Robin McAlpine – 13th January 2022
Were the Christmas Covid restrictions a mistake? Is this an issue that can be debated with maturity in Scotland? And either way, what does that mean for the path ahead?
It feels like this has become such a rigid debate that the answer is no, you can’t debate, you can comply or you can be classified as some sort of crazy anti-vaxer. There appears no space in between. That is a matter of significant worry because there are most certainly questions to be asked.
Let’s use the Christmas restrictions as a way into this discussion. With the caveat that new data is coming in all the time, the first thing to say is that there is virtually no data which suggests we can have any confidence that these restrictions worked as was claimed. You can choose your data set but you’ll only find that Scotland spent Christmas week either marginally better of than the UK in terms of cases or marginally worse off. There is nothing to sustain the Scottish Government’s assertion that its restrictions worked and the way it used data without legitimate context to support statements about the effectiveness of its decisions is telling.
Scotland introduced restrictions, England didn’t and so far nothing much is different. This is a direct echo of what happened in the late summer when modelling predicted a major wave of Covid that didn’t arrive, leaving newspapers filled with stories which started ‘experts baffled’. But raising questions like this is likely to lead to some pretty heavy backlash. Obey without question or you’re the problem.
This is a very concerning position to take in terms of public debate, because none of what is happening is happening in a vacuum. Right now we are not really managing a public health crisis so much as trying to stop a crucial public service falling apart. It is the crisis of NHS capacity rather than hard evidence of the deadliness of the Omicron variant which led to the restrictions. No-one is claiming that the restrictions in place just now will prevent the spread of Omicron, only that it will be slowed. And it needs to be slowed because the NHS is frankly falling apart. Staff are utterly exhausted and demoralised (when they’re not off isolating, sick or stressed) and there aren’t enough beds.
Why is that? A simple set of statistics will help you out here. In Germany there are 29.2 critical care beds per 100,000 of the population. In Romania there are 21.4. In Belgium 15.9, Hungary 13.8 and Cyprus 11.4. The EU average is 11.5. The UK? 6.6.
For 30 years (more because of Blair than Thatcher) the NHS has been run by financiers. They looked at the bed occupancy rates, saw a big proportion of empty beds and so just cut them. That it wasn’t the same beds empty each night is superfluous detail, money was saved. They cut the capacity which is there to absorb a crisis – and then we had a crisis. And before you reach for any sort of ‘Scottish exceptionalism’, the average number of available beds in Scotland’s NHS for acute specialities has been cut by 6.9 per cent in the last five years. Oh, how we could have done with that extra seven per cent of capacity right now.
Over the course of two difficult years the impact of Covid on public decision-making is significant. The threshold for ‘acceptable action’ just keeps dropping. Make no mistake, everyone should get the vaccine unless told not to by a qualified medic, but it is on the verge of no longer being a personal choice at all. Lockdowns and severe restrictions are now the go-to of some governments. In fact it can be quite hard to identify what it is other than these blunt instruments which has been done barring rolling out a vaccine programme and an insufficient test and trace system.
At the beginning of the crisis we had no option but to take measures which very substantially restricted civil liberties – we didn’t have enough information and were ill-prepared. But as time passed it was always going to be the case that the civil liberties issue would become more pressing; history is utterly littered with people who dismissed fears of creeping authoritarianism and few didn’t regret it.
Nor is any of this a matter of ‘following the science’, because science is not monolithic. The impact of lost education on a very large generation of children is now likely to echo down the generations. The psychological impact on everyone has been serious, with the young and the isolated old at serious risk. The impact on poverty and the cost of living is beyond alarming. The economic impacts we may only really understand in years to come. The social impact we haven’t even begun to assess. The impact on other NHS procedures will kill people and we don’t know the scale of that yet.
Nor is any of this neutral; these decisions are all (without exception) made by older people who are almost all at the very top of the income scale. The ease with which they ban young people dancing is not matched by a blasé attitude to restricting airports lest January skiing trips are disrupted.
These are not scientific certainties but value judgements, and the values which are being prioritised are those of people managing bureaucracies and those with powerful lobbyists. It is almost trite to have to repeat that we are most assuredly not all in this together.
And it was all predicated from the beginning on an exit point – the vaccine would return normal life, then the booster would return normal life, and then Scotland’s Hogmanay was cancelled yet again without any indication of a remaining exit and without any solid evidence it achieved anything much.
This is leading to a rapid reassessment of ‘scientific consensus’ – but mostly south of the border. It is not yet an undisputed position but senior epidemiologists are now concluding that the time to live with this has arrived. But in Scotland, absolutism still appears to rule (though Scottish politicians and officials are now performing a rather inelegant hand-break turn as they realise the ‘tsunami’ talk was ill judged).
And yet the NHS really is on its knees, Covid does still kill and this isn’t over. We are stuck between a broken health system and policy set by those who broke it. A health service which was created to protect the public must now be protected FROM the public; we are managed so it can be managed.
For what it’s worth, this was not the only option. Common Weal proposed a set of policies remarkably close to what some epidemiologists are now suggesting should have been done (though they’ve been attacked for ‘hindsight’). Common Weal called in April 2020 for the response to be decentralised to help us create capacity. We called for the rapid training of community health officers from within the communities they are supporting. They would have offered help and advice, monitored the risk of psychological harm, would have carried out randomised testing and could have been trained to administer the vaccine and the treatment of symptoms.
This would have created a proper control mechanism (the crucial error in Scotland’s handling was not trying to control the virus properly in between lockdowns), immediately increase the NHS’s capacity and enabled the kind of care that has been pulled away from too many people. But highly-paid, highly-centralised professionals in highly-centralised, poorly-performing Scotland did what they always do – they managed the system they created. The more it fell over, the more they pushed the burden onto the public.
Over and over again in Scotland we have failures which have resulted from specific actions and then to address the failures we repeat the actions. And over and over we’re told that we have no option but to obey because of the scale of the failures, so over and over we consent to the repetition of everything that caused the problem in the first place. With local democracy or net zero or land reform or economic development, the failures happened gradually so we ignored them. With Covid they happened quickly so we had our lives turned upside down. There is no obvious sign of this death spiral of failure and repetition ending.
So once again, when we are told we have no option but to accept failure, Common Weal politely declines to do so. We are working hard to assemble a team of experts to do for the NHS what our Care Group has done for care – refusing to accept the management of failure as our future and thinking hard about what we need to do to stop the failure happening.
Society cannot function if it must be closed down every time a public service reaches the end of a capacity the politicians have cut. Scotland’s NHS is now quite clearly in intensive care and on a ventilator. We can wait patiently for its demise or we can rebuild it.
So, if you work in the health sector or you have solid expertise in health policy, if you feel about health policy in Scotland like we do and if you want to do something about it, drop us an email and join the group. Help us rebuild the NHS, and help us to open this debate up from the dead end where we now find ourselves.