Archive for the ‘NHS’ Category

How effectively have governments responded to COVID-19 so far?

Theologos Dergiades, Costas Milas, and Theodore Panagiotidis take stock of how governments across the world have dealt with the pandemic. Their research provides further evidence of a strong relationship between the eventual number of deaths and the strength and timing of government interventions.

The spread of COVID-19 seems to be slowing down in many countries. Governments have employed a number of measures to reach this stage. In economic terms, month-long lockdowns are pushing the world economy into recession. The OECD predicts that each month major economies spend in lockdown will remove two percentage points from the annual GDP growth. The International Monetary Fund predicts that global growth will fall by 3% in 2020. The Bank of England forecasts that the crisis will result in the deepest UK recession in 300 years. In fact, the situation appears so grim that the Bank of England is considering negative interest rates for the first time ever.

At the same time, research flags the damaging effects caused by the lack of mitigation actions for the economy – as the infection spreads to workers, failure to mitigate its peak may trigger very large upfront costs in terms of output, consumption, and investment.

In new research, we used daily data on COVID-19-related deaths for 32 countries between January and April 2020 to assess the relationship between deaths and government interventions. Using statistical tests, we were able to identify a break in the growth rate of deaths country by country. Our findings suggest that for the UK, the ‘structural break’ in the growth rate of deaths occurred on 3 April; between one and two weeks after that for other European countries including Italy, France, Spain and the Netherlands. We also estimate that deaths in the UK grew by an average of 21.6% per day up to 3 April, after which it was suppressed to zero.

We then assessed the impact of government interventions on the average growth rate of deaths. To do so, we used the Oxford COVID-19 Government Response Tracker (OxCGRT) index which quantifies the stringency of policies adopted across the various countries. The index on any given day and country is the average of nine sub-indices: school closures, workplace closures, cancellation of public events, restrictions on gathering size, closure of public transport, stay at home requirements, restrictions on internal movement, restrictions on international travel, and public information campaign. Each of these takes a value between 0 and 100, with a higher value indicating more stringency.

As seen in Figure 1, stringency measures in China increased steeply in late January 2020. Among other countries, stringency measures in Italy increased significantly in late February. Only after that followed Spain, France, the UK and the US.

The countries are: Argentina (AR), Austria (AT), Belgium (BE), Brazil (BR), Canada (CA), Chile (CL), China (CN), Denmark (DK), Egypt (EG), France(FR), Germany (DE), Greece (GR), Indonesia (ID), Iran (IR), Ireland (IE), Israel (IL), Italy (IT), Japan (JP), South Korea (KR), Malaysia (MY), the Netherlands (NL), Norway (NO), Panama (PA), Philippines (PH), Portugal (PT), Saudi Arabia (SA), Spain (ES), Sweden (SE), Switzerland (CH), Turkey (TR), United Kingdom (GB) and United States (US).

Using this index, we were able to confirm that the greater the strength of government intervention at an early stage, the more effective it was in slowing down or reversing the growth rate of deaths. Figure 2 shows that countries like the UK and the US, who were late in their response, register only a probability of 0.3% (or lower) of ensuring an insignificant growth rate of deaths as the outbreak evolved. This explains why these countries are still registering more deaths compared to others. Sweden, which adopted a far less stringent approach towards the pandemic, registers a 0% probability of slashing the growth rate of deaths.

In contrast, by acting swiftly and decisively, Greece registered a much higher probability of maintaining an insignificant trend in deaths compared to other European countries. At 27%, the probability of maintaining an insignificant trend in Greek deaths related to COVID-19 was notably higher than the corresponding probability of 13% in Italy and 8% in Germany, for example.

Much remains unknown about the effectiveness of individual interventions, such as school closures. Overall, however, our results suggest that the number of deaths related to the pandemic can be limited by strong government measures taken as early as possible. Norway, one of the first countries in Europe to impose a lockdown on 12 March, recorded a 98% probability of achieving an insignificant trend in COVID-19 deaths according to Figure 2. Contrast that with the UK which only introduced lockdown restrictions on 23 March and consequently recorded a 0.3% probability of achieving an insignificant trend in deaths. There is obviously a tradeoff between acting as early as possible to save lives and the adverse impact early interventions can have on the economy. This is an unresolved issue that merits proper empirical research.

Other issues that need to be investigated include the actual number of deaths related to COVID-19. Ongoing research by The Financial Times suggests that global deaths linked to COVID-19 may be 60% higher than currently recorded. In addition, further Financial Times analysis suggests that the UK has recorded the highest rate of death among 19 countries that produce comparable data. The UK government’s decision to implement a ’test and trace’ approach might go some way towards dealing with additional waves of the outbreak but it is not a panacea – not least because it remains unclear when the system will become fully operable and how exactly it will work.

What is clear to us is that early and strong interventions do save lives. Therefore, the UK should not hesitate to move fast by imposing another national lockdown if outbreak signals are received by the government’s Scientific Advisory Group for Emergencies.


Note: the above draws on the authors’ paper available here.

About the Authors

Theologos Dergiades is Lecturer in the Department of International & European Studies at the University of Macedonia.



Costas Milas is Professor in the Management School at the University of Liverpool.



Theodore Panagiotidis is Associate Professor in the Department of Economics at the University of Macedonia.




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 Vincent Ghilione on Unsplash.

Abolishing the NHS surcharge for health and care workers is not as generous as it sounds – a pay rise is needed

The government was recently been forced to re-think its plans to continue charging workers in health and social care for using the NHS. But how many pay the surcharge and how much would it cost to abolish it? In answering these questions, Alan Manning explains why the gesture is not as as generous as many might think; more needs to be done to address the poor pay and conditions in this sector.

Currently, most migrants from outside the EEA who are on a visa of six months or more have to pay the Immigration Health Surcharge, which starts at £400p.a. though an increase to £624 is planned for October. This includes workers in the NHS and social care on whose work we have all depended in the pandemic.

Understandably, levying this charge on these workers at this time seemed to many a lack of generosity of spirit. The government, after some delay, has eventually decided to exempt workers in NHS and social care, seemingly permanently. But how generous is this gesture depends on how many migrants in these sectors are actually paying this charge. It is hard even for the government to answer this question because many of the relevant migrant workers are not on work visas, so the Home Office would not know what work they are doing. But here are some rough estimates:

Table 1 shows the fraction of UK-born, EEA-born, and non-EEA-born migrants in the sectors of ‘Human Health Activities’ (including but quite a lot wider than the NHS) and ‘Residential Care Activities’.

These figures come from the Labour Force Survey are a bit different from some other sources.  The migrant shares are much higher in some parts of the UK, notably London. EEA migrants do not pay the surcharge (but new arrivals will do so in the future under the government’s plans). Not all non-EEA migrants do either – it is only those on visas, essentially those who do not have permanent leave to remain in the UK. Those who have become UK citizens do not have to pay.  In health, 63% of non-EEA migrants report being a UK citizen; in care it is 46%.

Even among non-EEA migrants who are not British citizens, those with settlement do not pay. It is harder to estimate this proportion but one indication is length of time in the UK. For non-EEA migrants who are not UK citizens, the distribution of time in the UK is reported as:

Half of this group have been in the UK more than ten years when other data sources suggest most migrants will have settlement (though there are always exceptions). In fact, many of those coming under the family or work route (common in these sectors) will have settlement after five years. It seems likely that no more than half of the non-EEA migrants who are not UK citizens have to pay the charge.

These estimates imply that in health, only 2.1% of workers are paying the surcharge, 12% of migrant workers in the sector. In total, this is 50,000 workers though this includes many who are not in the NHS. Assuming each worker has an average of one dependent who also have to pay the charge (a high estimate I suspect) the total amount it will cost to waive the charge in the health sector would be about £41m annually. For the care sector, the estimates imply that 3.8% of workers are paying the surcharge, 18% of migrant workers in the sector. This amounts to about 39,000 workers paying £31m in the charge.

So, the total cost is estimated to be at most £70m annually and I again suspect this is an over-estimate. A nice gesture, and important for those who currently pay the charge, but perhaps not as generous as many might think.

When Boris Johnson says the charge has raised £900m, he may be summing over many years and including everyone who pays the charge, most of whom are probably students. To exempt health and care workers would cost very much less.

There is a flip side to this coin, however. It costs little because fewer workers in these sectors than many think are paying the charge, even among migrant workers. For those that do pay it, waiving it or abolishing it is an important gesture but perhaps we need to do more to thank workers in these sectors, both migrants and the UK-born.

My suggestion would be to make a start by immediately raising the pay of care assistants. Some supermarkets have already paid bonuses to their staff and the Welsh Government has promised a one-off £500 bonus for care workers. The UK Government has spent plenty of money on other things. But it should be a permanent rise in salary, not just a one-off bonus. That may necessitate resolving the problems of financing the sector, but everyone knows this needs to be done. The poor pay and conditions in this sector were a national scandal before the pandemic and the primary cause of the high level of vacancies. Raising the pay of care assistants would not just be an appropriate gesture of thanks for the present but a good investment for the future.


About Author

Alan Manning is Professor of Economics at the LSE and an Associate at LSE’s Centre for Economic Performance.




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 Stephanie Martin on Unsplash.

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