LOOKING FORWARD WITH LESSONS FROM 2020

by Sherbhert Editor
New shoots from debris

Interdependence, overdependence and independence are core features of the many lessons of 2020. Covid-19(CV) took the UK and much of the world hostage, necessitating innovative reactions, rapid and significant decision making, often flying blind, and changes in lifestyle that will stay with communities for many years to come. 2020 could be seen as a year to forget but better to be seen as a year of learnings and change with the opportunity to grow in 2021 and beyond. 

BACK TO BASICS

Human frailty was sorely exposed by CV, and resulting reactions, lockdowns and distancing, desocialisation, and confrontation with death itself necessitated a focus on life’s basics. The value of family and friends, the reliance on each other, were never more obvious: and the loneliness and harms caused by the lack of human interaction have yet to be fully felt.

The essential services providing health support, shelter, food, medicines and other basics, and transport meant that the population as a whole came to rely on those who deliver these services. Dependence on people who fill the food shelves, drive the vehicles that deliver to the stores and homes, teachers who not only teach but provide care for children, freeing the parents to work, became publicly and widely appreciated. Often it has been the less well paid, whether in shops or care homes, or caring privately, who provided the lifelines. Perhaps there is a renewed respect in communities for those on whom dependence is now understood and how interdependent people are in a modern society, where everyone has a role to play if they care to. 

And in the most testing times, it is generally the less well-off who have suffered the most risk and the most infection: those who live in over-crowded accommodation, who work in lower pay sectors, who cannot work from home, such as those in the hospitality and leisure businesses. They depend on their customers who have either been barred from attendance or who simply chose to stay away, playing safe. Many became more dependent on the State as did others on the furlough scheme. They will have to be weaned off dependence and jobs will be lost, although new opportunities will arise. UK Government seems to appreciate the need to reskill people in large numbers: assuming UKGOV and local authorities, commercial businesses and those, who can train, make available that option, it will be for individuals to take up these opportunities. In the long run that could be a result which is more sustaining for those people who lose jobs in sectors or businesses which were already in decline and probably doomed to failure in the longer term.

The interdependence of people within society is now clear to all who wish to look, and that ought to result in an increased decency in respect for and treatment of each other.

GLOBAL DEPENDENCY – A STRENGTH AND A WEAKNESS

The pandemic shone a spotlight on the global interconnection of nations: the initial rapid spread of the virus from China worldwide is attributable to air and other travel joining every country in the world. Then the lesson of interdependence of nations loomed large.

 For the UK and the EU, the necessity of a trade deal, reached at the eleventh hour before Christmas day, evidences the intertwined relationship. While the UK acquired its legal independence, the closeness of the commercial and social ties with Europe ensure that they can, from a reasonable basis, forge further mutual ties and benefits. Much was said about the UK as a competitor with Europe, but that was overplayed. UK businesses compete with Continental European ones, but within the EU a business in one country competes with others in other EU countries. There is no limit to potential cooperation in the future between the EU and the UK.

Far more disturbing overdependence emerged from the needs created by the pandemic. Suddenly early in 2020, all nations touched by CV required vast quantities of PPE. The UK and others were short of ventilators. Where could PPE be obtained? Most turned to China. The naive dependence on China for a variety of medical essentials dawned on the world. Dependence for other goods became highlighted. The Western world woke up to how it had allowed China to position itself with a clear objective to dominate others. With Hong Kong being swept up and its independence stolen, and Uighurs persecuted and interned in what Beijing terms re-education centres, but which resemble more concentration camps, overdependence on China around the world became a global concern and a general wariness of its intentions is established. The UK has quickly succeeded in creating a PPE and ventilator manufacturing capability. Diagnostics and vaccine production are following. There should be a continuing rebalancing of dependencies by developed countries generally.

When the chips are down, and nations turn to look after their own first, as did a number of EU countries, to rely on others for essentials becomes a risky business. Globalisation offers many benefits but diversity of supply chains for essential goods should always be a risk mitigation exercise. Even if it makes goods more costly, some domestic capability and spreading reliance should be a focus from the lessons of 2020.

TIME TO DISCUSS THE UNMENTIONABLES

In this politically correct world, many topics have been taboo, elephants in the room, often obscured or ignored for fear of retaliation, accusation and cancellation by twitter or otherwise which may result.

DEATH is a topic usually avoided. But the reaction in the media to the pandemic put death on top of the list. Daily death counts, interviews each day, still happening, with a grieving relative who lost someone close due to CV, or occasionally due to another undiagnosed cause indirectly brought about by lack of care due to CV, are regular media fare. It is as if death is somehow unacceptable, and yet it is the one inevitable certainty. Keeping people in existence seems to be, for some at least, a sacrosanct objective, irrespective of how old, dependent and demented they may be: there is an impression that perhaps even the State, UKGOV, has some duty to save everybody from this inevitability, which is patent nonsense. Before CV, in the UK on average some 11,500, mostly elderly, people died each week and quite rightly there was rarely a mention of a single one of these people or their grieving family, who certainly would not be interviewed. It was only celebrities or people who died in dramatic circumstances, who got a mention. CV deaths have perhaps become a disproportionate media obsession. However, perhaps publicity has meant people may consider death and come to terms with death more readily, while not lessening the grief of any single loss. Perhaps too, the death threat has been overused or abused by some in authority wanting to create a climate of fear to get the public to behave compliantly. Should not honesty prevail by recognising that the death of people in their eighties or nineties is often not a catastrophic event, especially when compared to the destruction of young lives? That recognition might make authorities’ decision analysis more objective, instead of being driven by fear of the accusatory finger.

THE NHS, its faults and funding, its culture and performance have always been political taboo, as to provoke discussion and perhaps change is again simply to risk a deluge of abuse and protectionism for this sometimes over-glorified institution. To stop the NHS being overwhelmed has been an important objective, and the reasons are obvious. So many individuals providing healthcare in the NHS to CV affected people have worked so tirelessly, often at personal risk, and achieved great things, looking after the ill and no doubt saving many lives. Applause resulted.

 The pandemic has revealed that the NHS can innovate and cooperate, improving many practices which might never have happened but for CV. Some GPs have performed well, but invisibility and unavailability for personal consultation is a regular criticism. Effective closures of GP practices were extraordinary. That so many people caught CV when in hospital indicates a need for changes. Weaknesses in NHS procurement and distribution have been revealed, and the armed forces may have saved some blushes when it comes to project management. A reluctance of public health management to let others help may have been costly, such as in the failure to use private laboratories. Many say that Germany’s health services performed more effectively than the UK, due to its localised structures and mixed private and public elements. Untreated illnesses and unmade diagnoses in the UK are it seems in the millions, which must be due to a failure of some description. Will lessons be learnt, and improvements made to avoid that ever again? While UKGOV bears most of the aggression and criticism for health failures, much must lay at the door of the senior management of the NHS who have had to put heads above the parapet occasionally during the pandemic but not nearly enough. When they have, dynamism and an ambition for improvement has not shone out. There are many lessons for the NHS which should embrace improvement. 

The UK is too FAT. People with underlying health conditions are considerably more at risk of serious CV consequences than others. Obesity, and diabetes so often caused by obesity, is now openly and regularly discussed as a major health problem in the UK with a new seriousness.

It is now a UKGOV agenda item to fight obesity and the pandemic has given the subject a necessary and urgent impetus. Not nearly enough is yet being done at that level, but Government cannot impose a change of culture towards consumption of rubbish foods and drinks, and reluctance to exercise, which underly the problem. Education on diet and cooking, and the dangers of over-processed foods are vital. UKGOV can build a framework of incentives and education for people and businesses but to place the blame, as is done for so many things wrongly, at the State door diverts from the real remedies and so should be put in perspective. However, food and related businesses must take an honest approach and put health of consumers first which they manifestly do not now do. Is it not for the individual to accept their personal responsibility for their actions, and parents to recognise that by fattening up the young they condemn them to possibly shorter, and almost certainly medically challenged, lives? Maybe GPs will adopt the remedy of good diet and exercise, facing up to the patient’s problem with consumption and physical laziness. Employers can play their part too. Schools of course are vital in instilling a culture of health and awareness of how children can care for themselves: but family and friends will be the best influences. The momentum in this war on obesity needs to be maintained and multiplied, as a national priority.

LOCAL NOT CENTRAL IS SOMETIMES BEST

Of course, many activities must be directed by UKGOV from the centre. But the pandemic perhaps has demonstrated a case for considerably greater responsibility to be given and taken at a more regional and local level. During 2020, neighbours and communities have perhaps overall become closer, with assistance being readily and selflessly offered to those at greater risk from CV or less able to self- help. UKGOV has made available vast sums to ameliorate hardship, and while there will be differing views on the efficacy and direction of the spending, as not all damage can be mitigated, it cannot be maintained that UKGOV has stinted in applying resources to problems.

However, the central machine has too much to do, and cannot be involved at every level. It needs to let go. Overall policy and guidance on protecting against CV can come centrally, but detailed roll-out is often best controlled and managed at a local level. For example, how an individual school handles CV and protects its children and staff, or how it delivers education, has to take account of its demographics, wealth, resources and children’s needs: it is the local authority and the school which should decide and implement the detail. Similar principles have been shown to be best applied to testing and tracing for CV, rather than commands flowing from London. Best practices can then be tailor-made for the needs and idiosyncrasies of the community concerned. Perhaps this culture of local over central might prevail more widely in years to come. If a local community owns a problem, it is surely more likely to implement solutions than if merely ordered by some civil servant in Whitehall without respectful consultation.

LEARNING THE LESSONS AND GRASPING THE BENEFITS

THE UK, and many Western countries, have made many mistakes in dealing with CV, unsurprising given it was unheard of till early 2020, and the script has been written while the play was performed. Is not the value of mistakes that learning is the result? So that is a way to treat them, not to dwell there wishing “if only” what might have been. Should we not take all the lessons and improve? Consider the following propositions:

  • The EU/UK trade deal is done: constant harking back will be destructive when a world of opportunity always beckons
  • The Oxford/AstraZeneca vaccine may be the weapon to defeat the virus worldwide
  • With that vaccine potentially spiking the CV guns perhaps by April 2021, a newfound freedom could lead to a surge in enthused activity
  • The UK was deemed the most advanced of 195 countries in its laboratory research capacity, its real-time surveillance and reporting of disease and its commitment to the sharing of genetic and biological data and specimens” (The Sunday Times of 27 December recording the conclusions of a panel of 21 global health experts who examined the world’s preparedness for infectious disease outbreaks)
  • The UK economy is predicted by some soon to return to pre-pandemic levels possibly by the end of 2021
  • The UK’s GDP is forecast to exceed that of France by 40% by 2035 (Centre for Economic and Business Research)
  • The UK is the innovative technology investment hub of Europe and innovation is the future
  •  The UK has the real opportunity to be a leader in carbon neutral energy and a champion of climate change.

If the lessons are learnt and propositions such as these are valid and embraced, then UK optimism is justified, and 2021 should be a launchpad for improvement and change out of the debris of 2020.

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