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Westlake Legal Group > Posts tagged "healthcare"

Andrea Leadsom: By enhancing mental health support in the early years, we can change our society for the better

Andrea Leadsom is MP for South Northamptonshire.

Last week we marked Mental Health Awareness Week. It offered the chance to shine a light on the importance of good lifelong emotional health and why the building blocks for its success lie in the first 1001 days of life – the period from conception to age two.

The first 1001 days shape the health, wellbeing and even the life chances of every human being. Countless neuroscience studies have shown that the first two years are the most important phase of brain development, with volume doubling in size. In just the first three months of life, the brain grows by 64 per cent, becoming more than half the size of the average adult brain.

Healthy brains develop naturally when babies have a loving, secure relationship with their principal care-givers and these relationships are the very foundation of our developing emotions. They help to cement our future personality traits and impact on our social, economic and physical outcomes.

Perinatal mental illness is, however, widespread across all parts of our society. I’ve been open about my own struggle with postnatal depression, and I know how helpless and hopeless it can make you feel.

The impact on human happiness, relationships and potential is reason enough to address it: but there is also a huge economic cost. It is estimated that every year, the long-term cost of failing to address the mental health issues of new mothers, and the impact this has on the outcomes for their babies, is £1.2 billion to the NHS and social services, and £8.1 billion to society.

The NHS Long Term Plan unveiled new perinatal mental health support for mothers and their partners, and extended the length of time that support can be accessed to two years from their child’s birth. This should radically help to improve the support available.

On top of that, the Government has invested £365 million to ensure that by 2020/21, up to 30,000 more women can access high-quality mental health care in the community or in specialist Mother and Baby Units.

It’s good that there’s been a shift in attention towards this issue. But there is so much more to be done to ensure that the parent/baby relationship is at the heart of all perinatal mental health support.

At present, the baby is almost always the ‘third party’ and the last to be considered, despite being profoundly susceptible to the emotions of their parents – and often with longer-lasting effects. Parent-infant specialist support is needed in those cases; and at the moment, there are too few skilled specialists in this field.

I was proud to chair an Inter-Ministerial Group on the early years, between 2018 and 2019. This cross-Whitehall group worked collectively on how we can develop good perinatal mental health services, as well as a whole raft of support measures that would ensure every baby gets the best start in life.

As part of our work, we visited support services across the UK and consulted with a wide range of parents with hugely differing needs. We looked at best practice and at the ‘postcode lottery’ to see what services were on offer to families, and what was missing. We took advice from a specialist panel of practitioners, as well as from academics in the early years arena. The Ministers who took part in the IMG gave their recommendations to the government in July 2019, shortly before Theresa May resigned.

My own return to the backbenches means I can now focus on taking forward this early years work, and I am delighted that our new Prime Minister has promised to support me. The wheels are in motion, and I am looking forward to making a real, positive difference to this critical period of life.

I am certain that by providing world-class support in the vital early years, we can change our society for the better. Supporting the development of secure attachment between new babies and their caregivers will lead to happier, more capable and healthier children, and ultimately, a stronger society.

Infant mental health is about more than babies. It’s about improving our whole lives, and striving for better outcomes that have a profound effect from cradle to grave.

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Luke Evans: The shutdown and economic crisis. The longer the first goes on, the more likely the second becomes.

Dr Luke Evans is a member of the Health Select Committee, and is MP for Bosworth.

Two days ago, Angela Rasmussen, a Columbia University virologist, posted a series of tweets about how much we still have to learn about Coronavirus.

Acknowledging that we have already come a long way in a short time, Dr Rasmussen wrote: “Unfortunately the focus on who is “right” and when they were right is giving oxygen to the “infodemic” that is contributing to the extreme polarisation of public health priorities. Nobody can be “right” about a pathogen that is still mired in so much uncertainty.”

Since the beginning of the Coronavirus outbreak, our Government, which has no Ministers as far as I know who are trained epidemiologists, have had to listen to information and advice proffered by the respected science community.

That advice will have been given in good faith, and it’s right that ultimately the buck stops with politicians, but of course as we develop greater knowledge it may well be that some measures taken based upon it will prove ineffective or even potentially damaging.

It’s not a matter of apportioning blame, but rather of accepting there are a great many things that we still don’t know about this novel virus.

Every action we take potentially brings with it a cost, many know the concept of ‘opportunity cost’. Michael Levitt, a Nobel laureate in Chemistry, claimed this week that “I think lockdown saved no lives…I think it may have cost lives. It will have saved a few road accident lives – things like that – but social damage – domestic abuse, divorces, alcoholism – has been extreme. And then you have those who were not treated for other conditions.”

Whilst Professor Levitt is not an epidemiologist either, and his comments appear to serve as an outlier to the wider scientific community, it’s undeniable that, for each action, there is a price to pay, even if we don’t know what the cost is yet.

One incontrovertible truth is that the longer that lockdown continues, the likelihood of the United Kingdom experiencing an economic crisis increases.

Entering into this pandemic, the working worst case scenario was 500,000 deaths from the virus itself if nothing was done, and the working financial cost of the virus by the Treasury is up to £300 billion. Both are extreme positions in themselves, the only commonality between them is that hope that they are both overestimations.

We have to understand that whilst economy and health are, on the face of it, completely separate matters they are inseparably intertwined, too. There is an unsolvable and immeasurable balance between lives and livelihoods.

Political opponents will point and say ‘another Tory bothered more about money than health’, without ever acknowledging the fact that our economy has a direct impact on health outcomes.

Yet a decision on one directly and indirectly affects the other.

In a study published last month by the Institute for Fiscal Studies, it was claimed that there may well be some short term health benefits to a recession: drinking, smoking and unhealthy eating all tend to reduce when there are negative income shocks; improved cardiovascular health comes hand in hand with lower pollution; even viral transmission tends to lower with reduced inter-regional travel.

But in the long term, the health of many also deteriorates because, in general terms, our health improves in a growing economy.

In other research published by the IFS, Janke et al suggested that health conditions worsen when economic factors deteriorate, especially in industrial areas, where populations are older and where others already experience poorer health outcomes.

The ONS records that whilst overall life expectancy has continued to increase the rate that it has done so has slowed significantly since the 2008 recession.

We know that between 2008 and 2010 there were over 10,000 excess suicides attributed to the economic crash, and that according to The Lancet in 2016, there were an estimated 260,000 excess cancer related deaths across the OECD.

Over the coming months, Government has difficult decisions to make about the manner and speed in which it seeks to lift lockdown.

We’ve seen that there has been a concentration of Coronavirus deaths in less affluent areas, and a second spike may well see that replicated. We also know that those negative health outcomes which come together with an economic shock and are felt more keenly in many of the same areas too.

In seeking to mitigate the worst impacts of an economic crisis, we are going to need consensus across the House, we have to move away from making casual and politicised comparisons, or of framing the debate in a binary choice of health versus economy.

We still are mired in uncertainty about Coronavirus, but there will come a time when we can be clear that the price of severely mitigating the disease is higher than not doing so; and that means having a frank and open discussion about the impacts felt now and in the future.

And just like Dr Rasmussen we need to be able to say there are things that we don’t currently know, but that we will be willing to listen to lessons learned from both here and abroad in the future.

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Cummings made a reasonable case today, and his critics should accept it – and move on

Dominic Cummings began his statement this afternoon by sitting down, in a garden, and continued by reading his words out loud from behind a desk.

While he didn’t go so far as to don a suit and tie for the occasion, he at least discarded the usual scruffy T-shirt for a tidier white shirt, with its sleeves rolled up.  He looked like a nervy teacher on the first day of term.

This lecturely style of presentation from Cummings, amidst the greenery and sunshine, somehow bled passion away from the event, and presented an aspect of him that many won’t have seen previously.

Indeed, many people will never have seen him before (and the majority still won’t have seen him at all).  But those who had heard rumour of him may have been surprised.

For instead of War Cummings (hunched, baiting, goading and contemptuous), they got Peace Cummings: not exactly wearing his heart on his sleeve, to be sure, but at least with his head firmly screwed on.

He was in the mode that those of us who know him see a lot: analytical, polite, highly intelligent, agile but unyielding – cool rather than chilly.  There will now follow a rush from his opponents to pick holes in the tapestry he wove.

Shouldn’t he have told the Prime Minister that he was leaving London?  Why test drive for a journey to the capital by motoring to Castle Barnard, rather than simply driving part of the way home?

Wasn’t that trip itself in breach of the lockdown regulations? Why wasn’t the exemption in them that he used publicised by the Government?  And so on.  But essentially, everything boils down to two contrasting views.

Both turn on an agreed fact: that Cummings is in a comfortable position, because he has relations with an empty property, and a privileged one, because he’s Boris Johnson’s most special adviser.

One take will be that he is using legalistic loopholes to justify exploiting his social advantages, while those same wrinkles in the law weren’t made known to others, who don’t have other dwellings to go to anyway

In short, this proclaimed anti-establishment firebrand has hypocritically married into the elites, and it’s one law from him – literally – and another for everyone else.

The other view will be that what we saw today was a resolute but honest man, stepping out from backstage and blinking in the light, striving to describe the trade-offs between work, home, family, time and dashes to hospital.

This perspective understands the downsides that come with his turf as well as the upsides, such as the threats to his family’s safety – and the impossibility of making perfect choices while his wife, his child and Johnson were ill.

You must take your pick between the two, and those who will do so represent the full spectrum of human attitudes and dispositions, or something like it.

At one end are those who have been unable to visit their sick relatives, grieve at family funerals, comfort the dying, and haven’t departed with their sick children for other places.  Many of them will have been raging at Cummings.

The rainbow then shifts through the permanently affronted or resentful to Cummings’ Remainer and Labour and Cadwalladresque opponents, who will never forgive him for trouncing them in 2016 and last December…

…And so on to his Tory enemies, most of whom he has insulted or bested or both, at one time or another.  As we say here at ConservativeHome, few come to Cummings will clean hands.

Our own assessement is that he is a peerless campaign winner – the great British centre-right one of our time – but not yet a deliverer in government.

Indeed, the experience of Coronavirus suggests – now that Red Wall gain triumphalism has been knocked sideways – that his preferred model of wielding centralised power via pliant Ministers doesn’t work.

We’d like to see a more traditional model of strong Cabinet Ministers exercising the freedom to run their own departments, with some policy shifts, too. But these are matters for another time.

As far as today goes, any fair-minded observer would think better of Cummings’ case, both legal and moral, at the end of today’s press conference than he or she may have done at the beginning.

However, the determinants of his fate will ultimately be crudely political, and there are two crucial audiences: Tory MPs, plus party members, and everyone else.

As far as the former are concerned, we suspect that the 1922 Committee Executive, if it meets this week, is unlikely to demand that the Prime Minister dismiss his adviser.

In the absence of new developments or information, we suspect that the temperature among most Conservative MPs will drop, at least for the moment.  The number openly calling for Cummings to go is still only about 20.

The public may be a tougher nut to crack.  Cummings would not have spoken today, in the wake of Johnson backing him yesterday, with no official inquiry pending, and the threat from the ’22 remote, without them in mind.

And as we wrote earlier today, Cummings will undoubtedly have been driven to take the gamble of a free-for-all press conference by polling or research that’s he’s seen that’s bad for him personally.

Will he have turned opinion round today?  We doubt it.  Those who have truly suffered during the lockdown – and there are many such people – are less likely to take a benign view of Cummings than this site.

They might say that if he himself is the victim of a culture of populist revolt, it’s one which he himself has helped to craft.  The charge has just enough sting in it to draw blood.

You may counter that there are wider horizans to look for.  The best part of a million people were thrown onto the dole last month.  Nearly a quarter of employees were furloughed in single a fortnight alone.

Britain is set to borrow more than twice as much as after the crash.  The price of lockdown may have been worth paying but the cost is damagingly high – in cancelled operations, domestic abuse, lost schooling, mental health.

Abroad, China is set to swallow up Hong Kong.  Here, the Government grapples with the Coronavirus.  If you think all this is more important than Cummings, you’re right.

But try telling that to his enemies – let alone some of the media pack who grandstood at today’s event.  (Jason Groves and Gary Gibbon were among the effective exceptions.)

The bottom line is that most of his foes want him out so that Boris Johnson can be weakened, the Conservatives damaged, the Government’s electoral chances set back and EU transition extended.

They shouldn’t succeed, but they may.  For if those poll numbers don’t move, we suspect that Cummings may walk.  We have few illusions here about British politics.  Or human nature.

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Andrew Murrison: Why we should be seriously concerned about Public Health England’s performance. And how we can do better.

Dr Andrew Murrison is a former Foreign Office and DfID Minister, a doctor and MP for South-West Wiltshire.

A global pandemic was top of the Cabinet Office National Risk Register even before Covid-19. We now know it presents a greater risk to Britons than any state or non-state actor. Health, not defence, holds the toolbox for tomorrow’s battles.

Preparatory work for the Integrated Security, Defence, Development and Foreign Policy Review was well underway across Whitehall when I left the Foreign Office in February. The pandemic has thrown a spanner in the works – a Covid makeover will push the Integrated Review well into the new year.

However, the review could not have come at a better time, since it will tell policymakers if they have what it takes to discharge the state’s primary responsibility of keeping its citizens safe. Indeed, the Prime Minister said in February that the review would identify reforms to government systems and structures needed to address the risks and threats that we face.

So let’s have a look at how we’ve been doing on this number one threat made flesh, and anticipate candidates for reform.

The UK mortality rate from Covid-19 is in the mainstream of European countries. That means there’s no cause right now for either mud-slinging or back-slapping. However, we shouldn’t hold back because another bug could well be mutating its way in our direction.

As a supporter of the Government throughout this crisis, I’d say much has gone well, some of it staggeringly so – the Nightingale hospitals, for instance, has been a truly world class effort. That’s despite the great clinical cathedrals that have sprung from nothing overnight being left empty thanks to squashing the curve by everyone staying at home.

However, the talk is that Ministers have been handicapped by flaws baked into our public health system. Knocking them out can’t wait for the recommendations of the longwinded public inquiry to come. The Integrated Review must intervene.

The modern public health function grew out of the need to control urban infectious disease that regularly washed through the slums of Victorian England. From time to time, it spilt into the posh end of town, prompting city fathers to appoint medical officers of health.

These stalwarts essentially just dealt with infectious disease – largely bacterial in a pre-antibiotic age. They would have been baffled by their discipline’s modern preoccupation with lifestyle-related morbidity and bewildered by their successors, Directors of Public Health – often not medically qualified, perched precariously between local government and the NHS.

In 2012, Andrew Lansley’s Health and Social Care Act – I was Andrew’s bag carrier throughout his time as Health Secretary – created Public Health England. For years, public health had been reinventing itself, responding to what were lazily seen as modern epidemics – obesity, smoking, alcohol – with occasional reminders that, for all our sophistication, organisms were still capable of blowing our world apart, as we found with AIDS during the 1980s.

The last Labour Government had put a lot of effort into reducing the lifestyle-related morbidity that contributes to health inequality. PHE was established by the Coalition Government to advance this version of public health, implying less emphasis on infectious disease. The process continued with the dismantling of the Public Health Laboratory Service in 2013.

PHE’s annual report and accounts published in July offer insights. We learn about the organisation’s work on lifestyle disease, tackling health inequality and illness overseas, but very little about global pandemics. PHE’s annual report certainly does not suggest – despite warnings from the 2016 pandemic planning exercise Cygnus – an organisation fired up and ready to tackle the number one threat on the National Risk Register.

Contrast with Germany which, so far, appears best in class. At federal level, Germany has the edge in Berlin’s Robert Koch Institute, roughly equivalent to PHE, but unequivocally focussed on infectious disease. The conduct of public health is heavily devolved. In March, Germany’s states acted swiftly and decisively, and have had a consistent and unwavering commitment to test, track and trace.

By contrast, Martin Green, Care England’s Chief Executive, and thus at the raw end of PPE and testing, is brutal: “I have serious concerns about PHE’s performance throughout this pandemic.” So do I.

What’s to be done? This crisis suggests that public health needs to get back to its roots, and spend much more time protecting the public against infectious disease. PHE is right to tackle lifestyle disease that generates health inequality. Who has been disproportionately affected by this pandemic, and who is most likely to suffer from the next? Throughout history, the burden of infectious disease has fallen most heavily on the poor and disadvantaged.

The case for infectious disease control to be overseen by our own version of the Robert Koch Institute is now very strong indeed. But epidemic management involves basic, practical skills like contact tracing. Apps might help – but it’s still street by street, door to door.

It’s a function requiring shoe leather that should be inserted unambiguously back into the top tier of local government.  The need for this will become more apparent as the pandemic evolves, and ‘R’ is seen to vary widely across the country and in different settings.

At the moment it looks like test, track and trace will be procured centrally and contracted out. I’ve been experiencing contracted out processing as a Covid volunteer NHS returnee. It hasn’t been great. Expecting contracted out test, track and trace to be a runaway success would be a leap of faith. Surely PHE itself, with Directors of Public Health on the ground, should be gripping this most elementary public health function?

Ministers have insisted that policy is lifted from expert advice from SAGE, a weighty contribution to whose membership comes from PHE. Time will tell if SAGE warrants its acronym, but an obsession with ‘soft’ behavioural science, and second-guessing how people under lockdown will conduct themselves, at the expense of hard data on the behaviour of coronavirus in the Far East may have been an early mistake.

It was a mistake, too, to dust down existing plans for a known unknown, influenza, rather than contemplate an unknown unknown, coronavirus. The advice to ditch test, track and trace after just a few days suggests a lugubrious adherence to the pandemic flu rulebook rather than the translation of what appeared to be working in the Far East.

It looks as though the UK has been managing this crisis overall at least as well as most comparable administrations. However, I sense ministerial disappointment with system failures and an appetite for better. The Integrated Review is a timely opportunity. Never letting the excellent be the enemy of the good, let’s make sure the next pandemic encounters a refocused, properly resourced and staffed, public health system that’s best in class.

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Iain Dale: Hancock’s claim that care homes were wrapped in “a bubble of care” has a hollow ring to it

Iain Dale presents the evening show on LBC Radio and the For the Many podcast with Jacqui Smith.

One of the main themes of any public inquiry into the Coronavirus crisis will be the dynamic between the politicians and their scientific and medical advisers. Another will be to what degree health ministers are involved in the guidance and direction given by NHS England and Public Health England.

Convention dictates that the buck stops with the Secretary of State for whatever happens within the different quangos and agencies under his or her department’s remit – however unfair that might look.

This week, we learned that in March and at the beginning of April hundreds of patients, or maybe even thousands, were transferred from hospitals into care homes without being tested to ascertain whether they were Coronavirus-free.

This, on the face of it, was pure madness. However, Robert Buckland said on Sky News on Wednesday that there was a choice to be paid – prioritise hospitals or social care. The hospitals needed the beds, so a directive was issued to clear as many elderly people as possible out of hospitals and put them into care homes.

The guidance on how to do this was issued to hospitals and care homes were told to comply – or else. This guidance was posted on the internal NHS England website, I believe, and was only withdrawn once a row blew up in mid-April.

Radio 4’s File on Four documentary this week made for some horrifying listening, but as well as answer some questions, it also posed many others. I had wrongly assumed that decisions to push out non-tested patients into care homes were made by middle ranking NHS managers, but that was not the case. It was deliberate policy.

On the programme, Jane Deith quoted an April 2 directive from government urging a national initiative to empty hospital beds and put people who may or may not have been infected with coronavirus back into care homes. It is also alleged that threats about funding were made to care homes who expressed doubt about accepting such patients.

Politico’s London Playbook quotes Susan Mckinney, who runs 14 care homes across the north-east. She maintains that she was given little choice but to comply.

“We had an incident on April 10 where twice we rang the hospital saying “we can’t accept this person back, we need them tested, we need a negative test so we know what we’re dealing with,’” she said.

“They turned up at the door in an ambulance and refused to go away. There was a sort of stand-off at the door of the home. The family members turned up, the paramedics had the poor resident on a stretcher at the door and would not go away until we allowed them in. And all we got was ‘you’re not following the guidelines’…We were threatened with the police if we did not let this person in.”

Quite astonishing. It’s one thing to have a policy of clearing out hospital beds, and you can understand why this was required. It’s quite another to then just dump these people in random care homes with no notice and no time to prepare.

Had it been said to care homes, with a bit of notice, that they needed to provide x number of rooms that could be isolated from the rest of the homes in question, they could have planned accordingly. But they didn’t.

So for the Health Secretary to say, as he did, that care homes were wrapped in a bubble of care right from the beginning of the crisis – well, it has a hollow ring to it, doesn’t it?

So were these patients moved from hospitals to care homes following a recommendation from the scientists and medical advisers? Was it a decision that ministers even knew about? Should they have? Did anyone actually think about the risks involved?

These are not questions which can or even should be answered now. But when they are answered, we’re going to learn an awful lot about how decisions are made not just at the heart of government, but in arms length quangos. And I suspect we’re not going to like what we discover.

– – – – – – – – – – –

The sheen came off Keir Starmer at this week’s PMQs, as he struggled to pin Boris Johnson to the wall.

Less forensic, more robot. He seemed to lack a certain fleetness of foot, something which also bedevilled his predecessor, whose name momentarily escapes me.

To be successful at PMQs. you have to be able to think on your feet and react to whatever answer your opposite number gives. If you just plough on with your pre-prepared six questions, you run the risk that you ask a question which has already been answered, and that is what happened to Starmer on Wednesday.

Having bested Johnson on their two previous encounters, and won rave reviews from commentators of all hues, it was down to earth with a bump for the Labour leader this week.

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Nat Wei: How the internet could have been used to protect lives and livelihoods during this crisis. And how we can do better.

Lord Wei is a Conservative member of the House of Lords. He is a co-founder of Teach First, a social entrepreneur, and a former government adviser.

Dominic Cummings famously admires America’s Defense Advanced Research Projects Agency (DARPA), and rightly has sought to create an equivalent organisation here in the UK.

But one not always recognised fact is that DARPA was instrumental to the creation of the internet, which in turn was based on technologies designed to enable global military communications to function even in the face of global catastrophes, such as nuclear war – or indeed pandemics.

We have Paul Baran, an engineer at RAND in the 1960s, to thank for getting the wheels in motion:

“Baran cooked up a system that could divide communications into tiny pieces and use distributed network “nodes” to pass these pieces around. If one node was knocked out, the others could pick up the slack. In 1964, he published a paper on this system – entitled “On Distributed Communications” – and a few years later, it would play into the development of the ARPAnet, the research network that would eventually morph into the modern internet.”

We need to count our blessings that the pandemic, at least in the West, has occurred at a time of widespread fixed and mobile access to the internet, with video calling and conferencing widespread, save in some rural areas.

Millions of families and individuals are getting (further) acquainted with the likes of zoom, houseparty, and their local and national online supermarket websites – and beyond this we are seeing an explosion of online workout sessions, church services and content, and health and education consultations and learning.

But we could have gone even further by now, and lessened the impact of this crisis to our society and particularly to livelihoods.

First, in business, we could have innovated further to enable all our local shops to have delivery services, and the ability to beam content to draw in virtual as well as physical footfall, and even enable automation and remote displays to serve the public even if one is forced to have staff work from home or elsewhere, whilst training up all staff to do better paid work managing and using the machines brought in.

Second, we could have designed our buildings to be even more intelligent than they are now, to protect us from threats such as pandemics, to have anti-viral sanitation built into their operations whether through air conditioning systems, far UV lighting, and in the way spaces are laid out – and we could have focused more on building offsite, in better controlled environments, rather than building as we always have done, largely to save costs.

Third, we could have applied the design of the internet to the way government works, what back in the day Big Society meant for me (not primarily as was widely reported, a way of harnessing volunteers, important and awe-inspiring as the voluntary response has been). This pandemic has shown the centralised government decision making and operations can be clunky, slow, and not always aware fast enough of changing situations which are the norm now in our volatile world – despite the heroic efforts of our leaders and frontline workers.

Fourth, our healthcare systems clearly need to be less centralised in future, since hospitals themselves are a source of infection. More emphasis could have been put on local delivery of services, drugs, and even training up patients and those caring for them to provide treatment using mobile medical equipment and remote consultation. Never again must we be in a race against time to prevent hospitals running out of beds, or put pressure on them to free up beds, nor must we ration testing in future, but make testing the norm even after this pandemic.

Fifth, our financial and business sectors also, for all the innovation in fintech and e-commerce, could have been even further advanced. In future there must be ways for governments and the Bank of England to be able to directly wire funds to citizens and businesses with real time information flowing back and forth. Instead we have been forced to use systems that were not designed for the situation we are in, to try to alleviate quickly the pressure on millions of people.

And, finally, as someone who works in Parliament, which laudably has fought to maintain face to face contact over centuries, we too need to look at how the internet can be harnessed to enable more remote debating, amending, and voting when necessary, as well as to engage the public beyond the usual lobby groups, and for the Lords at least to be like a legislative Wikipedia, in which we pull together to create laws that are just, measured, and which work on the ground.

Why, you might ask, have we not pursued a more aggressive application of the internet and its decentralised approach to our society, to better prepare for situations like this? Well, there are lots of reasons and we will no doubt uncover more over the coming years. Partly it is because we did not think a pandemic would happen (at least not in the way it has). Partly because of cost. Partly because change is hard. And partly because most of the money was focused more on funding Facebook, and Netflix, rather than the above. We basically got distracted.

Our local music school has had to shut recently, like many organisations. It turns out that the tutors could mostly carry on and make a living from one to one tuition online, but the school itself was sustained from group sessions, which have stopped.

I checked online, and up until a few years ago there was great software being worked on to enable live jam sessions, where multiple musicians could play together remotely. But many of the businesses and startups working on this ran out of funds for lack of interest.

Amidst the tragedy and death unfolding, and huge pressures on the NHS ,whose staff are heroes who we must protect and backup; and amidst the financial earthquakes reverberating around the world, we need as a nation and as a world, to make a bold decision to rebuild after this pandemic has peaked – harnessing all that is good about how the internet works – to rise out of the ruins of our old way of life and build a new, more resilient one.

And we need to remember the internet is a gift from above that we must not waste again, but harness it and the approach to design inherent in it, to allow us to weather and overcome other future shocks with both humility and strength.

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Bob Seely: What the Isle of Wight has learned from trialling the NHS’s Coronavirus App

Westlake Legal Group bob-seely-what-the-isle-of-wight-has-learned-from-trialling-the-nhss-coronavirus-app Bob Seely: What the Isle of Wight has learned from trialling the NHS’s Coronavirus App Technology Social Media security NHS MPs Media Local government Liberty Isle of Wight Highlights healthcare Health freedom facebook Culture and technology coronavirus Comment Cllr Dave Stewart Civil Society Boeing arts Alfred Lord Tennyson Airbus

Westlake Legal Group Screen-Shot-2020-05-19-at-20.23.29 Bob Seely: What the Isle of Wight has learned from trialling the NHS’s Coronavirus App Technology Social Media security NHS MPs Media Local government Liberty Isle of Wight Highlights healthcare Health freedom facebook Culture and technology coronavirus Comment Cllr Dave Stewart Civil Society Boeing arts Alfred Lord Tennyson Airbus


Bob Seely is MP for the Isle of Wight.

The NHS’s Covid-19 App will soon roll out across Britain. It is a critical part of our nation’s attempt to suppress the virus and reach a “new normal”.

On the Isle of Wight, we’ve been using the App and the Trace and Test programme – aka T&T – with it for more than a fortnight so far. We plan to collectively disseminate our experiences to MPs, local authorities, NHS staff as well as the voluntary sector and business. But before we do, here are some initial thoughts.

Why did the NHSX want to introduce Phase One of the national roll-out here?

The island is geographically separate from the mainland, and we have a diverse population of 140,000 large enough to provide a miniature version of a complex national model.

Why did we want it here? Since being elected, I have campaigned for the Island to pilot national initiatives. We know from our experience that if the Isle of Wight is not first, we tend to be last, and our separation from the mainland adds additional costs.

Some have questioned the appropriateness of the Island as the place to do this? It’s true that we are known for our pastoral beauty and as the sunniest place in Britain, whilst we’ve also been a national centre of painting and poetry inspired by our landscape and sea around us, from Turner and Tennyson to the modern day.

However, we also ‘do’ innovation. Marconi experimented with the world’s first wireless communications here, and the hovercraft was designed and built here. Today, if you are flying and look out of your aircraft window at the elegant, turned-up wing-tips on a Boeing or Airbus, there’s a good chance they are made in East Cowes on the Isle of Wight.

If you fly home over the North Sea, and spy the very large wind turbine blades that dot the surface below, generating an ever-increasing amount of our national power, many will have been made on the River Medina here. We are trialling telemedicine and pioneering the UK’s first medical drone supply service for the NHS. In short, we ‘do’ innovation.

The App

The App sits in the background of your smartphone after downloading and opening. Its battery use is minimal. It reminds you to turn it back on, should you accidentally turn it off, and sends instructions if you come into contact with those who are potentially carrying Covid-19.

It uses Bluetooth technology to plot a relationship with other smartphones. It doesn’t need your location – just the first three digits of your postcode. A full Q&A prepared by the Island is here.

What have the app designers learned on the Isle of Wight?

The NHSX – that’s the digital arm of the NHS that has developed the App – is gaining two types of insight: technical, relating to the app, and practical, relating to real world questions that it generates.

Examples of the technical relate to the appearance of the App, how people interact with it and what models of phones are unable to download it. Other questions apply to its integration with the T&T programme, which is being tweaked and improved.

I believe that the data will soon be available for ‘proximity information’, allowing NHSX to monitor changes in restrictions as they happen; for example, the effect of pub openings. That will be critical for seeing the effects of Government advice as we slowly lift lockdown.

Examples of real-world issues include questions over working practices – for example: (1) prison officers don’t carry personal smartphones, (2) advice to NHS staff to ensure they turn the app off when they have PPE on, and (3), questions about how some elderly folk who have simplified smartphones use it.

The island is giving feedback in four ways: first by simply using the App, second by using the feedback page, thirdly by replying to a mass survey and fourth, by organising official responses in the coming week or two.

Some initial findings

A small number of people have raised privacy issues. The answer is simple: whilst there are significant issues with data privacy in our modern world; this app is not part of that debate. People going onto Facebook to complain about data privacy is a near perfect definition of irony. No app I have ever downloaded has wanted less information than the NHSX’s Covid-19 app. It simply needs the first part of your postcode; that’s all.

What’s the take-up likely to be like? On the island, it has been very good. The total smartphone-owning island adult population who can download the App is at most, probably around 80,000 – this post explains the numbers.

As of last week, out of the 71,191 total app downloads, 52,250 were believed to be unique island downloads, so roughly two thirds of the 80,000 who can download it. Looking at our profiling this week, we now expect this to be over two thirds.

With this number of downloads, we can expect there to be meaningful suppression of the virus, benefiting everyone, – not just those who download the app. The national average for adult smartphone ownership is 79 per cent, and not all of those will be able to download the app.

It’s important to note that our role has not been to pass judgement on the app, but to make sure we use it in large enough numbers, to give feedback on it, and to allow study, by experts, of the app to understand how it interacts with the Trace and Test scheme, prior to the proposed national roll-out.

Within the first weekend of the app’s use, an average of 25 people per day were being tested for Coronavirus after reporting symptoms through the app (or being notified that they have come into contact with someone who had reported symptoms). Such a notification provides clear instructions on what to do next, including testing and self-isolation.

Until our detailed recommendations come out, our key piece of advice based on the island’s experience is this: MPs and councillors should lead their local communities to encourage uptake of the app – and the wider T&T scheme – at the earliest possible opportunity.

I’d start planning now. Perhaps the best way to look at this is the analogy with political campaigns. In general elections, there is the national campaign – the so-called ‘air war’ – and the local campaign, the ‘ground war’. MPs, councillors, NHS Trusts and the myriad of voluntary groups up and down the country will collectively lead the ground campaign. The ground campaign is critical for local engagement and areas that don’t have that won’t do so well driving use.

During the Covid-19 crisis, I’ve held twice-weekly video calls with the approximately 30 leading voluntary, business and public sector organisations on the island to share information and to drive a sense of empowerment in a time when it has been in short supply. It proved to be an invaluable line of communication in briefing our community leaders when we knew the app was coming.

In prepping for the Covid-19 app and the trace and test scheme supporting it, I’d also suggest the following:

  • Councils need to be outward-facing and engaged with the community, as most already are. MPs can work with councils to help ensure this. This is not a time for council media teams to be inward-looking or slow.
  • Don’t make this political. If opposition parties want to be constructive (whilst reserving their right to ask challenging questions) engage with them. If they want to scaremonger or grandstand, ignore them.
  • I personally feel that medical staff need to be advocates for the app in their localities. On the island we ensured that the app programme leader shared the media briefing with both myself and our council leader, Dave Stewart. It helped. I hope that as part of the national rollout, the NHSX/NHS will encourage doctors to front local media campaigns.
  • For the app, we produced tailored marketing materials and we engaged our local media ahead of time. There was initial clunkiness in the liaison between national and local communications and the myriad of stakeholders here, but we got there in the end.
  • The App and the T&T scheme had glitches, and so will the national programme. We didn’t complain on the island, as we knew that was part of our role. There will still be issues when everyone else gets it nationally. We should not be defensive about this. It’s being rolled out fast and if there are glitches, explain and help resolve them; be positive be part of the solution.
  • Personally, I’m proud that this app has been produced by NHSX. It has unique advantages over other systems. If there are changes to it in future, it’s not relevant to downloading the app now. The app is the app, regardless of how it is updated in future. People need to download this one, and not assume there’s another coming along.
  • On the island, NHS and council staff downloaded the app 48 hours ahead of the wider population, helping word of mouth. I suspect this may happen nationally, too. This helps to reinforce the idea that we need to continue to protect the NHS and its staff.
  • Preferably, MPs and councillors and other local leaders should drive the app take-up and the T&T programme for several weeks after the launch. This takes time, and needs to be factored into diaries. MPs should lead through engagement with the media, ensuring liaison with leading employers so that they get the message out too, as well as the voluntary sector (ranging from Citizens Advice to Age UK to sports and social clubs). Constituents need to receive messages from multiple sources.
  • MPs and active councillors will receive a lot of feedback and will need to be able to field questions.

On the island, we’re lucky in many ways. We have close-knit communities and many voluntary groups, clubs and societies through which to disseminate the message.

As well as being ‘techie’ enough to lead the roll-out, we have an old-school (not old-fashioned!) sense of values; we care for both our Island and our nation. This meant that we were ready to engage and support, rather than be dismissive or cynical. We knew the app – and the trace and test programme – would help keep us safe, but also help others.

We’ll hopefully publish details soon but, for now, I am proud that the Isle of Wight, so often the site of artistic and scientific innovation, is doing its job well.

Soon, it will be over to everyone on the other side of the Solent. The message is a simple one: if enough of us download this app, we can, through our joint endeavours and the trace and test programme, suppress the virus.

And for grandparents wanting to see grandkids, for parents wanting to get their kids back to school, or to restart their businesses, or to go to the gym or enjoy, as the Prime Minister said, “the ancient, inalienable right of freeborn people of the United Kingdom to go to the pub”, that should be all the motivation we need.

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Tom Waterhouse: Reducing obesity. Don’t expand the sugar tax. Expand social prescribing instead.

Tom Waterhouse is an Associate Director at Public First.

The Government is rapidly coming to the conclusion that the country’s obesity levels are a big reason the UK has been hit so hard by coronavirus. Current research shows it’s the second-biggest risk factor, after age. It was reported last week that some senior ministers and aides in Number Ten 10 want to consider extending the sugar tax – a levy on the amount of sugar in fizzy drinks. But this is not the answer.

The health of the nation is in crisis. Almost 65 per cent of adults are overweight or obese. Shockingly, so are 34 per cent of children aged 10-11, and 22 per cent of 4-5 year olds. That means we have millions of children whose current obesity levels mean they will die before their parents. It represents one of the greatest policy failures of successive governments of modern times.

Health policy in recent years has been dominated by gimmicks. The sugar tax, bans on advertising on the London Underground, school proximity policies – they haven’t made a jot of difference to obesity rates, and yet seem to pass for some kind of strategy. They have distracted from doing the hard thinking about how we help people improve their health.

It is, after all, actual people we are talking about. Not a threat to the NHS that needs diverting. Not a liability on the nation’s balance sheet. We’re talking about improving people’s quality of life. I qualified as a personal trainer six years ago to train people in my spare time. You realise your greatest challenge is breaking down the barriers people face to getting fit and healthy.

Knowledge is an obvious one. Confidence is a big one. So is time, money, old injuries, their lifestyle. Sometimes it’s deeper than that, such as lack of self-worth. But these barriers won’t be overcome by putting an extra 20p on a packet of Monster Munch.

My hope is for two things.

The first is that, with a Prime Minister motivated to take action because of his life-threatening experience of Covid-19, the political momentum created allows the opportunity to challenge the fundamentals of how we approach nutrition. If the Government engages with the likes of the excellent Dr Zoe Harcombe and concludes she’s wrong, then fine. But we should be asking why obesity was so low in the 1970s, and whether doing a U-turn on our dietary advice has something to do with today’s epidemic.

My second hope is that the promise in the Conservative Party manifesto to “extend social prescribing and expand the new National Academy of Social Prescribing” is fulfilled quickly. Here’s why.

The NHS offers a number of ways to help people lose weight, one of which is a GP’s referral to a weight loss group. It’s called ‘social prescribing’ and chances are, if you search the NHS website for a weight loss group in your area, it’ll be Slimming World.

Back in 2000, they partnered with the NHS in Derbyshire to run a pilot referral scheme, proving that a commercial weight loss management company could offer an effective solution to reduce overweight and obesity levels in the community. Paid by Clinical Commissioning Groups (CCGs) and subsidised by Slimming World, they have helped hundreds of thousands of people to lose weight. This is an incredible achievement, and one that’s effective as well as low cost.

But there’s a problem. It’s well-documented that these types of services are not always designed for men, and research has consistently shown an under-representation, both in those referred and enrolled in programmes. Slimming World has previously told the Health Select Committee that of their 250,000 members, just five per cent are men. Given that men are more likely than women to be overweight or obese (67.2 per cent of men, 61.5 per cent of women nationally) that’s a big challenge for the Government to overcome if it’s to tackle obesity.

In a major study undertaken by the National Institute for Health Research into the management of obesity in men, a key finding was that reducing diet did not affect long-term weight loss. What gave the most effective results was the right diet, plus physical activity and behaviour change.

An expanded Social Prescribing Academy could be working right now with the health and fitness industry to create more partnerships between the public and private sector to do just this. Competition and consumer choice in gyms has arguably never been better and has driven greater accessibility and affordability.

The likes of Puregym, Bannatyne’s Health Clubs, Anytime Fitness, David Lloyd Leisure and The Gym Group are just a few of the operators who are perfectly placed to offer the personnel and facilities for men – and women – to be referred to, that could help them break down the barriers to achieving better health outcomes.

There are hundreds of smaller operators who could do this too, if the right framework and criteria were created for them to comply with. We could be finding more low cost, effective solutions like the one pioneered by Slimming World by working with the nation’s gyms operators. And given the Government may well have to make gyms wait until the very last phases of lockdown before re-opening, a boost of this kind for the industry is sorely needed.

The Government also needs to find a way to incentivise doctors to do something very awkward, but vital: tell people when they need to lose weight. But having told them, GPs also need to have the right services to refer people to. Not just for men, as mentioned above, but for children too. This is, again, an area that an expanded Social Prescribing Academy could be put to work on.

My instinct is that the Government in the end won’t extend the sugar tax. It’s bad politics to be raising taxes on ordinary people in any case, but especially at a time when a great many more people’s finances have become precarious. It’s also bad politics to be smacking the food & beverage and hospitality industries with higher costs, threatening the jobs they support, after they’ve been amongst the worst-hit sectors by the pandemic. But most of all its bad policy – that will not help tackle the health of the nation.

Instead, let’s hope policies from the Conservative manifesto win through.

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If you thought staying in lockdown was hard, wait until you see what trying to get out of it is like. But here’s how Johnson could do it.

The Prime Minister’s broadcast to the nation last Sunday evening featured five main slides.  The first showed the Government’s five Coronavirus tests.  The second, the words: “Covid Alert level = R (rate of infection) + number of infections”.

The third displayed this R level applied to a kind of speedometer, with the lowest of five bands coloured green and the highest red – with restrictions on the public kicking in as the dial needle approached the red band.  (There was later a variant which showed this slide set against a map of the United Kingdom with assorted Coronavirus hotspots.)

The fourth showed those green to red level levels in bar form, with each described as an “alert level”.  The fifth showed an uneven hump with a long slope, like a wave, which represented a gradual slide from severe to less severe constraints on public activity.

The point of all this description is to show that although, at one level, Ryan Price is right (“what do you want, a full handbook, to tell you what to do?”), and much of Boris Johnson’s new plan is simply common sense, at another it is all just a bit more challenging.

With its accompanying dials, bars, humps and speedometers, easing a lockdown will be more tricky for Ministers than simply imposing one.  The where you’re going to of the plan may be straighforward, but the how to get there is more complicated.

So if you thought that the Government’s task has been difficult so far, or that its handling of the Coronavirus has been controversial, you ain’t seen nothing yet.  The Prime Minister suggested on Sunday that we have collectively reached the top of the mountain, and now face the daunting prospect of the climb down.

But the way we see it, the British people may not yet have staggered even to the outcrops of K2 – since the prospect of a vaccine, or effective treatments, or herd immunity remain shrouded in mist at the summit (though there may be good news on antibody tests).  And Ministers come to the next stage of the climb winded, for three main reasons.

First, for one that can’t reasonably be claimed to have been their fault.  Namely, that the playbook prepared for government when the pandemic came was a flu-style one, into which the idea of herd immunity was written, rather than a Sars-type one, which would stress testing and tracing, and the quarantining of those infected.

Second, for taking up a mass tracing and testing policy towards the end of last month, some eight weeks after the virus outbreak began to gather critical mass in Britain, in its third iteration of policy.  The date of the change is a matter of record and can’t credibly be disputed.

The third reason is perhaps the most exhausting and certainly as yet unproven.  It is the claim that Ministers and the NHS, in preparing hospital beds for an influx of virus cases, emptied them by sending a mass of infected but untested patients to die in care homes, thus sending UK death rates to the top of the league.

These international tables are riddled with problems and, for the rest, we shall see what the eventual inquiry brings with it.  What’s certain as this third phase of dealing with the Coronavirus begins (we’ve had almost normal; then abnormal; now, “the new normal”) – the Government has less room for manoeuvre than it did before.

True, most voters appreciate the scale of the problem, aren’t lost in the Twitter echo chamber, and don’t envy Johnson his task: many will not have forgotten that he has been through intensive care himself recently – and so is literally leading from the front.

Nonetheless, the lotus-eating experience of furlough – for some, anyway – can’t ultimately shut out the brutal economics of Covid-19, with its further waves of blighted schooling, bankruptcies, illness and job losses to come.  The tower of the Conservative poll lead may be built on sand. And Keir Starmer leads a more effective if unscrupulous Opposition

At any rate, the Government has now settled on a route and, though it may not be able afford many more mistakes, the good news is that the path it has chosen may take us all nearer where we need to go.  That’s to say, if not to the top of the mountain, then at least higher up its slopes.

Much will depend on whether Ministers can make testing and tracking work.  Some believe that the app is a kind of technological red herring, and that the real issue is that the Government may be planning for some 30,000 fewer trackers than it needs.

It may be that this calculation is wrong, or that Ministers are able to scale up numbers quickly, or that the incidence of cases falls swiftly.  In which case, there will be an adequate England-wide capacity to test, track and quarantine.  But though the capability would be national in its scope, the applicability wouldn’t necessarily have to be.

For testing on large scale would show the R-rates that matter: in other words, not a single UK-wide figure, the use of which is limited, but different local ones, showing where the virus is replicating fastest and among whom.  This would allow the opening-up of much of the economy on a regional, area or local basis.

Such a process would side-step the sterile debate about lockdown: after all, South Korea, on which the Government is modelling its policy, has been more limited.  Admittedly, we are starting with higher levels of the virus.  But if the testing plan works, lockdown could stop being a national all-or-nothing business, and become a local mix-and-match one.

How would the transfer of people from fully lockdowned areas to partially lockdowned ones be managed – with the risk of local R-rates being driven up again?  In part by opening some sectors and facilities, such as schools, before others, such as restaurants and hotels.  Though movement might well still happen on a significant scale.

Which tees up a big debate: is it better for the whole UK (or at least England) to move uniformally in lockstep at the pace of the most virus-threatened areas – even if that slows desperately-need economic revival – or to allow the ones that are less seriously affected to stride ahead, and move substantially out of shutdown?

If the testing, tracing and quarantine policy works, this is a debate that is surely bound to happen.  It would be more to the practical point than another: whether the NHS now has enough capacity to cope with any second or subsequent waves?  Raghib Ali, with his epidemiological experience, says yes.  Bernard Jenkin, citing statistics, says no.

The political weather for Johnson has been rougher than it was at the end of February.  And one can see how his political enemies – the Remaniac residue; Starmer; Nicola Sturgeon; his internal opponents – are setting him up for failure.  But there is opportunity as well as danger: a path if not to conquering the virus then at least to checking it.

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Bernard Jenkin: For its strategy to work, the Government will need more than double the number of tracers that it plans to recruit

Bernard Jenkin MP was Chair of the House of Commons Public Administration and Constitutional Affairs Select Committee 2010-2019, and is nominated to be Chair of the Liaison Committee. He is MP for Harwich and North Essex.

Jim Callaghan had an adage: “Nothing in politics is as good or as bad as it first appears to be”. We need a dose of that kind of wisdom now.

Boris Johnson’s address at on Sunday evening was long trailed, but delivered in just a few minutes. It provoked an immediate wave of criticism from all sides for its imprecision: yesterday’s press and the BBC coverage of reaction to the broadcast was anything but flattering or helpful.

The Prime Minister didn’t attempt to varnish the truth of the precarious position we now face. He did not patronise the public by holding back the grim detail behind the thinking: the all-important need to bring ‘R’ number below one, or the doubt about how this can be achieved while also relaxing the lockdown. He did not pretend that there could be any certainty about what measures will have to be taken when because he knows that it is hard to judge what measures will have what effects.

In doing this, he took the British people into his confidence. He demonstrated his candour and they will trust him to make the right judgements. As he subsequently told the House of Commons on Monday, he trusts people’s “good, solid, British common sense”.

By comparison, much of the media and his political opponents see this speech as weakness. They have now started to open fire with the kind of political criticism and opposition for its own sake that was more common before this crisis. They are exploiting what the Prime Minister admitted is a challenge: moving from a message as simple as stay at home to one with far more complexity. The assumption behind these attacks is that either excessive caution or (from some in my own party) a quicker liberalisation would win acclaim.

The attacks on the Prime Minister are shamefully aided and abetted (whether intentionally or not) by publicised divisions amongst senior ministers. We have grown inured to the idea that Sunday journalists are provided with anonymous briefings by government insiders, exposing personal rivalries, but this really must stop.

Yes, much of the science is contested, but a cold look at the agreed facts and at the economics of the lockdown, with intelligent appreciation of the mood in our cities, towns and villages, will find the Prime Minister has judged it right.

As my recent article for this website explained, our route forward is hugely dependent on our ability to track, trace and isolate cases of Covid-19 as quickly as possible. As people start to come out of their homes, the ‘R’ number is likely to rise above one. If it went to 1.2, that would mean that the current 136,000 cases in England would increase by 20 per cent compound every five-to-ten days. In the space of a few weeks, we would run out of ITU beds – and another much harsher lockdown would have to follow.

Without altering people’s behaviour, the only way to reduce R while opening up is to be much better at identifying infected individuals and their contacts before they infect others. Otherwise, self-isolating and quarantining alone will mean millions staying home and being unable to work, meaning the economic damage we hope to avoid will take place anyway – even before accounting for the human toll of the virus.

This must mean a substantially increased number of contact tracers – even above the Government’s target. The European Centre for Disease Control estimated that every identified Covid-19 case has 90 contacts that need tracing – approximately 13 per day in the week prior to diagnosis.

Early analysis from Univeristy College London calculates that effectively tracing each of these 90 people would require the work of six people for a full day. If, as we open up, our daily contacts remain at just half of their pre-crisis level, we will still need three contact tracers for every daily infection.

While we are diagnosing approximately 6,000 new cases every day, but we know the true number is closer to 15,000. That translates to 45,000 contact tracers: far higher than the 18,000 target the Government has announced it is recruiting.

It is possible, as Singapore and Taiwan have shown, to reduce the burden on contact tracing with mobile apps, such as NHSX currently being tested in the Isle of Wight. But these apps come with their own problems that the Government must solve. Although 80 per cent of people in the UK have smartphones, Office for National Statistics data shows that six in ten of those over the age of 65 do not have access to the internet via such a phone.

One in eight of the lowest income quintile do not have mobile phones. Relying too much on an app to replace manual contact tracing risks leaving us blind to outbreaks among the elderly and the poorest: those most in danger from this disease.

We risk repeating the tragedy currently taking place in care homes. It is by no means guaranteed everyone will download the app: one draft paper from the London School of Hygiene and Tropical Medicine estimates that only 53 per cent of the population will download the app – more than 32 million downloads in just a few months and, between now and July, nearly 700,000 downloads per day.

All of these strategies rely on increasing testing as well. If only 6,000 people, with 45 contacts each, are infected every day, we will need a capacity of 276,000 tests just to keep up. And this does not include regular testing for contact tracers, NHS and care workers, nor the Pillar 4 surveillance testing to track the disease at large in the country.

These tests will have to be delivered with the help of the private sector. In my former role as chair of the Public Administration and Constitutional Affairs committee, we looked at precisely this capacity for the government to deliver major projects and contract work to private companies. This is not the time for timidity: the government must be unafraid to use its power to make strenuous and clear efforts to harness the private sector in order to deliver.

None of these challenges is insurmountable: organising millions of downloads, hundreds of thousands of daily tests and tens of thousands of contact tracers can be done. The Government must be prepared to move quickly and, just as the Prime Minister did on Sunday, trust the public with the truth, complexity and ambiguity of all the ‘ifs’ in present policy, to maintain their consent. The one thing we cannot do is to pretend that the R number will go away or can be ignored, as the renewed lockdowns in Seoul, Singapore and North Rhine-Westphalia are beginning to demonstrate.

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