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Westlake Legal Group > Posts tagged "NHS"

Neil Shastri-Hurst: The NHS risks becoming a sacred cow. Let that not be the legacy of Covid-19.

Dr Neil Shastri-Hurst is a former British Army Officer, surgeon, barrister, and senior member of the Voluntary Conservative Party in the West Midlands.

There was a moral duty to return. Faced with the risk of the National Health Service being overwhelmed by Covid-19, I, like thousands of former clinicians, volunteered to head back to the coalface. There was never any doubt that we would return to help out, where we could, with this dreadful pandemic.

Those working on the Covid frontline are not heroes. There are no capes or special powers. It is something far more human. A group of dedicated and skilled individuals pulling together for the greater good. While the weekly round of applause is, of course, a deeply humbling and moving scene, I must admit that I have found it slightly embarrassing.

I suspect, among key workers, I am not unusual. It is not that I wish to appear churlish towards the public’s appreciation however, it is the concept of elevating us to the status of “heroes” that causes me awkwardness.

It is a term that gets bandied about very easily. Our skills and knowledge have not been bestowed upon us like some Marvel Comic character. Rather, they have been perfected through long hours of study and toil.

I returned to the NHS after almost two years. My surgical career had been somewhat derailed having been diagnosed with a peripheral neuropathy. It led to me changing tack and pursuing a career in medical law.

After such a period of time it was inevitable that things would have changed. With Covid-19, things had changed rather dramatically! Everyone was coming to terms with a new way of working; virtual clinics, the postponement of elective and non-urgent treatment, and a complete overhaul of rotas. Individuals were also being asked to operate outside their usual scope of practice.

However, despite all of these stressors and challenges one thing has shone through; the resilience and determination of all NHS staff to pull together as a team. It has been truly humbling to see everyone roll up their sleeves and muck in.

This is our “war”. As we move towards the next battle, my mind has turned to how we, as a society, have a more level-headed discussion about the future of the NHS.

“Don’t let the perfect be the enemy of the good”. This is a phrase often used in surgery. There is much truth to it. Tinkering around the edges in the hope of making that fracture reduction ever so slightly better can have the unintentional consequences of making it so much worse. The same can be said for healthcare reforms.

That said, while we quite rightly acknowledge and praise the endeavours of all our key workers, we must not put the NHS on such a pedestal that it becomes a sacred cow. There is a risk that there becomes – if it does not already exist – such a religious fervour around the institution of the NHS that its growth and development is stifled.

For many years, having a grown up conversation about the NHS has been nigh on impossible. Proposing reforms is met with accusations of privatisation through the back door. I fear that the additional adulation that has resulted from coronavirus will only further suffocate that debate.

“[T]he beating heart of this country” was how the Prime Minister described the NHS following his hospitalisation. The rhetoric was powerful. In this moment of crisis, the collective efforts of our NHS workers symbolise the beating heart of the nation. However, it would be unwise and a mistake to construe those same workers and the institution as one and the same.

In doing so, one cannot criticise any aspect of the latter without casting that same criticism on the former. It is perfectly logical to suggest that a system designed more than 70 years ago is no longer entirely fit for use today, while at the same time praising the sterling work of it employees.

I am, by no means, suggesting the NHS is unfit for purpose – the manner in which is has risen to Covid-19 has proven that not to be the case. But let us not kid ourselves; capacity and resources were created by pausing elective and semi-elective work.

As a result, waiting lists for cancer operations and treatments have regrettably been elongated, with the inevitable consequences in terms of prognosis. It is the workforce that has risen up to the challenge of the Coronavirus rather than the organisational structure itself.

Although in many areas NHS care is excellent, in others the same cannot be said to be true. In terms of breast, colon, and cervical cancer survivals rates the UK’s statistics fall behind those of healthcare systems in many other developed nations. We should be striving to achieve even better patient outcomes in these fields.

When debating the future of the NHS, the United States, a country without a universal healthcare programme, is often used as a comparator. In comparison to a combination of Medicare, Medicaid, and private health insurance, the NHS is infinitely better.

However, the US model is not the only model. We must not allow our view of healthcare workers to influence our ability to analyse failures in the organisation. We must be open to exploring what can be replicated from other healthcare systems that will lead to a more efficient and co-ordinated service. And, dare I say it; we must think how we fund health and social care in this country.

The principle that our health service should care for everyone regardless of their personal wealth is profoundly important. To undermine that would be to disrupt the foundations upon which it is built. However, we would be doing the NHS a disservice if we failed to have an honest debate on how we can improve it.

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WATCH: Sturgeon admits people should not have moved from hospital to care homes without tests

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Izzi Seccombe: During this crisis I’m proud of how Conservative councils are delivering the help needed

Cllr Izzi Seccombe is the Leader of Warwickshire County Council and the Leader of the Conservative Group of the Local Government Association.

Further to my recent article for Conservative Home on how our councils and councillors are playing a critical role in the national effort against Coronavirus pandemic, I am grateful to have been given another opportunity to showcase some more of the excellent work that is taking place across the country.

However, before doing so, I would like to acknowledge a number of recent announcements from central government that will support councils as we begin to move to the recovery stage with, for example, the forthcoming re-opening of schools and an anticipated further relaxation of lockdown restrictions.

These announcements include £283 million from Grant Shapps, the Transport Secretary,  to protect and increase transport services; £300 million, announced by Matt Hancock, the Health Secretary, to help councils expand their local test and tracing work; and £50 million, announced by Simon Clarke, Local Government Minister,  to support local high streets to get safely back to business.

I strongly welcome all of these announcements, and indeed the others which I do not have the space to acknowledge here, and would like to thank Robert Jenrick, our Secretary of State, with whom we continue to work closely, HM Treasury, and the other relevant Departments involved.

Of course, as well as being a health emergency, Coronavirus presents a severe threat to our economy and the Chancellor has rightly won plaudits for his unprecedented packages of support to both businesses and employees.

Local government has been absolutely critical to the delivery of many of the measures that he has announced, and I am delighted that Conservative councils have risen to the challenge. In the limited space available here I would like to highlight just a few of the many examples of best practice from across the country that I am aware of.

In recognition of the perilous situation which many local businesses found themselves in, South Kesteven District Council paid more than more than 900 support grants within 24 hours of receiving the money from the Government, thus ensuring that desperately needed funding was received almost immediately.

Meanwhile, Staffordshire Moorlands District Council redeployed 40 staff from services across the authority to make individual calls to business owners encouraging them to apply for the various grants that are available.

The council has received some very positive feedback to this proactive approach, including from a number of businesses that did not realise that they were actually eligible for the support.

In another example of proactive support, the Leader of Medway Council, Cllr Alan Jarrett, has used his urgency powers to defer rent collections from the authority’s commercial portfolio in order to provide businesses with some much needed respite.

Conservative councils across the country have also played an absolutely central role in meeting the Government’s target of getting homeless people off the streets and into secure accommodation.

For example, within a 48 hour period, Stafford Borough Council ensured that every rough sleeper was given emergency accommodation and 26 ‘homeless households’ have been given permanent accommodation during the lockdown.

Similarly, East Suffolk council have placed 26 homeless people in emergency accommodation consisting of the council’s own housing stock, hotel rooms, and private housing.

As we all know, isolation is a real problem during this period of lockdown and councils have been at the forefront of efforts to support their most vulnerable residents in any way they can.

For example, Medway Council has offered a personal shopper service for older residents and those who are at high risk and self-isolating. Furthermore, in a proactive move which has been much appreciated by those contacted, council staff have called the most vulnerable residents to check that they are well and have all they need.

In Suffolk, a Communities Board, which is comprised of the county and district councils, health services, the police and voluntary and community groups, was established at the start of the pandemic to support the most vulnerable residents. This collaborative working has helped more than 6000 people through the Home But Not Alone emergency hotline; supported over 1500 community groups who are directly helping vulnerable people; had more than 1800 people sign up to a volunteer app; delivered 4,100kgs of food to foodbanks across the county, and distributed 500 emergency food parcels to those in urgent need of supplies.

Meanwhile, in Lichfield the district council has been involved in a joint venture with the Co-Op to proactively contact those considered to be vulnerable and, if necessary, take their shopping order and arrange a priority delivery through volunteers.

Finally, whilst the work of councils as corporate entities has been a critically important part of the national response to the pandemic, it is important to recognise that Conservative councillors have also played a crucially important role as individuals in supporting their own local communities.

To highlight some examples from just one group, our Conservative councillors in Plymouth, where we are in opposition, have helped the vulnerable in a variety of ways, including collecting shopping for homebound residents who have not received booked deliveries; delivering prescriptions to those who cannot collect them personally, and assisting the setting up of a food bank and book swap club.

These are just some examples of the excellent work that Conservative councils and Conservative councilors have done to support their communities and residents during these unprecedented times. If you have a particular example from your own area that you would like to highlight please do email me at lgaconservatives@local.gov.uk

I look forward to continuing to provide further updates via Conservative Home in the coming weeks, when hopefully we will have moved even further into the recovery stage.

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Ben Obese-Jecty: Has the Coronavirus crisis now set the conditions for the Big Society?

Ben Obese-Jecty is the Deputy Chairman (Political) for Hornsey and Wood Green Conservative Association and stood as the candidate for Hackney North and Stoke Newington in the 2019 General Election.

Nearly ten years ago a newly elected Prime Minister stood at a lectern at Liverpool Hope University and delivered his vision for Britain. David Cameron’s Big Society speech outlined a framework proposing a redistribution of power from Westminster to the man and woman on the street.

Now, a tumultuous few months have all but torn up many of the 2019 Conservative manifesto pledges. A bold new strategy will be required in order to get the country back on its feet. But to what extent have conditions been created to facilitate the original Big Society agenda, and are they applicable to post-Coronavirus Britain?

The first strand of the Big Society’s framework spoke of the need to “foster and support a new culture of voluntarism, philanthropy, social action”. This selflessness and commitment to contribution is the key tenet upon which any interpretation of the Big Society is dependent. Without willing large-scale participation, the platform to create the other strands of the framework would founder.

In his 2009 Hugo Young lecture, Cameron argued that “the recent growth of the state has promoted not social solidarity, but selfishness and individualism”. With austerity measures having halted that state growth, emerging civic responsibility has naturally filled the gap where required – indirectly setting the conditions for it to grow organically, rather than by edict.

The current crisis has given rise to a new-found willingness to embrace these behaviours, underwritten by the mass engagement required to make them viable. Through a blend of cultural influences and necessity, attitudes within our society have changed markedly since 2010, but in recent times the sense of social cohesion across the country has arguably never been greater; from support for foodbanks to neighbourhood WhatsApp groups and the 750,000 NHS volunteers, the spirit of social action is currently highly evident. We have rarely seen such collective selflessness from the public and must seize the opportunity to ensure that it endures beyond the current crisis.

The second strand outlined the need for public service reform via “new providers like charities, social enterprises and private companies so we get more innovation, diversity and responsiveness to public need”.

Critics have argued that this appeared to be little more than an attempt to reduce Government expenditure under the auspices of civic responsibility; austerity by stealth mitigating any shortfall in resources. But as we look to how our post-Coronavirus environment may take shape, the role of new providers and the incentivisation of third-party providers will be key to encouraging the enterprise that needed in those areas where state support is not available.

The short-term application of big state has been championed by the left as vindication, Jeremy Corbyn going as far as to assert that he had “won the argument”, but a short-term response to an unprecedented situation, particularly one that is unsustainable, does not represent a strategic solution.

With the prospect of a decade of unwieldy state intervention, and the OBR predicting a rise in unemployment to a high of nine per cent, the Government will be keen to ensure that such a top-down approach is in place for only as long as is necessary.

Opportunities to devolve power will be vital in ensuring that tailored solutions are implemented for specific regions. Lord Heseltine’s proposal that metro mayors should be given a greater say over how best to rejuvenate their local regions is an example of where potentially innovative approaches may lie.

Though the response will initially see unprecedented levels of Government expenditure, an inevitable need to rebalance the books will follow. While the Government will be forced to employ a more holistic solution than a simple return to austerity, the incentivisation and invigoration of new organisations sitting on the periphery of the established framework could be a shrewd and practical response in reducing the burden upon local government.

A collegiate approach would be an effective way of identifying expertise to better target the areas requiring attention, as well as providing much needed stimulus to potential growth areas.

The third strand of the Big Society was community empowerment, centred upon communities feeling that “if they club together and get involved, they can shape the world around them”. As with the change in attitudes that has encouraged individual social action, the ability to empower groups at a local level may be significant in not only achieving innovative and democratic solutions, but also the required buy-in to maintain any mass engagement from the wider population.

As a Conservative government we should be embracing the personal responsibility shown by groups and communities eager to make a difference. Empowering community groups from the bottom-up and addressing the impact felt by any structural or regional inequalities facilitates what Cameron believed is the state “directly agitating for, catalysing and galvanising social renewal”.

By encouraging community activists and social entrepreneurs we can help them create the local enterprises vital to address those key areas where a reduced state has failed to identify a local need or is ill-equipped to service it.

This empowerment will not organically appear should the state retrench, as it must, in the strategic response to the crisis, but as the Government seeks to identify those areas where a difference can be made, the opportunity to harness the current groundswell of engagement should not be squandered.

The Government will need to ensure that when funding is made available in order to support efforts to reinvigorate areas in need, such groups are included as stakeholders within the discussion.

The expectation that the Big Society could thrive as some form of autarkic concept was undone by the prioritisation of fiscal conservatism; denied the investment it would need to establish momentum. The next decade will likely be hard, characterised by the complex balance of paying for the measures imposed to mitigate the impact of Coronavirus whilst attempting to deliver a manifesto partially rendered moot by the economic devastation of a global pandemic.

A key facet of the concept was the need to inculcate a spirit of civic participation amongst the population at large. It is significant that the current crisis has imbued people with the grass-roots motivation that would otherwise have been difficult to achieve.

Through both the cultural changes of the last decade and exacerbated by the Coronavirus crisis, many have experienced a change to their milieu. For the next decade there will be a need for us all to take better care of one another, both with regards to our health and our social fabric. The conditions might now be right to revisit the concept of the Big Society.

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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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Radical: A guide to trans-speak

Victoria Hewson is a solicitor and Rebecca Lowe is the former director of FREER, and a former assistant editor of ConservativeHome. Together they found Radical, a campaign for truth and freedom in the gender recognition debate.

Last week saw the alarming news of homework set for 13-year-olds at the Archbishop Sentamu Academy in Hull, in which they were asked to define terms like ‘hardcore pornography’.

We at Radical were inspired, and set ourselves some homework over the Bank Holiday.

Technical-sounding language – in need of defining and explaining to nervous teachers, public officials, and HR departments – has been a key tool in the toolkit of transgender activists.

So, we’ve set out below our definitions of commonly-used terms in the gender debate.

Some are quite specific or bespoke neologisms; others are standard words whose meanings have become contested.


Woman is a noun with a vast heritage; it’s hard to conceive of any verbal human civilisation that wouldn’t have had such a term.

Woman relates both to biological realities, and to non-biological norms and assumptions related to those realities.

Most of us have a pretty clear idea of what it is that makes someone a woman.

It’s easier, however, to think of sufficient conditions for this – e.g. all human beings who have ever had a period are women; all human beings who give birth are women – than its full set of necessary conditions.

Not all women have had, or will have, periods; not all women are petite; not all women like pink.

Debate rages as to whether all sufficient and necessary conditions of being a woman are biological in nature.

At Radical, we strongly believe they are: that sex is determined biologically, and that gender is a theoretical construct.


Alongside woman, man is a member of the two-member set best described as ‘sexes of human beings’.

Terms like ‘man’ and ‘woman’ aren’t value judgements, and don’t determine individual behaviour.

Rather, they relate to certain biological truths of sex dimorphism – i.e. the binary division, grounded in reproductive anatomy, observed in human beings.

As biologist Emma Hilton has emphasised, ‘humans, like almost every other thing that isn’t a mushroom or bug, are sexually dimorphic’.

That some living things aren’t sexually dimorphic doesn’t mean that human beings aren’t.

And that some particular human beings don’t fit perfectly into either of the two sex categories doesn’t mean that human beings aren’t sexually dimorphic.

There is no other human sex category aside from male and female.


A trans- (or transgender-) person is a human being, and is, therefore, either a man or a woman.

To some, that may sound offensive, but it is both true and important.

One reason it’s important is that human beings all share certain rights.

There are disagreements about the grounding of these human rights – whether they don’t exist unless they’re set out in law, for instance, or whether they’re simply a natural fact about the world, that’d remain true even if nobody ever knew about it.

However, what’s crucial is that they’re rights that all human beings hold, equally.

Now, transwomen are often contrasted with ‘natal’ women (ditto transmen and natal men), in that transwomen are human beings who don’t naturally meet sufficient biological conditions of womanness, but who believe themselves to be women.

Sometimes they ‘transition’ (see below), but transgender activists consider anyone whose gender (see above) does not ‘sit comfortably’ with the sex they were born as, to be trans.

Moreover, as some people don’t accept there are biological conditions of being a woman or man, it can be hard to agree upon a definition of ‘trans’.

This not least because, if being trans is simply to believe you are trans, then surely, a natal woman could be a transwoman.

Gender critical

To be gender critical (or GC) is, broadly, to be concerned by the increasingly popular idea that adherence to social norms commonly associated with one of the sexes determines whether one is, in fact and law, a member of that sex – or that these matters depend entirely on internal feelings of one’s personal ‘gender identity’.

Some GCs are philosophically conservative, some deeply value scientific truth, but the position is most commonly associated with feminists who object to the idea that being a woman is determined by stereotypes.


To transition means to change from presenting oneself as a member of one’s birth sex to presenting in accordance with the physical characteristics and gender norms commonly associated with the sex with which one identifies.

People who are not GC would describe this as transitioning from the gender one is ‘assigned at birth’, in order to reflect one’s ‘true gender identity’.

Transitioning can include undergoing medical treatment to change one’s physical appearance to resemble the opposite sex, but more frequently involves changing one’s name, pronouns, and ways of dressing – known as ‘socially transitioning’.

In law, under the Equality Act, ‘gender reassignment’ is defined as occurring when a person is ‘proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex’.

This gives the person concerned legal protection from discrimination, ‘on the grounds of gender reassignment’; no formal or legal process is required to gain this protection.

Gender reassignment is not to be confused with legally changing one’s sex by obtaining a gender recognition certificate under the Gender Recognition Act – for which a formal process and a diagnosis of gender dysphoria is required.


De-transitioning is the process of reversing a transition, thereby returning to accepting and identifying as the sex that one was born as.

In cases involving no medical treatment, detransitioning is straightforward although no doubt emotionally painful, but where the de-transitioner has had medical treatment, such as surgery or puberty blockers, complete reversal is often impossible, causing great distress.

A woman who had thought she was a transgender man, and medically transitioned at a young age, is currently taking legal action against the NHS clinic that carried out her treatment.


TERF is an acronym, that, like radar, has become a word in its own right.

Originally, it stood for ‘trans-exclusionary radical feminist’ – meaning someone with radical feminist politics, who doesn’t accept that transwomen are women, and therefore believes they don’t fall within feminism’s sphere of concern.

Now, TERF is mainly just a term of abuse, used against GCs, to imply they are bigoted, transphobic, and even (the horror) allied with conservatives.


Transphobia is an ill-defined term, which is often used to criticise anyone with GC views.

For example, LGBT activist organisation Stonewall defines transphobia as ‘[t]he fear or dislike of someone based on the fact they are trans, including denying their gender identity or refusing to accept it’. 

On that understanding, anyone with reservations about the concept of gender identity, and all its implications, can be described as transphobic.

Because being transphobic is considered a serious transgression, associated with discriminating against and distressing trans people, allegations of transphobia can cause people to refrain from expressing views on matters of sex and gender.

Hopefully this definitional exercise has been more educational than the homework set by Archbishop Sentamu Academy, which incited children to research pornography.

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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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Cummings. The Prime Minister is now gambling on what the ’22 does next.

At the heart of the words “Protect the NHS” – themselves at the centre of the Government’s three-part slogan when Dominic Cummings and his family drove north to Durham – was an unrebuttable political truth.

Namely, that had the health service collapsed as Italy’s did, with TV pictures of sick people “gasping for air, clutching at their chests and at tubes pumping oxygen into their oxygen-starved lungs”, Tory MPs would have risen in revolt.

Their e-mail boxes and Facebook pages would have teemed; Association activists would have been ringing and texting; friends and families would have been outraged; WhatsApp Groups would have boiled over.

And Boris Johnson, for all his 80 seat majority and thumping election win less than six months ago, would have been out.  Now turn from fiction to fact.

When the Coronavirus began to bite back in March, the anguished e-mails did indeed begin streaming in, and Conservative MPs were suddenly all over Rishi Sunak.

The Chancellor was forced to follow up his Budget on March 11 with a second major financial package on March 19 and a third on April 3 – plus a further series of tweaks, adjustments and changes, including furlough extension.

The language in parts of the Treasury about the propensity of Tory MPs to panic as the constituency pressure mounts has to be heard to be believed.

This takes us back to the future of Cummings.  Those e-mails and Facebook pages teemed yesterday; those activists rung and texted – and so on.  The boiling water may not simmer down over the next few days.

The 1922 Committee’s executive hasn’t yet decided whether or not to meet virtually this week.  That fact presents Boris Johnson with a choice.

He can gamble that it won’t.  Or that if it does, the discussion it has about his adviser – for one is certain to take place if there is a meeting – is inconclusive, or pulls any punches it might be minded to deliver.

The latter is the most likely course of action if the executive meets: one source on the committee says that “I’ve never known us resolve anything formally”.

None the less, punches will certainly be thrown in Cummings’ direction in such an event.  Three of the 16 MPs who have come out against him are on the executive: Steve Baker, Jason McCartney and William Wragg.

So if the executive meets, those punches aren’t pulled, and the committee formally resolves that Cummings should go, a trial of strength opens up between the Prime Minister and Conservative backbenchers.

Again, Johnson could gamble that, in these circumstances, the executive would back down.  But if it didn’t, he would be in very serious trouble.

Ultimately, a Conservative leader operates with the consent of Tory MPs.  The ’22 is a bit like a Canadian mounties: it always gets its man.  Or woman: after all, it eventually did for Theresa May, only a year or so ago.

His choice, therefore, is either to continue to tough it out, in the hope that the ’22 doesn’t meet and act, or else sack Cummings (which he surely won’t do), or else…send for Mark Sedwill.

The Cabinet Secretary could authorise an inquiry into whether or not Cummings’ flight from self-isolation in London broke the Special Advisers’ Code of Conduct.

Since Cummings had a legal case for what he did, and arguably a moral one, such a probe would be unlikely to recommend dismissal.

We also suspect, given the way the world works, that the top of the civil service is finely attuned to what this Prime Minister wants, for all the tensions between Sedwill and Johnson’s political operation.

At any rate, an inquiry would certainly stave off any push from the ’22.  And Cummings would probably survive it.  But that is not quite the end of the story.

Ultimately, what counts in the world of interaction between voters and MPs isn’t so much law, or even morality, as politics.  And the politics of this row are problematic for Johnson in one sense and perhaps in another.

Certainly, and as we argued yesterday, it has dealt a blow to the authority of the lockdown.  If so much depends on circumstances, common sense and context, as Ministers now proclaim, people will draw the obvious conclusion.

We understand that the Government’s plans for easing the shutdown, of which more is expected later this week, will rely more on the exercise of personal responsibility.  Under the circumstances, that’s just as well.

And arguably, what’s at stake is not merely the authority of the lockdown, but the authority of the Government – and by extension Johnson himself: the man who has been loaned the trust of Red Wall voters and so many others.

At the emotional heart of the affair is the sense from people that they have missed family funerals; sweated it out in lockdown with sick children; not seen parents and friends for weeks – and so on.

If they really conclude that “it’s one law for them, and another us” – with enemy-of-the-establishment Cummings ironically transformed into an icon of the establishment – the Prime Minister may be irreparably damaged.

This sense will feed through into polls and event in such a way that Johnson will have no peace until his adviser departs, and maybe not even then.

We are a long way from knowing whether this possibility is real, and the heat of this row, deliberately fanned by the enemies of Brexit, of the Conservatives and of Cummings himself is not the best place to make a judgement.

There are plenty of reasons for the Prime Minister not to order an inquiry.  The ’22 is unlikely to demand anything.  In the absence of further revelations and facts, the story may burn itself in the May heat.

Ordering a probe now would look and perhaps be weak. And it might not reach the conclusion he wants.  Still, there it is.  Either he calls for one or toughs it out.  But remember: a Tory leader is not ultimately master in his own house.

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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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The triumph of Whatsapp and trouble for the whips

The conventional wisdom has been that with Conservative MPs in lockdown – and so scattered to the four winds – the Tory whips would have fewer disciplinary problems to manage.

The opposite has turned out to be true, as the U-turn on the NHS surcharge showed.  The driving reason for it wasn’t the inquisitorial genius of Keir Starmer but, rather, the clamour among the WhatsApp groups used by Tory MPs.  These are turning out to be the grandmother of all nightmares for the whips.

“It all gathered pace during Brexit,” a former senior whip told ConHome.  “There was a Clean Global Brexit Group.  A Spartan Group.  And goodness knows what besides – all working themselves up into a lather”.

This is one thing when the whips are meeting daily in a room, and when they’re then able to work the committee corridors, tearooms, lobbies, bars and Portcullis House, together with their helpers or stooges (choose your label according to taste).

It’s quite another when team meetings must be carried out by Zoom or suchlike, and when the WhatsApp group jungle drums are beating themselves into a frenzy.

A vote on early release for prisoners was pulled recently. Twenty-two Conservative MPs voted in favour of Neil Parish’s animal welfare amendment to the Agriculture Bill.

The China Research Group is up and running, and its provisional wing will make energetic use of WhatsApp.  There has already been a backbench rebellion over Huwaei – a mere shot across the bows from a formidable band of MPs spanning the depth and breadth of the party.

So technology isn’t turning out to be the unalloyed plus for the executive that some thought it would, with virtual voting depriving MPs of their chance to worry at each other in the lobbies about the executive is up to.

Instead, the WhatsApp groups can have a self-reinforcing effect – whipping up concerns or discontent like a sudden storm at sea.  A majority of 80 bolsters Johnson’s Government against the rebellions that capsized Theresa May’s.  But there will be more trouble for him from where yesterday’s came from.

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