Cowper’s Cut: The Emperor’s New PPE

Perhaps the first two rules of political communications are the following. If you’re explaining your policy, you’re losing. If your enemies aren’t hurting, you’re failing.

It feels almost fatuous to describe the past week’s events in the politics of covid-19 as surreal. With each passing day, what is currently in charge of our country and its health and care system feels less like a government and more like an auto-satirising machine: one that is Dadaist in philosophy and Heath Robinson in design.

A couple of months ago, I wrote in this column that “the first rule of Political Lying Club is that nobody cares about political lying any more, until they do again. And that day is coming.” I think that remains a solid bet, and it is increasingly evident that the government agrees with me. It was fascinating to read former Department of Health permanent secretary Una O’Brien’s HSJ piece on the need for public inquiry preparation to start immediately.

In evidence to the Health Select Committee this week, deputy chief medical officer Dr Jenny Harries acknowledged there was a change of policy on virus-testing in March, partly because there was not enough capacity: “if we had unlimited capacity we would have done differently”.

The New Statesman’s Harry Lambert found footage from Lord Darzi’s WISH Foundation event in 2016, at which the then-CMO, Dame Sally Davies stated that a severe pandemic “will stretch everyone, it becomes very worrying about the deaths… and then what that will do to society, as you start to get all of those deaths… and then the economic impact”.

‘We have met the enemy, and he is us’

Because we should make no mistake: this is a scared government. It is also inexperienced, and constituted as a pro-Brexit right-wing Conservative in-group. This cocktail of being high on fear and low on competence is evidently toxic.

The main players of Brexit in this government have neither changed their style, nor developed a sense of loyalty – be it to colleagues, or to the truth. Two weeks ago I outlined how health and social care secretary Matt Hancock is being lined up as a Colt Seevers figure: The Fall Guy.

It is really not tricky to work out who briefed the Mail On Sunday their cover splash on the GPS whereabouts of the Uber driver of Mr Hancock’s career-hearse. At a time when the government should have a laser-like focus on the most effective and efficient ways to get covid-19 infections as low as possible, they have the energy and time for fighting one another.

Enemy sighted: enemy met. They may want to watch their backs, though: Mr Hancock will now have more than a hint of his likely fate. He may react accordingly.

This is not written with malice towards Mr Hancock. He is probably not a bad man (although his effort to tone-police actual accident and emergency doctor Rosena Allin-Khan in Parliament this week, when she asked him a difficult question, was strikingly dim). He is merely a glib one.

Given Mr Hancock’s previous app-related form, it was perhaps the world’s smallest surprise that the newly-launched covid-19 tracing app has a plethora of practical problems. This was predictable, and predicted.

100,000 tests for a day

It won’t be much of a political epitaph for Mr Hancock, to be remembered for dodgy apps, bad TV PR shots of him loading boxes of personal protective equipment, and for his “100,000 tests a day” promise turning out to mean “100,000 tests for a day”. There are worse fates than ending up as a pub quiz political trivia answer, I suppose.

The “100,000 tests for a day” issue led us to a rare and precious moment of beauty from the Department For Health But Social Care’s Twitter feed, which presumed to give us a lecture on statistical accuracy. Did chutzpah die in vain? Given their recent form, it is literally impossible to think of an organisation with less credibility on covid-19 statistics than the DHSC, as their own former senior statistician observed.

The “how far could you spit them?” level of trustworthiness of this government is of immense importance to HSJ readers. This set look likely to be desperate for social distancing from their responsibility for the conduct of the pandemic in this country. A single Colt Seevers won’t disperse the blame nearly far enough: from past form, they’ll look for as many bodies to throw under the bus as they can find.

(I assume that everybody has been keeping contemporanous notes of their instructions if briefed by phone or verbally; downloading their WhatsApp chats and emails; requesting the NHS equivalent of letters of direction as necessary – invent it, if you have to. You’re smart people: you know the drill. Better the awkwardness of requesting a letter of direction than to be receiving a Salmon Letter.)

Sophie’s Choice

The picture on deaths in care homes is grim. ONS data records the fact that “In England, the number of deaths involving covid-19 in care homes that were registered by 24 April was 5,575, while in Wales the number of deaths was 310… numbers of deaths involving covid-19 in care homes in England that were notified between 10 April and 1 May, which showed 6,391 deaths, of which 2,044 occurred in the week up to 1 May… the number of deaths involving covid-19 in care homes in Wales that occurred between 17 March and 1 May, which showed 295 deaths, of which 68 occurred in the week up to 1 May”.

One of the most disturbing aspects of the covid-19 crisis in this country was what retrospectively seems like the Sophie’s Choice-type decision to decant hospital patients from hospitals into care homes, to be able to have the surge ICU(ish) capacity. The covid-19 infection consequences for care homes have become apparent: the line of infection causation cannot (and may never) be known.

This was a genuinely tough choice, and I missed its importance at that time. Richard Humphries of the King’s Fund did not.

It is of course easy to be wise after the event, particularly one so unprecedented. The arrival of covid-19 felt very fast-breaking. We know that keeping people in acute beds who don’t need treatment there is also not good. And there was a reasonable hypothesis that care homes had single-room capacity that could have been able to keep vulnerable older people safer than open hospital wards – if care homes’ supplies of PPE and infection control training had been adequate.

The perceived probable trade-off of not having done this would have been an NHS hospital sector that would have been overwhelmed by the covid-19 demand surge.

I do not envy the person who had to make that decision.

King Harvest Has Surely Come

The phenomenon of mortality displacement is well-known to epidemiologists and public health colleagues. It is also known colloquially as “harvesting”. Deaths that would have happened in 2020 are being brought forward, in other words. This is not every story. Nor is it an excuse for the problems.

But it is where we are.

Stay alert – your country still needs lerts

The week ended with prime minister Boris Johnson’s pre-recorded speech about changes to the “lockdown regime”. It was better-delivered than his shambling speech on his return to work (and featured fewer invisible muggers), but obvious problems persist.

The government changed its covid-19 slogans, but to negative effect. Now we are urged to “Stay alert. Control the virus. Save lives.” (replacing “Stay home. Protect the NHS. Save lives”) The problem is that “stay alert” doesn’t actually mean anything; and it certainly doesn’t help “control the virus” without adequate information and infrastructure. Perhaps we’ll end up mixing and matching phrases: “Stay control. Protect the virus. NHS home.” makes about as much sense as the government’s current re-write.

In a pandemic of a new disease, effective and trustworthy communications are self-evidently vital. You don’t need to be a fan of the incumbent government of the day to want them to do these absolute basics to a high standard. This has been massively lacking (despite government insiders’ own self-assessment that “our comms have been some of the best in Europe”), and that lack is ongoing. I’ve spent some time covering the “following the science” in these columns, and Deborah Cohen’s film for BBC Newsnight is first-rate on looking into this area in greater depth.

One major problem is that the national media were given an unattributed briefing by 10 Downing Street on Wednesday, resulting in a crop of Thursday headlines suggesting that the lockdown would be significantly eased. A dreadful cynic might see that briefing as a prospective attempt to focus-group de-restrictions that would catch the public mood: thank heavens, then, that I am the sunniest of optimists at all times.

Any competent communicator needs to be deeply in tune with their audience. At the best of times, people hear what they hear, and it’s not always what you think you were saying. This lockdown has not been the best of times for most people. There must be a reasonable likelihood that many people have heard the broad tonal message that the lockdown is being eased or even ended – particularly if they have stopped the obsessive focus on the media and daily briefings that characterised the early stages of this period.

It’s hard to work out why public confidence in the government’s handling of this is falling quite sharply.

In my next column, if the madness abates slightly, I want to think a bit about what things may look like on the other side of all this, and of a virtually-inevitable second-wave. Until then, I want to warmly recommend Axel Heitmueller’s article on the future: it isn’t what it used to be.

On not being Matt Hancock

One final thought: I suspect that most readers feel pretty sure by now that I am not Mr Hancock, nor was meant to be. But if I were Mr Hancock, I wouldn’t be telling people in meetings to consider legal consequences of planned actions that “on these issues, I am the law”. Mr Hancock may bring fictional characters to our minds, but let’s be honest, Judge Dredd is not one of them.

Equally, if I were Mr Hancock, I think I would probably avoid describing my friend and NHS Improvement chair Baroness Dido Harding, the newly-appointed lead of the covid-19 test-and-trace programme, as “my human shield”. That’s neither a good joke, nor good manners.