1. The Guardian-Unequal impact of Covid should be part of UK inquiry says Chair

On 12 May 2022 the Guardian published an article with the above title in response to Lady Hallett’s call for greater focus on minority ethnic people, children and mental health. The article reads:

“The chair of the UK Covid-19 public inquiry has urged the prime minister to significantly widen its scope to better examine the pandemic’s unequal impact on minority ethnic people, on children and on mental health.

Heather Hallett asked Boris Johnson to beef up the inquiry after receiving more than 20,000 responses to a public consultation on the government’s draft terms of reference, which many civic groups complained were too narrow.

If the prime minister ratifies the redrawn terms, it will considerably extend a statutory inquiry that some experts predict will be the largest in modern British history.

The government’s draft terms already covered 26 topics, including preparedness, lockdowns, testing, borders, infection control in hospitals and care homes, PPE, vaccines, furlough and sick pay.

The inquiry has appointed 12 QCs to lead a mammoth effort that involves combing through what could be several million documents……..

Black, Asian and minority ethnic leaders had argued that the planned inquiry failed sufficiently to account for inequalities “as a result of systemic racism throughout the pandemic”.

Hallett told Johnson she had heard “compelling arguments to focus on children and young people, the mental health and wellbeing of the UK population” and how local and national government officials collaborated with voluntary groups. She said the inquiry should be expanded into these areas.

“The unequal impact of the pandemic was a theme that came through strongly in response to the consultation”, she said.

“I am therefore recommending that the terms of reference be reframed to put possible inequalities at its forefront so that investigation into any unequal impacts of the pandemic runs through the whole inquiry. This important recommendation will ensure the inquiry is inclusive in its approach”.

She said the inquiry should consider “any disparities evident in the impacts of the pandemic on different categories of people” not just those groups considered to have “protected characteristics”. That could allow the inquiry to consider poverty as a factor.

She urged Johnson to accept the recommendations in full and “swiftly” to “ensure the inquiry can begin its formal work without delay”……….

Downing Street said it will publish the final terms of reference “in due course”

No 10’s draft terms said it would “consider any disparities in the impact of the pandemic and the state’s response, including those related to protected characteristics under the Equality Act 2010 and equality categories under the Northern Ireland Act 1998”.

However, campaigners wanted specific references to minority groups and assessment of the impact on human rights.

Hallett said she wanted consideration of the unequal impact of the pandemic to run through all sections of the inquiry, with possible focuses on ethnicity, religion, disability, elderly people, children in care and people living in poverty.

Other topics the chair wants to be added are: the role of primary care, including the NHS 111 hotline, which many people used for advice on how to respond to Covid; the impact on places of worship; support for victims of domestic abuse; and access to bereavement support.

Studies of people bereaved during the pandemic found that difficulties accessing support from GPs and bereavement services were common.

After months of criticism that the government was too slow to initiate the inquiry Johnson promised to start it this spring, which is still technically possible.

Once he agrees the terms the inquiry will be formally established and can start gathering evidence and witness statements, even if the first cross examinations will not happen before 2023. Hallett has already told government departments to protect evidence from destruction.”

Lady Hallett has clearly listened so now we await the Prime Minister’s response especially given the government’s reviews of the impact of Covid on BME people, which we shared with you, denies that ethnicity contributed to the disparities seen throughout the pandemic-watch this space! 

  1. HSJ article-“Big Hospitals warn NHSE of dangers of ICS takeover”

NHS England’s plan is to devolve responsibility for funding and commissioning of specialised services down from the centre to integrated care systems (ICSs) when the latter are considered ready. Precisely what will be devolved and when has yet to be confirmed.

The HSJ article on 17 May 2022 made available a leaked letter from “the Shelford Group” dated 18 March 2022 to John Stewart, National Director of Specialised Commissioning, NHS England concerning the proposed reforms to the commissioning of Specialised Services in England. The Shelford Group is made up of 10 of the largest teaching and research trusts in England and their letter expressed their concerns about ICS reforms. The HSJ article reads:

“The group told the HSJ it had in recent months been “engaging very constructively with NHSE and other partners” and was generally supportive of the ICS reforms.

However, its letter-leaked to the HSJ this week-set out a detailed list of significant risks “in terms of quality, equity, value and system complexity what we do not yet see being taken fully into account”.

It said it “welcomes the policy intention to improve the co-ordination of patient pathways” and the “focus on early intervention, prevention and health promotion” and agrees “there are now some services were delegation of commission to ICS level makes sense”. It identifies renal dialysis and HIV screening in emergency departments as examples of the latter.

But it said “We do not see, however, that these examples justify the wholesale move of commissioning of 80-90 per cent of specialised services to an ICS footprint, particularly those services where the numbers and evidence base supports the planning and provision of care being done at a population size larger than a typical ICS footprint”…..

NHSE has said it will evaluate each specialist service later this year to see if it is eligible to be delegated or moved to ICSs, now or at some point in the future. It also told HSJ: “Services will only be delegated where [integrated care boards] are ready”.

NHSE has said it will remain accountable for services and will set national standards, but the Shelford Group letter said that there remained “a risk of derogation” from the standards “leading to increased variation by postcode, unless governance mechanisms and resources required to audit compliance are in place”.

There is also a risk ICSs “will focus on high volume services for their local population, leading to deprioritisation of specialised service, and/or an inclination to support development of services within that ICSs footprint as opposed to the optimal level for ensuring clinical quality” It said……..

Asked about the letter, NHSE’s national director for specialised commissioning John Stewart told HSJ: “Delegating certain specialised services will provide more joined-up care for patients, improve their experiences and speed up treatment. Services will only be delegated where ICBs are ready, with NHSE remaining ultimately accountable, including setting national policies and standards.

It is understandable that the biggest specialised providers have a strong interest in the future provision of services, and it is important they work with commissioners to better meet the needs of specialised patients, including those outside their immediate local area”. ….

The future provision of specialised services is of particular interest to us because of the potential adverse impact on BME communities. We intend to follow this issue very closely.

  1. Book by Jeremy Hunt MP concerning patient safety

The Sunday Times published an article revealing that Jeremy Hunt MP will be publishing a book next week entitled “Zero: Eliminating Unnecessary Deaths in a Post-Pandemic NHS. The HSJ’s coverage of the article the following day reads:

“…he told the Sunday Times he presided at the top of a “rogue system” more concerned with covering up mistakes to avoid a loss of public confidence than learning from the frequent mistakes that result in harm to patients.

Both NHS and Department of Health and Social Care were “complicit” in the culture of secrecy, fear of retribution and recycling of error-prone senior officials to similar jobs elsewhere, Mr Hunt said.

He recounted how he had to convince DHSC officials to show him letters from patients in which “shocking practices of treatment” were described, but he was scarce on detail about what he tried to put in place to change the poisonous way of working…….”

We know only too well the “rogue system” that he describes in the context of its lack of response to delivering on its statutory obligations concerning race equality.