England’s health policy response to covid-19BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1937 (Published 15 May 2020) Cite this as: BMJ 2020;369:m1937
All rapid responses
Reading Dr Hui’s response, I wonder if our World Class Leaders could learn a trick or two from Singapur?
We don’t have to admit it.
We can say we improved upon the Singapur method.
Competing interests: Susceptible. Vulnerable .
Alderwick and colleagues highlight the long neglect of social care. Austerity has left hospitals with limited capacity for any surge in ill-patients but numbers do not tell the whole story. Singapore has fewer nurses and doctors per capita than the UK . In the city-state, there has been no desperate measures or last-minute scramble for personal protective equipment. No health care worker has been infected in a hospital setting as yet and there have been few deaths from care home residents [2,3]. The difference lies in planning and following the established procedures for a pandemic:
Regular training on PPE and hand-washing, masks fittings; often on recruitment of staff
From the start of the out-break, staff in hospitals or care home could only work in one location
Members of the public, not just health care workers, with fever or respiratory tract symptoms were not allowed to go into work.
Patients requiring admission were separated into “clean” or “dirty” wards after triage in the Emergency Department.
Patients with fever or chest infections could only be discharged back to care homes or transferred to a “clean” ward if they have tested negative for COVID-19. Obviously, the aim is to avoid spreading the infection to vulnerable nursing home residents.
Simple measures could have avoided the tragic consequences, which were not inevitable. “Nobody could have foreseen this” should not be an excuse, because other countries have avoided the tragic outbreaks in care homes.
01. Ministry of Health, Singapore. Health Manpower, 18th May 2020 https://www.moh.gov.sg/resources-statistics/singapore-health-facts/healt....
02. Tan LF. Preventing the transmission of COVID-19 amongst healthcare workers. J Hosp Infect 2020 https://www.journalofhospitalinfection.com/article/S0195-6701(20)30183-3/pdf
03. Kok Xinghui. Why are there so few coronavirus infections in Singapore’s health workers? SCMP 28th March 2020. https://www.scmp.com/week-asia/health-environment/article/3077345/corona....
Competing interests: No competing interests
Alderwick and colleagues discuss the inadequate support for social care, and ask the question: ‘Is the government following or hiding from science?’
The government of the United Kingdom (UK) on 3rd March 2020, released an action plan for COVID-19 which outlined their forward plan.  This plan cited evidence from early data on COVID-19 which suggested that there was an increased risk of death and severe disease among elderly people.  As discussed by Alderwick et al., an action plan specific to the adult social care sector was not published until mid April. We argue in response to the authors’ question, which asks whether politicians are ‘following or hiding’ from science, that the government is up-to-date on scientific evidence but failing to respond to this evidence in a promptly manner.
In the period from April to May 2020, the UK Office of National Statistics (ONS) reported approximately three times as many COVID-19 related deaths in care homes in comparison to a hospital setting. From March, when the initial identification of elderly individuals as being more vulnerable to COVID-19 is established, there is then a delay in response of over a month before government legislation outlining a coordinated response to COVID-19 specific to adult social care is published. In the week this guidance was published alone, there were over 2,000 care home deaths attributable to COVID-19, compared with 800 in a hospital setting. 
In theory, identification of high-risk groups should inspire fast-tracked, life-saving legislation from government, and indeed it has in the hospital setting. NHS England on the advice of government took action in March: discharging medically fit patients from hospital, postponing non-urgent elective surgery and moving outpatient clinics to an online platform, freeing up hospital in-patient and critical care capacity. 
A further measure the government took was to build and open the Nightingale hospital, a 4,000-bed capacity relief hospital which was suggested could provide on-going care to elderly individuals with COVID-19 post-discharge from hospital.  The Guardian this week reported that London NHS Nightingale is set to close this week after treating a total of only 54 patients.
This is a perfect demonstration of lack of forward planning for individuals in the social care sector: a plan to transfer patients to a hospital which is now closed. This leaves elderly patients who may still be infectious and weak no choice but to return to a care home potentially ill-equipped to manage their care, and also risks further transmission of the virus to other vulnerable elderly residents.
Is the government following or hiding from science? The government acknowledges scientific evidence, however has failed to react at pace to this evidence in the social care setting, resulting in significant ramifications for one of the most vulnerable groups in our society.
 Coronavirus action plan: a guide to what you can expect across the UK. In: Care DoHaS, editor.: Gov.uk; 2020.
 Number of deaths in care homes notified to the Care Quality Commission, England. In: Statistics OoN, editor.: Office of National Statistics; 2020.
 COVID-19: Our Action Plan for Adult Social Care. In: Care DoHaS, editor. Gov.uk: Gov.uk; 2020.
 IMPORTANT AND URGENT – NEXT STEPS ON NHS RESPONSE TO COVID-19 In: England N, editor.: NHS England; 2020.
 Campbell D, Mason R. London NHS Nightingale hospital will shut next week. The Guardian. 2020.
Competing interests: No competing interests