An interesting take in The Guardian on the impact of a decade of reform on the response to Coronavirus. England’s ravaged public health system just can’t cope with the coronavirus:

The impoverishment of the NHS and the public health system in England is not the only depletion that has occurred in civil society that makes us ill-equipped to respond effectively to the greatest global health crisis in a century.

One of the first acts of the coalition government when it came to power in 2010 was to dismantle the regional structures that had provided a coherent mechanism for integrating and carrying out government policy within the English regions…the coalition also stripped the NHS of its regional management tier following the wide-ranging “reforms” of the 2012 Health and Social Care Act.

The result is the absence of any integrational, coordinating or management function at a regional level in England that could operate between Whitehall departments and the various bodies, often very local, that are charged with implementing government policy. The fact that some national bodies have adopted internal organisational boundaries that cover completely different geographical territories has also complicated the situation. This is notably and unfortunately true with respect to the key health bodies, NHS England and Public Health England.

I had been pondering what impact the introduced since 2010 have had. Things like the move of public health from the NHS to local government can make it more responsive to local needs but also more at the mercy of local financing whims and at the cost of losing central control.

I am, by instinct, a localist but there is a lot to the argument that stripping out the middle tier and fragmenting other provision across the public, private and third sector has harmed our initial ability to mobilise against the pandemic.

I’m not unusual in becoming COVID-19 obsessed. It’s affecting my professional life (I work in the health sector, although not a part directly affected), I’ve been thinking about it a lot as a school governor (not just the potential impact but also about how the messages are shared with anxious children) and my attempt to be pretend I’m an academic just happened to hit a stage of studying global health as a live case study was unfolding on a daily basis.

What has been somewhat disconcerting is that we have to deal with a pandemic at exactly the time we have a government almost uniquely incapable of dealing with it. The example of Nadine Dorries, a health minister, continuing with her schedule despite being symptomatic, causes me some concern about the quality of political decision-making. And while on 5 March the Chief Medical Officer was telling MPs we were mainly in the delay phase Boris Johnson thought we were still in the contain phase four days later. Then a few days later we have other government advisors who appear to have misunderstood how herd immunity works and suggested a plan that appears to amount to everyone just getting COVID-19. Which brings us to being presented today with an over-70s quarantine plan that isn’t fully formed (details will come later) and I can’t help feeling the government is just trying to style this one out.

At a time we need calm, authoritative, advice—and sometimes decisive action—that helps slow the spread and protect the most vulnerable in our society we are stuck with a government for whom the best thing you can say is that at least they aren’t Trump.1


  1. Having pretty much left social media, and felt so much better for it, I still needed the teeniest vent for this. The first duty of a government is to protect its people and I (along with hundreds of scientists) just have no confidence in this government in this situation. I hope I’m wrong. 

A few hundred people listening to the first-timers’ briefing Clapham Common parkrun this morning. There a touch over 1,100 runners and walkers in total, the biggest one ever (until next week, which is likely to be even bigger).

I’d always, intellectually, understood the benefits of parkrun but it wasn’t until I got involved with Clapham Common that I realised how powerful it is, not just because of the physical activity, but also because of the sense of community and volunteering it entails. However you might want to be involved I can not recommend it highly enough.