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Were the Christmas RESTRICTIONS A MISTAKE?

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.

7 thoughts on “Were the Christmas RESTRICTIONS A MISTAKE?”

  1. David Hutchison

    Robin appears to be tackling a different issue here from the response to covid by the Scottish Government. He rails against the centralised response by the ruling bodies but fails to recognise the impact of ten years of austerity on public services as having required that as a response given the budgetary constraints. Rationalisation of the Police, huge reduction in the schools and services provided, PFI etc etc.. he risks becoming a contrarian rather than a reasoned voice of evidence-based detached commentary. I would assert that Robin has an axe to grind here rather than a point to make. UK government imposed austerity prompted a rationalisation of priorities and political choices within a constrained budget. What other response is practicable. Independence would change the political dimension and perhaps even the centralising nature of government might change but I would suggest this is a response to austerity not a natural position.

    1. James Mitchell

      I disagree. The article goes to pains to mention that, for 30 years, cuts have been made to the NHS. I think you must have wilfully failed to notice this.

  2. Ann Christie

    The current problems are not just down to austerity. Robin is completely correct in the cutting of beds across services which started in earnest in the early 2000s and accelerated rapidly. Those of us working in health queried those decisions, but they were being made in the Scottish Government, not the Health Boards, which then had to manage the shortages. That was done by reducing length of stay post intervention, with patients often being discharged before they were fully ready to return home, cutting beds that were deemed unnecessary, for example alcohol and drug addiction beds were reduced to single figure numbers. In 2006 an alcohol and addiction service in NHS Argyll and Clyde was awarded national and UK wide awards for innovative service and the following week the service was cut the Greater Glasgow Health Board, which had been instructed to take over NHS Argyll and Clyde due to the actions of its Board. The Argyll and Clyde programme didn’t fit the policy being run by GG&C, which was centralised, so it was axed with the loss of a personalised service to remote and rural communities and skilled health practitioners being moved into other areas of practice.

    The SNHS has certainly been running on empty since the start of austerity, but it was struggling before that. Inverclyde Royal for example could not employ radiologists to work in Inverclyde. No-one wanted, apparently, a full time post there. There was a general shortage of radiologists across Scotland. Consequently locum staff were employed, many coming from the EU and South Africa to cover, completing 3 month contracts and then disappearing back to their normal practice. Then it became consultation via technology, with, as you can imagine, a time lag before the plates were reviewed and reported.

    With the loss of beds, services became more centralised to deal with the number of patients, where previously there had been greater community presence. Beds were reduced as larger units were developed, QEUH being a good example, which was designed and commenced before austerity. There is no doubt the facilities are better than the Southern General, but there are more people using it, fewer beds, with consultants fighting over provision, so the system becomes a production line rather than a Health Service.

    Out-patient clinics are also problematic. How can some clinics manage a large number of people on a daily basis without huge waits and others can’t? My husband has regular appointments across various specialities as he has a number of long term conditions. Ophthalmology is by far the worst. He has had to attend a variety of specialists over the last few years, especially recently. Never once has he been in the clinic for less than 2.5 hours (and it is usually much longer) and the vast majority of that time is spent waiting: to see a nurse, a scanner, a photographer, another nurse and then possibly a consultant or registrar.

    Even before Covid everyone was pressured, both acute and community services. I agree austerity has had an impact. So has Brexit. But why weren’t we training more staff anyway? Looming crises have been ignored. There were clearly a large number of consultants who were due to retire around the same or similar times. We knew that well before austerity was imposed. Same with GPs. But the numbers qualifying weren’t there, so the SNHS is running to catch up. Drop a pandemic into the mix and the problems become more acute.

    Then we have the constant battle with changing Government policies! Both Health and Education are key political battlegrounds and both services suffer as a result. Every time a government changes, previous policies are changed or vanish and a raft of new ones come in, very often the product of someone’s hobbyhorse. To my mind they should be taken out of the political arena completely and managed by a Cross Party group supported by health and education staff who understand what is needed. Believe me, every time health and education are criticised by politicians who are then echoed by the general public it impacts on services. Staff begin to wonder what they can do to satisfy the need, whether they are doing a good job, how much more tired they have to be, how many extra 12 hour shifts will they have to work, what new procedure or policy will drop on the mat for immediate implementation that will take time, effort and energy they no longer have to be accepted. They are both large organisations, so change happens slowly. It’s like halting a heavy goods train. It takes considerable time to slow down and metaphorically turn round. Longer when the staff believe the changes are for the worse, can’t see the need or are concerned about the impact on patient or student care. No wonder staff are demoralised and running on empty.

    Robin is also correct that the core of this is the influence of finance advisers and targets being set that may be appropriate for industry or business but not for health.

  3. Hi David,

    I don’t think I’m tackling a different issue at all. What I tried to do was to show that there wasn’t (and isn’t) evidence that Omicron was of a seriousness that under normal circumstances would have prompted the restrictions we faced (evidence might have emerged but hadn’t at the point the decision was made). You’ll accept I hope that even the Scottish Government is now taking this position and making clear that we now need to live with the virus.

    What there was was evidence that responding to it could overwhelm the capacity in the NHS. So I’m asking why that is. Health is a wholly devolved function so can we really just shrug off everything with a ‘…but Westminster’? Let me give you a direct example; the Scottish Government spent the best part of £100m on an ’emergency hospital’ with the Louisa Jordan. That was supposed to be our ‘extra capacity’, but it was centralised and not greatly useable (not least because it didn’t have any staff). There has been no other effort to increase capacity in the NHS since Covid began. It was largely decommissioned because the venue was needed for COP26 (and a half-million quid contract to do it was given to an American mutlinational without the usual bidding process). We should have been creating that capacity in smaller units round the country so it could actually serve everyone and it should have been in facilities that could be sustained.

    Equally, in recent years there has been an ever-increasing outsourcing of the Scottish NHS to the private sector and an awful lot of contracts handed to the usual suspects in terms of ‘providing advice services’. There is a lot more to say about this but while investment is important to the functioning of the NHS it is not the only issue.

    For what it’s worth I really don’t buy the argument that the Scottish Government handled Covid well and have explained this in some detail in the past. But I want to be clear about why I am especially bothered about the Christmas lockdown and it is because I am a very strong believer in civil liberties and I believe that we must set a high threshold to remove them. That threshold was easily met in March 2020 and I was a lockdown hawk. The threshold was also exceeded for the second lockdown (though I will never believe is should have been). I simply do not believe the threshold was exceeded before Christmas and I think what happened was a managerial response to the state of the NHS. What I’m arguing is that this leads in two directions; first, we need to turn our focus to why the NHS is in that state and second we need to start to normalise the possibility that objecting to a decision the Scottish Government makes on Covid is legitimate in our political culture (without being shouted down in harsh terms) and is not met with claims of bad faith. I believe that we must now have debate BEFORE decisions are made, not afterwards. We can’t live in a state of perma-crisis.

    As for ‘all blame is London, all answers are independence’ – you know my strength of support for the cause of independence but I cannot and will not buy the line that it is like some kind of permanent amnesty for the Scottish Government. I don’t think there is anyone with expertise that I can think of that will say that even within the envelope of funding available the NHS has of late been managed as well as it should be. How is asking why that is not legitimate? Oh, and also your faith that funding that will flood into the NHS after independence rather runs contrary to the ‘ten years of austerity’ which remains the SNP/Growth Commission official position for post-independence finances. We need independence, but it won’t fix anything in and of itself and I am one of those who is pessimistic that we will be seeing it in the near future. So until then I make no apologies for focussing whatever criticisms I have about an almost wholly-devolved function towards the devolved administration which has all the power over it.

    I very much hope we can create a plan for renewing and rebuilding the NHS which is achievable with the powers of devolution because for now that is probably our best immediate hope. That won’t be achieved by complaining about Westminster.

    Robin

  4. Adrian Simmons

    Can we please get away from the doom and gloom around education? “The impact of lost education on a very large generation of children is now likely to echo down the generations” is far too sweeping and generalised.

    Several studies have shown some benefits from the change in education during the pandemic, good round up here https://theconversation.com/lockdown-schooling-research-from-across-the-world-shows-reasons-to-be-hopeful-174714

    I’ve no doubt those benefits were unevenly spread, but that’s true of any change and as David points out was exacerbated by pre-existing and ongoing austerity and inequality.

    I don’t entirely disagree with Robin’s point about performative restrictions that have little effect but he’s given an impression throughout the pandemic of chafing at *any* restrictions – this article feels as much like it’s born out of personal frustration than reasoned argument.

  5. Robin McAlpine

    Hi David,

    I don’t think I’m tackling a different issue at all. What I tried to do was to show that there wasn’t (and isn’t) evidence that Omicron was of a seriousness that under normal circumstances would have prompted the restrictions we faced (it might have emerged but hadn’t at the point the decision was made). You’ll accept I hope that even the Scottish Government is now taking this position and making clear that we now need to live with the virus.

    What there was was evidence that responding to it would overwhelm the capacity in the NHS. So I’m asking why that is. Health is a wholly devolved function so can we really just shrug off everything with a ‘but Westminster’? Let me give you a direct example; the Scottish Government spent a good chunk of £100m on an ’emergency hospital’ with the Louisa Jordan. That was supposed to be our ‘extra capacity’, but it was centralised and not greatly useable (not least because it had no staff). There has been no other effort to increase capacity in the NHS since Covid began. It was largely decommissioned because the venue was needed for COP26 (and a half-million quid contract to do it was given to an American mutlinational without the usual bidding process). We should have been creating that capacity in smaller units round the country so it could actually serve everyone and it should have been in facilities that could be sustained.

    Equally, in recent years there has been an ever-increasing outsourcing of the Scottish NHS to the private sector and an awful lot of contracts handed to the usual suspects in terms of ‘providing advice services’. There is a lot more to say about this but while investment is important to the functioning of the NHS it is not the only issue.

    For what it’s worth I really don’t buy the argument that the Scottish Government handled Covid well and have explained this in some detail in the past. But I want to be clear about why I am especially bothered about the Christmas lockdown and it is because I am a very strong believer in civil liberties and I believe that we must set a high threshold to remove them. That threshold was easily met in March 2020 and I was a lockdown hawk. The threshold was also exceeded for the second lockdown (though I firmly believe that could have been avoided with more comprehensive action in summer 2020). I simply do not believe the threshold was exceeded before Christmas and I think what happened was a managerial response to the state of the NHS. What I’m arguing is that this leads in two directions; first, we need to turn our focus to why the NHS is in that state and second we need to start to normalise the possibility that objecting to any decision the Scottish Government on Covid is legitimate in our political culture and is not met with claims of bad faith. I believe that we must now have debate BEFORE decisions are made, not afterwards. We can’t live in a state of perma-crisis where everything happens by decree.

    As for ‘all blame is London, all answers are independence’ – you know my strength of support for the cause of independence but I cannot and will not buy the line that it is like some kind of permanent amnesty for the Scottish Government. I don’t think there is anyone with expertise that I can think of that will say that even within the envelope of funding available the NHS has of late been managed as well as it should be. Asking why that is is entirely legitimate. Oh, and also your faith in the funding that will ‘flood into’ the NHS after independence rather runs contrary to the ‘ten years of austerity’ which remains the SNP/Growth Commission official position for post-independence finances. We need independence, but it won’t fix anything in and of itself and I am one of those who is pessimistic that we will be seeing it in the near future. So until then I make no apologies for focussing whatever criticisms I have at an almost wholly-devolved function towards the devolved administration which has all the power over it.

    I very much hope we can create a plan for renewing and rebuilding the NHS which is achievable with the powers of devolution because for now that is probably our best immediate hope. That won’t be achieved by complaining about Westminster.

    Robin

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