Thursday, 2 April 2020

Conspiracy or Cock-up?

It's a widely held truism that the first casualty of war is truth and it's pretty obvious we are at war with the virus. It must also be pretty clear by now that we're being lied to on a daily basis at the stage-managed No10 briefings; there's not enough PPE of the right type; there's not going to be enough ventilators and there's virtually no testing going on. The official rhetoric on all three topics says differently, so is it Dominic Cummings plan for callous 'herd-immunity' by the back door, or is it that the UK government can't organise the proverbial piss-up in a brewery?

There's so much out there on all three topics we can't possibly cover it all in one blog post, so firstly, why the problem with PPE? This from the Guardian on Friday:-

Advice on protective gear for NHS staff was rejected owing to cost

Documents show that officials working under former health secretary Jeremy Hunt told medical advisers three years ago to “reconsider” a formal recommendation that eye protection should be provided to all healthcare professionals who have close contact with pandemic influenza patients.

The expert advice was watered down after an “economic assessment” found a medical recommendation about providing visors or safety glasses to all hospital, ambulance and social care staff who have close contact with pandemic influenza patients would “substantially increase” the costs of stockpiling. The documents may help explain a devastating shortage of protective gear in the NHS that is hampering efforts by medical staff to manage the Covid-19 virus pandemic.

Doctors are threatening to quit the profession unless they are properly equipped, and NHS trusts across England have been asking schools to donate science goggles due to the shortages, the Guardian revealed on Wednesday. The health secretary, Matt Hancock, has acknowledged “challenges” with the supply of protective material to NHS staff and has drafted in the army to get supplies to frontline workers.

In recent days, his department says, more than 15m face masks have been delivered to the frontline, including 24.6m gloves and 1.9m sets of eye protection delivered on Wednesday. However documents seen by the Guardian suggest officials working under his predecessor resisted advice about stockpiling supplies of eye protection in case of a pandemic of this kind.

In 2015, what is now the Department of Health and Social Care tasked one of its independent advisory committees, the new and emerging respiratory virus threat advisory group (Nervtag), to review the UK’s approach to stockpiling personal protective equipment (PPE) for use in an influenza pandemic “to help inform future stockpile and purchasing decisions”.

Nervtag had been created the previous year to advise the government on pandemic influenza and new virus threats to the UK. The advisory group made a series of “formal recommendations” to the department in March 2016, which had been compiled by a subgroup of senior NHS clinicians and scientists, and agreed by the wider committee.

Asked what items of PPE would be required in a pandemic, the government’s advisers recommended “providing eye protection for all hospital, community, ambulance and social care staff who have close contact with pandemic influenza patients.” They said the protection could be either visors or safety glasses, adding such equipment was necessary because there was some evidence of risk of infection via the eyes when in close contact with pandemic influenza patients.

However, according to minutes of a Nervtag meeting in June 2017, a health department official told the advisers to reconsider their advice as information had emerged about “the very large incremental cost of adding in eye protection.”

A minute from the meeting stated that “a subsequent internal DH health economic assessment has revealed that following these recommendations would substantially increase the cost of the PPE component of the pandemic stockpile four-to six-fold, with a very low likelihood of cost-benefit based on standard thresholds.”

The department asked Nervtag “to clarify the detail of their advice in light of the costings, and reconsider its recommendations against the strength of the scientific evidence of the ocular route as a source of infection, and the likely incremental cost-recommendations”.

The advisory committee then changed its official advice. The recommendation over protective eyewear was rewritten so that it instead told the department to buy enough eye protection for “exceptional usage” in higher-risk circumstances and when used with respirator masks during aerosol generating procedures.

According to a January 2018 minute, the update was made “in light of emerging evidence around cost-effectiveness, and the evidence around the incremental benefits of wearing eye protection.” It is not clear at what level of seniority in the health department the Nervtag recommendations were considered back in 2016 and 2017. In a statement to the Guardian, DHSC said it would be incorrect to say ministers “intervened in this decision making”.

“As the public rightly expects, decisions of this nature are evidence-based and take into account a number of factors, including expert clinical guidance, cost effectiveness and practical consideration, such as shelf life and storage,” a DHSC spokesperson said.

“The government has prepared and stockpiled for an influenza pandemic. The documents clearly state that the scientific evidence did not support a vast increase in procurement expenditure on face masks with integrated eye protection for pandemic influenza.”

The DHSC is now scrambling to find ways to better supply hospital staff as it faces Covid-19, a highly infectious respiratory disease, with reports of doctors and nurses frantically trying to buy their own PPE and a particularly acute need for eye protection.

At prime minister’s questions on Wednesday, the Labour leader, Jeremy Corbyn, highlighted that the Healthcare Supplies Association had appealed to DIY shops to donate PPE. On Twitter, the association said it needed visors and protective glasses, tweeting: “Do we have to commandeer the stocks of DIY stores?????”

Hunt, who ran the department between 2012 and 2018 and now chairs the House of Commons health select committee, has in recent days led calls to better equip frontline staff battling the coronavirus. Last week, he told the BBC: “We must sort this out. We are asking people to put their own lives at risk on the NHS frontline...It is absolutely heartbreaking when NHS frontline professionals don’t have the equipment that they need.”

His spokeswoman told the Guardian: “Jeremy does not believe he was personally involved in decisions about PPE for NHS staff, but was acutely aware of the shortage of funds in the NHS budget which was why that year he fought for and secured an £8bn rise in the NHS annual budget followed by a £20bn rise two years later.”

However, the documents suggest the efforts by Hunt’s department to water down the advice on PPE impacted a round of procurement that was due to take place in 2017 to stockpile for a possible pandemic. In addition to the discussions over eye protection, the documents also raise questions about the UK government’s policy regarding face masks for doctors, nurses and other health professionals dealing with Covid-19 patients.

In 2016, Nervtag advisers told the government that intensive care units (ICUs) should be designated “hot spots” carrying out aerosol generating procedures. Therefore, they said, a particular kind of mask known as an FFP3 respirator “should be recommended for all staff at all times in these areas when a patient with pandemic influenza is present”, except for some circumstances.

One intensive care nurse at a hospital in Yorkshire told the Guardian earlier this week she had had to spend £100 of her own money to buy a full FFP3 respirator mask online. In her unit on Monday, there were no masks or surgical gowns, another vital piece of PPE kit which has also been in short supply.

There have been other reports in recent days of NHS improvising in the face of insufficient PPE, with nurses in the Royal Free hospital in north London affixing clinical waste bags around their legs, while at North Middlesex hospital they have been tying plastic aprons around their heads.

Back in 2016, Nervtag advisers also recommended the government commission an update to its infection control guidance, which by then was seven years old. The guidance, they said, needed to recommend PPE usage “in line with the current evidence base and guidelines”.

In June that year, the department responded to Nervtag’s initial recommendations about pandemic stockpiling, saying work to reflect the advice was being prioritised and progressed. However, with regard to updating the control guidance to bring it in line with current evidence, officials replied: “This work is not considered a priority at this time and will be deferred for consideration at a future time.”

Frontline doctors and nurses have said recent changes to official advice in the UK have meant many NHS staff have been wearing less protective gear than the World Health Organization (WHO) recommends when caring for Covid-19 patients. The WHO’s advice recommends different standards of PPE to the UK advice in certain clinical situations.

--oo00oo--

For those who might be inclined more towards thoughts of conspiracy, the article I highlighted yesterday on BylineTimes regarding what the Tories really think about the NHS is well worth a read and in order to have prejudices suitably reinforced:-
"Boris Johnson and his Cabinet do not love the NHS, they are ideologically against the very fundamental idea of public healthcare. It goes against every research paper and book they love; against the desires of the millionaires who set up their lobby groups and policy think tanks. It is fundamentally a project that does not fit in their free market utopia."

Wednesday, 1 April 2020

Difficult Times

I found preparing yesterday's blog post difficult, a situation that only worsened as I became aware of what Toby Young had written on the subject. As the world-wide casualty figures continue to rise, I'm finding the callousness of such people really difficult to deal with emotionally. I'm also finding it hard dealing with the daily disingenuousness from our government regarding ventilators, PPE and testing. Maybe the casualty figures are just as economical in terms of truth? 

And meanwhile, the MoJ has still not issued definitive instructions for safe probation working practices or taken action on prisoner releases. Regarding the former, I notice the Probation Institute issued this yesterday:-     

Dear Readers,

Since the government restrictions were introduced to prevent the spread of Covid 19 we have seen different accounts of the management of the safety of staff and service users in Probation Services. We have looked at various websites to ascertain what guidance is being put in place in view of the importance of probation work, and the evident risks.

Currently neither HMPPS nor NPS websites have any specific information about the way in which the pandemic is being managed in Probation. There is considerable information concerning work in the prisons. A statement communicated through the BBC last week indicated that individuals supervised in the community by NPS will be supervised remotely except for sex offenders and other violent offenders who would be interviewed by phone at their own place of living.

Looking at eight CRC websites the messages vary from no reference to Covid 19 to detailed explanation of how services are being delivered during the emergency. Most staff are working from home. The majority of individuals will be supervised remotely by CRCs with specific exceptions including new prison leavers. Programmes and Unpaid Work are closed. London CRC state that they are using only the nine offices shared with NPS; we assume this may increase travel requirements for some staff.

General Health and Safety Legislation  https://www.hse.gov.uk/workers/employers.htm#  
requires the employer to provide a safe place of work and to guard against foreseeable risk of injury. The employer should provide a safety statement available to all employees and a specific risk assessment.

Concerns about safe working practices should be referred to the trade unions. Napo has issued a number of statements: https://www.napo.org.uk/covid-19-emergency
Unison also; https://www.unison.org.uk/tag/covid-19/

However, If you or colleagues would like to talk with some of the directors of the Probation Institute about any professional issues concerning Probation work and the Covid 19 pandemic we would like to invite you to join a Zoom "Probation Institute Meeting" on Monday 6th April at 5pm. If you would like to join please send an email to maryannemcfarlane@gmail.com We will then send you an invitation to join us on Zoom.

Wishing everyone the very best at this difficult time, stay safe.

Helen Schofield
Acting Chief Executive
31st March 2020

Regarding the latter, the Centre for Crime and Justice Studies published the following on Friday:-

Towards a lasting legacy for prisons from the coronavirus crisis

In a few short weeks, we have all had to adjust to a very different reality. In the face of the immediate threat posed by coronavirus, governments across the world have acted decisively and swiftly. The crisis has focused minds and prompted action in ways that would have been unthinkable only a few months ago.

In the UK, the government has been criticised for doing too little, too late, to contain the spread of coronavirus. Whatever the merits, or otherwise, of this as a general criticism, there is little doubt that in our prisons the potential crisis is very real, and growing.

The over 90,000 prisoners across England, Wales, Scotland and Northern Ireland, unable to take the routine precautions of most citizens, are at particular risk of infection.

Yesterday we learned that an 84-year-old prisoner in Littlehey and another elderly prisoner in Manchester had died after contracting coronavirus. There will be more cases in the days ahead. Last week, researchers at Imperial College London estimated that an uncontrolled outbreak of coronavirus infection in prisons in England and Wales could result in 800 deaths. Some consider this to be an under-estimate.

At the Centre for Crime and Justice Studies we support prisoners and prison staff trying to reduce the risk of infection in prison. Next week we will be embarking on a project with a number of partner organisations to assess the coronavirus situation in prisons across Europe and explore how different prison administrations are trying, or failing, to prevent infection and save lives.

Beyond the necessary, short-term measures to reduce the harm of coronavirus in prison, we also need a longer-term agenda. Across the UK, far too many prisoners, many of them elderly or with underlying health conditions, are being held in overcrowded, unsanitary, unhealthy prisons.

If an institution was to be invented with the express intention of maximising the spread of coronavirus, and of concentrating it among those most likely to be vulnerable to it, that institution would probably look much like a prison. We can't go on like this.

Over recent weeks I have been among those calling for an immediate managed release of some prisoners, as part of a wider programme to reduce the risk of infection in prison. This is a call that is now supported by a growing number of people. The government must act on this, and now.

The wasteful churn short prison sentences cause is well-recognised. The current context should give fresh urgency to ending it. Our short prison sentencing project will be seeking to influence just that, both making the case for immediate reform as well as seeking to secure the system changes necessary over the longer term.

And through our After Prison programme, we will be making the case for the long-term closure of much our prison estate. Prisons are a nineteenth century solution to a twenty-first century problem. There is always a better way to use a piece of land than as a place for a prison.

The coronavirus crisis has shone a light on the wider, and pre-existing, malaise in prisons. A fundamental rethink of our use of prisons would be a small, but important, gain to have come from the current crisis we are in.

Richard Garside
27th March 2020

Tuesday, 31 March 2020

Pandemic Denial

Like everyone I suspect, I'm trying to get my head around what's happening, but it's all moving so fast and there's so many angles to try and understand. There's so much I want to say, but the enormity of it all just seems so daunting. Like a rabbit caught in the headlights, I feel frozen to the spot. But I feel I must try and it might as well be on a topic I'm still frankly wrestling with, that of denial and minimisation, something we're familiar with particularly in relation to sex offending of course. 

We all know Holocaust denial exists and to be frank it's always baffled me. We're all familiar with conspiracy theorists and I think I'm right in saying there's still a Flat Earth Society. What I'm finding really scary is what I'll loosely term as 'pandemic denial' and it's already ubiquitous, takes many forms, masquerades as scientific but of course is political. From the guy in the US who asked why the economy was being 'tanked' in order to save a lot of old 'unproductive' people who were dying a bit earlier than they might, to Norman Tebbit suggesting in the Telegraph that it's all a bit 'overhyped'. 

One of the most worrying aspects of all this is that 'experts' are coming out of the woodwork in order to question the global response, such as a retired professor of pathology writing recently in the Spectator. Now there's a funny thing - that particular right-wing magazine is owned by the Barclay Brothers, who also own the Telegraph. 

We know the first instinct of Dominic Cummings and the Tory government was to push the idea of going for 'herd immunity', rather than social-distancing, but then baulked at the prospect of likely casualties being politically risky, not to say killing-off a lot of Tory voters. Which brings us back to the issue of politics, not least because COVID-19 is changing everything, everywhere and the realisation that things could be done differently has really rattled vested interests as they become increasingly scared about that prospect. We can expect considerable 'push-back' and denial in the coming months I think:-  

How deadly is the coronavirus? It’s still far from clear

There is room for different interpretations of the data

In announcing the most far-reaching restrictions on personal freedom in the history of our nation, Boris Johnson resolutely followed the scientific advice that he had been given. The advisers to the government seem calm and collected, with a solid consensus among them. In the face of a new viral threat, with numbers of cases surging daily, I’m not sure that any prime minister would have acted very differently.

But I’d like to raise some perspectives that have hardly been aired in the past weeks, and which point to an interpretation of the figures rather different from that which the government is acting on. I’m a recently-retired Professor of Pathology and NHS consultant pathologist, and have spent most of my adult life in healthcare and science – fields which, all too often, are characterised by doubt rather than certainty. There is room for different interpretations of the current data. If some of these other interpretations are correct, or at least nearer to the truth, then conclusions about the actions required will change correspondingly.

The simplest way to judge whether we have an exceptionally lethal disease is to look at the death rates. Are more people dying than we would expect to die anyway in a given week or month? Statistically, we would expect about 51,000 to die in Britain this month. At the time of writing, 422 deaths are linked to Covid-19 — so 0.8 per cent of that expected total. On a global basis, we’d expect 14 million to die over the first three months of the year. The world’s 18,944 coronavirus deaths represent 0.14 per cent of that total. These figures might shoot up but they are, right now, lower than other infectious diseases that we live with (such as flu). Not figures that would, in and of themselves, cause drastic global reactions.

Initial reported figures from China and Italy suggested a death rate of 5 per cent to 15 per cent, similar to Spanish flu. Given that cases were increasing exponentially, this raised the prospect of death rates that no healthcare system in the world would be able to cope with. The need to avoid this scenario is the justification for measures being implemented: the Spanish flu is believed to have infected about one in four of the world’s population between 1918 and 1920, or roughly 500 million people with 50 million deaths. We developed pandemic emergency plans, ready to snap into action in case this happened again.

At the time of writing, the UK’s 422 deaths and 8,077 known cases give an apparent death rate of 5 per cent. This is often cited as a cause for concern, contrasted with the mortality rate of seasonal flu, which is estimated at about 0.1 per cent. But we ought to look very carefully at the data. Are these figures really comparable?

Most of the UK testing has been in hospitals, where there is a high concentration of patients susceptible to the effects of any infection. As anyone who has worked with sick people will know, any testing regime that is based only in hospitals will over-estimate the virulence of an infection. Also, we’re only dealing with those Covid-19 cases that have made people sick enough or worried enough to get tested. There will be many more unaware that they have the virus, with either no symptoms, or mild ones.


That’s why, when Britain had 590 diagnosed cases, Sir Patrick Vallance, the government’s chief scientific adviser, suggested that the real figure was probably between 5,000 and 10,000 cases, ten to 20 times higher. If he’s right, the headline death rate due to this virus is likely to be ten to 20 times lower, say 0.25 per cent to 0.5 per cent. That puts the Covid-19 mortality rate in the range associated with infections like flu.

But there’s another, potentially even more serious problem: the way that deaths are recorded. If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’. So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections. If the patient has, say, cancer, motor neurone disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections.

Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu. That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.

In the current climate, anyone with a positive test for Covid-19 will certainly be known to clinical staff looking after them: if any of these patients dies, staff will have to record the Covid-19 designation on the death certificate — contrary to usual practice for most infections of this kind. There is a big difference between Covid-19 causing death, and Covid-19 being found in someone who died of other causes. Making Covid-19 notifiable might give the appearance of it causing increasing numbers of deaths, whether this is true or not. It might appear far more of a killer than flu, simply because of the way deaths are recorded.

If we take drastic measures to reduce the incidence of Covid-19, it follows that the deaths will also go down. We risk being convinced that we have averted something that was never really going to be as severe as we feared. This unusual way of reporting Covid-19 deaths explains the clear finding that most of its victims have underlying conditions — and would normally be susceptible to other seasonal viruses, which are virtually never recorded as a specific cause of death.

Let us also consider the Covid-19 graphs, showing an exponential rise in cases — and deaths. They can look alarming. But if we tracked flu or other seasonal viruses in the same way, we would also see an exponential increase. We would also see some countries behind others, and striking fatality rates. The United States Centers for Disease Control, for example, publishes weekly estimates of flu cases. The latest figures show that since September, flu has infected 38 million Americans, hospitalised 390,000 and killed 23,000. This does not cause public alarm because flu is familiar.

The data on Covid-19 differs wildly from country to country. Look at the figures for Italy and Germany. At the time of writing, Italy has 69,176 recorded cases and 6,820 deaths, a rate of 9.9 per cent. Germany has 32,986 cases and 157 deaths, a rate of 0.5 per cent. Do we think that the strain of virus is so different in these nearby countries as to virtually represent different diseases? Or that the populations are so different in their susceptibility to the virus that the death rate can vary more than twentyfold? If not, we ought to suspect systematic error, that the Covid-19 data we are seeing from different countries is not directly comparable.

Look at other rates: Spain 7.1 per cent, US 1.3 per cent, Switzerland 1.3 per cent, France 4.3 per cent, South Korea 1.3 per cent, Iran 7.8 per cent. We may very well be comparing apples with oranges. Recording cases where there was a positive test for the virus is a very different thing to recording the virus as the main cause of death.

Early evidence from Iceland, a country with a very strong organisation for wide testing within the population, suggests that as many as 50 per cent of infections are almost completely asymptomatic. Most of the rest are relatively minor. In fact, Iceland’s figures, 648 cases and two attributed deaths, give a death rate of 0.3 per cent. As population testing becomes more widespread elsewhere in the world, we will find a greater and greater proportion of cases where infections have already occurred and caused only mild effects. In fact, as time goes on, this will become generally truer too, because most infections tend to decrease in virulence as an epidemic progresses.

One pretty clear indicator is death. If a new infection is causing many extra people to die (as opposed to an infection present in people who would have died anyway) then it will cause an increase in the overall death rate. But we have yet to see any statistical evidence for excess deaths, in any part of the world.

Covid-19 can clearly cause serious respiratory tract compromise in some patients, especially those with chest issues, and in smokers. The elderly are probably more at risk, as they are for infections of any kind. The average age of those dying in Italy is 78.5 years, with almost nine in ten fatalities among the over-70s. The life expectancy in Italy — that is, the number of years you can expect to live to from birth, all things being equal — is 82.5 years. But all things are not equal when a new seasonal virus goes around.

It certainly seems reasonable, now, that a degree of social distancing should be maintained for a while, especially for the elderly and the immune-suppressed. But when drastic measures are introduced, they should be based on clear evidence. In the case of Covid-19, the evidence is not clear. The UK’s lockdown has been informed by modelling of what might happen. More needs to be known about these models. Do they correct for age, pre-existing conditions, changing virulence, the effects of death certification and other factors? Tweak any of these assumptions and the outcome (and predicted death toll) can change radically.

Much of the response to Covid-19 seems explained by the fact that we are watching this virus in a way that no virus has been watched before. The scenes from the Italian hospitals have been shocking, and make for grim television. But television is not science.

Clearly, the various lockdowns will slow the spread of Covid-19 so there will be fewer cases. When we relax the measures, there will be more cases again. But this need not be a reason to keep the lockdown: the spread of cases is only something to fear if we are dealing with an unusually lethal virus. That’s why the way we record data will be hugely important. Unless we tighten criteria for recording death due only to the virus (as opposed to it being present in those who died from other conditions), the official figures may show a lot more deaths apparently caused by the virus than is actually the case. What then? How do we measure the health consequences of taking people’s lives, jobs, leisure and purpose away from them to protect them from an anticipated threat? Which causes least harm?

The moral debate is not lives vs money. It is lives vs lives. It will take months, perhaps years, if ever, before we can assess the wider implications of what we are doing. The damage to children’s education, the excess suicides, the increase in mental health problems, the taking away of resources from other health problems that we were dealing with effectively. Those who need medical help now but won’t seek it, or might not be offered it. And what about the effects on food production and global commerce, that will have unquantifiable consequences for people of all ages, perhaps especially in developing economies?

Governments everywhere say they are responding to the science. The policies in the UK are not the government’s fault. They are trying to act responsibly based on the scientific advice given. But governments must remember that rushed science is almost always bad science. We have decided on policies of extraordinary magnitude without concrete evidence of excess harm already occurring, and without proper scrutiny of the science used to justify them.

In the next few days and weeks, we must continue to look critically and dispassionately at the Covid-19 evidence as it comes in. Above all else, we must keep an open mind — and look for what is, not for what we fear might be.

John Lee is a recently retired professor of pathology and a former NHS consultant pathologist.

Monday, 30 March 2020

Lockdown Week One

As we head into week two of 'lockdown' and heavy hints from government that restrictions may even tighten, concerns amongst probation staff being required to see clients face to face remain with 3,041 visits recorded yesterday. An improvement on Saturday, but I notice  discussion once again became fractious after I turned the computer off last night so I've decided it will probably be in all our best interests to suspend unmoderated commenting over night from now on.

Everyone is having to deal with this in their own way and at some point I intend to publish some of my own more discursive thoughts, as much for therapy as anything else. In the mean time here's Jonathan Pie's take on things:-   



Sunday, 29 March 2020

Ideological Constipation

We seem to have fallen into a new regular pattern of activity with 3,314 visits yesterday and basically opinion divided over the issue of face to face office contact with clients or not and especially in the absence of any PPE. The exchanges were tetchy at times, understandable given the possible consequences of our actions and high levels of anxiety. Lets try and not just rehash everything that was said yesterday, but possibly broaden the discussion? 

The issue of how the MoJ intend to deal with the prison situation remains disgracefully unresolved. During a time of unprecedented national edeavour, it seems remarkable to me that it appears beyond the wit of anyone to sort a release programme that could intelligently make use of information, assessment, testing, tagging, mobile phone issuing and remote supervision. With so much of the COVIS-19 response, it just seems to boil down to political judgement and willingness.

Today I want to publish two contributions that arrived by email yesterday:-

After a week of such unprecedented change in delivering case management in the NPS it is interesting to reflect on how remarkable it is. Command and control demands that cases are seen, OASYS is completed, forms are filled in again and again and if you want to book an AP bed for a potential release you follow an over complex maze of screens and forms at least 12 months in advance.....and of course there are no vacancies. 

The job of case managers is relentlessly demanding and unnecessarily complex. The purpose and drivers of our work with our cases and other agencies is to try to assist them to move away from offending and if they cannot, to protect the public and not spend so much time on the computer.

So now we are NOT 'seeing' all but a critical few & working at home in isolation and relying on phones and laptops. Of course a year or so ago we did not have laptops, so it would be interesting to reflect on how the situation would have been managed then! Naturally our leaders still want us to record changes to the type of reporting in duplicate, in both Ndelius and OASYS.

These are difficult times for staff but even more so for our cases and especially those in prison. Of course the worst is yet to come with prisons and APs likely to be overrun by the virus and more staff to become ill. What will happen if Ndelius and the IT goes down as it has in the past and what becomes of the emotional health of staff who are self isolating for 12 weeks because of SUMC or stuck working remotely for days and weeks? Probation will never be the same again but we must support one another and find ways to support colleagues at home.

Finally, a week ago civil servants could not be seen to have any 'perks'. £4.20 lunch allowance even if you are out most of the day and have to buy a coffee at a motorway services. This week LDU heads (who you feel are just following orders anyway) are to receive a £1500 monthly bung. For many colleagues this seems obscene when many of our cases as well as many of the public are desperately trying to survive, especially those trying to claim Universal Credit.

Hopefully, many colleagues will consider whether the bonuses they might receive could be donated, at least in part, to a charity or organisation helping out those who are struggling to survive out there in this crazy new order.


--oo00oo--


In The Name of Humanity

Whilst probation staff are categorised by the government as keyworkers. Clearly some keyworkers are regarded as more essential than others. I too stood on my door step on Thursday clapping for the "carers", but unlike most of the public I was also banging my pot lids for probation staff as well as other frontline staff.

There has always been public wariness of us probation staff as being "do-gooders" for working with people who have transgressed the criminal code. As a profession we have always been treated with suspicion even by other similar professions such as medical staff and social workers simply because of the people with whom we have chosen to engage with on our caseloads. Last year before I retired, our dedicated local authority housing officer explained that her colleagues were frankly apprehensive when recently released prisoners turned up at the homeless persons unit. Even these allied professionals harboured negative stereotypes common in the press and in their canteen culture due to a lack of familiarity and knowledge.

Therefore please do not judge that private landlord too harshly in the above article. I have encountered this attitude when I have been advocating for over 30 years on people on my caseload when trying to support them accessing mental health treatment and local authority housing.

One of my abiding principles is that to assess how humane any society is we need look no further than how the modern day social lepers are treated. This includes people with experience of institutions such as mental health hospitals and prisons. It is all too easy to categorise people into us and them. It is a natural instinct but one we constantly need to guard against to reduce the barriers between us all.

To give a personal example, I was working at the Stockwell Road probation office in South London on July 7th 2005, the day of the London bus bombings. I vividly remember a phone call one of my service users made to me explaining he was in East London and would try to make his way to his office appointment that day. When I told him on no account should he be attending the appointment and definitely not put himself in danger by using public transport, he was shocked. He asked me outright, "you're not going to recall me?". I said "we are are all Londoners aren't we?"

This is a plea to all the probation policy makers and senior managers and trade union officals to remember they have a duty of care to frontline staff and the people whom we work with. In the name of humanity, everyone, including their families, take care.

Saturday, 28 March 2020

Virus Roulette

With 3,324 visits to this platform yesterday, clearly probation staff remain concerned with their safety and many will no doubt be at home for the weekend, reflecting on the extraordinary situation they find themselves in. Those pesky EDM's are certainly taking time to sort out aren't they:- 
"This is taking a frustratingly long time to be agreed as there can be multiple versions before getting final agreement with the centre."
and one has to wonder what exactly is going on behind the scenes at the MoJ as they steadfastly refuse to release any prisoners and at the same time insist probation staff carry on with 'business as usual'. And here's a funny thing. Despite many attempts to get the main stream media interested in this story, they're not biting. Now why might that be exactly? I notice this has not gone unnoticed by at least one reader:-

Come on, media people. Richard Ford, Angus Crawford, Danny Shaw, Krish Gurumurthy, Adam McQueen. There's a story here about systemic negligence & what's happened - Mail & Torygraph have faithfully run the Govt's press release + Guardian has run a nasty-landlord story with inaccuracies that suggest probation officers see people from behind a screen.

HMPPS via NPS & CRCs are still debating deeply flawed policy directives which means that public health is currently severely compromised by unprotected contact between and unnecessary movement of people in towns & cities across England & Wales.

In Derbyshire the police have employed drones to shame people walking their dogs in the middle of nowhere. BUT... Probation staff, those they supervise & anyone else in their chains of contact have to play Virus Roulette.

Cabinet Ministers & other senior figures have contracted the virus in the last week or two, presumably asymptomatic whilst they've been shut in strategy meetings. Assuming there were significant efforts to limit the risk of infection to these senior figures it shows just how ubiquitous & amenable to transmission this virus is.

So why insist that people who are statistically more likely to have had exposure to the virus - for example those who may have just been released from prison, people with proven disregard for rules and laws, people from multi-occupancy accommodation, sofa-surfers or the homeless - have to travel to appointments in probation offices - where there are no bio-hazard facilities, no deep-cleaning, no screens in interview rooms, no capacity for 2-metre distancing - to meet with staff who are not equipped with PPE & thus have already had a high likelihood of exposure to the virus themselves?

It's a bit like filling several leaky jerry cans with petrol & diesel, placing them in the boot of a car with a known electrical fault, then getting a chain-smoker to drive that car through a packed city centre... and insist that if anyone is maimed or dies it was the fault of those who were too close to the vehicle when it exploded: "They were expected to keep their distance."


--oo00oo--

Another contribution poses this scenario:-

As with SFO’s, when it all goes wrong probation workers will be thrown under the bus by the top brass:-

"They were expected to keep their distance."
“They did not request PPE, although offices are frequently cleaned.”
“They agreed to continue to work despite warnings about self isolation and social distancing.”
“The local office managers implemented the exceptional delivery model without risk assessing the building first.”

“The Exceptional Delivery Model was supported by trade unions.”

Friday, 27 March 2020

Thought Of The Day

Having woken at a more reasonable hour, I see there were 3,395 visits yesterday and concern by staff for their safety continues pretty much unabated. The situation in prisons is of particular concern, but clearly the government has no appetite to consider any executive release, despite almost universal calls to do so. Ignoring all the rhetoric about us 'being in this together', it's still a right-wing government running things. 

I thought it would be good to re-publish the following from regular contributor 'Getafix today:- 

Like everyone else I'm terrified by Coronavirus. Especially as I have a family link to an NHS doctor working on the frontline in a hospital, and I'm afraid that the calm reassurences given to the gereral public by Government isn't reflected in what the doctors and hospitals are being told. The next 14 to 21 days apparently will show just how serious and deadly the situation is, and the 1.5 million most at risk because of serious underlying health conditions that received an NHS letter really need to keep themselves safe, as that letter also means that if you do get sick, it's highly unlikely you'll get access to a ventilator.

But as frightened as I am, I'm also fascinated by the rapid and liquid changes occurring to our social structures and what those changes are exposing. Richard Branson, Philip Green, Mike Ashley and Tim Martin have all caused outrage this week by their self interested response to the pandemic. Branson takes considerable amounts of money from Government contracts, many of them within the NHS, but he wants a £7.5 billion bail out for Virgin Atlantic, whilst at the same time telling his considerable workforce to take 8 weeks unpaid leave. Green has got rid of any staff he could without any renumeration, and Martin has told all his staff to go and apply for jobs at Tesco. He's also publically criticised the government decision to close pubs. There's no evidence he says that the virus can be spread by people going to pubs.

I'm sure that when this is over people will remember that those whose extreme wealth affords them access to political platforms, showed in a time of Global crisis that their primary concern wasn't for the safety and wellbeing of the public, but rather the protection of their own wealth.

We've also had a decade of austerity, and the mantra used for that was "we're fixing the roof whilst the sun shines". They've shrunk the State dramatically, and told us they've to sell off so much of our public services to the private sector to enable them to fix the roof. But now the weather's changed and the roofs OK but there's no walls left to put it on.

The State has been shrunk so much it's in a wholly inadequate position to deal properly with this crisis. But the call to Arms has gone out none the less, it's been sounded in the public sector, the third sector, a call for a huge voluntary contribution, and even to those that have retired from public service, all being asked to step up to the plate. The same call to Arms hasn't gone out to the private sector, and in fact much of the private sector are still being allowed to flaunt the rules, but they do so with the lives of employees, the CEOs just sit in their ivory towers. I'm sure many will remember all this when we come out the other side of this.

People too are beginning to realise just how important is is to be able to trade across boarders without restriction. Building the numbers of ventilators needed by the NHS to help combat the virus has been hampered as many of the components needed are manufactured in other countries that are also on lockdown. The same with our food supplies. Do we really want to live in a world where we create obstacles to essential supplies in exchange for some concept of national identity? It's terrifying, all of it, but I can't help being fascinated at the same time.

'Getafix

Thursday, 26 March 2020

The Dilemma

I've been up since 3am listening to the World Service, unable to sleep. I bet I haven't been alone. It's another day and I see there were 3,529 visits to this platform yesterday, mostly by worried and concerned staff, in many instances trying to reconcile a whole number of competing duties, demands, responsibilities and fears. I suspect today will be no different as the drama continues to unfold and the realities of what it actually means for probation to have been very unwisely merged with a uniformed service, all under direct civil service control become all too clear.  

A dilemma is "a situation in which a difficult choice has to be made between two or more alternatives, especially ones that are equally undesirable" and this tweet from Sonia Flynn yesterday rather neatly illustrates the tensions that being part of the HMPPS/MoJ monolith brings:- 
"The social distance club is our priority .. but as essential Key workers the probation service has to walk the line between PH guidance and Public Protection ... not easy"
I'm sure I'm not alone in pondering how differently the current situation would have been dealt with had probation remained an independent service, locally controlled and delivered. We certainly wouldn't have been faced with the current prison nightmare of OMiC where probation staff now find themselves basically helping to cover for some prison officer duties and subject to Governor directions. But it was all so inevitable given the forced marriage with HM Prison Service, an organisation with an entirely different culture and ethos. 

It should be entirely different in the community of course, but several years of centralised command and control by NPS/HMPPS/MoJ management has had its effect in engendering low morale, disillusionment and poor retention, even amongst newer recruits who can see the inherent incompatability of centralised direction in dealings with troubled, chaotic and challenging individuals. The once distinctive culture of the probation service has come under sustained attack from within, but joyously refuses to die and it's noticeable that in the current crisis, individualism and resistance to diktat is reappearing like the early shoots of spring.

When this is all over, the world is never going to be the same again and I'm optimistic about that. Why should it be? Isn't this just the opportunity to use enforced isolation in order to think about doing things better? The canals of Venice are running crystal clear; the smog has lifted in India and China; the homeless are being accommodated in hotels; the railways are nationalised: the Tories have realised the importance of the NHS and BBC and we will all realise that putting probation in bed with the prison service was a very bad idea indeed. 

Take care everyone.         

Wednesday, 25 March 2020

Latest From Napo 206

C19 - Update 25-03-2020 (bulletin 3)

Following substantial contact from members yesterday the general guidance on operations has been updated on our webpage, this is the HMPPS EDM (Exceptional Delivery Model) that all Probation providers (NPS and CRCs) are expected to follow. There will also be EDMs for APs, Courts, Electronic Monitoring and Probation in prisons. Each Division and CRC will then produce their specific EDM based on the HMPPS guidance and this will be signed off by the centre. Already we have made representations about one CRC owner’s EDM not being properly in line with the HMPPS guidance and we will continue to monitor and act on these to ensure that CRCs and NPS divisions are all working in line with the national model.

Clearly this process takes time and not all of the EDMs have been signed off yet. If any members are in a position where they feel they are being asked to work in a way that does not meet the HMPPS general model they should first take it up locally with their managers and seek support from local reps who can escalate to the national team if necessary. Over the past two days we have seen many issues resolved thanks to the proactive and persistent approach of our local reps who have managed to pull back attempts (however well-meaning) to pre-empt guidance or introduce different versions. As soon as we have any updates we will post them to the webpage so please check it regularly.

NPS staff working in prisons

We are still awaiting the specific EDM for this, and have made Senior leaders aware of the significant impact the delay is having on members. We expect the EDM to be with us by the end of the week, but in the meantime members should not be seeing any clients face to face except in the most urgent and extreme of circumstances and then only when social distancing protocols can be observed. Prison regimes should all now be in lockdown which should help in this. Staff based in prisons can, if they need to because of an underlying health issue, work at home and this can be agreed by their line manager. We have heard from some members that there is tension between the decisions being made by Probation managers (in line with NPS guidance) and the very real urgency for Prison management to make the establishment as safe as it can be in the face of a staffing crisis. We have made it clear to HMPPS Senior Leaders that this is unacceptable and that staff working in prisons remain employees of the NPS or CRC and not the prison.

Suspension of most disciplinary, grievance and attendance management cases in NPS

We have secured agreement that, during this crisis, all of these cases will be suspended (so no hearings or investigations will be taking place) until we return to “business as usual”. The only exception will be some gross misconduct cases and those cases where it is decided, very exceptionally, that to not proceed would cause too many difficulties. New allegations of gross misconduct where suspension is unavoidable will proceed to suspension and then a decision will be made in line with the above whether to proceed with the case or not. HMPPS will issue an instruction on this in the next day or two and we will share it once we have it.

What About Prisons?

As many probation staff continue to try and reconcile new operating instructions being issued by NPS and CRC managements, both with government instruction and common sense, this platform received 4,495 visits yesterday. (It should be noted that union guidance has been amended, but good luck spotting the changes.) Today attention inevitably turns to the prison estate with news of increasing numbers of prison staff not reporting for duty either due to sickness or self-isolation. This from BBC website:-

Coronavirus: Inmates could be freed to ease virus pressure on jails

The government is considering releasing some offenders from prisons in England and Wales to ease pressures caused by the coronavirus pandemic. Justice Secretary Robert Buckland said the virus poses an "acute" risk in prisons, many of which are overcrowded.

Some 3,500 prison staff - about 10% of the workforce - were off work on Tuesday because they were ill or self-isolating, a committee of MPs was told. Mr Buckland said releasing some inmates could help to "alleviate" pressures.

The justice secretary told the Commons justice committee he was "keen" to make use of release on temporary licence - where prisoners are let out for short periods, after a risk assessment. Mr Buckland said he was looking "very carefully" at whether or not 50 pregnant prisoners could be released. He also indicated some of the 9,000 inmates who are on remand, awaiting trial, could be transferred to bail hostels, if it was safe to do so.

Mr Buckland said the prison service must "balance the protection of life with the need to protect the public", but releasing prisoners early could help to "alleviate some of the pressures" the virus was having on the system. However, he pointed out that releasing more prisoners would be a "challenge" for probation staff.

Amnesty International UK's head of policy and government affairs, Allan Hogarth, said elderly prisoners and those with underlying medical conditions should "immediately" be considered for release "if they do not pose a threat to themselves or society".

Mr Buckland's appearance before the committee came as all visits to prisons were cancelled, as part of measures to curb the spread of the virus. Outside visitors, group activities and education classes have all been banned and inmates have been confined to their cells for 23 hours a day.

The Ministry of Justice (MoJ) said 55 prisons across England and Wales would be given 900 phones to allow prisoners to stay in touch with family members during the ban. The phones will not have internet access and would only be handed out to risk-assessed prisoners on a temporary basis, the MoJ said.

The justice committee also heard from Jo Farrar, chief executive of the Prison and Probation Service, who said 13 inmates had tested positive for coronavirus. The confirmed cases were in nine prisons although more jails are suspected to have had cases.

According to the latest Department of Health figures, there are now more than 8,000 confirmed cases of coronavirus in the UK - although the actual number cases is likely to be far higher. Some 422 of those patients have died. Mr Buckland said more tests for the virus were needed in prisons, and more personal protective equipment (PPE) was needed for staff. About 50,000 protective masks have been delivered for staff to use and a ban on bringing hand sanitiser into prisons has been lifted.

--oo00oo--

This from Eric Allison in the Guardian yesterday:-

Coronavirus is a disaster for UK prisons. Releasing the harmless now will save lives

The Prisoners’ Advice Service (PAS), a charity of which I am a trustee, asked the Ministry of Justice (MoJ) last week to release groups of prisoners in order to lessen the impact of coronavirus in the penal estate. They have done it in Iran, so why not here?

The UK government has already announced that it intends to ease pressure on prisons by increasing the number of prisoners released on home detention curfew with a tag. But the PAS is calling for those inmates who are old or infirm; or have long passed their tariffs – if they are serving a wretched imprisonment for public protection (IPP) sentence; or simply do not pose a threat, to be released immediately. These include the more than 1,700 prisoners, mostly men, aged 70 and over – some of whom are 80 or older, with a growing number in their 90s.

Releasing these prisoners, who are now completely harmless, will undoubtedly save lives, not just of prisoners but also of prison officers and other staff, especially in jails where there are wings full of elderly inmates. We have already had the first case of Covid-19 in a prisoner at Strangeways in Manchester. Make no mistake, this virus will take hold. Nowhere more so than in our antiquated local jails, such as Strangeways, where two or more prisoners are crammed into cells Victorian prison planners designed for one. Please tell us, justice minister, how such inmates can self-isolate?

Only last month a report from the National Audit Office on the physical state of prisons revealed a shocking state of disrepair, from leaking roofs and failing heating systems to broken cell windows and rat infestations. So, how can they possibly provide the hygienic conditions needed – particularly for frail, elderly prisoners – to fight this virus. Last year inspectors found that 10 out of 35 men’s prisons weren’t meeting minimum standards of cleanliness and infection control compliance.

When serving time, I experienced a few hairy moments, occasions when I felt my actions would lead to my physical harm. But my biggest fear, always, was suffering a serious illness. Of all the myths peddled by the MoJ, the line that prisoners receive healthcare comparable with that they would receive in the community is the hardest one to swallow.

Writing about the state of the prison system in England and Wales, my inbox is full of horror stories of medical neglect in the penal estate. They include prisoners who have died in hospital, more often than not in chains, after prison medical staff had ignored signs of serious illness until it was too late. The one I recount here did not end in death, but the scale of the neglect still shocks me.

A prisoner in a Midlands jail complained of severe pains in his leg. He was given paracetamol. Then his leg began to turn black and started to smell. The man did not have great mental capacity and simply accepted his pain. He was discharged from a relatively small sentence and his son immediately took him to their GP, who referred him immediately to a specialist. It was, of course, gangrene and there was nothing to be done but amputate. I put them in touch with a lawyer and the man eventually received compensation. But no treatment, on a leg that had turned black and smelly?

Ironically for the hang ’em and flog ’em brigade, the least dangerous prisons in terms of coronavirus will be the high security ones, which house those who have committed the most serious crimes. They are not overcrowded and all inmates have single cells. The local jails may well transform into charnel houses if nothing is done to release those who represent at worst a nuisance, rather than a danger to society.

On Saturday night I spoke to a pal from the old days, who is now retired from the game but keeps abreast of prison matters. He’s a Londoner and we discussed the impact this virus may have on the local jails he and I know well: Pentonville, Wandsworth and Wormwood Scrubs. We discussed our chances of survival if we were back inside any of them. Would we get the medical care our ages (we are now in our 70s) and our underlying medical conditions (I was a heavy smoker) required?

“More likely to be struck by lightning,” he said. “In Pentonville, we’d be lucky to get a mattress to sleep on.”

As many as 60% of prisoners could become infected with coronavirus, according to Prof Richard Coker at the London School of Hygiene and Tropical Medicine, who has looked at the potential spread of the virus in locked establishments.

Those who say criminals deserve what they get should bear in mind that, in life, as in prisons, there is a pecking order. The poor and disadvantaged, who have committed no crimes, will be the next in the line of fire of this disease.

Eric Allison is the Guardian’s prisons correspondent. He spent 16 years in prison for theft-related offences