Archive for the ‘coronavirus’ Category

Estimating how many Britons have already had COVID-19 using self-reported data

Using a random sample survey and self-reported data on infection and symptoms, Patrick Sturgis and Jouni Kuha find a symptomatic infection rate in the general population of Great Britain of approximately 10% by the end of April.

Any attempt to estimate the population infection rate must deal with two key challenges: how to measure infection and who to make the measurements on. Available methods for estimating the population infection rate have different balances of strengths and weaknesses with regard to these matters of measurement and sampling, respectively.

The most discussed approach to measuring population prevalence are the antigen tests carried out daily by Public Health England. These show that (as of 7/05/20) 1,139,626 people had been tested and 206,715 had tested positive – an infection rate of 18.1%. However, because these tests are targeted at groups likely to have contracted the virus, they will tend to over-estimate the population infection rate.

Antigen tests are also of limited value for estimating the population infection rate because they only identify people who are currently infected and will, therefore, miss the small but growing section of the population who have recovered from an earlier infection. For example, an ONS survey of 10,000 households found an infection rate of 0.27% between 27 April and 10 May, which is likely considerably lower than the proportion of people who have ever been infected.

Here, we assess whether random sample surveys using respondent self-reports of infection and symptoms can help get a better picture of the true rate of symptomatic infection in the population. To do this, we analyse data from the Wellcome Trust UK Monitor survey which was carried out on the NatCen probability-based panel between 30 March and 26 April.

The key advantage of probability surveys for estimating the population infection rate is that, in theory at least, the random selection of sample members from the target population will give approximately accurate estimates of population characteristics.

The corresponding disadvantage of surveys is that measuring the infection status of respondents is challenging. The best way to do this would be to administer both viral and antibody tests and, indeed, this is what the government is proposing to do when an accurate antibody test is available. In the meantime, we must rely on respondents telling us whether they think they have had the coronavirus and its associated symptoms and this kind of subjective data is clearly subject to a range of potential errors.

The 2,400 respondents in the Wellcome Trust Monitor sample were asked to give a probabilistic assessment of whether they have had the virus and ten of the most common symptoms of COVID-19. As shown in the Figure below, 0.9% said they had ‘definitely’ had the virus, 12% ‘probably’ had the virus, 43% ‘probably not’ had the virus and 44% had ‘definitely not’ had the virus (0.7% said that they did not know).

Combining those who say they have ‘definitely’ or ‘probably’ had coronavirus, gives a crude estimate of the symptomatic infection rate of 13%. However, some of those who think they have had the virus will not actually have been infected (false positives), while others are likely to have been infected but say they have not (false negatives).

One way of assessing the extent of these reporting errors is to cross-check self-reported infection status with reported symptoms. All respondents were asked whether they had experienced any of ten common COVID-19 symptoms since the start of February.

The figure below compares the reported rate of each symptom between those who say they have had coronavirus and those who say they have not. By taking the ratios of reported symptoms for these two groups, we find that the most distinctive symptoms are high temperature (ratio = 10), new cough (7.2), loss of taste/smell (8.5), and shortness of breath (5.4). This pattern is consistent with the list of typical symptoms reported by the World Health Organisation and the Centers for Disease Control.

Of those who said they have probably/definitely had the virus, 22% reported having had none of the five most distinctive symptoms, so these seem likely to be false positives. The high apparent rate of false-positives should be a concern for policy-makers, as many in this group are likely to (falsely) believe they are immune from infection and so cannot pass the virus on to others.

On the other hand, 3% of those who said they probably/definitely have not had the virus reported three or more of the five most distinctive symptoms. If we remove the false-positives from the group who report having been infected and incorporate the apparent false-negatives, we obtain an overall symptomatic infection rate of 11%.

A different way of estimating the symptomatic infection rate is to use a statistical model called Latent Class Analysis (LCA). This is a method for detecting groups or clusters that underlie distinctive patterns of response. We applied LCA to the symptoms data, focusing on a model which identifies four clusters of symptoms, as shown in the table below.

The numbers in the cells of the table are the probabilities for the people in each class of reporting each symptom and the numbers in bold are the proportion of the sample in each class. So, for example, 20% of people are in Class 3 and people in Class 3 have a probability of 0.34 of reporting a high temperature.


The pattern of probabilities for each class enables us to identify different symptom clusters. We can label Class 1 (42% of the population) as the non-symptomatic group as they have near-zero probabilities for every symptom. Class 2 (36% of the population) display the symptoms of the common cold but not the main symptoms of COVID-19. People in Class 4 (2% of the population) have a high probability of reporting all ten symptoms, so they show strong signs of having been infected.

Class 3 presents a less clear picture. This group has moderate probabilities of the core symptoms and higher probabilities of the others. So, Class 3 seems to contain a mixture of the infected and the non-infected, but we cannot distinguish between them based on these self-reported symptoms alone. The difficulty of identifying a single distinct cluster of COVID-19 symptoms is in line with research that suggests symptom patterns are quite variable across individuals.

One way to separate out the COVID-19 group in Class 3 is to combine class membership with self-reported likelihood of having been infected. Of the people assigned to Class 3, 34% said they have definitely or probably had COVID-19 (compared to 4%, 9% and 72% of those in classes 1, 2, and 4, respectively). If we combine these respondents with everyone in class 4, we get an estimated symptomatic infection rate of around 9% – similar to the 11% we found using a more ad hoc approach.

Finally, because the Wellcome Trust Monitor survey contains lots of other information about respondents, we can compare infection rates across demographic groups. Interestingly, we find no statistically significant difference in the symptomatic infection rate between men and women, or between people with different levels of income, even though substantial gradients have been found between these groups in COVID-19 fatalities by the Office for National Statistics. It would seem, then, that susceptibility to infection by coronavirus is more evenly distributed across demographic groups than are fatalities.

One exception to this pattern is age.  Here we find that older people are the least likely to report symptomatic infection, with only 5% of the over 70s falling into this group, compared to 15% of those aged 18-29. This suggests that, while older people are most likely to die from a coronavirus infection, they are less likely to become infected in the first place. This seems likely to be a result of older people following government advice to shield themselves from infection by staying at home and avoiding social contact.

The estimates of infection we have presented here should be treated with caution. Their key strength is that they are based on data from a high-quality random sample, their corresponding weakness is that respondent self-reports of infection and symptoms are prone to errors of both omission and commission. And, of course, self-reports can only ever be informative about the symptomatic infection rate, so will miss anyone who has been infected but displayed no symptoms.

We will not know the true rate of COVID-19 infection in the population until the results of the government’s large-scale random testing programme are available. Until then, these kinds of estimates can help to give a sense of the current rate of symptomatic infection in the general population.

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Note: the above was first published on LSE COVID-19 and represents the views of the authors only. Featured image credit: by United Nations COVID-19 Response on Unsplash.

About the Authors

Patrick Sturgis is Professor of Quantitative Social Science at the LSE Department of Methodology.

 

 

Jouni Kuha is Professor of Social Statistics at the LSE Department of Methodology.

 

 

 

UK’s coronavirus quarantine in force from June 8

LONDON — People arriving in the U.K. from overseas will need to self-quarantine for 14 days from June 8, Home Secretary Priti Patel said Friday.

The new measures will apply to all residents and foreign nationals, with exemptions in place for truckers and freight workers, medical professionals working on the coronavirus response, and seasonal agricultural workers, who will be permitted to self-isolate on the property where they are working.

Those moving within the U.K.’s Common Travel Area with Ireland will also be exempt.

Those who breach their quarantine in England will face £1,000 fines or potential prosecution. While the new rules apply to the whole of the U.K., Scotland, Wales and Northern Ireland will be responsible for their own enforcement.

All arriving passengers will have to fill in a form, before they arrive in the U.K., providing contact details and onward travel plans, so that they can be contacted if they, or someone they may have been in contact with, gets the virus.

The U.K.’s Border Force will be empowered to refuse entry to non-resident foreign nationals who refuse to comply. Failure to complete the “contact locator form” will be punished by a £100 fine, and public health authorities will carry out random checks in England to ensure compliance with the quarantine measures.

Anyone who cannot self-isolate at home, in a hotel, or with friends or family, will be required to stay in facilities organized by the government. Travelers are recommended to travel to their place of quarantine in personal transport, such as a car, where possible.

The U.K. measures comes as many EU countries are rethinking their quarantine requirements. Germany announced plans to loosen quarantine rules earlier this month and Italy is set to follow. France however introduced a voluntary two-week quarantine this week.

So-called “air bridges” — agreed between the U.K. and countries with a low rates of coronavirus infection where citizens are allowed to enter without quarantine — are still being considered by the government, but no such arrangements are yet in place. The overall policy, including the list of exemptions, will be reviewed every three weeks from the date the measures come into force.

“We are introducing these new measures now to keep the transmission rate down and prevent a devastating second wave,” Patel said.  “I fully expect the majority of people will do the right thing and abide by these measures. But we will take enforcement action against the minority of people who endanger the safety of others.”

The U.K.’s plan for a quarantine regime was first announced by Prime Minister Boris Johnson on May 10. Explaining the decision to introduce the measures now — as the U.K. emerges from the peak of its coronavirus epidemic — John Aston, Home Office chief scientific adviser said: “The scientific advice so far has been clear: while there has been significant community transmission of the virus within the U.K. the impact of putting in place additional border restrictions would have been negligible to the spread of the virus.

“However, the spread of the virus within the U.K. is now lessening. We have been successful in getting the reproduction number R — the average number of new people infected by one infected person — below 1. As the number of infections within the U.K. drops, we must now manage the risk of transmissions being reintroduced from elsewhere.”

COVID-19 and the Welsh economy: an extraordinary challenge, but also an opportunity

Craig Johnson summarises some of the economic challenges facing Wales in the wake of the coronavirus pandemic. He writes that alongside these difficulties, there are also opportunities to make positive changes in order to bolster economic recovery and resilience.

The COVID-19 pandemic is having a profound impact on the Welsh economy. It is an unprecedented shock to a Welsh economy already weakened by retrenchment and austerity in the public sector following the 2008 financial crisis, in addition to the challenges posed by Brexit. The pandemic adds to these challenges and exposes existing vulnerabilities. Nonetheless, it also provides an opportunity to think about the role of state and society.

The first challenge is the length of time the recovery will take, and the resultant short- and medium-term contraction of the economy. The Welsh Government’s lockdown exit strategy, like the other UK nations, prioritises restoring economic activity and public services. But the recovery will take time and the economy will contract in the meantime. The key test will be how economic activity is restored, and the action taken now will define the future.

A second challenge is the unequal effects of the crisis, both within and between UK nations: the coronavirus will not be a great leveller. Wales has specific characteristics that set it apart from the rest of the UK. Whilst some of these mitigate against any expected downturn (e.g. a greater proportion of workers are employed in the public sector in Wales), others present distinct challenges. Wales has a higher proportion of workers on low pay and working in shut-down sectors like retail and hospitality.

A third challenge is that Wales’s economic fate is not entirely in its own hands. The tax base has dramatically reduced as a result of the lockdown, which will reduce the Welsh Government’s budget, and a crisis of this magnitude requires key, state-led economic interventions. State intervention – through job retention schemes as well as tax and welfare support – is crucial but responsibility for it largely rests with the UK Parliament. The Senedd and Welsh Government have neither the powers nor the borrowing capacity to act alone.

So, the challenges being faced are huge. Yet evidence also points to a number of key interventions that can be taken to sustain and support economic activity in the medium and longer term.

Both the Welsh and UK Governments will need to find ways to continually support people who have been made particularly vulnerable by the pandemic. As well as addressing vulnerabilities, the longstanding economic priorities of skills and infrastructure remain as important as ever. And it is clear that some businesses and sectors will recover in different ways to others.

Some businesses, such as some retail outlets, will require support while they gradually return to something resembling normal economic activity. Other businesses, such as those in the hospitality sector, will require more sustained support as a return to normal will take longer, and employees’ labour and skills cannot be withheld for that long. A small but important third group of Welsh businesses may need tailored support, such as those in rural tourist areas, which do not have an obvious alternative source of income and activity while the pandemic is being tackled.

This asks a lot of government and its capacity to effectively support the economy. Mariana Mazzucato argues that COVID-19 ‘requires a rethink of what governments are for: rather than simply fixing market failures when they arise, they should move towards actively shaping and creating markets that deliver sustainable and inclusive growth’. This would require the state to proactively drive growth, with a more explicit focus on specific sectors and places.

Adopting a version of this approach is reliant on a number of considerations. Does the Welsh Government have capacity to play such a proactive role in the Welsh economy? Do other institutions like local government have the capacity to do so? If not, how can this be created? My colleagues have already shown the debate needs to be had about local government resilience and sustainability in Wales. It also raises questions about the role of other actors, such as universities, anchor institutions, the third sector and businesses themselves. An advisory group set up by the Welsh Government is likely to be considering many of these issues.

The pandemic has also reminded us of the fundamental importance of the state. Jonathan Portes argues that it was not the 2008 financial crisis itself that reduced life expectancy and economic wellbeing for the poorest in Britain, but the underfunding of the state and welfare system that underpinned the UK Government’s austerity response in the aftermath. There is an interdependence between investment in public services and welfare, and a dynamic economy. Supporting those made vulnerable by the virus and its impacts will provide crucial employment and wealth creation opportunities, and in turn finance public services for the benefit of future generations.

These challenges are multifaceted and require a systematic and agile government response. There will be trade-offs and impossible decisions for governments to take too, and with that should come as much clarity, transparency, and scrutiny as possible. But while this is a challenge not seen in our lifetime, the evidence suggests that the pandemic also offers a key window of opportunity, and that there are responses which, if adopted, could support a more sustainable and resilient Welsh economy in the future.

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About the Author

Craig Johnson is a Research Associate with the Wales Centre for Public Policy.

 

 

 

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: by Марьян Блан | @marjanblan on Unsplash.

 

Chilly, with a touch of Frost: 22 May Brexit update

The relationship between Michel Barnier and David Frost is growing terser than ever, write Ros Taylor and Roch Dunin-Wąsowicz (LSE). Meanwhile, with unemployment rising rapidly, Britons are being encouraged to pick fruit and veg in exchange for the minimum wage and schooling for their children.

How are the talks going? Badly. Briefly: no deal looks likelier than ever.

frost
Photo: Conal Gallagher via a CC BY-2.0 licence

James Forsyth offers this insight:

After Michel Barnier’s despairing announcement last Friday setting out how little progress had been made, both sides have dug in. Chief UK negotiator David Frost said the EU’s approach was ‘perplexing’ and wanted to know why it was “insisting on additional, unbalanced, and unprecedented provisions in a range of areas, as a precondition for agreement between us”. The documents setting out the UK’s aspirations reiterate that

Whatever happens, the Government will not negotiate any arrangement in which the UK does not have control of its own laws and political life. That means that we will not agree to any obligations for our laws to be aligned with the EU’s, or for the EU’s institutions, including the Court of Justice, to have any jurisdiction in the UK.

Barnier’s reply to Frost:

I share your commitment to helping the process move forward together. I do not think,
however, that an exchange of letters regarding the substance of the negotiations is
necessarily the best way to discuss on substantial points. It cannot be a substitute for
serious engagement and detailed negotiations and, in particular, I would not like the tone
that you have taken to impact the mutual trust and constructive attitude that is essential
between us.

‘The sense of urgency around these negotiations is increasing,’ says the BBC’s Chris Morris. However, Sam Lowe thought some progress had been made when the UK admitted that there would be new admin requirements for GB-NI trade. Meanwhile, the UK has launched its ‘Global Tariff‘ to replace the EU’s External Tariff, which scraps what it calls ‘nuisance tariffs’ of less than 2% and simplifies others. Tariffs on meat and cars remain, to protect British industry. Others, such as tampons, dishwashers, screwdrivers, ground thyme, mirrors and Christmas trees have been scrapped altogether.

The Bruges Group is pleased:

The economic recovery from COVID-19 should focus on people and their skills, not just technology

Heather Rolfe argues that, while investment in technology is undoubtedly needed as part of the UK’s recovery strategy, the pandemic has highlighted our reliance on people and their skills. The government should therefore also be focusing on how to get people back into better and more sustainable work.

The coming months and years are going to be among the most challenging in our lifetime for our economy, our society, and many of us individually. Problems of unemployment, low productivity, declining competitiveness and low innovation will be hard to resolve; harm will be inflicted on people’s working and personal lives. The post-coronavirus labour market is going to be very different to the one we left behind in March.

In earlier times where a route to economic recovery has needed to be mapped, politicians have called for technology-led solutions to accelerate innovation, production, markets and consumption. Take, for example David Cameron’s 2010 ‘Blueprint for technology’. Investment in technology is of course essential, not least since the current crisis highlights the importance of science and technology in combating future pandemics.

But what the crisis has shown most clearly is how much we rely on human skills. Previously ‘unskilled’ and undervalued workers in care homes, food factories or refuse collection have been elevated to ‘key worker’ status; we applaud the dedication and skills of NHS workers every Thursday evening. The government has been forced to extend the visas of migrant health workers, but is pressing ahead with more restrictive immigration policy.

We’ve all become more dependent on the skills of others: in our work on colleagues to keep us focused, motivated and productive; in our communities to stop the spread of the virus and to look out for the vulnerable; and on our family and friends for so much more than we would have expected. We’ve learned just how much we depend on, and learn from, others to get things done. We’ve learned that other people bring out the best in us.

As we come out of the crisis, we need a recovery strategy focused on getting people back to work, into jobs that are skilled and sustainable, in sectors we want to grow. This needs to include changes to the benefits system, to local economic planning. It also needs changes to our immigration policy which looks set to hinder recovery. It needs coordinated policies and action at national and local levels. And most of all, it needs to focus on people and skills.

Our benefits system needs an overhaul

Unemployment rose by 856,500 in the first month of the coronavirus lockdown and 7.5 million workers are currently furloughed. There’s no doubt that once the Job Retention Scheme ends, many furloughed workers will lose their jobs as businesses fail to recover. Unemployment is likely to reach levels not seen in the UK for decades and, as the Resolution Foundation points out, young people are likely to be disproportionately impacted.

As Jonathan Portes and Tony Wilson have proposed, a recovery strategy, involving Jobcentre Plus, should help workers to move from declining into expanding and viable sectors. They also propose careful tailoring of the Job Retention Scheme and high-quality support from jobcentre advisers to ease this transition. For this to work, the low-grade box-ticking ‘employment skills’ courses where participants repeatedly write CVs, need replacing by real training courses, leading to technical skills and designed and delivered in partnership with local colleges and employers.

Provision might include employment support with the guarantee of a job or training, as in the Future Jobs Fund wound up in 2012. A revised scheme could create jobs and training places in sectors important to recovery and progress, and tailored to local needs. As a first and immediate step, the Flexible Support Fund, which gives advisers discretion to give jobseekers financial support for training, could be rebooted: the current maximum payment of £150 needs to be raised to train people with skills for new jobs, in new sectors.

But revisions aren’t enough. Jobcentre Plus and the support provided to unemployed people need an overhaul. Worksearch and signing on requirements have been suspended during the pandemic. While some will prefer a more hands-off approach, this leaves many without much needed help in finding work at a very challenging time. When lockdown ends, the network of jobcentres, reduced substantially in recent years, will be hard pressed to help the hundreds of thousands of new jobseekers. Real support needs to be put in place. It needs to be based on a new approach, one that puts trust in jobseekers, rather than using conditionality and sanctioning to police and to punish.

Employment support services need to be made accessible to all 

The emphasis of our welfare system on benefits and enforcement needs replacing with a support and counselling ethos. It should aim to help people into good-quality and sustainable work. As we come out of the crisis, many will need to acquire new skills; others will have reflected on their working lives and be looking for a change. A survey conducted in March found more than one in four workers believe their job lacks meaning and that most people want a job that feels purposeful. Job loss and distance from work will have exacerbated these feelings.

To help people move into jobs which use their skills, abilities, and interests, a programme along the lines of Career Learning Pilots needs to be rolled out quickly. Help should be offered to people of all ages and include tailored guidance, rather than leaflets and web pages. Particular efforts must be made to reach migrants who are more likely than others to be in jobs which under-utilise their skills. This new provision should be located in accessible venues such as libraries and shopping centres, once open. Careers guidance needs to shake off its associations with school. It needs to repurpose itself as a service we should all use at points in our lives.

We need local solutions

The impact of the virus and lockdown has been very different across industries and parts of the UK. Hotels, restaurants, entertainment, tourism, retail and transport are among the long list of sectors hit hard by lost trade. Furloughing has been much higher in the North East of England and lower in London, Scotland, and North West England. At the same time, workers in London and the South East have been more likely to have lost their jobs. These variations highlight the need for recovery strategies which take account of local needs.

In 2018, Skills Advisory Panels were set up across the UK, consisting of Local Enterprise Partnerships, chambers of commerce, employer bodies, councils and devolved governments. These should play a leading role in identifying sectors for investment and support. The Learning and Work Institute suggests job creation might be targeted at sectors hit hard by the pandemic or where growth is desirable, for example charities, local authorities, and low-carbon industries. National and local bodies need to work together to identify priority sectors for renewal and growth.

And employers are, of course, key to the success of any measure aimed at getting people back to work and into jobs where they will be productive, effective, and fulfilled. In the short-term, they can use the furlough scheme for training and development. It’s not enough to expect employees to go online; training needs to be structured, assessed and new skills put into practice or ready to do so once the lockdown is lifted.

The coronavirus crisis has put the spotlight on skills

Technology has often been posed as the solution in economically and socially challenging times. Yet COVID-19 has highlighted the importance of skills. Over decades, policies and interventions have been half-hearted, under-funded, and ineffective. But now, with millions facing unemployment, we need to find ways of getting people back into work – into better, more fulfilling, and sustainable work. Technology must, of course, be part of recovery but it isn’t the solution. It is people, their skills and abilities who will rebuild our damaged economy.

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About the Author

Heather Rolfe (@Heather_Rolfe)is Director of Research at Demos. She previously lead Employment and Social Policy Research at NIESR. Her particular areas of interest include migration, inclusion and integration.

 

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: Pixabay (Public Domain).

 

The suspension of routine inspections renders care homes invisible to scrutiny and costs lives

Alison Tarrant and Lydia Hayes explain how certain regulatory changes have led to legal standards being potentially contravened behind care homes’ closed doors. Researchers and regulators now face an urgent mission to stop such violations and save lives.

The number of people living in care homes in the UK is comparable to the population of the city of Bristol. Imagine if Bristol were ravaged by COVID-19. Imagine that 20,000 Bristolians had died in the space of just four weeks, some of them in unnecessary pain without access to sedation. Imagine the intensification of the catastrophe if Bristol were cut off from the outside world, friends or family were not allowed inside the city, and the authorities had chosen not to inspect what was happening in real time. Furthermore, imagine that the city’s population is served by hundreds of thousands of workers employed by many different private companies that now operate without scrutiny. The workers are largely untrained, have been without adequate protective equipment for weeks and are ill-equipped to give optimal care when a Bristolian contracts the virus While the hospitals continue to refuse to admit residents who are ill, and access to advice from GPs is patchy across the city, the death toll rises every day.

This analogy reflects the scale of what has happened in care homes. In the week before the UK formally went into lockdown on 23 March, the official regulatory agencies for care and support services in England, Scotland and Wales each announced the suspension of routine inspections. With that suspension, each of the regulators dispensed with the core means by which they could examine what goes on in care homes. The legal function of inspection is to establish whether the provision of care meets basic standards of safety and quality, which are set out in law and cover matters such as sufficient staff numbers, safe care practices, provision of adequate food and hydration. Without routine inspection, there has been no mechanism for systematic examination of the care being provided during the pandemic, nor the impact of COVID-19 in care settings.

Correspondence from regulators to care providers suggested the decision to suspend inspection would free care providers from bureaucracy and enable their complete focus on the safety of care. However, it has become tragically clear that care has not been provided safely. We know this by the unfolding catastrophic consequences of unsafe care. In early April, our research found that a majority of care workers said that not enough was being done to keep them safe, and neither did they believe enough was done to protect the people for whom they cared. We highlighted how widespread non-payment of wages to care workers for self-isolation was fuelling transmission risk, as well as fears about the sharing of staff between homes and confusion over availability and use of PPE. Compassion in Care has reported a massive increase in calls to its whistleblowing helpline for care and support workers, who detail dreadful conditions and truly shocking attitudes from employers towards staff who report concerns.

The consequences of disregard for care standards can be fatal and regulators are now stepping in to deal with the aftermath. On the Isle of Skye, people have called for ‘honesty’ because they were ‘kept in the dark’ about 30 residents and 29 staff contracting COVID-19 in a 34-bed care home. They want to know ‘why serious failings of care were discovered so late on’. To date, seven of the residents have died from COVID-19 and the Scottish Care Inspectorate has acted to remove registration from its operators HC-One, the largest care home provider in the UK.

In England, 11 residents have died from COVID-19 in a small 30-bed care home in Kettering which has now been ordered to close by the Care Quality Commission (CQC) due to serious concerns about safety. Relatives of the residents are ‘in shock’ after more than seven weeks of assurance by phone calls from staff claiming there was no coronavirus in the home. One relative explained, ‘to say they had not had any cases was not right. We all thought the home had been doing an amazing job by not having any cases’. The home is one of 60 operated by Minster Care Group across the UK.

There is evidence that the potential for widespread regulatory breach during the pandemic was something of which regulatory bodies were aware. For example, the CQC has pointed to the unlawfulness of any blanket issuing of ‘Do Not Resuscitate’ notices for residents. It also addresses the fears of providers about potential prosecution for serious injuries occurring when there are insufficient staff on duty. Across the UK, the regulatory consensus has been that legal standards are at risk during the pandemic and the prospect of care providers struggling to meet such standards was anticipated. Furthermore, regulatory agencies and government departments appeared to accept that breach of legal requirements was an inevitability. In place of standard practice, regulators have stressed the importance of proportional and flexible approaches to compliance and the Department of Health and Social Care introduced a new decision-making primer based on calls for ethical reflection. What has been set in train is an unofficial, but officially facilitated, evasion of legal obligations.

With friends and family excluded from visiting relatives in care homes, the suspension of inspection has hidden care practices from view and made care homes invisible to scrutiny. Although the regulators have always maintained that investigation could be triggered in response to the most serious concerns, they have been unable to rely on the ‘eyes and ears’ of visitors to raise the alarm and care workers have been frightened to speak out.

Yet, as the human rights tragedy in social care is made increasingly clear, the pendulum has begun to swing back. On 15 May, the Secretary of State announced new arrangements to connect care homes with the NHS and with local authorities to deliver ‘the most intense support and scrutiny that care homes have ever received’. In this widely criticised address, he omitted to acknowledge that prior capacity for scrutiny had been removed in early March. The enormity of care home deaths means that widespread and gross violations of legal standards are likely to come to light over the coming weeks and months. Regulators will need to reinstate their inspection function. However, the pandemic has raised fundamental questions as to the purpose and value of the regulatory law that underpins the provision of social care.

As Bob Hudson has recently argued, there is a growing and very serious charge sheet about the management of coronavirus in care settings which requires both accountability and justice. A public inquiry seems inevitable, but we should not forget that inquiries can be used to kick scrutiny into the long grass, terms of reference are uncertain, and any verdict could be years in the making. What is needed here and now is an urgent mission by regulators and researchers to understand what is going on in care settings so that violations of legal standards can be stopped and lives saved.

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Note: the authors are currently undertaking research for the Social Care Regulation at Work project, based at Kent Law School. For more information see here.

About the Authors

Alison Tarrant teaches law at Cardiff University and is a post-doctoral researcher at the University of Kent.

 

 

 

Lydia Hayes is Professor of Law at the University of Kent.

 

 

 

 

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: by visuals on Unsplash.

UK negotiator to EU: ‘It does not have to be like this’

LONDON — The EU is demanding the U.K. sign up to a “low-quality trade agreement” combined with “unprecedented” oversight of British law, and should “think again,” Boris Johnson’s chief Brexit negotiator said.

In a forthright letter to Michel Barnier — his EU counterpart — David Frost accused Brussels of demanding the U.K. sign up to obligations on state aid that “any democratic country” would reject, and called their approach to fisheries “unrealistic.”

While the arguments are not new, the language in the letter reinforces the distance between the two sides with little over six months to go before the end of the U.K.-EU agreement covering the Brexit transition.

Criticising the suggestion that the U.K. should follow EU laws because of geographical proximity, Frost said the argument “amounts to saying that a country in Europe cannot expect to determine its own rules, simply on the grounds of geography, and that it must bend to EU norms.”

“That is not an argument that can hope to be accepted in the 21st century,” he said.

On state aid, Frost also appeared to suggest that the EU’s demands could hinder the U.K.’s economic recovery from the coronavirus pandemic.

The letter came as the U.K. published a set of draft legal texts it has sent the EU in recent weeks.

“It does not have to be like this,” Frost concludes. “I remain convinced that it would be very straightforward for us to agree a modern and high-quality [free trade agreement] and other separate agreements, like those you have agreed with other close partners around the world, and that we could do so quickly.

“I do hope that in the weeks to come the EU will think again about its proposals in a way that will enable us to then find a rapid and constructive alternative way forward.”

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