Leicester lockdown set to heighten suffering of 25k children

A charity has warned that the Leicester lockdown is set to heighten the suffering of 25,000 children living in poverty, the city is among the top of the 20 per cent most deprived areas of England, says Save the Children.

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More than 25,500 children live in poverty in Leicester – and the extended lockdown will exacerbate the suffering of thousands of families in the city, a leading charity has warned. Deprivation in Leicester is expected to rise, Save the Children said, after new restrictions were enforced following a surge in Covid-19 cases.

The city council reported 944 positive tests in the two weeks to 23 June – about one in 16 of the total UK cases during that period – while hospital admissions for coronavirus have crept up to between six and 10 a day.

Amid the government’s decision to place Leicester back into lockdown, with all schools and nonessential shops closed, concern has been raised over the continuing struggles of the city’s poorest children.

Leicester is among the top 20 per cent most deprived areas of the country, and children in the city are over four times more likely to be living in poverty than those in wealthier areas of England.

More than a quarter of children in Leicester (27 per cent) live in poverty before housing costs are taken into account. Save the Children has warned that without urgent intervention, the high level of child poverty could rise, pushing families even further below the breadline.

Recent research by the charity, alongside the Joseph Rowntree Foundation, found that families on universal credit and child tax credit are struggling to afford food and basic utilities, such as gas and electricity, with two thirds sliding into debt since the start of lockdown.

With the lockdown measures extended in Leicester, families on low incomes will be forced to struggle for even longer. Save the Children has called for a £20-a-week increase to the child element of universal credit and child tax credit to help the poorest families. Those on universal credit currently receive £235.83 per child per month.

Becca Lyon, head of UK poverty campaigns at Save the Children, said: “Life in lockdown has already been extremely tough for families and their children, and it’s not right that it is the poorest who are being hit hardest.

“Further local lockdowns mean families face several more weeks of being unable to go to work or send their children to school, resulting in even more time without an income. We need urgent action to support struggling families – a £20 a week increase will give families with children the lifeline they need to pull them through these difficult times. “By taking action now, we can prevent increased child poverty from becoming a damaging legacy of this pandemic, which has already caused too much suffering.”

Other cities and towns said to be at risk of local lockdowns include Bradford, Barnsley, Rochdale and Oldham, all of which have some of the highest rates of deprivation in England. More than 100,000 children in these areas are already living in poverty and could be at even greater risk if lockdowns are extended, Save the Children added.

Research by Loughborough University, published earlier in the year, showed that child poverty in the UK has increased by 2.8 per cent in the last four years. Experts involved in the study warned that this figure will grow for the entire country as a result of the pandemic.

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Domestic Abuse Bill: Glaring holes mean women will still have no escape route

Campaigners claim the Domestic Abuse Bill has glaring holes, which means women will still have no escape route from violence. “Glaring holes” in the landmark Domestic Abuse Bill mean many women will still have no escape route from violence or being killed, campaigners are warning, ahead of crucial votes next week. – The Independent 

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Ministers are being urged to make urgent changes to the legislation – championed by Theresa May – when it returns to the Commons next week, to give proper protection from partners or stalkers.

The bill has been beefed up during a protracted three-year journey, creating a legal duty on local councils to provide refuge spaces and halting cross-examination by abusers in courts. But women turning to community health services for help, those stalked at work and – most alarmingly – migrant women will continue to fall through the cracks, it is feared.

Jess Phillips, a Labour MP and key campaigner, revealed police officers are paying for abuse victims to stay in hotels “out of their own pockets” because victims are denied help under the harsh no recourse to public funds (NRPF) rule – a bar that will remain in place. “These are often the hardest cases, involving the highest risk victims – they end up being the names [of murdered women] I read out in parliament every year,” Ms Phillips warned, speaking to The Independent.

“The pledge to reduce domestic homicide will not be served until these gaps are filled.” The charity Women’s Aid also called for the NRPF rule to be axed and for a duty on health professionals to provide vital support, saying: “Only one in five survivors calls the police.”

In March, in what has become a grim annual event, Ms Phillips named more than 100 women murdered by men in the past year – taking more than four minutes to do so. What she calls an “epidemic of male violence against women” prompted the Domestic Abuse Bill, to increase prosecutions and eradicate a postcode lottery in the way victims are dealt with by police forces.

The last prime minister called it a personal priority, but it was delayed three times, by the general elections in 2017 and 2019 and by Boris Johnson’s illegal shutdown of parliament last summer.

It will finally clear the Commons on Monday, creating a new domestic abuse protection order to make it easier to take out restraining orders in abuse cases stopping short of violence, or the threat of it.

Campaigners are also delighted by the legal duty on councils to provide refuge services, that the homeless will be a priority, and by the changes in family courts, including to ensure victims and alleged attackers do not share spaces. But there are huge concerns over funding and whether an estimated £173m required for a proper national network of refuges will be made available.

And Ms Phillips said she was still urging ministers to go much further in three areas:

  • To require health and other community services – which are approached by 70 per cent of abuse victims – to provide refuges
  • Better protection at work – arguing a majority of women with stalkers report they “use workplaces to control them”, and describing a promised review as “a way of kicking this into the long grass”.
  • An end to the NRPF policy – to ensure “immigration status does not decide if a woman gets support”.

The Birmingham Yardley MP explained: “If you are here on a student visa, or a work visa and you have no recourse to public funds, you will not be entitled to go into a refuge.

“When you’re a victim and you’re standing in front of a police officer, or a housing officer, or a doctor, the level of support they will be able to find for you that night – for you to be safe from harm – will depend on what stamp is in your passport.

“The police would have to say, ‘I’m afraid you are going back to your house tonight.’ Loads of officers have written to me saying this is a massive problem.” And she pleaded with ministers to concede further ground, saying: “I will never give in – I will blame them for every migrant woman murdered.

“The bill now is in much better shape than when it started, but still has some glaring holes in it.” Nicki Norman, acting chief executive of Women’s Aid, echoed the criticism that the bill badly needed more work.

“For many survivors, health care settings are one of the few places that they feel safe to disclose domestic and sexual abuse and seek confidential support without the perpetrator present,” she said. And she added: “Migrant women with no recourse to public funds face insurmountable barriers to accessing support services, including a refuge space, which is paid for by housing benefit.” But the Home Office said it was “working hard to support migrant victims, including investing £1.5m to help them access safe accommodation”.

“The Domestic Abuse Bill is a game-changing piece of legislation that will transform how we deal with this horrific crime and will ensure that victims of domestic abuse and their families are supported and protected while perpetrators face justice,” a spokesperson said. “For those in the workplace, protection orders can support anyone struggling, and the government has launched a review of support in the workplace for victims of domestic abuse.”

Ellie Butt, head of policy at the charity Refuge, welcomed “the potential to transform the response to domestic abuse”, but called for exemptions from repaying universal credit advances.

“Making sure that the benefits system works for women fleeing domestic abuse is one of the most important changes the government can make to protect survivors,” she argued.

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Anyone who requires help or support can contact the National Domestic Abuse Helpline which is open 24/7 365 days per year on 0808 2000 247 or via their website https://www.nationaldahelpline.org.uk/


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Coronavirus: Why disabled people are calling for a Covid-19 inquiry

 

Ginny Butcher
As a disabled woman, Ginny Butcher is roughly 11 times more likely to die from coronavirus than her peers. New figures also suggest almost two-thirds of Covid-19 deaths in the UK have been disabled people. There are now calls for an inquiry.

Ginny is a 22-year-old wheelchair user who needs two personal assistants with her at all times. She is at high-risk of coronavirus and is still shielding at home.

She has a ventilated tracheotomy and says she’s been “extremely anxious” during lockdown because there has been “zero guidance” on what to do if any of her assistants became ill or had to isolate.

She points to the impact of the Coronavirus Act – the emergency legislation the government passed at the beginning of lockdown – which took away significant parts of councils’ duty to provide care for disabled people.

Critics said it gave councils – who previously had an obligation to provide certain care – the power to “downgrade” provisions for disabled and elderly people.

‘We’re being abandoned’
“Disabled women were left wondering how they were going to get out of bed in the morning,” Ginny says. “With much less care, women were forced to venture outside to get groceries and other essentials, putting themselves at risk.”

Those who do have care support have “struggled immensely” to get vital personal protective equipment (PPE), she adds, saying this puts both carers and disabled people at risk.

Ginny couldn’t get any PPE for the first eight weeks of the crisis, despite being on the government’s list of people who are clinically vulnerable to the virus. “It has been my biggest concern throughout this crisis,” she says.

It comes as the latest ONS figures showed more than 22,000 disabled people died from coronavirus, from 2 March to 15 May, making up two-thirds of all deaths.

The statistics suggest working-age disabled women like Ginny are more than 11 times more likely to die from coronavirus than their peers. For disabled men, the death rate was 6.5 times higher than non-disabled men.

“I’m not surprised at all”, says Ginny. “Hardly anything has been done to protect disabled women. In fact, the opposite is true. Disabled women are being abandoned and left to die.”

The ONS analysis suggests that much of the disparity is caused by social and economic factors, such as “region, population density, area deprivation, household composition… and occupation”.

Inequalities have been shown to disproportionately affect disabled people. But Chris Hatton, professor of public health and disability at Lancaster University, highlighted two key factors.

He says disabled women, and disabled people in general, are also more likely to have other health conditions that can increase their risk of dying from coronavirus. People with learning disabilities are disproportionately likely to be obese, have diabetes, or have kidney disease, he adds.

Crucially, he says people with learning disabilities often develop those conditions at a relatively young age, which could explain why the difference in death rates is particularly pronounced when it comes to young disabled women.

The second factor, Prof Hatton says, is that disabled people often have their health concerns overlooked and diagnoses are often delayed because new issues are assumed to relate to existing disabilities, rather than a new condition.

‘We feel gaslighted’
Those same issues have spilled over into discrimination in coronavirus treatment. At the end of March, the National Institute For Health and Clinical Excellence (Nice) published guidance which appeared to recommend prioritising coronavirus patients based on a “dependency” scale .

People who were highly dependent on others in their daily lives would be the first to be denied intensive care in the event that units became overwhelmed, regardless of whether they were clinically less likely to survive.

While hospital ICUs never exceeded capacity and the guidance was partially rescinded, Prof Hatton says it badly damaged confidence among disabled people.

“Medical professionals do not listen to disabled women, and often gaslight disabled women into thinking that they are not sick, unwell or in pain,” Ginny adds.

“I’m not surprised that disabled women are failing to receive the medical treatment that they need.” Ginny says more needs to be done and disabled people’s organisations agree.

“It feels like there has been a systemic failure to understand and address the needs of disabled people”, says Mike Smith, a former commissioner of the Equalities and Human Rights Commission, who is now chief executive of disability charity Real.

He says an inquiry needs to look at all the “structural inequalities” disabled people face. “All the way through this pandemic there has been a narrative to the wider population: don’t worry, it only affects older people, and those with pre-existing conditions – as if, somehow, the value of those people’s lives was less.”

Leading charity Disability Rights UK agrees.

“We would want to know whether there are things that could have been done differently, such as earlier provision of PPE, earlier provision of testing, speedier diagnosis, access to critical care – as well as tackling increased isolation,” says the charity’s policy manager Fazilet Hadi.

A Department of Health and Social Care spokesperson said the government was “determined to take the right steps to protect” those who are most vulnerable to the disease and “minimise their risk”.

“More than two million people have been identified as clinically extremely vulnerable and we have provided guidance to GPs and clinicians so they can add people to the shielded patient list, as they are best placed to advise on the needs of their individual patients.”

The department said the care provisions implemented in the Coronavirus Act are only intended to be used when absolutely necessary and should be temporary.

There are no plans to extend shielding for extremely vulnerable people beyond the end of July but Public Health England continues to monitor the effects of the virus on different minority groups, the department said.

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Universal Credit: A decent society would not allow this scandal to continue

Recent changes to Universal Credit have been welcome, but more work is needed to address flaws in the system that are pushing people into debt, writes Laura Robertson.

Our social security system was designed to be an anchor to provide stability during hard times. With three million people now turning to Universal Credit, we can no longer ignore the reality that our system of social protection is in urgent need of repair.

In a decent society, it cannot be right that people are relying on friends, family and food banks to meet their basic needs.

Two reports released in the last two weeks add to the already significant body of work detailing the flaws in Universal Credit.

First, the Commons Work and Pensions Committee made a host of recommendations to reform the social security system, including ending the five-week wait for the first payments of Universal Credit, and ensuring anyone who’s been left worse off by the move to Universal Credit during the pandemic should be allowed to move back to the benefits they were previously on.

Then, last week, the Joseph Rowntree Foundation published research carried out by Poverty Alliance and the University of Glasgow which detailed the anxiety and hardship last year’s initial roll-out of Universal Credit had on people in Glasgow.

Recent changes to the system – particularly the £80-a-month uplift – are welcome but, with more people than ever relying on Universal Credit, we need to ensure the system supports people. As a researcher on the report, I interviewed claimants new to Universal Credit alongside Jobcentre Plus staff and other people involved in supporting claimants in Glasgow.

It is now widely reported that Universal Credit pushes people into debt. The five-week wait for claimants to receive their first payment after being granted the benefit leads to long-term financial hardship as claimants struggle with deductions for rent arrears and repayments of advance loans.

Lack of internet access

One woman we interviewed, Kirsty, was struggling every day to get by financially, due to deductions for an advance payment and fuel debt. She described having to alternate between borrowing money off her sister and father and going without basic amenities like home internet access.

Our research, conducted before the crisis, also revealed that the Universal Credit system was failing to provide the individual support needed for claimants to find employment.

Jobcentre staff shared the strain they were under as they tried to manage an increase in more complex cases. Many people were reliant on phones to conduct the required 35 hours a week searching for jobs, with the costs of wifi and data adding to their worries.

Navigating the system is more straightforward for people who are confident with and have easy access to IT. This is not the case, however, for many claimants who lack IT literacy or access.

The Department for Work and Pensions has stated that during the pandemic claimants are not expected to look for work. However, with many sectors due to reopen in the coming month, the likelihood is that claimants will soon be expected to provide evidence of up to 35 hours of job-search activity a week again but amid levels of unemployment not seen since 1947. This will be unnecessarily stressful for claimants and will only add to the pressure on Jobcentre staff as they police an ultimately futile search.

Searching 35 hours a week for a job without success

Whilst many of the people we spoke to had positive relationships with their work coach, they did not feel that they had adequate support to find a job. A conditionality-based system based on quantity of job-search activity rather than quality is not a supportive one. It will come as little surprise to anyone who has ever been unemployed, that everyone we spoke to felt that 35 hours a week of job search was unrealistic. As one interviewee put it, “If you job searched for 35 hours, and you’re not getting a job, I’d guarantee within a month you’re going to have depression.”

Whilst Universal Credit is a reserved benefit, variations in Scotland, called “Scottish Choices” offer some positive options for claimants north of the Border. Many of the people we interviewed in Glasgow were scared of losing their homes, so the ability to have their rent paid directly to landlords was welcome. Conversely, despite claimants struggling between monthly UC payments, take-up of the option to receive payments twice a month was low. With the bi-monthly payment option, payment dates fluctuate every month leaving claimants with a sense of unpredictability.

Our report provides a list of recommendations and actions for the all those involved in delivering Universal Credit in Scotland.

Most importantly, the UK Government must increase the value of payments so they reflect the cost of living and end the deeply unjust five-week wait. The crisis has highlighted just how crucial our social security system is in keeping us afloat; it is only right that we redesign it so that it protects all of us. 

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Where to go for benefits help


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The Economy before Your Health

Boris Johnson rules out furlough extension claiming it’s ‘stopping people from working’

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FURLOUGH has been criticised by the Prime Minister Boris Johnson, as he has said the retention scheme must draw to a close in October to kick start the economy.

Furlough was introduced by the government back in March to provide the British workforce with additional financial support. The turbulence brought about by COVID-19 meant many businesses were forced to close their doors, leaving people unable to work. In order to avoid mass unemployment, the Treasury introduced the Coronavirus Job Retention Scheme (CJRS), otherwise known as furlough.

New furlough rules today – what this mean for pay and working hours
It provides workers with 80 percent of their salary up to £2,500 a month, as well as currently covering National Insurance and pension contributions.

The scheme was originally intended to draw to a close in July, however it was extended to October after a surge in demand. However, some have said the government may be able to do more with protections.

There have been calls to further extend the scheme, even into 2021, to ensure workers are protected. The Prime Minister, however, has slammed this prospect, issuing a “very, very blunt” warning the scheme will have to draw to a close.

In an interview with the Evening Standard, Mr Johnson said: “We’ve spent £120billion supporting people, it’s a huge commitment and we have put our arms around people.

“But I think people need to recognise that the particular restrictions that furlough places on you are not, in the long term, healthy either for the economy or for you as an employee. “You are keeping people in suspended animation. You are stopping them from actually working. “I am being absolutely frank with you, we are pushing it out until October, but in the end you have got to get the economy moving.”

In early June 2020, it was revealed by the Treasury that some 8.9 million workers had been placed on furlough across the country. The cost had spiralled up to £19.6billion by that point in time, with the sum expected to rise over the coming months.

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two fingers to your health

In fact, although furlough is now estimated to cost the government less than originally expected, the figure is still substantial.

Furlough extension: Could furlough extensions be considered?
The Office for Budget Responsibility estimated in June that the gross cost of furlough would climb as high as £60billion.

This appears to signal towards the financial strain Mr Johnson referenced, and emphasises the need for a return to the status quo, for the sake of the economy.

The furlough scheme is set to change over the coming months, with the first major modification occurring at the start of this month.

On July 1, employers were permitted to bring back their workers on a part time basis on full pay, with these individuals on furlough pay for the remainder of the time. Until the scheme ends, employers will be required to take on more responsibilities, but employees should be unaffected in terms of pay.

In August, employers will be required to take on their first set of responsibilities in the form of National Insurance and pension contributions, while the government continues to pay 80 percent of salaries.

The significant change comes in September, where the government will drop its contributions to 70 percent, with employers expected to cover 10 percent of furloughed salaries. Finally, in October, the government will again reduce contributions to 60 percent as Britons are gradually eased back into work.

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Review of benefit rules for terminally ill still not complete

Drew Hendry MP.
Drew Hendry MP.

Money to burn!

When I saw this title I thought of all the [unknown] billions that the DWP has wasted inflicting cruelty on the sick, disabled, jobless, homeless, rape victims, single parents and they didn’t care about the collateral damage.

Court case after court case has been won, at WHAT cost? THEY DON’T CARE BECAUSE IT’S NOT THEIR MONEY!!

Universal Credit has to be the biggest of money, I don’t think we’ll truly know how many billions have been lost on that! Suffice to say the DWP has money to burn


DWP wasted £10m on failed IT projects last year!

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The Department for Work and Pensions (DWP) had to write off more than £10m of taxpayer money on failed IT projects in the past year, according to its newly published annual report (PDF).

The wasted cash was spread across three costly duds. Accounting for the biggest share was the health transformation programme, which frittered away £4.8m on a contingency IT solution to support Personal Independence Payment assessments, in the event that a new platform wouldn’t be available in time for a transition.

However, work on this contingency solution was halted when it was realised the new digital platform would be ready for transition from March 2020.

DWP publishes digital delivery results and cost of IT blunders

A loss of £3.1m was also recorded for a deal with Computacentre for the purchase of ‘Remote Secure Access and Secure Web Gateway’, a cloud based software service from Palo Alto Technologies. According to the report, which was first spotted by Computer Weekly, it became clear after purchase that the service wasn’t able to support the number of necessary users.

Finally, the “fruitless payments” section notes a misfire on signing up to cyber security product Microsoft Defender Advanced Threat Protection (MS Defender). The report notes that over time it became apparent that MS Defender wasn’t compatible with aspects of the Department’s IT environment and had to be abandoned, but unfortunately not before costing the department (and the taxpayer) £2.8m. Altogether, the wasted cash totals £10.7m for IT projects.

The department highlighted the aims of 2019-20 IT projects, which included enabling transformation, improving stability and performance of digital systems, strengthening cyber security, and building a future digital approach in addition to cultivating the sufficient skills to expedite these goals.

In recent months, Covid-fuelled joblessness has sparked a six-fold surge in people applying for Universal Credit, which led to the DWP’s systems becoming log jammed earlier in the year. The annual report notes the need to make quick changes in response to the pandemic, including a more timely delivery of the Confirm your Identity service to fast-track new applications and let Universal Credit applicants prove their identity online.

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Authoritarianism, to what end?

Mark Sedwill, the UK’s top civil servant is stepping down. Another casualty in the government’s war against reality. Unsurprisingly, he leaves amid rumours of hostile briefings and that he provoked the ire of Dominic Cummings, a familiar pattern of the last 7 months.

The government is given to behaving in an increasingly authoritarian fashion. This is alarming, given that they have a huge majority and over three years left to do as they please. Since December, one after the other, anyone who doesn’t toe the line has been targeted. First the cabinet was purged, then the Conservative party itself. The BBC has been targeted, the civil service is being stuffed with unqualified Brexiteers. Anyone who won’t simply allow the government to inhabit the fantasy Britain of its choosing is in the firing line. Coupled with their fixation with opacity (Russia report?). It is a worrying cocktail. Even the handling of the pandemic has been largely about planning to shift blame in future rather than handling the situation well in the present.

Johnsonian personality cult

We’ve even seen the cringe inducing first attempts at some kind of Johnsonian personality cult using the right wing press, press ups anyone? Johnson compared himself to Roosevelt, offering us a “new deal”. All while denying NHS staff weekly covid testing and asking us to clap for the bankers who brought you a decade of austerity, it is beyond absurd.

While it may seem that it is a truly deliberate power grab by design, an attempt at autocracy for its own sake, the reality is simpler. It’s a product of a broken system reaching its inevitable conclusion. In the UK, game theory has been very influential in political thought since the mid-80s. The idea that people are motivated by selfishness and paranoia. To get the most out of people, you must entice them by using their innate selfishness to the total exclusion of altruism and idealism. The reasoning goes that although people are altruistic and idealistic, each man has his own version of what is good, leading to chaos and disorder. Selfishness is far more predictable.

These principles were embraced with good intentions in the 80s after the problems of the previous decade. Idealism was seen as the cause and this new ideology was seen as the cure, a way to get the most out of society, the government and public institutions.

New age political system

With this in mind, it’s important to note that Johnson, Cummings, Trump et al. are some of the first political leaders who are truly products of this system, they have spent their whole political careers inhabiting it. In this light their behaviour and their successes make far more sense. They have prospered in a system designed to reward and encourage the negative traits they are notorious for, a system that conditions politicians to be like them. 

Dominic Cummings is a simple man to deconstruct. Entirely selfish and egotistical, hating those who disagree with him, exacting petty vengeance on people who have spoken up or who have the potential to impede his plans. Authoritarianism is merely a by-product of his personality. Parliamentary parties embrace a broad church with a wide range of opinions, not if he can help it. The civil service is supposed to offer constructive advice on enacting government policy, not on his watch. The inherent problems that arise from this were laid bare when he and Johnson were incapacitated by illness early in the pandemic, the rest of government was largely paralysed through fear. In turn, Cummings is the perfect foil for Johnson, where he is devious and ruthless, Johnson is weak and lazy. Johnson needs Cummings and gives him a platform, so Cummings is happy to help him stay in power, quid pro quo.

An unfortunate side-effect

The unfortunate side-effect of a government produced entirely by a selfish system is that it has no purpose besides self-sustainment. Brexit was a shallow slogan used as a tool to win the election and beyond that there is only empty space. After January 1st 2021 there is nothing apparently in the pipeline besides coping with the fallout from Brexit. The poor quality of the government is evident now in the totally ad-hoc nature of everything they do. Their autocratic behaviour seems to be a coping mechanism to deal with their lack of quality rather than a means to an end. After Brexit there are three more years that could in all honestly lead anywhere that suits them as they capitalise on the present rather than taking the UK into the future.

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Coronavirus: Why surviving the virus may be just the beginning

Waking up

The first thing Simon Farrell can remember, after being woken from a medically induced coma, is trying to tear off his oxygen mask. He had been in intensive care for 10 days, reliant on a ventilator just to breathe. “I was trying to pull the mask off my face, and the nurse kept putting it back on,” he recalls. – BBC News

When doctors woke him up, his body had fought off the worst of Covid-19 but he still needed oxygen to support his damaged lungs. And the 46-year-old father-of-two was suffering from such severe delirium he was trying to deny himself the oxygen he required.

“Try to stop me,” he remembers saying, when nurses at Birmingham’s Queen Elizabeth Hospital said they would have to put his hands in boxing glove-sized medical mittens unless he relaxed.

“In the end they had to tape my hands up. I was trying to tear the mittens off, I managed to bite through them, and they had to put new mittens on.”

It is not an unfamiliar story for anyone working in intensive care. The assault Covid-19 mounts on the most severely ill means patients are ventilated for longer, and require a deeper level of sedation, than the typical ICU patient.

That has produced “a lot of delirium, confusion and agitation”, explains Dr Kulwant Dhadwal, a consultant who runs the intensive care unit at London’s Royal Free Hospital.

“Usually if you have a surgical procedure, or normal pneumonia patients come to ICU, you wake them up and they’re less confused and less disoriented than this.” “This particular group of patients were a lot more difficult to wean off the ventilator.”

Even when that process is a success, it is only the beginning of a long process of physical and psychological recovery. And now the UK has moved past the peak of the virus, attention is turning to the huge challenge – both in the health service and in the community – of rehabilitating Covid-19 survivors.

“Often rehabilitation is seen as a Cinderella service and not a priority,” says Sally Singh, professor of pulmonary and cardiac rehabilitation at the University of Leicester.

“But because of Covid, and the number of people that it has affected, the need is pressing. It has become a national priority – to support people to get better.”

A long road

Tens of thousands of people around the UK are now setting out on that journey. Some came close to death in intensive care units, others needed less intrusive hospital treatment to help them through the worst. All of them have had their lives changed by Covid-19.

But for the most seriously ill patients in intensive care, rehabilitation begins well before they are woken from a coma. Physical and psychological support has to be there from the start. Even when a patient is asleep, nurses and therapists will move their joints and their bodies to make sure they don’t get too stiff.

“For example, we have an in-bed bike,” explains Kate Tantam, a specialist rehabilitation sister in intensive care at University Hospital Plymouth NHS Trust.

“Even if a patient is on multiple organ support on a ventilator, and on lots of drugs to keep them alive, we will still put them on a bike.” “We bring it to the bed, and we can put their feet into it, and the machine can then do the work for you.”

ICU staff will also talk constantly to patients while they are deeply sedated, telling them where they are, and what is happening to them, and reassuring them that they are safe. It’s all part of the process of preparing them for the moment when they are woken up.

“Some patients do wake up saying, ‘I remember your voice,'” says Kulwant Dhadwal. “They wake up with some kind of memory.”

Hospital read out

But the process with Covid-19 has proved even more delicate and difficult than normal, partly because so many ICU patients were on mechanical ventilators for extraordinarily long periods of time.

Many of them woke up profoundly weak, although some regained strength unexpectedly quickly.

“Usually when somebody’s been asleep for 40 days or more, it takes six weeks or longer for them to be totally free of the ventilator, to be ready to even start walking or standing,” Kulwant Dhadwal says. “But some of these patients were making progress within a week, which we found very unusual, very specific to this disease.”

Another challenge in the immediate recovery from critical illness with Covid-19 is the severe inflammation. Many patients can’t cope with a breathing tube inserted through the mouth because the larynx and the area above the vocal cords are badly swollen as part of the illness. That means doctors have often had to often perform tracheostomies, creating an opening in the neck to gain access to the windpipe, in order to remove the breathing tube that connects patents to the ventilator.

“You’ve got to look after the tracheostomy, it’s a wound in the neck,” explains Carl Waldmann, a consultant in intensive care at the Royal Berkshire Hospital in Reading. “So, it was a long, slow process getting them off the ventilator. It might take them a week or two weeks or even longer.”

“I was nearly a goner”

And behind every observation lies a human story. Abraham Raskin’s family were told in late April that it was unlikely he would survive. But on 12 June he finally left the Royal London Hospital after more than 50 days in intensive care, a tracheostomy, and a month in a medically induced coma.

“The very fact that I’m alive now is a miracle,” he says, “I was nearly a goner.”

On a video call arranged by nurses on 18 May his family saw his face for the first time since he was taken into hospital in early April. He wasn’t able to say anything, but he did raise an eyebrow.

Abraham was severely delirious for some time after waking up. “I was talking all kinds of rubbish,” he says. “Afterwards when I heard about what I was saying, I felt like I was mad or something. It’s not pleasant.”

But he is now back at home, still very tired, and following a basic exercise programme planned from him by a physiotherapist. With support from family members, he can get upstairs to sleep at night.

“Some people can’t really walk anymore when they come out of this,” he says, “and some take months to recover. I hope I’m not one of them.”

Delirium

As many as three-quarters of intensive care patients who need mechanical ventilation to help them breathe will suffer from delirium. And the observations of many doctors suggest that delirium has been particularly acute, and hallucinations unusually vivid, for people who fall critically ill with Covid-19.

Delirium can be caused by the infection itself, and the fevers which accompany it. But it is intensified by the strong sedative drugs that have to be used to keep patients comfortable, and the unsettling environment of intensive care they find themselves in.

While patients are in a coma, and after they wake up and begin withdrawing from these drugs, they often experience frightening hallucinations, and cling to unsettling beliefs about what is going on.

“Delirium doesn’t have a dreamlike quality,” says Dorothy Wade, the principal health psychologist in intensive care at University College Hospital in London. “Patients always say ‘it was completely real – I was just living in this terrifying alternative reality.'”

Doctors think that chemical imbalances prompt the brain to create its own explanation for why the body can’t move and the patient can’t speak. Often people think they’ve been kidnapped or tortured, or they think they’re in a prison cell about to be put on trial.

“They tend to feel that the nurses and the doctors and the staff are all in some conspiracy,” says Dorothy Wade, “that this is all part of a conspiracy to make money out of them by selling their blood or their organs.”

It means that psychologists like Dr Wade try to step in as early as possible. It’s important not to argue with delirious patients, she says, but instead to try to offer reassurance about what has really been happening.

Simon Farrell left hospital relatively quickly after being taken off a ventilator, but he still recalls the vivid nature of the delirium he experienced.

“I remember Elliott, my younger son, coming into the room in PPE,” he says. “Now, that clearly wasn’t right. No children were allowed on the ward. The hospital was locked down. It didn’t happen.” In his head at the time, though, he believed it to be absolutely true. “You just feel it is what’s happening,” he says. “And there was a lot worse than that. That was a simple one.”

Family

The challenge of dealing with the acute delirium that accompanies Covid-19 has been heightened by the fact that family members can’t be at the bedside when patients are trying to return to reality. Seriously ill people wake into a world of flashing lights and machines, of disrupted sleep and hospital staff in full PPE.

“It has a huge impact on patients,” explains Krystyna Walton, a consultant in rehabilitation medicine at the Salford Royal Hospital in Greater Manchester. “They are already confused, and it must be incredibly difficult.”

“If somebody has suffered encephalitis (inflammation of the brain) and they have memory problems or insight problems, they’re not aware of the way that Covid has affected the world, so they can’t understand why there are no visitors.” And the social isolation imposed by the pandemic also has repercussions for friends and family.

Hannah Farrell, Simon’s wife, works as a neuro physiotherapist at the Queen Elizabeth Hospital in Birmingham where he was a patient. She recalls one evening when he was still severely delirious, a nurse she knew rang and suggested that hearing her voice on the phone might calm Simon down.

“Apparently, it settled Simon, but it certainly didn’t settle me,” she says. “I didn’t sleep all night, because Simon just didn’t sound like Simon at all.” “For me, it was quite upsetting, and I’m sure other relatives have said the same.”

Long-term problems

Some patients can still be delirious weeks after waking up. And delirium, says Kate Tantam, along with other frightening early experiences, “is the key link to post-traumatic stress, anxiety and depression” among people who survive their time in ICU.

Roughly one in five people who pass through intensive care in normal times go on to exhibit symptoms of post-traumatic stress disorder (PTSD). And the signs are that with Covid patients that number could be considerably higher.

The same goes for more general anxiety and depression after leaving hospital. The extreme circumstances of the Covid pandemic, and the social isolation that has come with it, are likely to make things worse.

The lack of a reassuring family presence, for example, continues to pose additional problems after patients are released from acute hospital wards into care homes and rehabilitation units. Hospitals have invested in iPads to facilitate contact, and family liaison teams make sure video calls take place every day, but it’s not quite the same.

Krystyna Walton gives the example of one of her patients who had severe Covid pneumonia, as well as renal failure and dialysis. The patient spent several weeks in critical care, and several more on a medical ward before being moved to a rehabilitation ward with cognitive deficits. They have not been able to see their family for three months.

Normally in a rehabilitation unit, staff would try to personalise a patient’s surroundings and encourage them to wear their own clothes. But the restrictions surrounding Covid have prevented much of that. And because family members are unable to visit, or speak to medical staff face-to-face, they often struggle to understand just how sick their relative has been.

“There are no visitors in care homes, there are no visitors in rehabilitation in the NHS or in the independent sector,” says Krystyna Walton. “And even after leaving rehab there have been restrictions that we all have had to deal with, which makes it more difficult to visit a vulnerable person in their own home. All of this has a huge psychological impact.”

So, the NHS is going to have to prepare for the possibility of a fresh wave of PTSD patients, just as it is trying to deal with a backlog of mental health (and other) cases which have been neglected during the worst of the pandemic.

“We won’t know for several months how big a problem this is going to be,” says Dorothy Wade. “To begin with people are very relieved to be out of hospital, especially after such a long stay. Sometimes it can take quite a long time for them to realise that something still isn’t quite right.”

It doesn’t always turn out that way. Alongside post-traumatic stress, doctors acknowledge the concept of post-traumatic growth, and point to patients who emerge from critical care with a new outlook on life.

“There are some people who – no matter how difficult this has been – find themselves in a more positive frame of mind,” explains Julie Highfield, a consultant clinical psychologist based in intensive care units in Cardiff.

“People feel this is a chance they never thought they would have, and they are determined to live their life well.”

Simon Farrell is certainly trying to focus on the positive and he has been recovering week by week. But he admits it has to be tinged with realism. “I think people feel if they get physically stronger, they’re then mentally stronger and they’re fine. And that’s not always the case. The two are not aligned.”

Physical recovery

For many people physical recovery can provide the biggest challenge, particularly if they have spent weeks in intensive care. “Covid is a nasty, nasty disease that kicks every single system you’ve got in the neck,” says Kate Tantam.

And sometimes when people wake up from four weeks of sedation, like thousands of Covid-19 patients have done, the only thing they can move is their fingertips.

“We have to rebuild everything with them,” she says, “and teach them how to do everything physically again – from being able to feed yourself or being able to touch your hair, to being able to stand and being able to sit.”

A prolonged period of recovery is not unusual after intensive care, but many Covid-19 patients have experienced particularly severe fatigue and muscle wasting. They are exhausted – sitting in a chair for half an hour might be followed by four hours sleep. And rebuilding muscle takes time. “If we don’t give patients the right level of nutritional input, they are not going to recover,” Kate Tantam says.

So, dieticians have an important role to play, alongside physiotherapists, speech and language therapists and occupational therapists. If you have just survived a multi-system disease which attacks different parts of the body in different ways, it stands to reason that you need various forms of help to recover.

Many Covid patients will return to normal life relatively quickly. But some have suffered kidney failure and may require ongoing renal support, while others will need to be referred to cardiologists or may have developed neurological conditions that require specialist care.

The challenge, says Carl Waldmann, “is to make sure that everyone gets what they need, and that the right support can be provided at the right time.”

“I think the greatest burden will be in the community,” argues Krystyna Walton, “because many of these patients will have quite subtle deficits that will only become evident to them as they start recovering physically, weeks and months after going home.”

Breathlessness

The most common physical challenge for recovering Covid-19 patients is shortness of breath – and that can apply to people who had moderate as well as severe symptoms of the disease.

“For patients that are coming out of hospital,” says Sally Singh, “clearly they’re breathless because they’ve had a respiratory disease. Their lungs are temporarily damaged, but they are also deconditioned because they’ve been lying in a hospital bed for so long that they’ve become pretty unfit.”

It means that simple things like going up and down stairs can become extremely challenging, especially in elderly patients. But breathlessness is an issue that goes well beyond survivors of intensive care. And a significant minority of people who’ve been infected with the coronavirus are still struggling to shake it off.

“I’d crash in a heap”

Jenny Goldblatt, an infectious diseases doctor at the Royal Free Hospital, fell ill with Covid-19 in March and it has lingered ever since – returning in waves of fatigue, chest pains and breathing difficulties.

She spent a couple of days in hospital in March, where she was given a little extra oxygen. But it was only after going home that her problems began in earnest.

“Every 10 days or so I’d start to feel a little better and I’d start to go for longer walks,” she says. “But then I’d crash in a heap and couldn’t get out of bed for a week.”

It was a month after falling ill that she first managed to walk to the end of the road and back. A keen cyclist, her next goal is to cycle around the block. “I can’t imagine when I will be able to take my bike for a proper ride, and if I think about that too much it gets a bit depressing.”

Jenny thinks she has cleared the virus, and she has “easily detectable” antibodies in her blood, but her body is continuing to react in unusual ways. Post-viral fatigue is not unique to Covid-19, but this is something more.

Jenny has suffered chest pains and breathlessness; other patients with lingering symptoms report severe headaches or abdominal pains. Three months after falling ill, going back to work or resuming normal life is out of the question.

“I am getting better slowly,” she says, “but I can’t be too ambitious. It is frustrating to be on this rollercoaster, with absolutely no idea how long the journey will take.”

Challenges

Previous medical experience with pneumonia suggests it can take months, or in extreme cases years, for patients to get back to where they were before. With Covid-19, we are still early in the cycle of rehabilitation and recovery, and every patient is different.

“The honest answer is we don’t yet know how long it will take,” says Sally Singh. “People are researching that as we speak – monitoring chest x-rays, symptoms and the wellbeing of patients to help us identify what the best intervention to support these people may be.”

The trouble is the provision of rehabilitation services across the country can be patchy, especially for people emerging from critical care. And the NHS is already dealing with a massive backlog of non-Covid cases that have been delayed.

“The huge challenge,” says Krystyna Walton, “is going to be the increase in numbers.”

At the peak of the outbreak the priority was to get patients out of acute hospital settings quickly to free up bed space. That means in many cases the rehabilitation assessments that would normally be done in hospital would have been done in the community, or in a care home or a non-specialist rehabilitation setting.”And my suspicion,” Krystyna Walton adds, “is that many patients may have not had their needs assessed properly.”

Carl Waldmann, who has been working on improving the rehabilitation of seriously ill patients for more than 25 years, says one of the best analogies he can think of is building a rocket, and training an astronaut.

“You put them up into space, but you also have to think about where they’re going to land and what we’re going to do when they get back.” It is the same, he says, if you put a patient through the complexities of intensive care.

“We’ve had some patients who need seven specialists looking after them afterwards,” he says, “and unless they have all those bits of the jigsaw puzzle, there is a chance they won’t make the recovery they could have made.”

It is important to emphasise those rehabilitation needs don’t stop after the immediate recovery period. Many patients will suffer from scarring of the lungs – a permanent and often debilitating condition. Doctors also know that a significant number of people who have been critically ill have suffered cognitive deficits. Ideally they should have screening for return to driving a vehicle, and for return to work.

“Rehabilitation has to sort of blur into real life and getting back out into the community,” says Krystyna Walton, “doing what you used to do before, looking after your family, earning an income, enjoying leisure facilities and exercise.” “And that is what takes time and expertise.”

The NHS and individual hospitals are of course building rehabilitation into their Covid recovery plans, but this is a system that has been overlooked for years. Experts in the field hope, despite all the pressures, that Covid will provide a launch pad for change.

“Hospitals are very good at treating people, doing something to somebody to make them better,” says Kate Tantam. “But what they are not always very good at is prioritising the therapeutic and rehabilitation input afterwards.”

It is, in other words, not just about survival, it is about health-related quality of life. “There is no point giving somebody a massive intensive care stay, if you don’t try to return them to where they want to be.”

PIP figures provide fresh evidence of virus deaths

Coronavirus: Government PIP figures provide fresh evidence of virus deaths By John Pring Dqan2TSWkAEnCoe

New government figures have revealed that the proportion of disability benefit claimants who died in April was 15 per cent higher than the previous year, providing fresh evidence of the impact of the COVID-19 pandemic on disabled people.

The figures, secured by Labour MP Debbie Abrahams, also show a rise of eight per cent in the proportion of personal independence payment (PIP) claimants who died in March, compared with March 2019.

The figures emerged only days after Office for National Statistics (ONS) figures showed disabled* females aged between nine and 64 were 11.3 times more likely to have died due to COVID-19 than non-disabled females in the same age group, while disabled males* between nine and 64 were 6.5 times more likely to have died than non-disabled males.

The ONS figures, reported by Disability News Service (DNS) and later followed up by The Times and other newspapers – but previously largely ignored by the mainstream media – prompted calls for an inquiry into the causes of the disproportionate impact of coronavirus on disabled people.

They also led to calls for the government to take urgent action to protect disabled people from COVID-19 in advance of an expected second wave of the virus.

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