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Monday, 27 April 2020

A damning indictment of Whitehall's public health failure

The smug complacency of the Whitehall establishment prior to the impact of the Wuhan virus was sickening. They were - and are - convinced that gross centralisation is the answer to everything, but C19 has proven the fallaciousness of this delusion.

This country has had a long history of response to threats to public health, from Snow's cholera-infected Soho pump in 1854 onwards. We had local boards of health, and medical officers of health, one for each local government area. They ensured that adequate provision was made for burials, clean water, sewers and other public health infrastructure - but above all they were the nation's first line of defence against epidemics. Cholera, Typhoid, TB, Diphtheria. Being 'modern' is no defence against zoonotic or parasitic epidemics - as this paper, describing the challenges to public health post-1945 in Germany, describes -
... the following years were characterized by deficiencies of hygiene which had not occurred previously in Middle Europe during the 20th century. There were focuses of typhus, typhoid fever, tuberculosis, diphtheria, scarlet fever, and meningitis. Insufficiencies in the removal of faeces caused high incidences of shigellosis, hepatitis A, and ascariasis. As a result of insufficient body care, many people were infested with fleas, lice and scabies. The migration of large proportions of the population resulted in an increasing prevalence of syphilis an gonorrhea.
Our experiences in liberated Europe renewed our commitment to local public health, and a generation of Medical Corps officers who dealt with these conditions at first hand moved into environmental and public health positions in local government. For many years we benefited from their experience. The Guardian takes up the story from this point;
The system of local communicable disease control was established in the 19th century. After the NHS was set up in 1948, it was supported in England and Wales by national, regional and more than 40 local public health laboratories. But since local medical officers of health were abolished in 1974 – replaced by community physicians at different levels of the NHS – the system has been gradually but relentlessly eroded, fragmented and centralised.

Communicable disease control was centralised in the Health Protection Agency in 2003, and local public health laboratories transferred to NHS hospitals. Public health was then carved out of the NHS in England in the 2012 Health and Social Care Act, which abolished local area health bodies, created Public Health England to fulfil the government’s duty to protect the public from disease and charged local authorities with improving public health – but with limited proactive scope for infectious disease control and woefully inadequate resources.
The woeful failures of Public Health England, which we have catalogued, are not the only consequences of woke centralisation. PHE effectively abandoned their responsibilities for epidemic control, implemented an unworkable and ineffective central system and concentrated their resources on the faddish obsessions of the middle-class woke well - smoking, alcohol and sugar. As the authors of that Guardian piece also point out, the concentration on NHS 111 - telephone helplines that simply collapsed under the weight of hundreds of thousands of anxious callers - left local GPs with direct local knowledge completely unused.

The utter abandonment of their key responsibilities has not been the only negligent direction that PHE has taken. As John Ashton reported to the Telegraph, PHE officials have run up 5.1 million air miles over the past 3 years on 'the global health security agenda'. It's easy to see what's happened. They've utterly neglected their fundamental local public health responsibilities in favour of quasi-academic junkets to Florida or Singapore, business class travel and international hotels on the public purse, when they should have had their heads down sewer-covers in Birmingham. As Ashton, a former Director of Public Health, comments carefully "PHE's time would have been better spent ensuring testing facilities were up to scratch throughout the country" he said. "It's been inadequate and they have failed to catch up with themselves even when it was shown to be inadequate," he told The Telegraph.

We must keep pushing the absolute necessity for localisation and decentralisation. We must keep exposing the manifold failures of the central Whitehall machine. They are costing lives.

Levels of TB in London greater than Iraq, Ethiopia or Afghanistan are a damning public health indictment


JPM said...

It's your Tory government that has failed Raedwald.

They've been in power for ten years. Whatever kind of civil service the country has is entirely down to them.

And it's not the latter's fault anyway.

Drink that bleach and get on with it.

DeeDee99 said...

Whenever a centralised group of highly-paid, generally left-wing, bureaucrats are assembled with a taxpayer-funded trough the consequences for the taxpayer are bad. The Government continually replenishes the trough, but they are basically unsupervised as they squander it on the "experts" pet obsessions.

Quangos perform a very useful function for the Government. When something goes very badly wrong in their area of "expertise" they can be blamed for failing to prioritise correctly and/or failing to deliver, protecting the Government/Minister from blame.

But the fault is really the Governments: for failing to set clear priorities and instructions; failing to ensure they are delivering and for failing to properly monitor expenditure.

Another fairly recent example was the Environment Agency before the Somerset Floods of 2014. Captured by Environmentalists who were obsessed with recreating a wetland, they gave no though whatsoever to how their "let it flood" policy would affect the local population. Owen Paterson, Sec of State for the Environment then took a great deal of interest into the failings of the Environment Agency; made them refocus and this winter the Somerset Levels did not flood.

PHE's failings are the failings of WESTMINSTER and successive Sec of States for Health, as well as the failings of Whitehall Mandarins.

Dave_G said...

Well said DeeDee and the execrable JPM should be able to discern between incumbent Government action (always changing) and Westmonster (NEVER changing) who have been the main instigators and deliberate interference with the Brexit process too.

Anonymous said...

Personally, I have found it difficult to understand why it was the Government's responsibility to provide PPE - pay for it, yes, maybe, but to source it why the heck? That's where NHS bureaucracies have let us down. In my view there should be a cull of overpaid NHS 'managers' after this is over.

If you look at those TB hotspots in your map, they are the result of BAME immigration. If Covid-19 is killing disproportionately many BAME people, maybe it's the result of their poor state of heath and hygiene is at the root of it. It will be interesting to see what the map looks like after the crisis is over.

Anonymous said...

DP writes

National agencies like PHE and its supranational equivalent WHO, deal with matters that are generally not in the public eye on a yearly basis. Therefore they are susceptible to capture by the Gramsci Left, who can get on with their own agenda.

Unfortunately for them, covid-19 has raised the lid on their nice little number. WHO has just lost its major donor.

Liberista said...

"We must keep pushing the absolute necessity for localisation and decentralisation."
Sir, while i totally agree on the above, i am very skeptical about it ever happening.
total centralization of power is inevitable, and the ultimate goal of any ruling elites.
every bureacrat prefers to be part of the largest possible organization, as this offers better career opportunities, or better opportunities to reach retirement without ever having to work.
all politicians as well prefer to be part of the largest club possible, being planetary government (and thus absolute power) the ultimate goal.

the largest and more powerful the government, the more captive and less free are the masses. centralization of power makes voting useless, and leaving more difficult when not impossible.

so i do not expect decentralization to be on any government agenda any time soon.

and as for decentralization happening under pressure from below, i really do not expect that happening from a population that tamely (and gladly) accepted to be put on house arrest for weeks just because the chinese goverment said it was the right thing to do.

Edward Spalton said...

I had the same thought as I was walking past our closed local pub. In the window was a sticker, proclaiming its high standard of food hygiene. The Environmental Health Officers (EHOs) , no longer engaged in checking up on that, could be diverted to tracking, tracing and isolating known COVID -19 contacts and that was normally the first stage of epidemic control under the old tried and tested system. Isolation hospitals were used to keep the infection out of general hospitals. That stage was hardly attempted as PHE did not have the staff. I understand there are some 10,000 EHOs who could have been available. The infection became widely established whilst the politicians mumbled about “herd immunity”. So we bot lock-down.

A neighbour, who deals mostly with public authorities, tells me that the supply chain is now complicated by “standardisation”. The authorities now insert middlemen called “ Procurement Companies” who vet suppliers to check that his firm is not employing slave Labour or destroying the environment and is compliant with “ equalities” legislation etc . These companies publish information about the requirements of authorities and will only accept quotes from companies registered with them.

It seems that the Derbyshire clothing firm, David Nieper, received no acknowledgement of its offer from the NHS supply chain and went straight to Derby hospitals which accepted their offer. The factory is now back working and the hospitals are getting PPE supplies.

Span Ows said...

5.1 million miles in three years?!! That is the equivalent of a return flight to Cairo every single day including Saturdays and Sundays (with enough for someone else to do a return flight to Cardiff every day for the same amount of time). Did they think the E stood for Egypt?

Totally random destinations :-) )

the TB thing is fucking scary.

DiscoveredJoys said...

I used to think that the American system, where many jobs (Sheriff, Judge, Dog Catcher) were filled through democratic local elections, was open to corruption. I now wonder if it is any more corrupt than the non-transparent systems we use in the UK and certainly provides a better way of removing the incompetent ones.

Jack the dog said...

The American system of elected public officials has in my view a lot going for it, but to make it work you need a population who can be arsed to involve itself in this stuff.

Just look at the fiasco of the elected Police and Crime commissioners. On the face of it a good idea, but because nobody's bovvered, the posts are effectively farmed out to party hacks and place fillers - totally the opposite of what was supposed to happen.

Let's just hope that enough of the population does finally realise after this nightmare that excessive centralisation adds cost and uselessness and that there is benefit in local accountability even at the cost of taking an interest in who does what at local level and holding their feet to the fire.
Literally if necessary.

Anonymous said...

We've got used to not doing anything, granted not everyone but enough for it to make a difference, so we see this gradual slide toward a more primitive era in public health. The quiet killers never go away and we would do well to remember that when capital seeks cheap labour from the Third World, or indeed the ideologues wish to 'enrich' us into oblivion.


Farmer Giles said...

Not looking good on the 'control our borders' front.

Anonymous said...

Bye bye Lugano Convention?

Law firms and their tax contributions moving to Ireland.

Anonymous said...

@farmer Giles how so?
Think you need to brush up on your French and or your google translate skills.
Eleven new border controls are ready in France if and when the UK leaves on the 31/12/2020 as per EU regulations

Span Ows said...

Anon 03:17...yep, was going to write exactly the same thing. Veterinary, phytosanitary etc., health inspection of animal origin and plant food products, customs inspections of heavy goods vehicles.