7. Lower profile changes to policy and practice

A future series of posts will describe the many ways in which policy will (or should) change in practice, as public sector and other organizations change the way they do things in response to crisis. Current examples include the relaxation or postponement of high-political-stakes issues such as NHS targets and testing in schools, and as-important but lower stakes issues such as mental health self-management and the local authority obligation to provide social care.

In relation to oral evidence, examples include:

• Stevens (17.3.20: q150-3) discusses relaxations on rules for GP prescribing, paying GPs upfront in relation to contracts, reducing the regularity of Care Quality Commission checks, and taking a more flexible approach to A&E and other targets to avoid their inevitable unintended consequences. The changes take place in the context of a reduced-capacity NHS and growing waiting list for services not met during the lockdown (see Hopson, Dixon (Chief Executive The Health Foundation), and Edwards (Chief Executive The Nuffield Trust) 14.5.20: q75-84).
• Taiwo Owatemi MP (17.4.20: q371) on medicinal cannabis for children.
• Hancock (17.4.20: q373) on the availability and operation of cancer services (compare with Rosie Cooper MP, 17.4.20: q380; Palmer, National Cancer Director NHS England, 1.5.20: q21-35; Murray, Chief Executive The King’s Fund, 14.5.20: q73)
• Dean Russell MP (17.4.20: q386):

‘Last November, the Committee [Joint Committee on Human Rights] identified that human rights were being abused for people with learning disabilities and/or autism in mental health hospitals. As part of that, one of the concerns is that with coronavirus, family visits are currently being restricted and routine inspections have been suspended, which in turn potentially increases the young people’s isolation and also makes them more vulnerable to abuse of their rights.’

• Walton (Chief Executive, Royal College of Midwives) (1.5.20: q11) on ‘domestic abuse increases during pregnancy’ and ‘it appears that during lockdown domestic abuse and control issues have increased’.
• Murdoch (National Mental Health Director, NHS England) (1.5.20: q47-51) on the temporary reduction in referrals to child and adult mental health services, followed by a general consensus (MPs and witnesses, 14.5.20: q87-90) that adult and child mental health services were poorly funded anyway, with too few staff, dealing mostly with emergencies, so the post-pandemic provision is a major worry since there will be the latent demand plus new causes of mental health problems.

COVID-19 policy in the UK: oral evidence to the Health and Social Care Committee (5th March- 3rd June 2020)

1. The need to ramp up testing (for many purposes)
2. The inadequate supply of personal protective equipment (PPE)
3. Defining the policy problem: ‘herd immunity’, long term management, and the containability of COVID-19
4. Uncertainty and hesitancy during initial UK coronavirus responses
5. Confusion about the language of intervention and stages of intervention
6. The relationship between science, science advice, and policy
7. Lower profile changes to policy and practice
8. Race, ethnicity, and the social determinants of health