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Justice system
The scale of the challenge facing a creaking criminal justice system is perhaps best articulated by the recent decision to allow the lord chief justice to ask for unlimited funding to open up more courtrooms in England and Wales.
Currently, more than 57,000 criminal cases are in a queue for the crown court, stretching to 2023. Clearing the backlog will cost hundreds of millions of pounds – modest sums in the context of the government’s response to the pandemic but crucial if delays to justice are not to become permanent.
The pandemic exposed years of underfunding in the justice system. Between 2010 and 2019, more than half the courts across England and Wales were closed. Rebuilding capacity is one thing but the human cost of delays to victims is immeasurable.
Stephanie Boyce, the president of the Law Society of England and Wales, says the status quo has left “victims, witnesses and the accused in limbo”. She said: “Government must invest in criminal and civil courts as a matter of urgency.”
Funding cuts have also destroyed legal aid provision. In 2013, legal aid was removed from many civil law cases to save £350m a year. Boyce says the system needs to be changed. “Restoring legal aid for early advice – particularly for family and housing issues – would help keep cases out of civil courts, as problems can be nipped in the bud.
“To build back better and redress imbalances across England and Wales, the Ministry of Justice must make sure people on low incomes can get the legal support they need no matter where they live. Decades of underinvestment have left swathes of the country as legal aid deserts, particularly for issues like community care and housing, for which there is likely to be a greater need than ever now the eviction ban has ended.”
Other cost-cutting measures by the government are likely to need reassessing as the justice system plays catch up after the pandemic. Cuts to funding and staff numbers in the last decade left prisons in a poor state to manage more inmates. Government spending plans might fall hundreds of millions of pounds short, depending on the number of cases that result from the recruitment of more police officers.
Even before coronavirus, some warned that the rule of law was under threat. The need for significant and sustained investment is now accepted; the issue is how much will be required.
Boyce said: “The rule of law must underpin every step of the UK’s recovery from the pandemic.” Mark Townsend
Mental health
As a professor of clinical psychology at the Institute of Mental Health, Roshan das Nair has spent two decades researching the wellbeing of the nation. Never before has he been so concerned about the mounting crisis of mental health. “The challenges presented by the pandemic are so complex and wide-ranging, they cannot be solved by health and social care professionals alone,” he said.
There is only so much doctors, nurses, psychologists, therapists and other healthcare professionals can do to support the estimated 10 million people needing mental health support as a direct consequence of Covid-19, because there are only so many of them to go around.
“Even if you throw a lot of money at it today, it takes a long time to fully train healthcare professionals,” said das Nair. “That increased capacity won’t be felt until years later. Help will be needed from employers, from educational institutions, from the ‘third sector’ if we’re going to prevent people from becoming unwell.”
The steep rise in anxiety, depression, social isolation, substance misuse, trauma and loneliness has been unsurprising, but das Nair says a joined-up, multi-disciplinary approach is needed urgently. “We need to bust bureaucracy. The astonishing speed at which science has been able to come up with solutions through Covid-19 is something that needs to happen.”
He calls for a public health response that doesn’t just see money urgently put into the NHS, but seeks solutions that compel schools and employers to take more responsibility in helping people stay well. “For instance, there is a role for the education sector to monitor how pupils are faring, and we can train young people to be better at looking after their mental health.
“If flexible working has reduced stress for some workers, can employers take that on board post-Covid? Preventative measures are key – often we’re only reacting to mental health issues when they arise, and we can’t continue in that vein because of the sheer number of people reporting problems.”
The NHS entered the pandemic already stretched following the longest funding squeeze in its history, but the strain on mental health services is predicted to devastate the nation for years. In the spring, the government announced a £500m mental health recovery action plan to “level up mental health and wellbeing across the country” by targeting groups most affected, including young people and frontline staff. Leading medical organisations including the BMA and the Royal College of Psychiatrists have said more is needed and have lobbied for NHS staff to have access to mental health support similar to that available to war veterans. “The strain on NHS workers and their mental health and wellbeing is a huge concern,” said das Nair. “The pandemic has taken its toll on those who work to look after others and we need them to be well.” Nosheen Iqbal
Education
Barry Read has seen many shifts in government policy in his 16 years as a headteacher. But last week’s rejection of Sir Kevan Collins’ post-Covid catch-up plan for schools, followed by Collins’ resignation, has left Read and other headteachers devastated.
The head of RJ Mitchell primary school in Havering, east London, with colleagues, met Collins while he was working on his report as education-recovery commissioner. “We came out of that meeting so optimistic, we really felt there was going to be change, we believed there was a long-term plan coming on to the table, only to be dashed again – which has happened so often in the past few years,” Read said. “We are bitterly disappointed. Now there is no plan – it’s just a mash of strands of different headlines and the problem is that none join up.
“Schools are constantly being told to produce three-to-five-year budget-recovery or school-development plans. But this is not a plan. We have no timescale, no detail, no benchmarks, nothing. Just a series of headline-grabbing words and only a tenth of the money we need.
It’s been a catalogue of disasters. We won’t forget that a year and a half ago Gavin Williamson said, at the beginning of the outbreak, basically, ‘Man-up teachers and get back in the classroom’. How he is still in a job, I have no idea. If I was a headteacher with his track record, I’d be gone.”
Read said the lockdowns had exposed flaws in England’s school system, with an urgent need for better funding for those with special educational needs and disabilities (Send). “The problem is the system didn’t work before the pandemic. I’m the head of a school with 18% of children with [education and healthcare plans], compared with 3% nationally, those are the kinds of challenges I face. Those children were poorly funded, Send was poorly funded, [child and adolescent mental health services] were non-existent, mental health and wellbeing support is not there.
“We are coming out the other side of the pandemic with the same problems, if not worse, and we’re expected to run on peanuts again.”
So far, the government’s major catch-up effort has been to fund external tutors for schools but Read says he was unable to find any through the flagship national tutor programme. So he had to hire his own. “There’s no joined-up thinking, there’s a lot of soundbites. The money they’ve just announced is over three years, not one. So if you talk billions it sounds good, doesn’t it? But divide that by three and it sounds like a lot less.” Richard Adams
Health
Donna Doyle is a human face of a problem affecting millions, and threatening to become a major challenge for Boris Johnson – the growing waiting-list for NHS care.
The 52-year-old has been waiting 22 months for reconstructive surgery on her right foot to correct deformity – splayed toes – and agonising pain caused by rheumatoid arthritis. “I’m in constant pain,” says Doyle, an NHS clinical trials manager in Lancashire.
“When I walk it’s like trying to walk with pebbles in my shoe grinding against the bone in my foot. It’s affected my mental health as well as my physical health.”
Doyle is one of the 4,950,297 people in England on the waiting-list for planned hospital treatment – the highest number on record. That total rose by over 250,000 to that figure in just one month, between February and March, as patients who were deterred from seeking NHS help during the pandemic, or could not access it because of the widespread suspension of normal care, took advantage of Covid’s retreat to see their GP and finally get referred to hospital.
Experts fear the list could reach 10 million by 2024. Hospital managers say staff shortages, workforce exhaustion after Covid and sickness absences, some caused by pandemic-induced mental health problems such as PTSD, will limit the response to the backlog.
The latest figures, due on Thursday, are likely to see the waiting list pass 5 million for the first time. While the plight of cancer patients is often highlighted, the figure includes people with heart problems and disabling conditions such as arthritis, some of whom need a new hip or knee. Liam O’Toole, the chief executive of Versus Arthritis, said widespread cancellations of surgery means people are “having to endure agonising pain for even longer”.
Patients should be treated within 18 weeks, But NHS statistics show that the number of those forced to wait at least a year has rocketed from just 3,097 in March last year to 436,127 in the same month this year. Worryingly for Johnson, usually government-friendly newspapers such as the Daily Mail and Express titles have begun highlighting the long delays patients are now facing.
Doyle adds: “I went on to the waiting list in August 2019. My pre-op appointment due last April was cancelled due to Covid. Last September, the hospital said I couldn’t have my surgery because it was the NHS trust’s policy not to operate on people who are extremely clinically vulnerable because their compromised immune system means they were at too great a risk of catching Covid in hospital. That includes me, because rheumatoid arthritis is an autoimmune condition.
“They rang me again in February and said nothing had changed and they’d ring me again in October. That’s not really good enough. When they told me that, I was angry and upset. I’ll have been waiting for two years, come August. My surgery is on my mind all the time.”
Doyle is desperate for surgery, but also resigned to the wait. “I just want the NHS to get on with it. But with staff exhausted after Covid, and some even leaving altogether, I just can’t see it happening. It looks like we’ve replaced one crisis – the pandemic – with another: all these people waiting for a long time for care. For some, treatment will come too late. Denis Campbell
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