Lockdown curbs made children collateral damage
Messages expose the way physical and mental health of young was sacrificed by school closures and squeeze on NHS
AS the third anniversary of the first national lockdown approaches, the true human and financial cost of the policy is still emerging.
Missed operations, economic scarring, compromised schooling and ruined mental health were just some of the problems stored up for the future by shuttering the country three times in 2020 and 2021.
The ministers and officials behind lockdowns were well aware of the possibility, and then the reality, of collateral damage being caused to millions of lives as they pushed ahead with the controversial policy despite warnings that the cure would be worse than the disease.
Whatsapp conversations contained in The Telegraph’s Lockdown Files show that those running the country privately acknowledged the “terrible” price of lockdowns and twice reimposed the national shutdowns even as they discussed the damage they were causing. For many people, the worst knock-on effects of lockdowns were on children, whose physical and mental health and future prospects were all damaged by the closure of schools and the squeeze on the NHS.
By May 2021, when the last of the lockdowns were over, ministers were increasingly seeing the extent to which children had become collateral damage. One topic of conversation was child deaths in mental health units, raised by a civil servant in a message to the then health secretary Matt Hancock on May 14.
[Civil servant 1]
Matt, I’ve just sent you a note updating you on an NHSEI [NHS England & NHS Improvement] Rapid Review into the sad deaths of children in Tier 4 Mental Health units. The number of deaths for 2021/22 is already at 4, where the annual total figure for 2020/21 was 6. Nadine [Dorries, health minister] will meet NHSEI leads first thing next week to grip further – Emma [Dean, special adviser] and Damon [Poole, special adviser] have seen. Thanks [14/05/2021, 18:50:04]
Matt Hancock
Ok. Nadine lead
[14/05/2021, 18:50:24]
[Civil servant 1]
Noted
[14/05/2021, 18:50:50]
Three days later Ms Dorries raised the issue of deaths among children being seen by the Child and Adolescent Mental Health Service (CAMHS).
Nadine Dorries MP
I’ve sent to Emma too as I know you are concerned re the 4 deaths in CAHMS [sic] Re Tier4 CAHMS – we’ve had far more CYPS [children and young persons] in T4 than before pandemic. Pressure on paediatric beds has been huge due to MH EOS [mental health education officers] which is consistent with the two main groups we know were affected. The number of deaths is at 4, compared to the previous year of 2 – I’ve asked for the tier 4 data, but I’m not alarmed given the pressure we know T4 has been under. Meetibg with [redacted] this week for more information on the two recent cases and to run a rapid inquiry
17/05/2021, 07:49:38]
Matt Hancock Great. Very important [17/05/2021, 09:15:57]
Late that night, a civil servant in Mr Hancock’s private office sent him a Whatsapp message, alerting him to a child respiratory virus that was expected to surge in the summer months as a result of the virus being suppressed during lockdown (known in Whitehall as an NPI, or nonpharmaceutical intervention).
[Civil servant 1]
Matt, just sent through an urgent submission on PHE modelling relating to a upcoming epidemic in child respiratory syncytial virus (RSV) given winter suppression of infection due to COVID NPIS. This is urgent this evening as NHSE intend to write to paediatric critical providers tomorrow (Annex A) and there are Comms handling considerations (Annex B). Emma has commented and Damon is sighted and reviewing Comms approach. Thanks [17/05/2021, 22:04:12]
The concerns proved to be well founded. The virus, which usually causes symptoms similar to a common cold, causes an average of 29,000 hospitalisations and 83 deaths per year in the UK, mainly in infants.
Because so few children were exposed to RSV during lockdown, there was an “unprecedented” surge in cases in 2021, according to a paper published by The Lancet Infectious Diseases.
In the summer of 2021 there were more than 12,000 cases of RSV, compared with the average of fewer than 900 in a typical summer.
Back in April 2020, a month into the first lockdown, Mr Hancock was already coming under pressure over cancelled NHS operations, and became personally involved in an individual case, described as “tragic”.
It involved a 17-year-old girl who had had part of her skull removed in January 2020, after a brain haemorrhage and needed surgery to reconstruct it after developing life-threatening complications. The case was gaining national media attention and the local MP, Steve Baker, asked Mr Hancock to step in. He forwarded Mr Baker’s message to a colleague – also called Steve – and urged them to “get right on this”.
Matt Hancock
Steve – this tragic local case of a 17 year old not getting urgently-needed surgery for a brain injury is becoming a national cause celebre. I have multiple Labour MPS in touch because the family are well-connected there. [LINK REDACTED]
[LINK REDACTED]
I doubt the family mean to be politically aggressive, but Labour are certainly seizing upon the case.
Can you please therefore *ensure the Department answers my two named-day WPQS in a politically astute way?*
[The message then includes links to two Parliamentary questions from Steve Baker, one of which asks Mr Hancock “when the NHS plans to resume urgent surgery” and the other asking “if he will take steps to resume urgent elective surgery in the NHS as soon as possible”]
*In particular*, if the civil service says what the Table Office first said – that elective surgery is by definition not urgent – then I will quickly find myself tabling a UQ [urgent question] with Labour weighing in behind me and I do not want that.
My goal is to help the individual but unfortunately casework and national policy have intersected.
Thank you and Godspeed,
Steve
[29/04/2020, 12:18:44]
Matt Hancock
Can u get right on this pls? [29/04/2020, 12:18:54] Matt Hancock
From Steve Baker [29/04/2020, 12:19:04]
Allan Nixon [special adviser] Yes. On this [29/04/2020, 14:09:18]
In December of that year, shortly after the month-long “circuit breaker” lockdown and with the four nations of the UK adopting a “tiers” system of graded localised restrictions, Mr Hancock was again becoming involved in a case where Covid rules were causing a personal tragedy.
Jacob Young, the Redcar & Cleveland MP, had raised the issue of a boy with a brain tumour, who had been given no more than two years to live, being blocked from holidaying at Center Parcs with his family.
Mr Hancock forwarded Mr Young’s message to his special adviser, Allan Nixon.
Matt Hancock
Hi Matt. I’ve raised this with Allan but need a resolution ASAP.
I have a sad case of a family with a child who has a brain tumour, and they’d planned a holiday to Centre Parcs near Dorset for his birthday – his prognosis is only a year/two. Can we get them an exemption for travel/ overnight stay? The stay is for 4 nights from the 14th-18th.
J
[09/12/2020, 16:05:24]
Matt Hancock
Any luck for Jacob Young? [09/12/2020, 16:05:24]
Allan Nixon
Yeah I went back to him days ago. Maybe he didn’t like my answer: I couldn’t find a legal loophole for him, but suggested he speak to Home Office spads [special advisers] to see if they can get the local PCC [Police and Crime Commissioner] to say they won’t prosecute or such like.
[09/12/2020, 16:10:26]
Matt Hancock
Are you sure we can’t offer them a compassionate exemption? [09/12/2020, 16:50:44] Matt Hancock
I could write a letter [09/12/2020, 16:50:50]
Allan Nixon
Can do if you’re up for it, but surely that doesn’t change the law? Hence why I suggested the PCC “no enforcement” approach
[09/12/2020, 16:52:08]
Matt Hancock
Is there a reasonable excuse exemption? [09/12/2020, 17:25:42]
Aside from the health problems being stored up for children, there were also discussions that month about university entrants “taking the hit” from the exams fiasco. [Civil servant 2]
Proposed response from [Civil servant 3] to CST: Your condition means that this year’s applicants take the hit from the screw-up over A-levels last year – which will be completely toxic. Surely that is not what you intend [20/05/2021, 10:33:08]
[Civil servant 2]
Have you had a chance to send this? ^ If so, has CST responded? [20/05/2021, 11:10:51]
Ofsted has since warned that nearly all children fell behind in the pandemic, and that loneliness, boredom and misery became “endemic” among children, whose physical and mental health declined as a result.
Even before the lockdown curbs had been reimposed, following an easing of the rules over the summer of 2020, Simon Case, the Cabinet Secretary, was discussing the “terrible” cost of lockdowns in a Whatsapp group that included Boris Johnson, Mr Hancock, the Chief Medical Officer and the Chief Scientific Adviser.
Simon Case
I think we have to be brutally honest with people. Full lockdowns optimise our society/ economy for tackling the Covid R rate – but they are terrible for other outcomes (non-covid health, jobs, education, social cohesion, mental health etc). That’s why, even if we have to do something tougher now in the short-term, the only way we get through this in the long-term is through a balanced approach, which needs everyone to play their part in keeping people safe (hands, face, space, isolate etc). Mass testing or a vaccine might significantly alter the calculus in our favour, but if they don’t work/we fail to deliver them properly, we can only rely on the behaviour of everyone to get us through. Even with mass testing, we can build the most amazing distribution system on earth, but if people don’t isolate or take other precautions if they get a positive test, it is all for nought. Lockdowns also contributed to an NHS backlog that the British Medical Association has said will take years to clear. By December 2022 there were 7.2 million people on NHS waiting lists, compared with 4.43 million in February 2020, on the eve of the pandemic. Meanwhile excess deaths – the number of deaths over and above a long-term average – were greater in October 2022 than during the pandemic years of 2020 and 2021. 29/10/2020, 08:22:18]
James Bethell, a health minister, warned about this in September 2020, but only made what he called a “gentle” challenge to a policy of cancelling an information campaign urging people to seek medical help even for minor symptoms of illness.
James Bethell
A gentle challenge. Are you sure about killing the ads urging people to check minor symptoms? It will lead to long term capacity pressures as minor ailments turn into acute and more expensive problems. Our net “excess deaths” numbers might nudge upwards even if we have more capacity for winter flu/covid management. [02/09/2020, 11:14:44]
Lord Bethell, Mr Hancock, Ms Dorries, Helen Whately, social care minister, Jo Churchill, junior health minister, and special adviser Emma Dean discussed the problems being stored up for the NHS in a Whatsapp chat in May 2021. Their conversation ranged from online GP appointments to NHS backlogs to receptionists triaging patients despite having no medical training.
James Bethell
On the GP open-for-business issue that’s raging amongst MPS, thought I’d flag that I have a debate next week in HOL [House of Lords] on this. Several peers including a couple of the clinical experts are on the warpath on this. Has the potential to become a “thing”.
[05/05/2021, 15:29:52]
Matt Hancock
Do we have a clear answer? [05/05/2021, 15:32:19] Jo Churchill
Look at this. Needs a standing ovation [05/05/2021, 15:41:27]
[She sends a link to a local GP surgery website] Jo Churchill
This was sent me by a GP friend not their practice. Simple answers there are not but it refers back to me saying we need to educate patients despite doing much on line people won’t fill on econsult forms (they are winding it down) demand has doubled (hence putting the same phone in and taking demand out and being able to analyse data better) people contact without selfhelp first and don’t refer to best place etc – there is too much variation and NHSE poor at monitoring etc ....
Nikki K and I are on it but they are seeing more people – some are using CV-19 but many are working harder than ever I agree has the potential to become a thing but the profession doesn’t need kicking but monitoring we have also promised to 3rd vac the 50+ this autumn – the WA is 4 MPS with no specifics every practice in Worthing, Winchester, Kensington doubtful – the patient has to be educated to use the resource.
[05/05/2021, 15:48:56] Matt Hancock
We need a plan to handle this pressure before it blows up
[05/05/2021, 15:51:17]
Emma Dean
Am picking up [05/05/2021, 15:51:32]
Jo Churchill
Sorry campaigning! Actually it’s a lot broader because we have all those people waiting for their electives so you have more people living with problems that they are waiting for attention we also have backlog issues that we are trying to pick up particularly in cancer screening/ diagnostics and you have new requirements under QOF – Also NHSC are monitoring and West Suffolk for example is hitting a third face-to-face while and national is 56% so we have some quite a long way ahead and put some quite a long way behind so it is really difficult to state where we are without ticking them off [05/05/2021, 17:42:24]
Helen Whately
I just wonder if now is the moment to move on from unqualified receptionists performing triage?!
[05/05/2021, 19:57:43]
Nadine Dorries MP
One of my daughters told me today how efficient it was now that you rang for an appointment and instead of having to schlep to a surgery, the GP called you back. My 85 yo mother on the other hand, is demanding to
know what her GP has done with his year off. [05/05/2021, 20:01:47]
Matt Hancock
100% this [05/05/2021, 20:08:11]
Jo Churchill
Love your mum Nad! that’s the point of educating the patient half love it half of them hate it (often to do with their condition) and in your mid 80s they treat it as an outing! and Helen yes but 111 for example has now stopped triaging dental patients we don’t have the control we need to triage everyone say via 111 or us overseeing a uniform phone system to each practice and then we have some quality control and better data capture over appt numbers, time spent with patient & doctor numbers – let’s just say data pretty suboptimal – we have to take the profession with us and we’re going to have to pay for it or lease it to them or it is likely to exacerbate retention – also 3rd vaccine, certification, diagnostics, rehab, MH – if primary care GP, pharmacy, community is to be the glue 82% of the care but not of the cash we have to think differently – build back better is a good slogan for primary care that saves the system cash – open door so no focus on need if not triaged correctly and no control over the customer! They are up for changing but their customer will have to be helped... [05/05/2021, 21:19:14]
Ms Dorries, whose brief as a health minister covered mental health and suicide prevention, was also concerned that as the authorities became increasingly stretched by the demands of the pandemic, the number of suicides was being underestimated – something the Government was reluctant to admit.
Nadine Dorries MP
This is the provisional data for 2020 – Provisional data show there were 10.3 suicide deaths registered per 100,000 people in Quarter 1 (Jan to Mar) 2020 in England, equivalent to 1,262 registered deaths and the same as the rate observed in Quarter 1 2019. In Quarter 2 (April-june) 2020 there were 6.9 suicide deaths registered per 100,000 people, equivalent to 845 deaths. [01/09/2020, 13:31:41]
Nadine Dorries MP
Policy leads don’t want us to announce bcse [because] they think it’s due to suicides not being recorded due to Covid – apparently [01/09/2020, 13:38:46]
Matt Hancock
If it’s published data it’s published data [01/09/2020, 14:05:44]
Nadine Dorries MP
Yep – I will state it if a MH [mental health] topical comes up [01/09/2020, 14:08:24]
As early as July 2020, with the first lockdown still in place, Ms Whately was worried that one of the knock-on effects of lockdown was that care home residents would have been neglected following the suspension of inspections by the Care Quality Commission (CQC). Ms Whately had hoped the issue had been avoided through emergency arrangements, but Kate Terroni, chief inspector of adult social care, did not share her optimism.
Helen Whately
So you’re aware – CQC have at last shared with me info about what their inspectors did March-june. They have been in touch with many care homes & raised concerns with Las [Local Authorities]. However, they did NOT share their concerns with me (despite me requesting more info in regular meetings). There is also a material risk – now they are restarting inspections – that they will uncover cases of neglect. The processes put in place in March were meant to prevent that, but Kate Terroni is not confident. I have asked her to keep me updated so we are forewarned rather than seeing things in the media first. [01/07/2020, 12:45:04]
Matt Hancock
Ok thanks [01/07/2020, 12:48:20]
Helen Whately
Sorry it’s more – potentially – bad news. But thought better you should be in the picture. I really pushed CQC to have a system in place that would pick up and stop neglect / poor care.
It’s frustrating that Kate could not assure me on this in my meeting with her today. [01/07/2020, 12:53:54]
Matt Hancock
Better to know and better to get it sorted There were also knock-on effects from a legal point of view. In April 2021 Mr Hancock’s special adviser, Allan Nixon, was worried about the Government being sued by the families of those who had died because of the backlog on cancer care and elective treatments.
[01/07/2020, 12:52:42]
Allan Nixon
Just a thought: Have you seen anything on risks of US/NHS receiving a torrent of law suits from GLP and others on people dying due to us not tackling the cancer & electives backlog etc?
[29/04/2021, 14:20:28]
Allan Nixon
Worth us commissioning properly bottomed– out thinking on what could come down the tracks in the coming months/years? [29/04/2021, 14:21:44]
Matt Hancock ok [29/04/2021, 14:22:28]
The inquiry into the pandemic response, which will begin hearing from witnesses later this year, will consider, among other things, the effect of the pandemic on the mental health and wellbeing of the nation, and its impact on children and their education. Its terms of reference do not, however, specify that the inquiry will examine the knock-on effects of lockdowns or whether using lockdowns was the right policy at all.
THE LOCKDOWN FILES REPORTING TEAM
Katherine Rushton, Gordon Rayner, Claire Newell, Sophie Barnes, Robert Mendick, Jack Leather, Janet Eastham