the governance structures at a Board level of many of their local NHS providers (I will declare an interest as I am a Lead Governor of Central and North West London NHS Foundation Trust). In local government, we have a view of the NHS from the root up and dare I say probably a more detailed picture than those operating at a national level or, to use today’s jargon, a ‘granular’ picture, which shows that every area has its own strengths and weaknesses that may or may not align to the national picture.

So, now we are settling back into the business of ordinary scrutiny committees there are three areas which, drawing on my own experiences, I think many healthy overview and scrutiny committees will be focusing on in 2020. They look a little different to the recent national debate.

Firstly, the quality of services, particularly of primary care, is a growing area of importance alongside access to services. The Care Quality Commission publishes ratings for each of the primary care providers in each area; it’s always worth keeping up to date with the local picture, in particular how ratings change. What you will want to see is an improvement in these ratings, and fewer GP providers being placed in special measures as a result of an inadequate CQC rating. If it’s heading in the opposite direction in your area, it might be time to ask why.

Secondly, working at scale is increasingly the big challenge for the NHS. On the commissioning side in north-west London there are plans to merge eight separate CCGs into one body by April 2021. That will mean a single operating model, and I assume some commissioning arrangements, operating at scale, commissioning services across many different boroughs. That’s something we will be tracking with care.

Finally, workforce is an issue which is frequently raised at health overview and scrutiny meetings. We’ve heard a lot about problems nationally of recruiting to specialist posts, as well as vacancy rates for nurses. But is it time to ask about the local pressures on recruitment and retention in the hospitals for the big provider trusts in your area?

So, now the national political tremors have settled let’s re-focus on local health scrutiny issues for 2020. Who knows, they may be very different to the national picture.

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Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. 

 

Can we commission for outcomes?

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Anniina Tirronen

‘Outcomes-based commissioning’ has become the dominant approach to commissioning services in the United Kingdom, with similar concepts such as value-based purchasing and payment by results being explored in the United States and Australia.  Instead of determining the volume or exact nature of services, outcomes-based commissioning focuses on desired ‘outcomes’, such as changes, healing or other effects that take place as a result of services, allowing producers and clients to shape the way targets are reached.  But what effect does commissioning for outcomes have, and is it a better way to commission services?

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