Interim Report | December 2020
The report contains 71 key findings, which inform 44 recommendations. The recommendations range from the very specific (on Long Covid recognition and support) to the operational (highlighting the need for the 'Isolate' part of Test, Trace, Isolate to be financially compensated more generously) and the strategic (the lack of a coherent exit strategy).
The report's topmost recommendation is that we urgently need a UK-wide exit strategy that acknowledges that by saving people’s lives, we in turn safeguard their jobs and the economy. We challenge the UK Government’s core argument that there is a ‘balance’ to be found between the health and wealth of the UK, and instead advocate an approach closer to those nations that have successfully ‘beaten’ the virus. This includes strong initial restrictions to get case numbers extremely low everywhere, a TTI system that is locally led and nationally resourced that pays people to stay at home if they need to and aggressive testing at the borders, turning our island geography into a powerful advantage.
We are concerned that the Government’s approach so far has not worked and has left the UK mourning among the highest number of lives lost to the pandemic, while at the same time bracing for one of the deepest recessions in its aftermath. The vaccine may be around the corner, and that is brilliant news, but the logistical challenges and uncertainty make it almost certain that we have months, if not years, of aftermath to contend with.
Chapter 2: Lockdown and Exit Strategy
- Lockdowns are a means of slowing down the incidence of the pandemic when all other means to control the virus have broken down.
- The UK government’s centralised test and trace system is not working.
- The failure to provide sufficient financial support to those in self isolation is a barrier to compliance.
- Public messaging is unclear, and the reasons for the application of NPIs are ill-defined.
- There needs to be greater coordination between all stakeholders involved in the Coronavirus response.
- Relaxing lockdown restrictions too early, without sufficient suppression, can cause more economic damage in the long term. ‘Balancing health versus wealth’ is a false dichotomy.
- There is no such thing as Herd Immunity to Covid-19 in the absence of an effective vaccine.
- A future vaccine should not be relied upon as a ‘silver bullet’ to solve the pandemic.
- The UK government must remain focussed on NHS staff recruitment, retention and support.
Chapter 3: The Impact of Covid-19
- The UK government did not adequately prepare in terms of stockpiling sufficient and adequate Personal Protection Equipment (PPE). The procurement, supply and distribution of PPE to the NHS and social care sector was delayed and poorly coordinated, with ineffective oversight.
- There are significant staff shortages in both the NHS and social care sector. Covid-19 has had a considerable impact on the health, safety and well-being of the workforce.
- The social care sector has been severely impacted by the pandemic. There was insufficient coordination of supply and distribution to the social care sector which led to significant problems with access to PPE. The quarantine arrangements for those coming into the social care sector from hospitals were inadequate.
- In the first wave of the pandemic, there was a considerable resource shift in the NHS to managing patients with Covid-19. This has led to a considerable backlog of care.
- The centralised Test and Trace system is not working.
- Covid-19 has not impacted society equally.
- Communication between the UK government and local systems of healthcare provision needs to be improved.
Chapter 4: Long Covid and Bereaved Families
- The UK government is not counting the number of individuals who are left with long-lasting effects of Covid-19 as a measure of the severity and impact of the pandemic.
- As a medical condition, Long Covid has not yet received full recognition, sufficient research funding or adequate rehabilitation support.
- There are very few guidelines for employers or for GPs on recognising and managing Long Covid.
- There must be a judge led inquiry into the UK government’s handling of the pandemic.
- UK government was too slow to lockdown during the first wave of the pandemic.
- The advice given by the NHS 111 service may have resulted in people who were experiencing severe symptoms being advised against seeking medical advice.
- Hospital admissions may have led to increased incidence of Covid-19 in the first wave.
- Shielding guidance from the UK government was unclear.
- There is a lack of support for bereaved families as the normal support systems (family, friends, mental health support) are not accessible while Covid-19 restrictions are in place.
Chapter 5: The Impact on Social Care
- There has been a failure of those in social care. The social care sector has been failed during this pandemic. This failure has brought into sharp relief the urgent reforms required for social care, with centralised oversight, funding and support.
- The impact of complex bereavement, anxiety and depression on people in later life as exacerbated by the pandemic needs better recognition and support. Blanket lockdowns for long periods have had a severe impact on the mental health of residents and those who care for them.
- The guidance on visiting care homes has been unclear.
- The initial failure by UK government to include known mortality figures of those in the social care sector and reports of the use of blanket ‘Do Not Resuscitate’ Orders has created the impression that those in the social care sector are less valued.
- Covid-19 has had a disproportionate impact on the health of those from Black, Asian and Minority Ethnic (BAME) backgrounds.
- Social Care is addressed in chapters 3, 5, 6, 7, 8 and 9.5.6 The charitable sector has seen an unprecedented need for its support services. At the same time, the financial viability of the charitable sector is at risk. Government financial support had not been distributed in a transparent or timely way.
- Supermarkets need to increase the availability of slots for older and more vulnerable people and coordinate better with each other in their local communities
Chapter 6: Test and Trace
- Investment in the fields of virology and microbiology is needed urgently.
- The UK government has not invested sufficiently in the UK’s laboratory capability.
- Arbitrary testing targets have been prioritised over a coordinated testing strategy.
- There has been a lack of coordination between Pillar 1 and Pillar 2 laboratories.
- Information flow between Pillar 2 laboratories and the NHS has not worked well.
- The UK government’s decision to abandon test and trace in March the virus to take hold in England and the UK unchecked.
- The centralised test and trace system is not working.
- Regular and accessible staff testing is critical to enable the NHS and social care sector to provide care.
- Turnaround time of tests is not always meeting the required maximum 24-hour target.
- For effective pandemic management, the NHS and Social Care sector responses need to be coordinated.
- There has been no effective oversight of the social care sector since March.
- Isolation is having a devastating impact on those in social care.
- The cost of testing is a significant challenge for the social care sector.
- Local authorities do not currently have a sufficient role in the organisation and oversight of testing for the social care sector.
Chapter 7: Local Authority Response and Reorganisation of Public Health England
- The inability for local authorities to access the precise real-time data has significantly impaired their ability to work effectively at a local level to contain outbreaks.
- The Covid-19 crisis has demonstrated the vital and reciprocal relationship between the NHS and social care.
- Local authorities need enhanced powers and support.
- Reorganisation of PHE should be delayed until after the pandemic.
- Independent and trusted public health advice is critically important for a strong response to future threats.
- Public health resilience has been impacted by reduced spending over the last decade.
- In any reorganisation of PHE, all the functions of PHE should be read across and strengthened.
- The public health system requires joined-up local, regional and national functions, that are responsive to the needs of local communities.
Chapter 8: The Impact on Frontline Workers
- From the outset of the pandemic, frontline workers had inadequate access to personal protective equipment.
- The pandemic is having a clear impact on the mental health of frontline health and care workers. Many are experiencing stress, depression and burnout.
- Access to testing for frontline workers has been unsatisfactory.
- The social care workforce must have the same level of PPE and access to Statutory Sick Pay (SSP) as NHS staff. Greater guidance is needed for the sector.
- Workers from Black, Asian and Minority Ethnic (BAME) backgrounds have been disproportionately impacted by the pandemic.
- Doctors are particularly concerned about preparedness for winter and the ability of the NHS to face the elective backlog.
Chapter 9: The Impact on Mental Health
- Covid-19 has had profound consequences for individuals’ mental health.
- Those with pre-existing mental health conditions have seen their mental health decline further throughout the pandemic.
- Many individuals are experiencing mental health problems for the first time as a result of complex grief.
- Throughout the pandemic there has been a reduced access to services and support as a result of Covid restrictions. The impact of this has meant more people are suffering without having access to support and thus causing their condition to worsen.
- The reduction in normal activity and increased isolation has caused many to experience mental health problems for the first time.
- There is specific concern for the mental health of key workers. Key workers urgently need support now and as we move into the next phase of the pandemic.
- Those from BAME backgrounds have felt higher levels of depression and anxiety across the pandemic.
Chapter 10: International Comparisons
- The UK government failed to learn from other countries in their handling of the pandemic.
- Find Test Trace Isolate and Support is most effective when run at a local or regional level.
- Countries with experience of tackling SARS and MERS have dealt with the virus most effectively such as South Korea, Taiwan and Singapore. Those that implemented widespread testing at an early stage with effective contact tracing, cancelling major public events early on, using masks and social distancing measures had better outcomes. Countries which imposed testing and quarantining measures at their ports of entry also had a better rate of success, such as New Zealand.
- Communication, clarity, trust and risk perception are essential for compliance.
Conclusions and Recommendations
The UK is currently experiencing a second wave of Covid-19. The APPG believes that there are measures that the UK government can implement to reduce the impact of the pandemic. By providing better protection and support to those most affected, by empowering local authorities to assist in the management of the crisis, by recognising and mitigating against the unequal impact that Covid-19 has had on our society, we can reduce the scars of Covid-19, thereby helping us to come out of this period more united and more resilient.
The APPG urges the UK government to implement the following recommendations:
1. The UK government’s approach to tackling the coronavirus pandemic has been based on the false choice between saving lives or saving jobs and the economy. The APPG recommends that the UK government adopts the Covid-Secure UK plan as the long-term exit strategy to protect both the health and the wealth of the UK until widespread immunity through vaccination is achieved.
The Covid-Secure UK Plan consists of three steps:
- Control - bring the reproduction rate below 1, reduce community transmission by implementing a locally led Find Test Trace Isolate and Support system.
- Suppress - minimise transmission within the UK at large and stop imported infections at the UK borders.
- Eliminate - obtain widespread immunity to coronavirus through vaccination. The Covid-Secure UK plan is set out more fully in chapter 1.
Find Test Trace Isolate and Support
2. The centralised and outsourced Test and Trace system operating in England is not working. Ithas consistently failed to meet the required target of 80% of contacts traced to be effective. The UK government has prioritised arbitrary testing targets over a coordinated testing strategy.
Mass testing needs to be backed up with adequate resources to ensure that tests are carried out by trained staff, supported by an information campaign which informs about the sensitivity and specificity of tests, and by an effective and comprehensive contact tracing service.
The UK government’s outsourced tracing service has consistently traced only 60% of contacts, well below the required 80% target. Local contact tracing services have been much more successful, regularly tracing 90% of the contacts. This is due to their understanding of the local areas, their ability to go directly to people’s premises and their ability to foster trust and offer advice, explanation, and support. Without adequate financial support and general assistance to isolate, the requirement isolate is not being complied with by a significant proportion of cases. As a result, the chains of transmission are not being broken, and cases continue to rise. In areas where local teams are resourced to trace cases and to offer support for those required to isolate, including on aspects such as shopping, financial advice and general support, compliance is much improved.
Lockdowns have become the UK Government’s only solution to bringing down the incidence of Covid-19 in England, because it does not have a locally led Find, Test, Trace, Isolate and Support system in place throughout the country.
The APPG recommends that the UK government empowers local authorities to deliver a Find, Test, Trace, Isolate and Support system, backed up with proper financial support and assistance for those isolating. [reference Key Findings from Chapters 2, 3, 6, 7 and 10].
Empowering Local Authorities
3. The inability for local authorities to access the precise real-time data has significantly impaired their ability to work effectively at a local level to contain outbreaks. The APPG recommends that local authorities are provided with precise granular test and trace data in a timely fashion to enable local authorities to understand the incidence of Covid-19 in their areas and to trace contacts rapidly and effectively. [reference Key Finding 7.1]
4. Local authorities need sufficient powers to enforce restrictions where necessary. The APPG recommends that the UK government provides local authorities with the powers to take flexible and localised actions to enforce appropriate forms of non-pharmaceutical interventions, including lockdowns, where local action is necessary above national imposed restrictions. [reference Key Finding 7.3]
5. Centralised identification of, and communication with, those shielding has not been consistent or clear. Moving to a new ‘accounts based system’ to manage the records of those identified as clinically vulnerable provides an opportunity for the UK government to work closely with local government to improve the current system, so in the future the support to those who might need to shield is delivered more effectively. The APPG recommends that
the UK government works closely with local councils on future shielding programmes to ensure effective communication and delivery of the shielding programme. [reference Key Findings 5.3 and 7.3]
6. Local authorities need the powers to respond to local outbreaks. The APPG recommends that the UK government delegates the powers to open and close schools and pre-schools, as contained in the Coronavirus Act 2020, to local authorities to enable them to respond quickly to local conditions. [reference Key Finding 7.3]
7. Councils need clarification on the resumption of the policy of ‘everyone in’ (ensuring accommodation for all homeless people). The APPG recommends that the policy requiring local authorities to ensure that homeless people are housed during the pandemic continues until widespread immunity to Covid-19 is achieved through vaccination. [reference Key Finding 7.3]
8. The APPG recommends that the No Recourse to Public Funds condition be lifted to enable the sheltering of homeless people and to prevent homelessness for households experiencing financial shocks. [reference Key Finding 7.3]
9. UK government advice and guidance on shielding and on visiting those in residential care has been inconsistent and unclear. The APPG recommends that the UK government works with the primary health care and social care sectors to ensure guidance and messaging on shielding is clear and precise. [reference Key Finding 4.8]
10. The APPG recommends that the UK government works more closely and collaboratively with the devolved administrations towards the shared objective of suppressing the virus on a UK wide basis. Each devolved administration should retain the ability and capacity to respond to its own needs where necessary, but within the framework of an agreed four nation strategy. [reference Chapters 1 and 2]
11. UK government public health messaging has been inconsistent and unclear and the reasons for the application of NPIs are ill-defined. The APPG recommends that the UK government reinstates the daily coronavirus briefings to keep the public informed for the duration of the pandemic. [reference Key Finding 4.8]
12. The APPG recommends that the UK government requests national broadcasters to report on the local level of infection present as part of each news and weather bulletin. This should occur across all news platforms, including broadcast, radio and online. [reference Ch 1]
13. Access to testing for frontline NHS and social care staff has been unsatisfactory, resulting in staff being absent from their role while they or their family members wait for test results. This impacts on the ability of the NHS and social care sector to provide care. The APPG recommends that testing is made available to frontline workers and their families as a priority, such that they are able to access a test at least once a week. [reference Key Finding
14. The international standard for the turnaround time of tests is 24 hours. The APPG recommends that the UK government improves turnaround time for tests, such that all results are accessible within 24 hours. [reference Key Finding 6.9]
15. Routine inspections of social care providers were suspended in March 2020. The APPG notes that testing has now been extended to all those in social care, including ‘support and specialist staff required to maintain the UK’s health and social care sector’. The APPG recommends that this definition applies to all those in managerial positions in the social care sector, including those in the Care Quality Commission, such that oversight of the social care sector can be fully reinstated. [reference Key Finding 6.11]
16. The APPG finds that there has been inadequate coordination between Pillar 1 (NHS) and Pillar 2 (commercial) laboratories, which has detrimentally affected testing capacity, information flows and management decisions. The APPG recommends that there is much greater coordination between Pillar 1 and Pillar 2 laboratories including at leadership and management levels, and on data and information sharing. Pillar 1 testing expertise should be represented on the national Test and Trace committees. The two Pillars must work together to ensure that testing capacity is maximised. [reference Key Finding 6.4]
17. The coronavirus pandemic has exposed the capacity deficiencies in the UK’s public health laboratory capability: existing public health laboratories did not have the capacity to meet the surge in demand posed by Covid-19. The APPG recommends that the UK government invests in its public health laboratories to ensure that the UK can deal with the present coronavirus pandemic and be adequately equipped for any future epidemic. [reference Key
Findings 6.1 and 6.2]
18. The recently announced proposals for testing at airports are not sufficient. To minimise the number of imported cases of Coronavirus, the APPG recommends that the UK government requires proof of a negative Covid-19 test 72 hours prior to travel, followed by mandatory testing 5 days after arrival in the UK. The APPG further recommends that there are post travel requirements such as quarantine at regulated locations. [reference Ch.1]
Personal Protection Equipment
19. The APPG finds that there was an insufficient supply of PPE for those in the social care sector and NHS. The APPG notes UK government guidance for the stockpiling, supply and distribution of PPE published in September 2020. The APPG notes the intention as stated in that guidance to move to a different model beyond March 2021. The APPG recommends that the UK government continues to assume direct responsibility and oversight for the stockpiling, coordinated supply and distribution of PPE beyond March 2021, in order to ensure thatthere continues to be a sufficient supply of PPE for NHS and social care workers, which is fit for purpose and accounts for cultural, religious, ethnic, gender and disability considerations, to meet any future need. [reference Key Findings 3.1, 3.2 and 3.3]
Public Health England
20. The reorganisation of Public Health England would be detrimental to UK’s ability to respond to the coronavirus pandemic. Furthermore, institutional change as a means to address the challenges posed by Covid-19 pandemic fails to acknowledge the other key responsibilities of Public Health England. The APPG recommends delaying any reorganisation of Public Health England until after widespread immunity to Covid-19 has been achieved by vaccination. [reference Key Finding 7.4]
21. To command public trust, any future national public health body must provide transparent advice which is independent of government. The APPG recommends that any reorganisation of Public Health England ensures that the body remains publicly funded, but independent of government, able to give independent and transparent advice, and with strong links with local and regional public health authorities.[reference Key Finding 7.5]
Support for the NHS
22. The APPG recommends that the UK government commits to at least repeating the emergency uplift in funding due to Covid-19 for 2021/22 and should commit to annual real
terms increases in total health spending by at least 4.1% per year going forward. [reference Key Findings 3.1 and 3.4, chapter 3 submission]
23. Before the coronavirus pandemic, NHS England had around 106,000 FTE vacancies including nearly 44,000 nurses and more than 9,000 doctors. Given the level and pace at which many staff on the frontline have been working, there is a need for significant ongoing support to manage the considerable impact the coronavirus pandemic has had on the mental health of NHS staff. The APPG recommends that the UK government publishes a UK wide plan to improve the recruitment, retention, and support of NHS staff. [reference Key Finding 3.2]
24. The APPG recommends the NHS develops an effective system of risk assessment for all doctors, nurses and frontline NHS workers, including those from Black, Asian and Minority Ethnic (BAME) backgrounds, and those who are pregnant, to ensure that they can work in a way which minimises risk to themselves and patients. [reference Key Finding 3.2]
Support for the Social Care Sector
25. The UK government guidance on visiting care homes in England is unclear and inconsistent compared to the equivalent advice and guidance issued for hospital visits. The APPG recommends that the UK government issues much clearer guidance on visiting care homes, recognising the impact that isolation has on care home residents. [reference Key Finding 5.3]
26. The social care sector did not receive sufficient support in terms of PPE, guidance, testing or quarantining provisions for those coming from the NHS into social care settings. The APPG recommends that there is much greater coordination between the NHS and social care sector and that the UK government ensures equality of pay, training, career development and workforce planning between the social care sector and the NHS. [reference Key Finding 5.1]
27. At the outbreak of the pandemic, there was a shortage of 100,000 social care staff. The APPG recommends that the UK government publishes a national plan to improve the recruitment, retention, and support of social care staff. [reference Key Finding 3.2]
28. Oversight of the social care sector was stopped in March 2020 due to a lack of testing availability for Care Quality Commission inspectors. The APPG recommends that the UK government ensures that the full oversight of the social care sector by the Care Quality Commission is resumed as a matter of urgency by making testing available to inspectors. [reference Key Finding 6.11]
29. Isolation is having a devastating impact on those in social care. All people living in care or supported living need to be safely reconnected with their support networks for the crucial emotional and practical support that friends and families provide. The APPG recommends that the UK government ends isolation for all those supported or cared for in the social care sector, including all those in independent and supported living. Visits must not be restricted to a maximum of one or two family members or friends. The UK government must make clear that there is no requirement for staff supervision during visits. [reference Key Finding 6.12]
30. For the visitors of residents in all social care settings, the APPG recommends that relatives and visitors be classed as key workers to enable them to access testing and PPE. The APPG further recommends that shorter turnaround tests be made available to facilitate an end to the isolation of all residents. [reference Key Finding 6.12]
31. The APPG recommends that there is an effective system of risk assessment for all social care workers, including those from Black, Asian and Minority Ethnic (BAME) backgrounds, and those who are pregnant, to ensure that they can work in a way which minimises risk to themselves and those they care for. [reference Key Finding 3.2]
32. The Covid-19 pandemic has brought to the fore longstanding structural inequalities that persist within the UK and our public services. The APPG has found that NHS staff, and in particular those from BAME backgrounds, have experienced bullying and discrimination in the workplace when raising questions of workplace safety and lack of PPE. The APPG recommends that the UK government ensures that the NHS continues to fulfil its Public Sector Equality Duty (PSED) obligations throughout the pandemic. Equality monitoring must continue throughout the crisis and steps must be taken to identify and mitigate health inequalities and disparities of experiences and outcomes as they arise. [reference Key Finding 5.5]
33. The Covid-19 pandemic has brought to the fore longstanding inequalities that persist within the UK and our public services. The impact has been particularly detrimental on those living in areas of high deprivation, on people from BAME communities, on older people, men, those with a learning disability and others with protected characteristics. The APPG recommends that the UK government renews its focus on health inequalities to strengthen future resilience. [reference Key Findings 3.6 and 5.5]
34. The APPG urges the Prime Minister to meet with the Bereaved Families for Justice group and commit to a judge-led public inquiry on the UK government handling of Covid-19. [reference Key Finding 4.1]
35. The advice given by the NHS 111 service may have resulted in people experiencing severe symptoms being advised against seeking medical help. The APPG recommends that there is an immediate review of the advice given by the NHS 111 service. [reference Key Finding 4.6]
36. With Covid-19 restrictions in place, many lost loved ones to Covid-19 in isolated circumstances, where the normal support systems have not been accessible. The APPG recommends that the UK government ensures that bereavement counselling and mental health support are available to those who have lost loved ones to Covid-19. [reference Key Finding 4.9]
37. As a medical condition, Long Covid has not yet received full recognition, sufficient research funding or adequate rehabilitation support. The APPG recommends that the UK government formally recognises Long Covid, that it expands research on the long-term effects of Covid19 on people’s health to include those who were never hospitalised or tested, and the UK Government should launch a national registry to count the number of people living with Long Covid in the UK and spearhead global effort to research Long Covid. [reference Key Finding 4.2]
38. There are insufficient guidelines for employers and GPs on recognising and managing Long Covid. The APPG notes the work commenced by NICE and SIGN and recommends that the UK government expedites the work to develop new guidelines for GPs and ensures that there are also guidelines for employers. The APPG recommends that the UK government commits to a firm date by which these will be produced. [reference Key Finding 4.3]
39. The UK government is not counting the number of individuals who are left with long-lasting effects of Covid-19 as a measure of the severity and impact of the pandemic. The APPG recommends that the UK government collects and publishes regular figures on the number of people living with Long Covid, and those who have received support under the NHS England Covid Recovery service. [reference Key Finding 4.1]
40. The APPG finds that Covid-19 has had severe impact on the mental health of a significant proportion of society. This may be because of isolation, loss of income, or loss of daily routine. The APPG notes that the UK government has committed to an additional £500 million spending pledge. The APPG recommends that the UK government details how this funding will be spent and all respective success metrics. [reference Ch 9]
41. The APPG finds that there has been an increase in demand for mental health support services, with many individuals seeking help for the first time. The APPG also finds that those suffering from mental health issues, including addictions, have seen their condition worsen over the course of the pandemic. The APPG recommends that the government prioritises improving and strengthening both the availability of mental health services and the mental health estate. The condition of mental health wards must be improved. The UK government must also ensure that there is adequate sheltered housing for those suffering from a mental health condition to live with dignity in the community. [reference Ch 9]
42. For those living in mental health accommodation, the APPG recommends that the UK government ensures that relatives and visitors have access testing and PPE to facilitate an end to the isolation of all residents. [reference Ch 9]
43. Throughout the duration of the coronavirus pandemic, the charitable sector has seen an unprecedented need for its support services. At the same time, charities have had to furlough frontline staff leading to a further reduction in charities’ ability to deliver their services. The APPG recommends that the rule preventing furloughed staff from volunteering with their employer is disapplied to the charitable sector. [reference Key Finding 5.6]
44. The UK government has failed to look to or learn from other countries in their handling of the pandemic. The APPG notes the experience of Norway and Finland, who built up their Find, Test, Trace, Isolate and Support systems over the Summer, as well as those countries who instigated testing and quarantine measures at airports early on, such as South Korea, Singapore, New Zealand and Hong Kong. The APPG recommends that the UK government looks to other countries and implements the measures that have resulted in a much more successful handling of the pandemic. [reference Key Findings 10.1 and 10.3]