In media coverage yesterday of the change in the official response to swine flu from ‘containment’ to ‘treatment’, I was struck by the usual ambiguity as to whether the information provided related to England only or the whole of the UK. For instance, in the BBC News website’s report, it stated: “Andy Burnham, the health secretary in England, said: ‘The national focus will be on treating the increasing numbers affected by swine flu. Cases are doubling every week and on this trend we could see over 100,000 cases per day by the end of August'”. Pleasing that the BBC correctly characterises Andy Burnham as the English health secretary; but then, is the “national focus” one for England only or for the whole of the UK? Probably the latter, as the 100,000 cases per day figure was being talked of as the UK-wide total. But all the same, this got me wondering: how is the response to swine flu being co-ordinated – if at all – between the UK government and the devolved administrations, with their separate responsibilities for health care? And is the apparent failure of the containment strategy in part a consequence of different approaches having been adopted in the different UK nations?
Unlike the radio and TV coverage, the BBC website article did report that, “Scottish Health Secretary Nicola Sturgeon announced similar changes to the flu strategy at a simultaneous briefing in Edinburgh”. So it appeared that there is a single UK-wide strategy and a co-ordinated response across the different health departments. This was even more apparent when I visited the Department of Health [England]‘s and the Scottish Government‘s websites and read their remarkably similar statements on the change in tactics.
After much further investigation, it turns out that the Department of Health [England] has retained the responsibility for drawing up the overall UK strategy for dealing with flu pandemics, along with the lead role in co-ordinating the operational response to any actual outbreak; although the devolved administrations are supposed to put in place their own NHS and civil-contingency systems and resources for responding to any crisis – in line with the UK plan.
As the government’s national framework document puts it: “A ministerial committee (MISC 32), comprising ministers from across central government departments and the devolved administrations, oversees and coordinates national preparations for an influenza pandemic”. Then, in the event of the World Health Organisation declaring that a pandemic has reached phase 4 or higher (currently, we’re on phase 6 for swine flu), the following happens: “the Government’s dedicated crisis management mechanism – the Civil Contingencies Committee (CCC) – [is] activated in support of the Department of Health. The CCC will direct central government activities, coordinate the wider response, make key strategic and tactical decisions on the countermeasures required and determine national priorities. The CCC will be guided by input from central departments and agencies and from local responders through Regional [English] Civil Contingencies Committees (RCCCs) and the devolved administrations. It will work with the national News Coordination Centre to maintain public confidence [i.e. manage the news]”.
So we’re currently in a situation where a nebulous Civil Contingencies Committee is co-ordinating the response UK-wide, in keeping with a pre-established plan, and managing the news in such a way as to maintain morale. No wonder that the English-UK and devolved health departments appeared yesterday to be singing perfectly from the same hymn sheet in their media pronouncements in a display of quite exceptional synchronisation and unity! And that, despite the imminent prospect of 100,000 new cases of swine flu per week, we’re being blandly reassured that we’re now moving in a controlled, pre-planned way from containment to ‘treatment’ – implying that it can be successfully ‘treated’ in the vast majority of cases; whereas, in reality, we’re all just desperately praying that it doesn’t suddenly become much more virulent or resistant to Tamiflu.
But, as I said above, one can’t help wondering whether the failure of the containment approach (surely, prevention is better than cure?) is partly the result of the wheels of co-ordination between the UK central government and the devolved administrations not running as smoothly as yesterday’s united front would have us believe. If you read the national framework document, the sheer number of organisations – international, national-UK, ‘regional’ (English), devolved and local – that are involved in formulating strategies and co-ordinating the response is mind-boggling. Amid this already hugely complicated landscape the fact that the NHS and civil-contingency measures are replicated with slight variations in each of the devolved nations and the ‘English regions’ surely cannot help to streamline processes and ensure that everybody knows what everybody else in the chain of command is supposed to be doing.
Take a look at the section that deals with the different organisational elements involved in each of the devolved administrations (pages 49 to 52). This is a masterpiece of bureacracy-speak, and of bureacracy full stop, with departments, committees, sub-committees, groups, sub-groups, directors, trusts, agencies, directorates, etc. etc. all having a role to play. I can’t prove that having these complicated and distinct organisational schemes in each of the devolved countries has contributed to the ineffectiveness of the containment measures; but they surely cannot help. And it is the case that Scotland is one of the ‘hotspots’ of the disease, in part – allegedly – because no Scottish-Government advice for people to stop travelling to Mexico was given out in the early stages of the outbreak.
But, for the time being, we are supposed to be resting assured that all the UK health departments are acting perfectly in concert according to a well-structured plan. But the only reason they’re able to both act in this way, and be on message to such an extent, is that their actions are being centrally directed by a shadowy Whitehall committee, which is also driving the media communications in such a way as to reassure the populace that ‘the government’ has everything under control.
And one of the principal, and well-tried, weapons of media misinformation at the fingertips of the national ‘News Coordination Centre’ is to imply – to gullible people in England, at least – that everything forms part of a homogeneous UK-wide health-care and emergency-response system. Well, the plan may be UK-wide – and the operational direction currently is, too, now we’re in an advanced phase of the pandemic – but the delivery certainly is not.