Mesh: Denial, half-truths and the harms

Sharon Hartles, Member of the Harm and Evidence Research Collaborative, The Open University

Mesh implants used ‘with no clinical evidence’ (Screenshot). Photo Credit: BBC Two Victoria Derbyshire 15th January 2020

Surgical meshes have been in use since the late 19th century. In the mid-20th century the clinical usage of mesh increased. Now, in the early 21st century, procedures involving mesh implantation are common surgeries that are performed around the world. Despite the frequency and worldwide usage of mesh medical devices, the debate about whether or not the benefits outweigh the alleged harms remains highly contested.

Mesh implants are manufactured from synthetic (non-absorbable or synthetic absorbable) and biological materials. Synthetic non-absorbable materials include: polypropylene, polyester, and polytetrafluorethylene. Synthetic absorbable materials include: polylactic-co-glycolic acid and polyhydroxybutyrate. Biological materials include: modified collagen of porcine or human dermal or visceral collagen.

Surgical (open) or laparoscopic (keyhole) approaches are carried out for the clinical applications of mesh implants. Mesh medical devices have been installed in breast reconstruction, abdominal/pelvic hernia repair, and hiatal hernia repair. Regardless of mesh implant technique and location, each material provides its own set of challenges.  As such a complex range of potentially harmful side effects can occur.

The recent publication of the Independent Medicines and Medical Devices Safety Review (IMMDSR) report, First Do No Harm and thesubsequent recommendations were welcomed by individuals and campaign groups effected by: mesh implants, Primodos and the anti-epilepsy drug sodium valproate. However, the mesh focus was centred on abdominal and vaginal pelvic mesh procedures used in the treatment of stress urinary incontinence and pelvic organ prolapse. For this reason the voices and lived experiences of many other mesh-harmed individuals, who did not fall into the particular focus, were not heard and did not form part of the IMMDSR publication.

Mesh-harmed individuals and campaigners experience traumatic, excruciating, unbearable pain and debilitating life changing harms, yet it is not only the medical devices that cause harm. Stubbornness and reluctance to blame implants in certain cases has led to doctors being accused of gaslighting – psychologically abusing mesh patients by questioning their sanity. This is exacerbated by flaws in the healthcare system, in some circumstances stemming from inexperience of professionals; gaps in research linking side effects to medical devices; and contested safety and efficiency status.

Dismissed as ‘women’s problems’, harms resulting from mesh implantations have been suppressed by doctors, leaving patients feeling belittled, ignored and above all disempowered. Relentless campaigning by patient groups has raised awareness of the lack of informed consent and a failure to listen to patients’ voices. In addition to this, campaigners have generated media and public interest into this injustice. This is not just localised to the UK, mesh surgeries are performed worldwide, and thus mesh-harmed activists are campaigning for justice around the world.

On 4th March 2021, in a landmark judgment, the Federal Court of Australia dismissed an appeal by Johnson & Johnson (one of the main manufacturers of vaginal mesh), who was found to have acted negligently. Johnson & Johnson concealed known complications about mesh implants and aggressively marketed their faulty implants successfully based on half-truths. A clear case of profit before harm, Johnson & Johnson had no regard for the serious and debilitating side effects thousands of women would experience from their mesh devices; and instead was driven by profiteering and commercial interests.

Although it is overwhelmingly women’s voices which have been ignored and women’s lived experiences which (until recently) have not been validated; it is paramount to note that mesh medical devices are also implanted into men, children and babies. Therefore it stands to reason that the devastating impacts of mesh are not just experienced by women. In December 2018, Graham Robertson, was left with a multitude of serious health complications, allegedly stemming from hernia surgery in 2007. While he experienced chronic pain, professional responses to his situation ranged from dismissal to denial. From the doctors’ perspectives the hernia had not returned, thus demonstrating the success of the procedure. Yet, despite the successful nature of the surgery, in this case, the side effects outweighed the benefits. 

The responses to many questions remain contested or disputed at this time, such as:

  • Do the long-term benefits of mesh medical devices outweigh the risks (side effects)?
  • How is reasonable assurance of safety and effectiveness of mesh medical devices measured? 
  • What practices are in place (locally and globally) to ensure patient voices are listened to and acted upon?
  • What systems are in place to deter companies from favouring profit and commercial gain above the interest of patient safety?

Nevertheless what is apparent is the need to ensure patients are able to make informed decisions about their healthcare and well-being. In order to do this patients must be fully informed about the risks. Beyond this, a patient-led approach must be centred at the heart of future health care procedures and provision. The hope is that such an approach will guarantee the focus remains on patient safety first; and deters other agendas which would potentially conflict with the best interests of patients.

There are a number of mesh campaign groups throughout the UK and globally which offer general advice and support to individuals affected by mesh harms. Groups include:

This blog was originally published by the Harm and Evidence Research Collaborative at The Open University. See

Reflections on COVID-19, Prisons and Legal Activism

Dr. David Scott, The Open University and Prof. Joe Sim, Liverpool John Moores University

In April 2020, we provided expert legal evidence to a court case involving a terminally ill prisoner. To the best of our knowledge this is the only legal case to date calling for the release of a dying prisoner in the context of the elevated risks to prisoner health through the spread of COVID-19 in prisons.

Prisons are crowded and unhygienic environments which historically have been hot-beds for the spread of contagious diseases, such as tuberculosis.  Many prisons are vermin infested and in a poor state of repair. They are often also draughty, something also significant given the recent evidence of how COVID-19 can spread through the air. A number of prison cells do not meet the basic international standards and minimum rules with regards to size or conditions and some prisons, such as HMP Coldingley and HMP Long Lartin, hold prisoners in cells with no integral sanitation.

Epidemiologists and other experts, including the government’s own advisors from Public Health England, have noted that unless there was a radical reduction in the prison population, which on 21st February 2020, stood at 83,695, then there could be a humanitarian catastrophe resulting in up to 3,000 prison deaths.  Whilst government initially seemed persuaded by these arguments, any possibility of a radical reduction in prison numbers disappeared off the political agenda almost as quickly as it had arrived.  By 12th February 2021, the prison population had declined by more than 5.000 during the pandemic to 78,188 and this small and almost certainly temporary reduction in numbers is now considered sufficient by a government clinging tightly to a ‘law and order’ ideology at whose centre stands the prison.

A Dual Strategy

Since March 2020, penal policy has followed a bifurcated strategy aimed at expanding the capacity of single-cell occupancy (by around 500 places) and containing the spread of the disease through cohorting, which brings together prisoners who actually had symptoms of COVID-19; shielding, which is very similar to the notion of isolation within the broader community; and maintaining social distancing through an authoritarian lockdown which has  dramatically curtailed the already limited prisoner interactions prisoners have with each other and the wider community. This strategy, which is dehumanising and hugely harmful to prisoners’ physical and mental health, has denied them visits with their family and left them isolated in prison cells for up to 22 and a half hours a day. In a thematic study published on 11th February 2021 exploring the impact of the pandemic on prisoners, the HMCIP found incontrovertible evidence that the ‘cumulative effect’ of the prison lockdown was having a devastating impact on ‘prisoners’ emotional, psychological and physical wellbeing’.  Whilst some prisoners do have access to telephones, in-cell sanitation, showers, computer games and televisions, all too many are living in bare and austere prison cells.  One embarrassingly antiquated response of the Prison Service in an attempt to keep prisoners occupied during the lockdown has been to give them crayons and colouring in books.

It is too early to tell just how harmful this lockdown is going to be in terms of the wellbeing of prisoners, or indeed, how people are going to react once the lockdown is lifted and there is an outlet for their pent-up frustration.  What we do know is that in 2020 there were 318 deaths in prison in England and Wales and that 67 (of those currently classified) were self-inflicted deaths. In December 2020 alone, there were 24 Covid-19-related prisoner deaths and between March 2020 and January 2021, at least 86 prisoners died from the disease.  In this same 10-month period, 10,345 prisoners tested positive for Covid-19 – which is about 1 in 8 of the prison population – indicating the limited effectiveness of the current authoritarian approach.  We also know that there has been a dramatic increase in the number of self-harm incidents in women’s prisons, where according to Ministry of Justice data, during the 12 months from September 2019-September 2020 there was a reported 3,557 incidents of self-harm for every 1,000 women prisoners. It has also been recently reported that the first six months of 2020, 15,615 prisoners were put on ACCT (assessment, care in custody and teamwork) / suicide-watch plans in prisons in England and Wales, which is a significant increase on the numbers from the previous year.

Going to Court

In March 2020, we were approached by a member of the legal team representing a terminally ill prisoner in HMP Stocken who had bladder cancer.  The prisoner had a life expectancy of somewhere between three to 18 months but had been denied compassionate release under the Prison Service Order 600 and the Criminal Justice Act of 2003. The significant thing about compassionate release is that it is permanent, rather than release on a temporary licence (ROTL).

For various reasons, compassionate release was denied. His lawyers asked us to submit written evidence indicating the limitations of the existing lockdown policy and highlighting some of the difficulties that a prisoner would face in terms of living with a terminal illness in the context of COVID-19.  Our first submission drew attention to concerns raised by Her Majesty’s Chief Inspector of Prisons about the unhygienic environment in HMP Stocken, as well as evidencing broader concerns about the spread of COVID-19 in prisons across the country.  Our submission was in compliance with the broader position of the prisoner’s legal team that the current government approach to COVID-19 in prisons was presenting an existential threat to life and, more broadly, was a breach of human rights.

The Ministry of Justice’s case was that as the prisoner had perpetrated a violent crime and there was some ambiguity about how long he had to live, that he would continue to present a threat and was, therefore, a risk to public protection.  They argued that the Prison Service had made what they considered to be reasonable adjustments to existing policy to accommodate people who were terminally ill within prisons.

One of the basic rules for those giving expert evidence to the courts is that any claims made in written or verbal submissions must be fully substantiated by evidence and that the function of the expert is to help the court come to an informed decision rather than present an argument from a given political or ethical standpoint. Any claims must ‘stand up in court’ and rightly should be subjected to the greatest of scrutiny.  Yet, in their formal written response to our first submission, the state’s lawyers largely side-stepped the evidence we had marshalled and instead indicated that we might be less than credible witnesses because we were, and are, closely associated with the hugely nuanced and sophisticated theoretical and ethical perspective of abolitionism. Our submission was dismissed because we argued simply ‘against imprisonment’. This is a classic tactic pursued by the state when it has little or no answer to challenges to its authority: discredit critics, apply pejorative labels, simplify complex positions and suggest critics are biased while implying that the state’s position is exemplary and value free. It is the politics of distraction.

Operating within a very short deadline, we drafted a second submission, reiterating the evidential basis of our first submission and questioning some of the assumptions of both the prison service’s evidence and the skeleton case for the state. The government’s response was that HMP Stocken had introduced a successful shielding situation, and thus because of the reasonable adjustments made there would be no difficulties with the spread of COVID-19. This has proved to be a dangerous and inaccurate assumption.  On 18th February, according to a report in the Times, Public Health England indicated that 92 out of 117 prisons had experienced an outbreak of the virus. In the previous week, ‘an outbreak at HMP Stocken caused Rutland, England’s smallest county, to have the highest infection rate in the country with around about half of 199 new cases reported in the prison’. The local Rutland and Melton MP Alicia Kearns indicated that the number of COVID-19 infections at HMP Stocken at this time was approximately 100 prisoners.  According to the Times, ‘ten of its inmates [prisoners] ended up in intensive care in local hospitals’.

The case wended in a stalemate, when the Secretary of State’s legal team indicated that the prisoner might now be considered for release on temporary license, the ROTL.  Prior to the court hearing it had appeared that any possibility of ROTL was impossible and therefore had not been fully pursued.  The prisoner’s legal team continued to work for his release (both on ROTL and compassionate grounds) and drew upon the evidence we had submitted to strengthen their case.  In early August 2020, the prisoner was permanently released on compassionate grounds under Prison Service Order 600 and the Criminal Justice Act, the grounds that were originally pursued by the legal team.


The acceleration in COVID-19 cases in prison, and the traumatic physical and psychological impact of the lockdown on prisoners and their families, raises profound questions about the government’s strategy for protecting prisoners and ensuring their safety. It also raises profound questions about the abject failure of Ministers to grasp a unique opportunity to begin the process of radical decarceration, removing people from prison and investing in well-funded, well-staffed alternatives to custody. However, this government, like its Conservative, Coalition and Labour predecessors, remains welded to an iron, law and order ideology which, despite all of the evidence to the contrary, unconditionally supports the misplaced idea that the prison acts as a bulwark against crime – or at least crimes committed by the poor and the powerless as the systemic criminality of the powerful, and the harms they generate, remain protected by an unapologetic culture of immunity and impunity. Jeffrey Reiman and Paul Leighton’s powerful assertion that ‘the rich get richer and the poor get prison’ remains as true now in the middle of a pandemic as it ever was. The corrosive failure to develop radical alternatives to the prison is not simply a political choice but represents a moral failure of the highest degree. To detain dying prisoners inside until literally their last breathe is shameful. However, asking government Ministers to feel ashamed is like asking not only for the moon but for every star in the universe. Such a move requires a degree of self-awareness and humanity which the inhumane logic of neoliberalism, and the starkly degrading policies and practices of state institutions, neither encourage nor support. That is the brutal reality for prisoners, and their families, in this pandemic.

This blog was published simultaneously by the Harm and Evidence Research Collaborative at The Open University and the Centre for Criminalisation and Social Exclusion, Liverpool John Moores University. See:

Primodos: The Next Steps Towards Justice

Sharon Hartles, Member of the Harm and Evidence Research Collaborative, The Open University

Wednesday 8th July 2020, marked the publication of the final report by the Independent Medicines and Medical Devices Safety Review, which was commissioned to examine the harmful effects of three treatments: Primodos, an oral hormone pregnancy test that caused birth defects;  sodium valproate , an epilepsy drug that also causes birth defects, and surgical mesh, a treatment for incontinence that causes chronic debilitating pain. Primodos was the most widely prescribed ‘hormone pregnancy test’ in the UK (and around the world) in the 1960s and 1970s until it was taken off the market in 1978.  First Do No Harm found that avoidable harm was caused because the UK Government and the Healthcare system failed in their duty to protect patients and regulate Primodos.


For the Primodos-affected members of the Association for Children Damaged by Hormone Pregnancy Tests, a lobby group, the findings and recommendations offered recognition ‘that hundreds of families have been wronged.’ Recommendation 1 of First Do No Harm was fulfilled when Matt Hancock apologised for the avoidable harm caused to those who suffered. However, after this welcomed and prompt first step towards justice, the next steps – the implementation of the remaining eight recommendations – have been fraught with resistance. 

Baroness Julia Cumberlege, a life peer who chaired the Independent Medicines and Medical Devices Safety Review, explicitly championed the need for the recommendations set out in First Do No Harm to be implemented with determination and urgency. Despite this, it has now been more than three months since the report was published, which may not seem like much time within the political agenda, and given the preoccupations with Covid and Brexit, but England is lagging behind Scotland. At a 9th July 2020, press conference, Julia Cumberlege raised concerns about the importance of implementing the report’s recommendations and the significance of not leaving it to “sit on a shelf and gather dust”. 

Yet, two months later, amid rumours the report was going to be buried, during a Parliamentary debate which took place on 2nd September 2020, the Baroness requested assurances from Ministers that the recommendations would be implemented. On the same date, MP and chair of the All-Party Parliamentary Group on Hormone Pregnancy Tests, Yasmin Qureshi, took a different approach. Namely, she accused Government Ministers of hiding behind irrelevant “legal action, which has no bearing on this report’s findings” to ignore their duty to implement First Do No Harm recommendations a point which she had previously voiced in a letter to Matt Hancock on 15th July 2020.

To its credit the Scottish Government has led the way; and on 1st September 2020, First Scottish Minister Nicola Sturgeon confirmed that Holyrood had accepted, in full, the recommendations of Baroness Cumberlege and would be appointing a Scottish Patient Safety Commissioner, “the emphasis of this new role is on the patient voice within the safety system.”  Moreover, on 13th September 2020, Andrew Davies, Shadow Minister for Health announced that a Welsh Conservative-led government would appoint ‘an independent patient safety commissioner in Wales.’ Currently, First Minister of Wales and the Welsh Labour-led government Mark Drakeford has not made any announcements regarding intentions towards the appointment of an Independent Patient Safety Commissioner.  

The Independent Medicines and Medical Devices Safety Review findings have had wider reaching ramifications. Primodos, a drug marketed by the West German pharmaceutical company Schering AG, was marketed in West Germany until 1981 as Duogynon. On 16th September 2020 the German Federal Ministry of Health announced it would be launching a review into whether or not the relationship between the regulator then the Federal Health Office today known as the Federal Institute for Drugs and Medical Devices  and the manufacturer then Schering AG, now Bayer AG led to ‘the drug remaining on the market despite concerns about its safety.’ 

In an article by Jason Farrell, Home Editor at Sky News, published on 19th September 2020, he noted ‘The German government has been reluctant to look into the issue and campaigners in Germany were relying on a breakthrough in the UK. That came after an independent review in Britain found in July that government health regulators had failed patients and that Primodos was responsible for “avoidable harm”.’ Although Jens Spahn German Federal Minster for Health, confirmed a research project into possible collusions between the German regulatory authority and the manufacturer; he also made it clear that “all the known findings and the scientific evidence do not currently support a causal link” between the hormone pregnancy test and birth defects.

Marie Lyon, chair of the Association for Children Damaged by Hormone Pregnancy Tests, met with the German Health Committee and MPs in March 2019 to present analyses from Oxford University scientists Carl Heneghan and Jeffrey Aronson. Based on the research conclusions she discussed a possible review of Primodos and Duogynon and its association with ‘increased risks of congenital malformations.’ The subsequent pressure from German politicians calling for a review, together with First Do No Harm findings played an instrumental part in sparking the German investigation into the Duogynon scandal. For Marie Lyon, who has been working with the Duogynon Network, an association for members affected by Duogynon, since 2012, the announcement came as “a huge step forward for the German campaign group and one we thought we would never see happen”.

Image: Courtesy of Sharon Hartles (adaption/remix of  I , IIIIIIV , VVI, VII ) MPs supporting calls forthe implementation of First Do No Harm recommendations. (From left to right – Sir Ed Davey, Leader of the Liberal Democrats, Ian Blackford, Westminster Leader of the SNP, Sir Jeffrey Donaldson, Leader of DUP Party in Westminster, Caroline Lucas, co-Leader of the Green Party, Liz Saville-Roberts, Plaid Cymru, Westminster Leader, Colum Eastwood,  Leader of the Social Democratic and Labour Party and Sir Keir Starmer, Leader of the Labour Party).

Back in the UK, in a bid to ensure that First Do No Harm is not ignored on 16th October 2020, six leaders of political parties: Sir Ed Davey, Ian Blackford, Sir Jeffrey Donaldson, Caroline Lucas, Liz Saville-Roberts and Colum Eastwood signed a joint letter to Prime Minister Boris Johnson urging him to ‘instruct the Department of Health to implement the findings of the Cumberlege Review’. According to the All-Party Parliamentary Group on Hormone Pregnancy Tests on 28th October 2020, Sir Keir Starmer added his signature of support, a notable action, because all seven opposition party leaders have presented a united front in calling on Boris Johnson to implement the Independent Medicines and Medical Devices Safety Review recommendations “in full and without delay.”

The UK government failed in its duty to regulate Primodos. The health care system failed in its duty to protect patients.  These failures resulted in avoidable harms spanning decades. For Primodos survivors these alleged life changing harms include: cardiac malformations, musculoskeletal, neurological, neurogenetical malformations, miscarriage and stillbirth. However, it was not the role of the Independent Medicines and Medical Devices Safety Review to determine whether or not there was ‘a causal association between HPT use and physical malformations’. Therefore the review findings have not laid to rest scientific debate around the contested harmful nature of this synthetic sex hormone. And so there are still open questions regarding claims about the effects caused. What is significant, is that Recommendation 4 of First Do No Harm states ‘The state and manufacturers have a moral responsibility to provide ex gratia payments to those who have experienced avoidable damage from the interventions we have reviewed.’  First Do No Harm may not have determined a causal association but recommendation 4 suggests that the Independent Medicines and Medical Devices Safety Review findings are a long way from establishing harmlessness.


Now is not the time for the Government to unnecessarily prolong further suffering. It is time for these survivors of Primodos (and of sodium valproate and surgical mesh) to get the recognition and justice they so rightly deserve. In line with Recommendation 2, the appointment of an Independent Patient Safety Commissioner who will champion the patients’ voices and perspectives is long overdue. Furthermore, in accordance with Recommendation 9, action must be taken immediately to set up a task force in order to schedule a timetable for the implementation of the remaining recommendations as set out on 8th July 2020 by First Do No Harm.

To find out more about the Association for Children Damaged by Hormone Pregnancy Tests (ACDHPT) campaign and keep up to date with news, visit In addition, there are a number of ways you can support the campaign:

– Follow ACDHPT on Twitter
– Follow ACDHPT on Facebook
– Sign ACDHPT’s petition Protect patients and make our healthcare system safer for your children to Prime Minister Boris Johnson calling for him to implement the recommendations set out in the Cumberlege Review
– Encourage your MP to join the APPG for hormone pregnancy tests
– Make a donation to help ACDHPT continue their campaign
– Get in touch with Marie Lyon

This blog was originally published by the Harm and Evidence Research Collaborative at The Open University. See:

Primodos: The first step towards Justice

Sharon Hartles

Primodos was the most widely used hormone pregnancy test prescribed to women in the UK. During 1958 to 1970 Primodos was marketed as a hormone pregnancy test and for the treatment of secondary amenorrhea. However, this was changed to just the treatment of secondary amenorrhea from 1970 to 1978, at which stage Primodos was withdrawn from the UK market. When Primodos was placed on the UK market in 1958 there was no centralised structured pharmaceutical regulation. In other words, no licence was required, no specific safety test was needed and there was no general consumer protection legislation.

In 1978, the Association for Children Damaged by Hormone Pregnancy Tests, was set up in the UK to represent families who suffered congenital abnormalities, stillbirths and miscarriages, allegedly due to taking the oral hormone pregnancy test Primodos. Decades of fighting for justice to uncover the truth about the failures of past Government Health Regulatory Authorities led to a review being commissioned in February 2018, by Jeremy Hunt, the then, Secretary of State.

The announcement in the House of Commons was for a review into how the health system responds to reports about harmful side effects from medicines. This stemmed from patient-led activist campaigns on the use of: hormone pregnancy test Primodos, sodium valproate and surgical mesh. Jeremy Hunt stated “patients and their families have had to spend too much time and energy campaigning for answers in a way that has added insult to injury for many.”

Two and a half years after this review was commissioned, on Wednesday 8th July 2020, the Independent Medicines and Medical Devices Safety Review published the First Do No Harm Report. This Report, together with the additional supporting documents to accompany it including: Personal Testimonies, Oral Hearing Transcripts, Hormone Pregnancy Tests Supporting Information, Timeline Key Events, History of Regulation and the Press Conference Speech (by Baroness Julia Cumberledge, CBE, Chair of the Independent Medicines and Medical Devices Safety Review) evidence unequivocal systemic failures and a clear link between PRIMODOS and its tragic side-effects.


Source: Sky News

Marie Lyon, Chair of the Association for Children Damaged by Hormone Pregnancy Tests and active campaigner for justice, since 1978, on reading the First Do No Harm Report, declared “I’ve tried to be very calm and I can’t. It’s the fact it’s been acknowledged. They’ve actually looked at the documentation honestly and openly and for me that is the biggest result for our families today. They will be absolutely overjoyed.”

The Independent Medicines and Medical Devices Safety Review has set out nine recommendations in their First Do No Harm Report. Recommendation 1: states ‘The Government should immediately issue a fulsome apology on behalf of the healthcare system to the families affected by Primodos, sodium valproate and pelvic mesh.’ On the 8th July (the date the report was published) Matt Hancock, Secretary of State for Health and Social Care apologised “on behalf of the NHS and the whole healthcare system” to those who have suffered and their families.

For decades, there have been numerous publications evidencing an association between hormone pregnancy tests and congenital malformations in babies. In 2018 and 2019, Oxford University published an analysis of data which found a clear association relating to Primodos and birth defects. Other supporting research which have found links between hormone pregnancy tests and birth defects includes:

However, there have also been opposing publications which have found no association and/or inconclusive results. In 2017, the Medicines and Healthcare products Regulatory Agency (MHRA) published their report on the use of hormone pregnancy tests and adverse effects related to pregnancy including possible birth defects. The MHRA is an independent Expert Working Group of the UK’s commission on Human Medicines, which was established, in October 2015, in order to conduct this review. The MHRA found there to be insufficient evidence to support an association. Other opposing research includes:

For Marie Lyon, Chair of the Association for Children Damaged by Hormone Pregnancy Tests “after viewing the oral evidence presented by members of the Expert Working Group who were responsible for the scientific publication in 2017, it seems I already have a perfect example of the denial and protection culture endemic in our regulators. Denial when problems occur and protection, not for the patient but for the manufacturer.”

In light of the decades of jostling to and fro of supporting and opposing evidence, it is clearer to understand why the findings of the Independent Medicines and Medical Devices Safety Review in the First Do No Harm Report, together with Matt Hancock’s prompt apology on behalf of the UK Government and acceptance may in the first instance offer some form of relief for the families of the Association for Children Damaged by Hormone Pregnancy Tests.


In the Press Conference Speech by Baroness Julia Cumberledge Chair of the Independent Medicines and Medical Devices Safety Review, she stated ‘In our view Primodos continued to be given as a pregnancy test for years longer than it should. In the face of growing concerns it should have ceased to be available from 1967.’ Yet Primodos remained on the UK market until 1978. This is a failure on behalf of the UK Government to protect its population from harm. Equally, a failure on behalf of the corporation Bayer (Schering). Primodos, was manufactured by Schering in Germany. In 2006 Schering was acquired by Bayer plc.

It is important to point out that Amenorone Forte a hormone pregnancy test prescribed by GPs, during this same time frame, acted in much the same way as Primodos and was manufactured by Roussel in France.  Roussel was acquired by Sanofi in 2004. For this reason families of the Association for Children Damaged by Hormone Pregnancy Tests hold both corporations accountable for the avoidable harm inflicted.

According to the Independent Medicines and Medical Devices Safety Review, History of Regulation, The Medicines Act 1968 received Royal Assent in October 1968, however the ‘transitional period’ meant this Act did not come into effect until 1st September 1971. During this time the Committee on Safety of Drugs was formed, yet it had no legal powers. With little irony, there was no formal regulator, it was part of a voluntary arrangement. There was no body to legally mandate the removal of a drug from the market and limited mechanisms to regulate drugs and restrict their use.

More systemic failures followed because the Committee on Safety of Medicines, (which replaced the Committee on Safety of Drugs, 1st September 1971) focused its gaze on formalising new medicines entering the UK market. Products, including Primodos, which had been on the market before the 1st September 1971 were automatically granted a Product Licences of Right (PLR).

Primodos was awarded a PLR yet its product which had been on the market since 1958, had never been required to submit evidence of quality, safety or efficacy. This oversight to ensure Primodos met the appropriate standards of safety, quality and performance in line with new rules was another missed opportunity to protect public health and safeguard the interests of patients and users.

The Independent Medicines and Medical Devices Safety Review Timeline has brought to light other damning evidence. On 22nd July 1969 Schering UK wrote to Schering Germany recommending the removal of the pregnancy testing indication. In a letter dated 17th February 1970 to Schering, Dr Ruttle a member of the Standing Committee on the Classification of Proprietary Preparations (known as the MacGregor Committee – 1965 and 1971) which provided guidance as to which preparations should be used on the NHS, stated ‘The Committee would be prepared to place the product in A.3 if the promotional indication as a “pregnancy test” were withdrawn and I would suggest that the most appropriate and, acceptable to the Committee, promotion be “symptomatic treatment of amenorrhea to produce withdrawal bleeding.”

On the 9th March 1970 Schering agreed ‘to the deletion of “pregnancy test” from the indications, and to the promotional statement “the symptomatic treatment of amenorrhea not due to pregnancy, by producing withdrawal bleeding”. Further correspondence in April 1970 acknowledged the suggestions from Schering (removing the pregnancy test indication and altering promotional statements) and confirmed that Primodos would be placed in category A.3 (prescription-only medicines).

Five years later, the Committee on Safety of Medicines (an independent advisory committee to the UK medicines licencing authority) published a letter in the British Medical Journal (BMJ) on 26th April 1975. In this letter the Committee on Safety of Medicines stated they agreed with an article published five months earlier in the BMJ entitled Synthetic Sex Hormones and Infants which advised ‘there is little justification for the continued use of withdrawal type pregnancy tests when alternative methods are available.’

On 5th June 1975, the Committee on Safety of Medicines sent an alert letter – to all doctors in the UK – entitled Hormonal Pregnancy Tests, in which they advised them of a possible association between hormonal pregnancy tests and an increased incidence of congenital abnormalities. The Committee on Safety of Medicines stated ‘In view of the possible hazard, doctors should not normally prescribe certain hormonal preparations for pregnancy tests’.

Spanning 1958 to 1978, Primodos was given to around 1.5million women in Britain. Primodos was a hormone pregnancy test prescribed to women to detect pregnancy. It consisted of two tablets which were to be taken on consecutive days. A negative pregnancy test would result in a withdrawal bleed (within three to ten days of consumption of the tablets). It is now known that Primodos prescribed to women to confirm their pregnancy, by today’s standards equates to 13 morning-after pills or 40 oral contraceptive pills. Moreover, the hormones contained in Primodos are now used in the morning-after contraception pill.

A statement taken from the Independent Medicines and Medical Devices Safety Review Personal Testimonies from the families of the Association for Children Damaged by Hormone Pregnancy Tests illustrate their distress – “We feel that we were used as collateral damage by the pharmaceutical company who were developing the contraceptive drug at the time.” The personal testimonies of Nicky Gibbins and Daniel Mason evidence how “The effect on our lives have, as you can imagine, been devastating.” The alleged impacts of PRIMODOS comprise:

  • all congenital malformations
  • more specific malformations:
    • cardiac malformations
    • musculoskeletal
    • neurological
    • neurogenetical malformations
  • birth defects
  • miscarriage
  • stillbirth


The First Do No Harm Report together with the supporting documents is significant because it evidences a clear link between Primodos and the terrible avoidable harms that have been perpetuated for decades through a culture of denial and the absence of state and corporate accountability.

Acknowledgement in the form of an apology on behalf of the Government was the first step towards justice. However, in a letter dated 13th December 2018, to the Independent Medicines and Medical Devices Safety Review, Bayer stated ‘there is nobody at Bayer plc who could usefully contribute anything on the subject matter of your inquiry’. Notwithstanding this response, it is now time to look to the future.

The Government (on behalf of the UK regulators) and corporations Bayer (Schering) and Sanofi (Roussel) should as recommended in the First Do No Harm Report, fund the costs of care for those affected by state and corporate harm. In addition to this, the families of the Association for Children Damaged by Hormone Pregnancy Tests using the Independent Medicines and Medical Devices Safety Review evidence should be able to successfully take legal action for the harms done to them by Bayer, Sanofi and the regulators.

n line with recommendation 9, of the First Do No Harm Report, the Government has a duty to set up a task force which must schedule a timeline for the implementation of the remainder of the recommendations. Such initiatives should endeavour to provide a safety net to ensure that a patient-led approach is centred at the heart of future health care provision.

This blog was published simultaneously by the Harm and Evidence Research Collaborative at The Open University.

The Perfect Storm: Reflections on the Death of Care Homes Residents and Social Care Workers

Vickie Cooper, Senior Lecturer in Criminology, The Open University

At the peak of the COVID-19 pandemic, 25,000 NHS inpatients were discharged into care homes and the responsibility to protect this particularly vulnerable population was passed onto the social care sector.

Like a mirror, coronavirus reflects the damage done under austerity. In 2010, right-wing governments blamed the deficit problem on public sector expenditure, and through savage cuts to welfare, they removed key support mechanisms for people out of work, in low-paid work and those who cannot work. The social care sector has been particularly affected by austerity. Since 2010, £8 billion has been wiped off the social care budget, directly affecting who can access social care and quality of care.  The devastating impacts of these cuts can be seen in the spike in mortality rates amongst people over 60 and care home residents, with 45,368 excess deaths counted over a 4 year period.

This was the mortality landscape under austerity, long before COVID-19. Now at the peak of the COVID-19 pandemic, government ministers have rolled out reckless policy decisions and have multiplied the risk of infection in a sector that was already struggling against the tide of austerity. These reckless policy decisions have led to the death of scores of care home residents and social care workers. It is estimated that approximately 16,000 care home residents have died directly or indirectly as a result of COVID, but data is still emerging and the actual number is still unknown. Not alone in this plight, critical attention must also be paid to the disproportionate number of social care workers who have died as a result of COVID 19.

Vickie pic 1 blog


Mishandling at the Backdoor

At the peak of the pandemic 25,000 NHS inpatients were released into care homes. Health Ministers were quick to rule out the possibility that the NHS could meet the full demand of the COVID-19 pandemic. Already struggling with pre-existing demand and running on dwindling resources, the government knew that the NHS couldn’t survive a health crisis of this magnitude. Rather than face that inevitability, the government changed the goal posts and urged NHS trusts to move patients out the backdoor, to discharge them back into the community. And we’re hearing mixed messages about how this was coordinated, if it was coordinated at all.  NHS directors are claiming that they only discharged patients to residential homes where those homes agreed that it had the capacity and early on, Matt Hancock waded in with the vacuous promise to do ‘whatever it takes’ to support the social care sector. But care home providers claim that hospitals were discharging patients where there was no residential capacity and without protection or testing for the staff and residents. If the government’s farcical planning of PPE and testing is anything to go by, then we are probably safe to assume that decision to discharge NHS inpatients into care homes was not a joint or coordinated venture. On the contrary, testimonies and leaked reports reveal how government ministers repeatedly ignored expert advice not to discharge NHS patients into care homes and instead, local authorities ‘block-booked’ care home beds.

In February, just prior to lockdown, Public Health England National Infection Service advised the government not to discharge elderly patients from hospital to care homes, fearing that it will increase the spread of the virus. Age, pre-existing health conditions, shared communal facilities and regular contact with staff and care workers, were all known contributing factors seriously affecting care homes at the peak of the COVID pandemic.  Ignoring this advice, government reports then tried to peddle the idea that care homes were not at risk, claiming that its “very unlikely that anyone receiving care in a care home or the community will become infected.”

Now thousands of bereaved families want to know why: why the government made the dangerous decision to discharge 25,000 patients into under-resourced and unprepared care homes.

This may be a new virus, but government Ministers were not facing too many unknowns when considering the impact of COVID 19 on care homes. Experience could be drawn from other countries. Just before the UK went into lockdown, we saw neighbouring countries struggle with mass fatalities in care homes. In Spain, the military found care homes abandoned by staff and found residents left in their beds, dead. Italy, Belgium and Sweden have reported similar, but different devastating impacts of Covid in residential homes. The evidence emerging from those countries was unambiguous: without radical lockdown measures, care home residents faced multiple, acute risks. These deaths could have been avoided. Had the government heeded the warning and legislated for radical lockdown measures in care homes, the outcome could have been very different. Radical lockdown measures could have involved the use of temporary accommodation to quarantine and isolate residents and the provision of full-payment of staff to move into the care home. The care homes that successfully reduced the risk of infection, voluntarily implemented radical lockdown measures and recommendations, whereas care homes that continued to admit new residents, owing to pressures from NHS levels of discharge, saw a rise in infection rates. Even with the provision of basic protection measures, the outcome could have been very different. At the beginning of lockdown, care homes struggled to acquire sufficient PPE and the extra local authority funding they received went towards independently purchasing PPE from over-priced suppliers. Amidst the PPE calamity, the government also ceased community testing in March and limited these crucial protection measures to hospitals. To the dismay of health experts and public at large, the government ceased community testing in support of ‘herd immunity’, which they suggested could delay the spread of the virus and ‘flatten the curve’. The government’s swaggering commitment to herd immunity led the implementation of dangerous political decisions that multiplied the risk of infection for this vulnerable population and social care staff.

Official health guidance published in February 25th states: “it’s unlikely that anyone receiving care in a care home or the community will become infected.”

Vickie blog pic 2


Institutional racism and structural inequality

The other silent killer in this uncomfortable story is the labour market and rampant inequality underpinning the social care sector – compared to other areas of the labour market. Blame has been apportioned with the model of working, with staff working between care homes and coming into contact with multiple different residents in any one shift. But rather than look to individual staff, we need to shine a light on the labour market driving the social care sector: the low-paid, precarious workers it relies upon, the creeping privatisation of sector at large, and regulatory framework tasked with monitoring the network of  public and private providers. It is these volatile economic conditions that drive the risk of infection and seriously undermine the health and safety conditions for care home residents and social care workers.

And these concerns are reflected in the data on coronavirus-related deaths, per occupation. The Office for National Statistics show that social care workers are particularly vulnerable to infection, where a disproportionate number of these workers have died as a result of COVID-19:

Men and women working in social care, a group including care workers and home carers, both had significantly raised rates of death involving COVID-19, with rates of 23.4 deaths per 100,000 males (45 deaths) and 9.6 deaths per 100,000 females (86 deaths).

The institutional and economic landscape of the social care sector also reinforces the same racialised and structural inequalities that are unravelling under COVID-19.  People from black, Asian and minority ethnic backgrounds constitute a disproportionately high number of social care workers. In England, 1 in 5 social care workers in England are black, Asian or from a minority ethnic background, but this representation varies geographically. In London, for example, 67 per cent of social care workers are black, Asian or from minority ethnic backgrounds.  In terms of waged-labour, the social care sector notoriously ranks amongst the lowest paid sectors within the labour market, with a high number of staff recruited on zero-hour contracts, which is the most precarious form of employment. With such a low-waged sector, social care employers struggle to recruit and retain staff and draw heavily upon agency workers, bank staff and migrant workers as a source of low-waged labour.

How did such a critical source of care and support to so many become so volatile? Social care workers provide a crucial provision of care and support to millions of vulnerable people in society, but the scale of inequality they endure, compounded by years of government disinvestment, has culminated in the countless number of deaths of already disenfranchised and marginalised groups. The risks presented under COVID-19 are particularly acute for these groups because of the targeted nature of the political decisions and policies implemented, long before and during this pandemic. Political decisions were made that prioritised groups who matter and downplayed the risks of those who matter less. From care home residents to social care staff, government ministers ignored and downplayed all the known risks and rather than heed the warnings, they put them at even greater risk by releasing scores of vulnerable patients into the community, accommodated them in communal settings and refused the most basic safety provisions for the social care staff tasked with protecting them.

This blog was originally published by the Harm and Evidence Research Collaborative at The Open University. See: 

Moving on: Burying Coronavirus Deaths

Joe Sim, Professor of Criminology, Liverpool John Moores University and Steve Tombs, Professor of Criminology, The Open University.

The first reported UK death as a result of coronavirus was recorded on 2nd March. It was followed by three hospital deaths the next day – the day of the first Downing Street press briefing, where Boris Johnson said: ‘I was at a hospital the other night where I think there were actually a few coronavirus patients and I shook hands with everybody.’ Johnson would continue shaking hands until at least 9th March when it was confirmed that a fifth person had died. In fact, updated NHS England data indicated that 16 people had died by 9th March, including three on the day Johnson declared that he was still shaking hands.

Then, on 23rd March, Johnson went on to announce what was to become quickly known as the ‘lockdown’ – albeit a misleading euphemism as many had to continue to work, if under far from normal conditions. These were the ‘key’ workers, a group covering not only health, social care and emergency service staff, but also included transport and shop workers, those in the food supply chain, cleaners, postmen and postwomen, refuse collectors, and, albeit less celebrated, workers in construction, security and the diffuse areas of the gig economy. These groups who worked through the ‘lockdown’, mostly in “low-paid, manual jobs”, were, it was revealed in early May by the Office for National Statistics (ONS), up to four times more likely to be killed by exposure to the virus than those in “professional and technical roles”.

Counting the Cost of Coronavirus?

Within three months, by 8th June, the government’s record on the coronavirus was described as “shameful”. In a global context, the UK’s sorry status was reported as follows:

5th in the total number of cases;
4th in terms of deaths per million of the population;
2nd in the total number of deaths;
1st in excess deaths per million of the population.

Coronovirus deaths

Source: BBC

One week later, on June 16th, the Office for National Statistics revealed that the total number of excess deaths – the statistic that is regarded as the most comprehensive for measuring the impact of a pandemic – had reached 64,500, or 671 a day, dating back to 2nd March.

This gruesome figure for excess deaths does not begin to account for the cancellation of hospital operations for ongoing medical conditions which has added another lethal layer beyond the devastating immediacy of the virus. To take one example: it is estimated that a further 18,000 extra cancer-related deaths could occur over the next year as a result of delays in cancer treatment during the height of the pandemic.

Nor, of course, do stark figures of death say anything about the traumatic desolation experienced by, and the multitude of harms caused to, the anguished families, relatives and friends of the deceased, a toll which is incalculable but increasingly being hidden, ignored and marginalized – except, that is, for the frankly insulting platitude of ‘our hearts go out to all those who have lost loved ones’ message mealy-mouthed by whichever politician happened to draw the short straw to front the Government’s daily press briefing and was thereby obliged to mention the hundreds of deaths the previous day, before moving on, of course, to ‘the next slide’.

Draw a Line and Move on

Exactly one week after the ONS had revealed a total of excess deaths close to 65,000, Johnson, in typically upbeat tone, announced in the Commons the effective end of lockdown in England, dubbed by himself as the end of “our long national hibernation”, and by others as ‘Super Saturday’, or as the UK’s 4th July ‘Independence day’ which the Telegraph had demanded weeks earlier.

Johnson went on to “encourage people to take advantage of the freedoms that they are rightly reacquiring”, wanting to see “people out in the shops—it is a fantastic thing to see. Yes, I want to see people taking advantage of hospitality again—a wonderful thing”. And he urged those in tourism to send out a welcoming signal ​to people from other parts of our country and to roll out the welcome mat, rather than the “Not welcome here” sign. The next day he spent much of Prime Minister’s Questions encouraging MPs from seaside towns to throw open their doors and extend hospitality to visitors.

BBC Beach

Source: BBC

As he spoke, a mini-heatwave was moving northwards across the UK, accompanied by mass gatherings in parks, resorts and city centres. Some of these resulted in clashes between people and police. The net effect was to generate real fears of social disorder two weeks later, when such gatherings, not least in and around bars, would become quasi-legal. Two days later, on 26th June, it was announced at the Government’s daily coronavirus press conference that it would be the last.

Back to Business and Burying the Dead

However, over the previous 24 hours to 26th June, 186 people had died from the virus. In the seven days up to that day, there had been 848 such deaths, a rolling average of 121 a day. This was, of course, considerably down on the reported April 8th peak, when 1,445 people died from Covid-19 in 24 hours – one of 22 consecutive days on which more than 1,000 people died in the UK every day.

But this ‘low’ figure of of 848 weekly deaths, unnoticed as a return to business as usual was being eagerly heralded, has to be placed in the context of more ‘normal’ times and more routine Government priorities. For example, in the year up to September 2019, there were 617 homicides in England and Wales. Or, if the same number of 121 people who died on an average day that week had been killed in a multi-fatality incident – an industrial disaster, plane crash or ‘terrorist attack’ – the cries of outrage would have been deafening. Not with COVID-19, though. The dominant discourse had become, and remains, that it was ‘unprecedented’, a word that appears to cover much – every death toll, every error, every incompetence, every lack of preparedness – but does not really say anything.

So while 848 people died, this was the week in which the Government sent out signals that the crisis was more or less over. Only local “flare ups” were to be feared should now fully responsibilised citizens fail to act to protect each other by maintaining ‘1 meter-plus’ distancing at work in shops, offices and factories – where possible – or as they drank and ate in bars, restaurants and cafes whilst planning holidays to kick-start the hospitality economy, all the time once again freely moving around and between our cities and towns.

Given this bizarre juxtaposition – still over 100 officially recorded deaths a day in the context of the effective announcement of normality – how were the deaths covered in the broadcasting and print media?

Taking the main news broadcasts on Friday 26th June as a snapshot, there was no coverage at all of the daily death rates on Channel 4 News broadcast between 7 and 8pm. The BBC’s main news bulletin at 10pm did provide some coverage of the virus, including the daily death rate. This lasted for 34 seconds. In contrast, Liverpool’s Premier League Championship win took up 6 minutes and 20 seconds, 11 times the coverage of the daily death rate. This, in turn, was almost a full minute more than the lead story which concerned the appalling devastation in Yemen where one child was dying every ten minutes due to a combination of war and the virus. So even here the broadcaster still gave more air time to football than to the harrowing and utterly preventable deaths of children.

On ITV’s News at 10, COVID-19 was covered for 1 minute 39 seconds. The programme at least recognised that the 186 deaths was the highest daily increase for 10 days but did also introduce the usual caveats about focussing on the rolling 7-day average rather than looking at one day’s figures. Liverpool’s League Championship win was given twice the coverage, at 3 minutes 22 seconds.

The main headlines on the front pages of the nine national newspapers on the morning of 27th June also contained nothing about the latest number of deaths, but did contain advice for foreign holidays: Green Light for Hols (The Mirror) and Fly Out for Sun, Sea and 70% off (Daily Mail).

Clearly, at this point, we would not claim that these broadcasts and headlines were based on any kind of random sample. However, they do reinforce our argument and suspicion about the government’s shameless desire to move the caravan of death on and to open up the country again, for British business, beer and holidays. Quite literally, in human and media terms, the disposables have been disposed of. Coronavirus death has become normalised.


Several questions become crucial as we are on the brink of the weekend on which ‘lockdown’ is released – albeit as tighter restrictions on work and travel have been re-imposed on Leicester, a city of over half a million and one of the most ethnically diverse in England, facts-on the-ground indicating that there is no real, only a discursive, ‘moving on’.

These questions include: where is the political discussion about the devastating and still unfolding toll of avoidable deaths? Who or what will be held accountable, and how? And, will there be a time when the daily rate of death ever again becomes politically and morally unacceptable and a focus for the media, politicians, the government and the wider population? Or, will the facts around the horrendous levels of preventable deaths, and the long-term devastation wrought by the virus on hundreds of thousands of lives be, in the words of Hannah Arendt ‘denied and distorted, often covered up by reams of falsehoods or simply allowed to fall into oblivion[?]’

If this happened it would be morally and politically intolerable. However, at this dangerous moment it would not be surprising given the political forces at work in constructing the dominant, consensual narrative that society needs to move on to the promised land of Brexit and to the ideological normality that the UK has a world-beating, track record in every conceivable area – excluding, of course, in preventing COVID-19 deaths.

This blog was published simultaneously by the Harm and Evidence Research Collaborative at The Open University. See:  

“You despicable beasts”: Dignity Funerals and commodified death in the spotlight

Samantha Fletcher and William McGowan





In late March 2020, Dignity Plc were on the wrong end of a string of angry messages from members of the public who had received advertising leaflets through their letterboxes. The leaflets read “Save money and protect your loved ones with a Dignity Funeral Plan”. At the very top of the page a brightly coloured offer boasted a “£100 off Discount ends 30 April”.

As the UK headed into coronavirus lockdown, the timing could not have been worse. One user commented: “@Dignity_UK you despicable beasts. Mass posting flyers through doors on the first day of lockdown is abhorrent and you should be ashamed!!!!” Another highlighted the emotional impact on local residents: “#badmarketing you couldn’t make it up […] It’s really upset some elderly residents”. Several people bemoaned ‘profiteering from misery’, accusing Dignity of “callous commercialism” and stating: “Absolutely disgusted […]. We are in lockdown and this is posted to our house and to pensioners’ bungalows! Putting people’s lives at risk for profiteering! Sickening practices.”

Dignity was put on the back foot immediately, issuing repeat apologies and promising to stop all marketing activity, as citizens from far and wide lambasted their advertising strategy. One user contributed their photograph of the funeral leaflet to a separate thread –“compiling a list of people to avoid after we return to normal. The c**ts list!” – a thread kicked off with Virgin tycoon Richard Branson, Mike Ashley of Sports Direct, Wetherspoons owner Tim Martin and celebrity chef Rick Stein, each included for their appalling treatment of staff during the economic downturn.

Who are Dignity Plc?

Let’s roll back 12 months. Following a mild winter, in May 2019 Dignity expressed concerns that a shortfall in projected death rates in the first quarter of 2019 was hurting their underlying profits by nearly £7m. Deaths were down 12% for the period, leaving the firm hoping things would “improve” in the second half of the year. Using language many people might not readily or comfortably associate with death and dying, they accepted:

“Operating performance in the first quarter was below the board’s expectations as a result of the significantly lower than expected number of deaths. Funeral market share and average income were in line with the board’s expectations.”

As the world continues to make sense of the Covid-19 crisis, it has brought attention to a whole range of commodity networks, supply chains, and labour processes that usually go unseen or are taken-for-granted. We are often better able to see how things work when they stop working. Or, in the case of Dignity’s mistimed marketing, when business as usual is out of tune with the mood music of the day.

So, what, or who, is Dignity? Dignity Plc, to be more precise, is the UK’s largest “single” funeral provider. It is currently the only publicly listed UK funeral provider on the stock market, with reported annual turnovers of £324m and £316m in 2017 and 2018 respectively.

Dignity has over 350 subsidiary companies within its somewhat dizzying corporate structure. Many have names such as ‘Dignity Services’, ‘Dignity Limited’, ‘Dignity Finance Holdings Limited’, ‘Dignity Finance plc’, ‘Dignity Holdings No.2 Limited’, ‘Dignity Holdings No.3 Limited’, etc., but most are funeral directors that Dignity has bought out, retaining their original trading names such as ‘G.M. Charlesworth & Son Limited’ or ‘F.E.J. Green & Sons Limited’, in a bid to keep the family-run traditional high street feel. Many such funeral directors have premises in several locations, meaning Dignity control over 700 individual funeral branches – with plans for further expansion.

Crematoria ownership represents significant capital accumulation for the corporate group too. By June 2018, there were 293 crematoria in the UK — 183 operated by local State authorities and 110 by private companies. Of these private companies, Dignity is again the largest operator with 46 crematoria. And these expanding operations mean Dignity has been building up a considerable real estate portfolio, ‘driven by the need to meet shareholder and investor expectations in terms of profit and growth’.

As with many other publicly listed companies, Dignity’s listed shareholders include many of the big investment funds that own most of the world’s capital – the likes of Standard Life, Aviva, Barclays and Blackrock.

But Dignity plc’s largest current shareholder, with 26% ownership, is a smaller specialist UK investment manager called Phoenix Asset Partners. Based in Barnes, West London, Phoenix is headed by founding partner Gary Channon, who had his “investing epiphany” after reading US billionaire investment guru Warren Buffet.

Channon’s claim to be the Warren Buffet of Barnes is boosted in a glowing recommendation from the Financial Times’ Investors Chronicle magazine, which says Phoenix’s UK investment fund has “smashed the total return of the FTSE All-Share since its launch in May 1998.” Channon’s strategy is to buy chunks of a small number of UK listed companies he believes are going cheap – “good companies that can be bought for less than half their so-called ‘intrinsic value’ due to short-term problems.”

Gary Channon, the Warren Buffet of Barnes

Dignity’s troubles

Unfortunately for Phoenix, Dignity hasn’t yet made the expected turnaround – according to Investors Chronicle, the company has been a “major drag” on Phoenix’s overall performance. With many other shareholders pulling out, the market value of the company has collapsed – Dignity’s share price had fallen to a quarter of its peak 2016 level by 2019.

Again, one of the main reasons Dignity had given for its declining profits before the pandemic was a falling death rate. On top of that, the company has faced increasing competition, including what the Evening Standard described as a “price war” with its main rival, Cooperative Funerals. This has pushed the company to start cutting prices on its cheaper funeral products.

Then there is the fact that Dignity is saddled with heavy debts. At the end of 2019, the company owed £542 million to the bond market. This, plus its other liabilities, were actually worth more than its assets, which is never a sign of financial health. Dignity borrowed heavily to fund its buyouts of local funeral directors and crematoria, and to climb to the top of the industry. This strategy worked out so long as prices and profits kept rising – but makes the company vulnerable if the market turns.

Finally, there is a big unknown that may have spooked investors: two ongoing regulatory investigations into the funeral industry.

In March 2019, off the back of a preliminary consultation in November 2018, the Competition and Markets Authority (CMA) announced it would be launching ‘an in-depth market investigation into the funerals sector’. This will investigate the soaring cost of funerals over more than a decade, and current ways of operating by business providers of these services. Then in June 2019, in light of accusations of ‘high pressure’ and ‘bullying tactics’, the UK Treasury announced plans to seek to regulate funeral service providers through the Financial Conduct Authority (FCA).

The results of both investigations were due for completion and release in late 2020, but have been delayed for the time being due to the Covid19 pandemic.

Clive Wiley, chairman of the board

The high cost of dying

As Dignity and its shareholders complain about price cuts and dropping profits, we need to put those complaints against a longer-term backdrop. Prices and profits in the funeral trade soared for more a decade from the early 2000s until the late 2010s. The average cost of a funeral is now many times higher than it was 20 years ago, and this cost has largely been driven, and pocketed by, funeral companies.

In March 2019, the CMA published a detailed “Funerals Market Study” as part of “phase one” of its investigation. This set out some key points, including that:

“Over the past 14 years, the price of the essential elements of a funeral is estimated to have grown by 6% annually, twice the inflation rate over this period.” (p.6)

The study further concluded that:

“for a considerable number of years the largest firms of funeral directors have implemented consistently large annual price increases, without reference to underlying operating cost pressures.” (p.6)

Since 2002, Dignity maintained a company policy of increasing their prices by 7% annually (p.99-100). One reason the companies have been able to get away with this relates to the nature of their product. According to the CMA study (p.100), only 8% of bereaved families “shop around” for alternatives.

For the companies, this long boom of rising prices has meant extremely high profit margins. The CMA study compared the profits of Dignity and other big UK operators with equivalent companies in Europe, the US, Canada and Australia, for the four years between 2014 and 2017. It found that profit margins (before deductions) in these regions were between 19-26% on average. Some were much lower. For example, Ahorn AG in Germany and the Park Lawn Corporation in Canada were 6-13%. In contrast:

“Dignity’s profit margins have been 36-38% in all years, so more than 10% higher than international benchmarks. [..] Dignity’s margin appears to have been significantly higher than both international benchmarks and larger UK companies in the funerals sector.” (p.123)

But while funeral profits were being driven up to finance the asset growth and accumulating debts described above, many of the households paying for them were facing the violent impacts of austerity. Basic average funeral costs are now over £4,000, or more than £9,000 when professional fees and discretionary extras such as memorials, flowers, and catering costs are considered – compared to around £1,900 in the early 2000s. For many, the inability to pay these rising costs means the growth of personal debt and funeral poverty. This trend is one example of a much broader serious problem in society today – the transference of corporate debts into personal bank accounts.

As the CMA study notes (pages 20-21), total funeral expenditure varies very little by average household income: households earning over £100,000 per year do not pay 10 times more than households on less than £10,000. In 2017, the total expenditure of a family in the lowest 10% of the population by income was £11,050. This means that a “basic” funeral could cost nearly 40% of the total year’s budget – higher than total spends for food, energy and clothing combined (at 26%).

In short, this morphing of the market hits working-class families, exacerbating income inequality and compounding existing poverty in the UK.

Dignity have responded to this problem, in their own way, by promoting a range of budget alternatives through their sister brand Simplicity Cremations – again, readers may have noticed their avid marketing campaigns. Simplicity provides direct cremations without the added extras associated with an expensive “send off”. Like other Dignity products, they also offer pre-need payment plans – a major point for regulatory scrutiny at the heart of recent investigations.

Despite these efforts, and being able to stake their claim as the largest provider, Dignity are lurching from one crisis to another. Their CEO Mike McCollum recently left the company with immediate effect and their profits have actually fallen during the pandemic as they are unable to sell the full range of service extras that some of these profits rely on. After almost two decades of extortionate price increasing – “a core part of Dignity’s strategy for a considerable period of time” (CMA study cited above, p.99) – the inherent contradictions of exponential growth and driving capital accumulation alongside debt accumulation look like they are finally taking their toll. This period has also served as a painful reminder to so many mourners that what they miss most at the funerals of their loved ones is not the expensive funeral service add-ons, but their family and friends.

Need for systemic change

Soon after Dignity received the above barrage of criticism we outlined at the start of this article, the UK government introduced the Coronavirus Act 2020. Nestled among a raft of emergency changes to existing legislation are a series of “temporary” changes to the funeral industry, which will continue to “have a significant impact on what happens to the dead and how funerals are conducted in the coming weeks and months”.

As well as family-only funerals with limited attendance, this includes a more flexible approach to registering deaths, scrapping inquests for suspected Covid-19 deaths, and multi-organisation provision for transporting and storing growing numbers of bodies which would otherwise overwhelm existing mortuaries. While these are emergency measures, which must subject to ongoing scrutiny, they do nothing to address long-standing issues within the industry including poor working conditions and inadequate protection for workers.

Similarly, we can ask whether the CMA and FCA investigations will even begin to satisfactorily address all the issues of cost, profit, competition and exploitation that shape the industry. At best, these investigations aim to ensure the industry is ‘fair’ under the rules of the market itself – there is no hint of any significant or radical challenge to the way funerals are marketised, financialised and provided.

The funeral industry is a peculiar space that provides a vital frontline service every single day. Without serious systemic change, there will be no end to the vulgarity in profiting from death that people now recognise more acutely. While not at all downplaying the seriousness of the Covid-19 crisis, we want to raise broader questions about unfettered corporate freedoms to profit from … well, strictly anything, including death, at all times, both in the midst of a global pandemic and beyond.

** This blog was first published by Corporate Watch on 10th June 2020 **

‘Calling us heroes just makes it ok when we die’: Constructing Coronavirus News

Joe Sim, Professor of Criminology, Liverpool John Moores University

If I die, I don’t want to be remembered as a hero. I want my death to make you angry too. I want you to politicize my death. I want you to use it as fuel to demand change in this industry, to demand protection, living wages, and safe working conditions for nurses and ALL workers. Use my death to mobilize others. Use my name at the bargaining table. Use my name to shame those who have profited or failed to act, leaving us to clean up the mess. Don’t say “heaven has gained an angel.” Tell them negligence and greed has murdered a person for choosing a career dedicated to compassion and service.

These poignant words were written by Emily Pierskalla, an American nurse, and were cited in an article published in mid-April which focused on the daily Downing Street press briefings about the coronavirus. The article debunked a number of myths which had been fostered through these briefings: glorifying science despite the fact that knowledge about the virus was in its infancy; the launch of a badge for carers in the middle of a pandemic (when these same workers could not access PPE equipment to protect their lives); blaming China for the government’s initial inaction; focusing on the health of the Prime Minister; and the distractions generated by the ‘clap for carers’ campaign. The cloistered sterility of the briefings – ‘wooden and evasive’ – according to one commentator – meant that the government was ‘manufacturing news’:

The government is tightly controlling the news agenda. Its daily press briefings are not keeping it accountable; they’re allowing it to recycle soundbites. While lobby journalists don’t always do the best job, they have – at times – tried to ask some decent questions. It’s just the questions aren’t answered; and because it’s a press conference, there isn’t the scrutiny of an actual interview.

On April 14th, the lack of face-to-face interviews was highlighted on Channel 4 News. The broadcaster had asked government ministers for an interview on 8 consecutive days. None was forthcoming.

The staged, stilted nature of the briefings was legitimated by the presence of scientists to whom the politicians deferred as a matter of course. However, even here, the idea that there was a coronavirus reality that could be objectively measured through a scientific consensus was also problematic. As Professor Brian Cox noted:

There’s no such thing as ‘the science’, which is a key lesson. If you hear a politician say ‘we’re following the science’, then what that means is they don’t really understand what science is. There isn’t such a thing as ‘the science’. Science is a mindset.

The restricted format generated a specific narrative, a drive towards a consensus which constructed insiders – those who supported a response based on national unity – and outsiders – those who did not. Inevitably, this drive marginalized other narratives and distracted attention from the devastatingly bad decisions the Prime Minister, and his government, had made. For Nesrine Malik:

Here’s what we already know. The government delayed implementing a lockdown for no clear reason – perhaps it was the prime minister’s outsized regard for the “freedom-loving instincts of the British people”, or a misguided bid to pursue “herd immunity” – and then reversed its position. Weeks were wasted, and thousands of lives were lost. The government abruptly stopped its contact-tracing programme in mid-March; it claimed mass testing wasn’t necessary, and then U-turned while repeatedly shifting the goalposts on the number of tests to be done. It did not provide adequate levels of PPE for NHS and care home staff, and hundreds of workers are dying. This government’s Conservative predecessors underfunded the NHS and undermined the UK’s preparedness for a major crisis such as a pandemic.

Professor John Ashton too expressed his doubts about the briefings:

It was the failure to convene [the emergency committee] Cobra at the beginning of February that meant everything else flowed from it, the failure to order equipment etc. Now we are into the cover-up. Any journalist worth their salt should boycott this propaganda [the daily briefing]. They don’t answer any questions. The chief nurse deflected the question about the number of nurses and doctors who died because of confidentiality. She wasn’t being asked about individuals, she was being asked about numbers.

Ashton also pointed to an issue that was to come to dominate the debate – care home deaths. For him, people were dying at home, and in care homes, without being tested while others were being ‘sent home to die before they had been tested. There are probably large numbers of people who are not being counted’.

At the end of April, Alistair Campbell pointed to the journalists’ lack of preparation for the briefings, the ‘platitudes and homilies’ on which the government’s answers were based and the off-the-record briefings conducted away from public scrutiny. Pippa Crerar, the Political Editor of the Daily Mirror, noted that the list of broadcasters who could ask questions was drawn up by 10 Downing Street. Furthermore, when the briefings first began journalists asked one question after which their microphone was turned off by Downing Street so there was no follow-up. For her:

…often the biggest problem we contend with is the lack of answers that are forthcoming from the government, it can be really frustrating when you ask a question and then all you get back is the government’s pre-planned line and that happens quite a lot…when you ask a specific question about …testing capacity or different elements of PPE getting to the front line and you get a sort of stock response that tells you nothing then it does feel very frustrating.

On April 27th, BBC 1’s Panorama highlighted the deadly impact of the shortage of PPE and other equipment. Directly reflecting the words of Emily Pierskalla which began this blog, the Thursday night ritual of clapping for carers was criticized by some staff on the ground who felt that it was glossing over the shortages on some of the wards. One nurse, working in intensive care, told the programme, ‘calling us heroes just makes it ok when we die.’ Despite Panorama’s intervention, the press headlines the following morning were overwhelmingly concerned about the ending of the lockdown. All that is except one. Reflecting the contradictions in the media’s coverage, the Daily Mail, not noted for its criticism of the government, carried as its main headline – Doctors’ PPE Desperation; 1 in 4 forced to reuse protective clothing; Failure to stockpile gowns & visors dates back 11 YEARS. In coming back to PPE, the newspaper returned to an issue which had dominated the debate for weeks yet had virtually disappeared from the press briefings and the other print outlets over the previous two days. 

Another medic pointed to the iniquity of the government’s position, in praising staff on the ground as ’heroes even while watching us die without proper personal protective equipment. How dare they? Testimony from staff forced to wear bin bags, Marigolds and even sanitary towels as facial protection should shame every member of the cabinet’.

At the end of April, Nesrine Malik, while recognizing that the media did not speak with one voice, was critical of the overall message that was being presented:

For all that the facts look damning for the government, the overall picture presented to the public has not been notable for its scrutiny and scepticism. This is not a swipe at an amorphous “media” failing to hold the government to account. Many journalists are probing and investigating – and getting flak for doing so. But much of the press has either stenographically taken the government’s word for things, or relegated the awkward matter of our appalling death toll to a mere footnote amid other concerns about life under lockdown. Last week, The Sun had a front-page splash that read “Lockdown blow. Pubs shut until Xmas”. On a small image of a Covid-19 virus splodge on the same page, it said “596 dead. See page 4”. Other papers, such as the Daily Telegraph, have effectively become mouthpieces for the government.

On Saturday May 2nd, the circle of distraction was complete. At the daily press briefing it was announced that the number of deaths had increased to 28,131, up by 621 from the previous day. No questions were asked from the press or public (who had been coopted into the briefings on April 27th) about these figures. The final question came from a reporter from the Sun on Sunday (the newspaper to which Johnson gave his only post-hospital interview) who was positioned in front of one of The Sun’s most notorious front pages, published during the Falklands War. When an Argentinian ship, the General Belgrano, was torpedoed with the loss of over 300 lives, many of them teenage conscripts, the newspaper’s headline – Gotcha – epitomized the merciless nature of its coverage which unequivocally supported British forces in the Falklands. The paper’s undiluted militarism, as ever, was reinforced by a sense of ‘fun’:

Page Three girls were given a military theme – ‘all shipshape and Bristols [geddit] fashion’. ‘THE SUN SAYS KNICKERS TO ARGENTINA!’ was one editorial brainwave featuring pictures of semi-naked girls ‘sporting specially made underwear embroidered across the front with the proud name of the ship on which a husband or boyfriend is serving’.

To see Gotcha in a question and answer session about a pandemic where so many had endured such traumatic desolation and devastation was another nadir in what passed for journalism in many, though not all, of the daily press briefings.

Tabloid ‘Humour’ and Human Interest Stories

It was not only the daily press conferences which were problematic. As ever, the tabloid coverage was based on generating a sense of sexualized ‘fun’. On Saturday March 28th, the Daily Star ran the following headline:

Daily star image 1

This headline followed the largest day-on-day increase in deaths at the time. On Friday March 27th, the number of deaths rose by 34% to 1019, up by 260 from the previous day. On April 1st, the newspaper produced another cover which (presumably) reflected a ‘fun’ date in the British calendar:

Daily star image 2 

On March 31st, the day before the Star’s ‘fun’ headline, 381 people died in the UK, a record number at the time, taking the death toll to 1789.

And then there were the human interest stories designed to shore up morale: Boris Johnson’s health took up all but 9 minutes of BBC 2’s flagship Newsnight programme on April 6th while on April 10th, Good Friday, the Sun’s headline ‘BORIS IS OUT (Now that really is a Good Friday!), was published on the day that the UK recorded the highest number of deaths in Europe; the Queen’s speech to the nation; Johnson’s new child; and 99-year old Captain Tom Moore’s efforts to raise money for the NHS. These stories distracted attention from other issues. In the case of Captain Moore, there were no questions asked about why a centenarian was privately raising funds – £31 million – for the NHS. In raising this sum, Captain Moore raised £10 million more than the £21 million spent by Jeremy Hunt on consultants to legitimate the brutal cuts imposed on the NHS.

Coronavirus Masculinity

The focus on the Prime Minister’s health, and the birth of his son, also distracted attention from his attitude in the early days of the virus when he had, without sustained challenge from the media, talked about shaking hands at a hospital where there were patients stricken by the virus. In doing so, he was plugging into the politics of coronavirus masculinity, and the patriarchal sense of masculine entitlement, displayed by ‘strong men’ politicians internationally: Trump in America, Erdogan in Turkey, Orban in Hungary, Modi in India, Putin in Russia and Bolsonaro in Brazil who encapsulated his brutal response to the crisis by declaring that ‘[w]e’re going to tackle the virus but tackle it like fucking men – not like kids.’ On May 13th, it was reported that the country saw a record rise in the number of daily deaths to nearly 900 taking the number of deaths to more than 12,000.

In the UK, the analogy with war – a persistent, masculine theme in political and popular consciousness, and one which had been a central discourse in the tortured debates around Brexit – was used by the government, and Johnson, in particular, in media briefings, to mobilize the country against an external enemy. However, this was ‘a problematic analogy as what is mainly needed to tackle COVID-19 is care, social solidarity and community support – not fighting and violence’:

These patriarchal discourses can have serious implications for government policy, such as encouraging overly militaristic, authoritarian approaches, and prioritising male-dominated sectors of the economy and society. For instance, women are more likely to be in temporary, informal or precarious work which falls outside the protection packages being established.

From the perspective of those on the ground, such ‘war talk’ was ‘an altogether different matter’. It was a:

….clever and calculated distraction. The worth of nurses is so self-evident to this government, for instance, that they are routinely compelled to use foodbanks. And Hancock may have offered Britain’s 1.5 million carers a badge recently, yet two-thirds of them are paid the minimum wage, with many on punitive zero-hours contracts. How convenient that now, with the spotlight on their vital work, their poverty wages are being augmented by lavish ministerial clapping.

The writer also pointed out that those Conservative MPs who were applauding NHS workers, ‘voted down a proper pay rise for nurses’ in 2017. This included Rishi Sunak, Dominic Raab, Matt Hancock and Boris Johnson. The decision was cheered in the House of Commons.

Contradictions and Contingencies

Inevitably, there were (and are) contradictions and contingencies within the media. For one thing, the public were not enamored with the coverage. The first study of the public’s attitude towards the role of broadcasters in the pandemic found that they wanted media personnel to be more critical of the government:

Far from the public losing faith in journalists or asking them to rally round the flag, our research shows most people trust broadcast media, but want more critical scrutiny of the government. This suggests broadcasters should not be cowed by politicians or commentators, but emboldened by the public who want them to challenge the government about how well they are handling the pandemic.

Furthermore, the devastating, human impact of the virus was not ignored. The point is that it did not merit the same attention. On April 7th, Channel 4 News reported that Thomas Harvey had died from the virus. At that point, Thomas was the 15th NHS worker to die. He had been an NHS worker for more than two decades. According to his desolate family, they had tried, on four occasions, to have him admitted to hospital and had been refused each time. The brief discussion about Thomas’s death was preceded by a 20 minute piece on the Prime Minister’s hospitalisation. The arcane nuances in the British constitution – what was the role of the Deputy Prime Minister, who was in charge, who would make decisions? – obsessed journalists as they attempted to outdo each other to be first with the latest, breaking news about Johnson’s health and divulge what they had learned, or rather what they had been briefed about, to what they thought was an expectant nation.

Clearly, other issues were covered – the lack of PPE; deaths in care homes; the desperate rise in domestic violence; the disproportionate number of BAME deaths inside and outside of the NHS; the potential number of deaths globally in countries where social distancing was virtually impossible because of the structural violence of institutionalized poverty; the health of prisoners; the positive, social contribution of foreign workers living in the UK despite the Brexit-fueled vilification towards them; the fearless role of poorly paid, overwhelmingly female, care workers; the disproportionate impact of the virus on the poor; and the high death rate in the UK compared with other countries (something which the government argued they could not discuss due to differences in data collection methods, a comparison Ministers might have been happy to make if the UK had the lowest rate in Europe). However, these issues were not linked together into a coherent, critical, alternative narrative.

Additionally, broadcasters were confronted by an ideological brick wall built on constructing an inclusive consensus based on the mantra that ‘we were all in it together’. Given the evidence of the disproportionate number of deaths in relation to social class and ‘race’, as well as the dangers women faced as a result of the lockdown, the idea that the country was all in it together was clearly fallacious. Nonetheless, it did not prevent it becoming another taken-for-granted mantra, implicitly and explicitly conjuring up the wartime, blitz spirit and the Dunkirk feeling of national unity in the ‘fear-haunted world’ that the country had become.

On 8th May, Victory in Europe day – a day that saw 626 deaths – the blitz spirit appeared to be in the ascendant for a few hours as the government’s failures were lost in a cascade of bunting. However, even here there were serious questions to be asked about the links between the past, present and the future:

Britain, in the best possible way, still needs to get over the war. Were it not for the pandemic, Boris Johnson would have commandeered this holiday to elide the Britain of 1945 with that of Brexit. He would have offered a vision of renewed global greatness, with himself as the new Churchill. He may yet try. But events have made such claims immoral as well as preposterous. This is not a time for rejoicing or false pride. There is no British victory to celebrate today. Instead, there is a Britain whose state institutions were unprepared and insufficiently resilient to minimise the Covid-19 crisis. As in May 1945, the real questions facing Britain are not about the past. They are about the future.


The Nobel Laureate Samuel Beckett once said that we should not ‘look for meaning in the words. Listen to the silences’. In terms of this virus, and its relationship to words, written or verbalized, Beckett’s point is important. Despite the endless hours of broadcasting, and acres of print coverage, it is in the silences where the politics of this virus is being played out. Recognizing the silences, refusing to accept them and acting on them so that media coverage is taken in another, more critical direction, should be the political and moral prerogative for broadcasters and journalists. However, given what has happened at the press briefings so far, this is probably too much to hope for.

Thanks to Kym Atkinson for her intellectual and technical support with this blog.



Coronavirus and prisons: the need for radical alternatives

David Scott and Joe Sim

Wandsworht prison
Photo: Wandsworth Prison from the air by Thomas Nugent

Thinking critically about the coronavirus (COVID19) means thinking about the exercise of power and social divisions. While it has been reported that the rich have been jetting off to private islands, and while celebrities have been paying for testing and then unashamedly proclaiming to the world that they are not infected, as ever it is the economically and socially vulnerable who are being harmed by this pulverising virus. The brutal imposition of free market capitalism, and the retrenchment of social democratic states from policing the economic and harmful activities of the powerful, lie at the root of the crisis. It is these processes, and the systemic indifference to their human costs, which are now proving to be the gravediggers of the powerless.

The coronavirus is of greatest danger to the most vulnerable people in society, especially those with underlying health problems and/or living in inadequate social conditions.   The incubation and spread of the virus is hastened by dirty, overcrowded and unhygienic environments with poor ventilation and sanitation. Close physical contacts in restricted spaces results in what epidemiologists are calling “cluster amplification”. Whilst the virus presents an existential threat to many around the world on the downside of capitalist exploitation, especially those in slums, ghettoes, refugee camps, or among the homeless, the focus of this article is on risks associated with prisons. Indeed, at the time of writing, the coronavirus already has a presence in a number of prisons England and Wales, with a significant number of prisoners and prison staff developing symptoms and subsequently placing themselves in isolation. The first prisoner death was reported at HMP Littlehey on 26th March, and later that same day another death at HMP Manchester. At the time of writing, a new birfucated approach appears to be in the making, with the government apparently on the verge of both introducing mass lockdowns across the penal estate, enforcing 23 hour bang-up for most prisoners, whilst at the same time seriously considering whether pregnant women and remand prisoners could be transferred to bail hostels.

In this article particular attention is given to the position of prisoners. What about their health and safety? How will they be protected physically and psychologically from the ravages of the virus? What about different groups of prisoners? What should a radical response be to this life and death issue for prisoners? This article considers these questions in relation to England and Wales.

Minimising Disruption or Minimising Harm?

In a remarkably candid account on BBC Radio 4’s Today programme, the current president of the Prison Governors Association, Andrea Albutt, warned that the transmission and death rate of the coronavirus was likely to be much higher in prisons than the general community. Despite further warnings from leading epidemiologists that up to 60% of the prison population (approximately 50,000 prisoners) could be infected resulting in a death rate perhaps as high as 2.3%, the government response thus far has been one of containment and situational control. The prisons minister, Lucy Frazer, in her statement on preparedness to deal with the virus in prisons on 12th March 2020, focused on reassurance and minimising disruption to the existing penal regimes:

Prisons have existing, well-developed policies and procedures in place to manage outbreaks of infectious diseases. This means prisons are well prepared to take immediate action whenever cases or suspected cases are identified, including isolating individuals where necessary.

Basic hygiene is a key part of tackling the virus and good practice is being promoted on posters throughout the estate. Handwashing facilities are available to all prisoners – not just in cells but other shared areas such as education blocks and kitchens. Staff and visitors also have access to handwashing facilities and we have worked closely with suppliers to ensure adequate supply of soap and cleaning materials.

Prison officers are to adopt prophylactic measures (like wearing disposable gloves; fluid repellent face masks; plastic aprons; and disposable face visors or goggles), minimise non-essential contact and try to keep less than 2 metres distance from prisoners. Alongside this emphasis on ‘protective isolation’, and the payment of prison officer bonuses to cover extra shifts, the the government is also considering a strategy of ‘cohorting prisoners’ (which is grouping people together who have symptoms of COVID19 should there be insufficient isolation.

Should the numbers of cases in an establishment increase, isolation resources could be under pressure. Cohorting is a strategy which can be effective in the care of large numbers of people who are ill by gathering all those who are suspected confirmed cases into one area (or a limited number of areas where it is necessary to keep some prisoners or detainees separate).

However, these policies have severe limitation, an issue to which we now turn.

The Limitations of the State’s Response

Given that the negative health implications of COVID19 are much more severe for those with multiple exposure to the disease (as evidenced by the deaths of health care workers) the proposed last-ditch strategy of “cohorting” is deeply concerning. Indeed, this policy, if introduced in the coming weeks, could prove disastrous. Prisoners with COVID19 housed together will be subjected to multiple infections of the disease and, especially for those with underlying health problems, this could escalate the seriousness of the illness. Indeed, the consequences of the cohorting policy may become tantamount to ‘social murder’ – cohorting COVID19 positive prisoners is a political decision that almost certainly will result in social arrangements that are unsafe, harmful and result in premature and otherwise avoidable deaths. But this is not the only limitation of the current policy. The emphasis on social isolation and social distancing, designed to curb the virus, continue to dominate the state’s response are problematic for different groups both inside and outside prisons. For example, outside prison, they fail to consider women in domestically abusive relationships. How can these policies protect them and minimise harm?.

In prisons, safe quarantine measures are effectively impossible to implement. For decades, the appalling conditions inside, compounded by gross and needless overcrowding, particularly in male, local prisons, have been highlighted by critical academics, prisoners’ rights organisations and by official bodies such as the Prisons Inspectorate. Since the beginning of 2018, the Inspectorate has produced a number of withering reports which have pointed to the abject and soul-crunching conditions in which many prisoners exist. The Inspectorate’s report on Birmingham prison, published in August 2018, was scathing about the conditions inside:

Communal areas in most wings were filthy. Rubbish had accumulated and had not been removed. There were widespread problems with insects, including cockroaches, as well as rats and other vermin. We saw evidence of bodily fluids left unattended, including blood and vomit. I saw a shower area where there was bloodstained clothing and a pool of blood that apparently had been there for two days next to numerous rat droppings. Many cells were cramped, poorly equipped and had damaged flooring or plasterwork. Most toilets were poorly screened, many were leaking and we saw cells with exposed electrics.

The National Audit Office, looking more broadly at the prison estate, also recently found that prisons were infested with vermin, damp, wet, and cold. This evidence of dilapidated prison building seems to stand in stark contrast to the claims of the prison minister about prison hygiene. Given such conditions, the point made by Richard Coker is crucial. As he notes [p]risons and centres of detention are well-recognised ‘epidemiological pumps’. They can spread disease outwards into the community if the internal dynamics of disease transmission are not confronted. This happened in the USA, and the former Soviet Union, when HIV and multidrug resistant tuberculosis infected those beyond the walls. Therefore, reducing ‘unnecessary close contact in closed environments may help prevent large case clusters and superspreading events that seed beyond those confined’. Whilst such ‘bridgehead’ arguments about the spread of diseases alone are not sufficient (they erase the human dignity of prisoners), they do highlight the importance of getting the policies on containing the virus in prison right.

In his annual report published in July 2019, the Chief Inspector of Prisons was blunt: ‘far too many prisoners still endure very poor and overcrowded living conditions’. The physical and spatial restrictions of the prison place also mean that there is more handling and touching of goods and physical objects and there are numerous concerns regarding the spread of contamination through the physical limitations imposed by security measures on preparations for food and drinks. Given current living conditions, security restraints, and the overcrowding which means that many prisoners are sharing cells and ironically are often isolated and locked down in these cells because of the lack of purposeful activity, how can prisoners feasibly be kept safe and harm minimised by the limited policy suggestions of the government in recent days?

Prison during lockdown

Photo: prison landing during lockdown

These issues were further highlighted in a report published by Parliament’s Health and Social Care Committee into prison health care in November 2018. The two paragraphs below provide a clear indication of the state of health care inside:

Even the most basic needs of people detained, such as their diet and living conditions, continue to be compromised in some English prisons. HMIP’s most recent annual report noted that inspections over the last year have identified poor, and even squalid, conditions in several prisons. Prison establishments frequently struggle, according to the inspectorate, to provide meals of sufficient quantity and quality on £2 per day per prisoner.

Short-staffed, overcrowded prisons severely limit access to healthcare and the ability of prisoners to lead healthy lives. Prisoners spend the vast majority of their time in their cells, limiting their opportunity to move and engage in adequate levels of physical activity, and their access to healthcare, inside and outside prison, is restricted. Only 16% of prisoners report being unlocked for the recommended minimum of 10 hours per day. A third of people detained in local prisons and almost 40% of people held in young adult prisons report spending less than 2 hours out of their cell a day. Low staffing levels, excessive waiting times for some services and inadequate management of prisoners with chronic conditions are three recurrent concerns HMIP and CQC have about the delivery of healthcare in prisons, based on the findings of their joint inspections over the last year (emphasis in the original).

The report also noted that 15% of prisoners have respiratory problems – a condition associated with virus-induced deaths – compared with 8% of the general population.

It is important to recognise that prisoners are not a homogenous group. The population is diverse with complicated health care needs. Elderly prisoners, one of the fastest rising groups in the prison population and of course, the group most vulnerable to the virus on the outside, are confronted by a prison system which even if there was no crisis, does not deal with their needs.  There are more than 1,800 prisoners over the age of 70 (219 people in prison are over the age of 80) and more than 60% of prisoners over the age of 50 have disability. According to the Health and Social Care Committee’s report, older prisoners ‘are frequently held in prisons which, even with reasonable adjustments, are unfit for their needs….’.

Other prisoners have specific health issues. For example, what about women in prison who are pregnant? What about the specific health care needs of black and minority ethnic groups?

It is also important to recognise two other issues which have not been addressed so far. First, it is not just a question of protecting the physical health of prisoners. There is also the issue of their psychological health. Being detained in a prison cell waiting for the virus, or simply waiting to hear details about the spread of the virus, and, unlike those on the outside, having very little, if any autonomy, to address negative thoughts about the virus, is likely to have a detrimental impact on the confined. Therefore, it is important to address the particular situation confronting prisoners with respect to the psychology of the virus. The prison makes all prisoners not only physically vulnerable but also psychologically vulnerable. This may also be intensified for those prisoners in segregation. Second, there is the issue of prisoners’ families and the stress that they are likely to experience in not knowing about the physical and psychological health of their relatives. Like prisoners, their families are also often treated as less than human and as less eligible subjects as the often-desperately negative experience of the families of prisoners who die in custody indicate.

The organisation of prisons makes even the most practical policies difficult to implement. Whilst the UK government claims there are appropriate handwashing facilities in prisons in England and Wales, hand sanitisers, for example are often considered contraband in prison because they can contain alcohol. Handcuffed or otherwise restrained people cannot cover their mouths when they cough or sneeze, sinks often lack soap. According to a recent account by a prison doctor, there is also the issue of getting prisoners to hospital who are ill given the combination of security and staff shortages. In dealing with one prisoner in Wormwood Scrubs she pointed out ‘I knew as always, that I would have a battle on my hands to arrange for his admission to hospital’ (emphasis added). At Wandsworth, in 2017, two hospital appointment a week were missed on average because there were no officers available to escort prisoners. For Chris Atkins, who served part of this sentence in Wandsworth, ‘[p]rison health care is straight out of the Middle Ages. It wouldn’t have been out of place if they had started dispensing leeches’.

Radical Alternatives

What is the way forward in England and Wales? There are two dimensions to developing radical alternatives to the state’s policies. First, the state should abandon the fallacy that more prisons and prisoners equal less crime. This is palpably untrue, yet has (mis)informed the law and order policies of successive governments for the last two centuries. Instead, the present government could learn lessons from around the world where prisoners are being released in a number of countries such as Turkey, Spain and Iran where 85,000 prisoners have been released. Different states and cities in America – New York, Los Angeles, Ohio – have followed a similar decarceration path. Ross MacDonald, the chief medical officer for Correctional Health Services in New York, has called on prosecutors and judges to enable prisoners to be released from the state’s jails in response to the outbreak. These countries have therefore begun to think beyond the traditional punitive responses to crime – locking people up in increasing numbers and leaving them to fester in often-deplorable conditions – and have begun to follow the least coercive, dehumanising and intrusive and restrictive policy possible of releasing prisoners.

This policy challenges the physical and psychological harm that prisons engender and which will only be intensified and magnified if the virus takes hold inside. Of course, how long this decarceration policy will last is a matter of conjecture, but at least there has been some movement away from the blind alley of state coercion and control. It is also important to note that in countries where no such action has been taken, such as Italy, there have been, at the time of writing 27 disturbances resulting in 9 deaths. And not all countries are pursuing these policies. For example, prison labour is being used to shore up supplies of face masks and hand gels in Hong Kong Lo Wu women’s prison where 100 prisoners are working six days a week, in shifts of six to 10 hours, including night shifts. Retired or off-duty prison officers – 1200 of them – are also working to produce the masks. The governor of New York announced the state will also be using prison labour to produce 100,000 gallons of hand sanitiser for schools, prisons, transportation systems and other government agencies.

March 2020 Italian prison disturbance

Photo: an image of the March 2020 Italian prison disturbance

However, it is important to recognise that even if such decarceration policies were implemented, there is still the question of the quality of community support prisoners would receive given the decimation of community support networks due to the ‘violence of austerity’. Prisons cost £4 billion annually, within a criminal justice budget of £16 billion. The expenditure pattern is skewed towards security, control, public order policing and the militarization of the state. Therefore, there needs to be a radical redirection of expenditure towards well-funded community alternatives, staffed by well-trained, fully committed staff. Even in pre-virus times this has not been the case. Allied to this is the fact that the number of ex-prisoners dying in the community is already disproportionately high. An influx of new prisoners into the community will only be detrimental unless radical policies are put in place to respond humanely, urgently and empathically to them.

On March 25th it was reported in the media that one possible option under consideration by the government was the release of some sentenced prisoners (50 pregnant women prisoners), release of a small number of other prisoners on licence and the possible rehousing of remand prisoners in bail hostels. Whilst these policies are to be welcomed (and are certainly much more humane than the lockdown of prisoners) they do not go far enough.   Commentators such as Eric Alisson and the charity INQUEST have suggested more radical alternatives to the current situation. INQUEST’s proposals include:

a) An immediate release of all those held in immigration detention centres, in line with recommendations made in the British Medical Journal by key health professionals in the field.

b) Relieving the pressures within prison system by closing child prisons (Secure Training Centres and other facilities holding children) as soon as practicable.

c) Prompt release into the community and relevant support services for women in prison, alongside increased funding for women’s centres and other specialist support services as a priority.

d) Dramatic reduction of the population across the rest of the prison estate, with consideration of options to release all those who safely and reasonably can be. This should be done with input from (and funding provided to) community and voluntary sector services providing support for people on release. Nobody should be released into destitution or poverty or faced with a lack of health and welfare support.

Second, there needs to be a radical transformation in how prisoners are regarded, not just in relation to the current coronavirus crisis but when the crisis has abated. For the last two centuries, they have been regarded as less than human, as less eligible subjects who were undeserving of, or entitled to, decent health care services. There was, in effect, no ethics of care. In practice, this has meant that prison regimes have always been inherently unhealthy and demonstrably unsafe for prisoners which, in turn, has had an often devastating impact on the physical and psychological health of prisoners who have remained outside of the social democratic orbit of care, compassion and protection which those on the outside the prison’s walls have as a right, at least in theory. In areas such as deaths in custody, this has led to prisoners being blamed for their own deaths either because they have allegedly had some kind of abnormal characteristics which have propelled them into self-inflicted death or they have died ‘naturally’.

However, as INQUEST has pointed out: ‘no death in prison is natural’ as the ‘failure to treat prisoners with decency, humanity and compassion is a “consistent feature” of deaths [inside]’. In their evidence to the Health and Social Care committee in relation to ‘natural’ deaths in prison INQUEST pointed to ‘serious lapses in the delivery of, and access to, healthcare’. They included, ‘failures to make urgent referrals where it is suspected that prisoners might have cancer or a failure to “review and treat abnormal blood test results.” The Committee went on to note that it had

…….received similar complaints in response to our call in Inside Time. For example, one prisoner informed us of the death of his friend who complained repeatedly to healthcare services within the prison about pain he was experiencing. When healthcare services finally did help “it was too late, he had cancer and only had weeks to live.” (ibid)

This is a key point not only for critiquing the statistics around deaths in prison but more broadly in the present coronavirus crisis. Health statistics, like all social statistics, are social constructions. Therefore, while deaths may well be put down to the underlying condition of the individual in fact, such deaths may well be caused by institutional structure of power. In short, such deaths are preventable. As an example, on March 17th in an interview in The Guardian, a consultant cardiologist pointed out that in the previous week, a 79-year old woman was admitted ‘for an elective, non-urgent procedure. She was then diagnosed with Covid-19, which, he says, “she almost certainly acquired on our wards”. She was put on a ventilator but died on Monday night. “I’m sure she will go down as an elderly patient with underlying conditions, but she should have lived to 90,” he said’.

Therefore, there needs to be a political, cultural and social shift away from the criminal (in)justice model that current prevails and which has abjectly failed to protect prisoners and indeed the wider society both from conventional crime and also the rampant criminality of the state and the powerful who enjoy a culture of immunity and impunity not afforded to the powerless. This means developing structures of democratic accountability based not on criminal (in) justice but social justice for all. At the same time, the prison system should be be abolished in its present form, the prison building programme should be stopped and the radical alternatives discussed above should be implemented. Coupled with a less hypocritical understanding of what crime is and who the ‘real’ criminals are, and the removal of the rabid social divisions and gross inequalities in wealth and power that scar the social landscape and destroy lives, these radical alternatives will ensure the health, safety and protection of the whole society, including prisoners and their families.

** This blog was first published by New Socialist on 26th March 2020**

Bad Moon Rising : Criminal Justice after the Election

Joe Sim is Professor of Criminology, Liverpool John Moores University

On November 29th, two weeks before the general election, Jack Merritt and Saskia Jones were horrifically murdered by Usman Khan. In the immediate aftermath of Jack and Saskia’s appalling deaths, Boris Johnson, appearing in nearly every news outlet, made it clear that there would be changes to the criminal justice system including tougher sentences and restrictions on early release. The poignant interventions from Jack’s father, Dave, who pointed out that his murdered child would have had no truck with such retributive policies, and who passionately believed in the redeeming spirit of rehabilitation and reform, were ignored by Johnson in the rush to invoke a grotesque spirit of revenge and punishment. On December 9th, three days before the election, Joseph McCann received 33 life sentences. He had committed 37 rapes against 11 women and children aged between 11 and 71. And while none of the victims had physically died, the account below from one of the survivors of McCann’s misogynist terror, spoke eloquently about the psychological death she had experienced:

This is a significant and limiting change in my lifestyle. I used to be very independent with no fear of going out and doing things alone. I am now much more dependent on other people. My life looks very different from how it once did. It has been a huge loss for me. My aspirations, both small and big, and my vision of a positive future, have been violently taken from me. My partner and I both exhibit symptoms of post-traumatic stress disorder and my sleep remains disturbed by nightmares and physical pain. I often feel like I’m hiding a terrible secret and I can’t connect with people like I used to as a result. To replace a life thriving with one of surviving is deeply demoralising and difficult. I only hope that this process will take us one step closer to building a society in which rape and sexual assault are never excused, in which the voices of victims and survivors are heard and respected, and in which this can never happen to anyone else.

In contrast to his intervention after Jack and Saskia’s murders, McCann’s crimes provoked little response from the soon-to-be Prime Minister, nor indeed from any of the other political parties. (Nor did any of them see the desperate irony in the fact that those who confronted Khan, and who could also have lost their lives, came from two of the most vilified groups in an increasingly pitiless society: a Polish immigrant and serving and ex-prisoners). On December 12th, Johnson was re-elected as Prime Minister.

Johnson’s reaction to Jack and Saskia’s deaths, and his non-reaction to the crimes committed by McCann, was not unique. Over the last forty years, both major parties have hypocritically capitalised on specific crimes in order to legitimate hard-line, authoritarian policies. The horrific murder of James Bulger in Liverpool was mobilised by Tony Blair to justify New Labour’s infantile law and order mantra, ‘tough on crime, tough on the causes of crime’. New Labour politicians had plenty to say about this appalling murder but had much less to say when Anthony Walker was brutally murdered by racists on Merseyside. Why was this? Because Anthony’s mother did not utilise the language of revenge and retribution but pleaded for understanding and forgiveness. However, like Dave Merritt, her views were ignored. Her language did not suit the retributive law and order policies favoured by politicians. So the idea that victims are centre stage in the thoughts of politicians is false. Only some victims’ voices are heard, the ones that suit those in power, or, in Johnson’s case, those seeking and winning power.

Over the decades, it is has become clear that the main political parties, having no answers to the complexities around conventional crimes, and the lamentable failure of their law and order policies in dealing with these crimes, have responded to any criticisms of their policies by labelling their critics as pro-crime and anti-victim. This offensive caricature, and the morally vacuous sloganeering that underpins it, has mystified the fact that, in practice, it has been successive governments which have been pro-crime, for example, in terms of their attitudes towards, and lack of response to, white collar and corporate crime. And it is they who have been anti-victim, for example, in their deplorable response to domestic and sexual violence in England and Wales. In Boris Johnson’s post-Brexit world that is likely to remain the case.

Other Issues

There are a number of other issues to consider. First, implicitly and explicitly, Johnson’s view is that the criminal justice system in general, and sentencing in particular, have become too liberal. Not so. Sentences have been getting longer while England and Wales imprisons more people per 100,000 of its population than any other country in Western Europe.

Second, there is his view that a prison-driven, hard-line approach to conventional crime (not, of course, to corporate, white collar or state crime) will protect the wider society and prevent more people becoming victims of crime. Given this fairy-tale logic, America, the country with the highest rate of imprisonment in the world, should also be the safest country in the world. Again, not so. Speaking on the 39th anniversary of John Lennon’s murder in 1980, – a ‘hollowing experience’ – Yoko Ono pointed out that there are 100 gun-related deaths each day in America while over 1,400,000 people have been killed by guns since John’s death in December 1980. Additionally, between 1968 and December 2015, more Americans were killed by gun violence than the combined number of Americans killed in all of the wars pursued by the USA in that country’s history.

Third, like his Conservative and New Labour predecessors, Johnson was, and is, concerned with crime in the world of the public. Of course, deaths such as those resulting from knife crime have a terrible, traumatic impact on families, friends and communities. However, there are other crimes in the public which do not receive the same attention. For example, the number of hate crimes increased from 42,255 in 2012/13 to 103,379, in 2018/19. There is still little debate, nor concern, about the impact of these crimes on the families, friends and communities of these victims. Then there is the question of crimes in the world of the private. In the year ending June 2019, over one-third of offences involving violence against the person were domestic-abuse related. What about sexual violence? There were over 163,000 sexual offences recorded by the police in the year up to June 2019, including nearly 59,000 rapes. Police recorded sexual offences were at their highest volume since the introduction of the National Crime Recording Standard in 2002. Grassroots women’s organisations and survivors, continue to point to the lack of empathy, sympathy and support from criminal justice personnel towards them and the traumas they continue to experience when, and if, these crimes get to court. A highly masculinised criminal justice system reflects and helps to reproduce, a highly masculinised political and popular culture in these particular cases.

Fourth, as ever, there is the marginalisation of the social harms, including death, generated by white collar, corporate and state crime which have had, and continue to have, a profound impact on the wider society. Johnson’s post-Brexit state is unlikely to address:

income tax avoidance and evasion, which even on the Government’s own “laughable” estimate now stands at a record £35 billion per annum, nor the 36,000 deaths each year which the Government links to air pollution in the UK in its recently revised downwards estimate, nor the 50,000 work related deaths which occur year in, year out in one of the wealthiest economies in the world. The cultures of immunity and impunity which allows the rich and powerful to engage in routine criminal activity will continue to be encouraged: programmes of deregulation and non-enforcement of law against businesses have been institutionalised since 2010 to the point where, for example, there are no officers to enforce law in some local authority areas, where some regulation has been privatised, and where prosecution in some areas are now non-existent.

Fifth, and more broadly, there is the question of the democratic accountability of state servants. Peter Clarke, the Chief Inspector of Prisons, and former Assistant Commissioner for Special Operations in the Metropolitan Police – therefore he is hardly a paid up member of the revolutionary Marxist clique which is central to the caricatures articulated by politicians towards their critics – has consistently pointed out that his recommendations for improving prison safety have been systematically ignored by prison managers and staff. Between 2009 and mid-December 2019, 2713 prisoners died in England and Wales, 854 of which were self-inflicted. Up to mid-December 2019, there were 271 deaths in prison, 75 of which were self-inflicted. Johnson has had nothing to say either about the institutional chaos and dehumanising regimes which provide the traumatising context for many of these deaths, or about the lack of implementation of official recommendations from Peter Clarke which could have prevented many of them or about the culture of immunity and impunity in which these deaths occur.

Finally, there is the question of access to justice. The cuts to the criminal justice system which have been implemented since 2008 have been devastating in terms of reducing access to civil and criminal justice, and legal representation, particularly for the poorest and most impoverished members of this society, especially women. Will these cuts be restored? Allied to this is the question of miscarriages of justice. Will this issue be taken seriously or will those who claim to be innocent continue to be dismissed as dissembling liars which is ironic given what passes for ‘truth’ from the political class in this country. In 2017/18, despite an increase in its workload, the Criminal Cases Review Commission’s (CCRC) budget for investigating miscarriages was cut to £5.6 million, down from £7 million in 2003/04.

Expenditure on the CCRC represented a fraction of the criminal justice budget for the year. In fact, the annual budget for investigating miscarriages was below the average salary of the Chief Executives of the Financial Times Stock Exchange 100 companies which stood at £5.7 million. Altogether, the top five executives earned £148.1 million over the year, more than 25 times the budget for the CCRC. The cost of the CCRC was also less than the cost of the relocation expenses for some Chief Executives – over £6 million – in recent years. This included £497,000 for the Chief Executive of the National Grid to relocate 97 miles from Warwick to London.

In focussing on crime and insecurity in the world of the public, including knife crime, Johnson was, and is, consciously and uncritically following the dominant discourses articulated by successive governments for decades, discourses which have relentlessly been reinforced by the mass media and state servants and their representative organisations such as the Police Federation and the Prison Officers Association. This corrosive network of power has been crucial in socially constructing what crime is, where it takes place, who is responsible for it and how it should be responded to. In the rush towards the further intensification in the process of punishment, revenge and retribution for conventional crime, the systemic inequalities in the delivery of criminal justice, or rather criminal injustice, will continue to be marginalised and are unlikely to make it onto the punitive radar of the Prime Minister, or his hard-line Home Secretary.

The Brexit State

On the Saturday after the election, the Daily Mail, which devoted 25 hagiographic, triumphalist pages to Johnson’s election victory, indicated that he would start with a‘100-day whirlwind’. This will involve employing 20,000 police officers, 6000 of whom will start next year. Additionally, ‘the law will be changed to allow more stop and search. He will end early release at the halfway point of sentences for paedophiles, terrorists and other serious criminals, who will have to serve at least two-thirds of their prison terms’. Chillingly, in terms of the constitution, the newspaper also noted that there would be ‘restrictions on judicial review’ and asked [c]ould there also be a look at how Supreme Court judges are selected?’ Writing in the Sunday Telegraph three days after the election, Simon Heffer, demanded ‘radical constitutional reform.’ The government, he said, should ‘fix the scandal of our broken constitution’. In saying this, Heffer did not mean changing the anti-democratic and unfair nature of the voting system through introducing proportional representation thereby democratising and modernising how politicians are elected. Rather, his proposals would involve boundary changes to Parliamentary constituencies (which will overwhelmingly benefit the Conservatives), reforming the House of Lords (which often has been the main bulwark against Conservative policies) and reviewing the work of the Supreme Court whose members, according to Heffer, ‘must be subject to confirmatory hearings in which they declare their political allegiances’.

Not surprisingly, he had nothing to say about the appalling role of the mainstream media and social media in demonising the Labour leadership and in reducing political debate to superficial, echo-chamber sound bites. Even his own paper pointed to the ‘grievous falsehoods’ mobilised at the election including: the false claims that a Tory party member had been ‘whacked’ by a Labour activist; temporarily disguising an official, Conservative party Twitter account as a fact- checking service; and the fact that ‘[m]any voters were fooled by a tweet supposedly written by Jeremy Corbyn, which depicted him as sympathetic to the London Bridge attacker- and which was supposedly cited on doorsteps’. Additionally, of nearly 7000 Facebook ads posted by the Conservative, ‘88% were “misleading”’.

Generating hostility towards the Human Rights Act through the media has been another dimension in the Conservative Party’s drive towards deconstructing and repealing the Act as a bulwark against the untrammelled power of the state. Their 2019 manifesto indicated that the government would ‘update the Human Rights Act and administrative law to ensure that there is a proper balance between the rights of individuals, our vital national security and effective government’. The manifesto also indicated that within a year of being elected, the government would establish a Constitution, Democracy and Rights Commission to make proposals in this area. Essentially, ‘the basis of their argument seems to be that if human rights are universal to all then we may have now gone too far – as they also apply to “bad people”’.

After its defeat, the Labour Party is engaging in a period of reflection including attempting to reconnect with its traditional heartlands. This sounds ominously like a recipe for perpetuating the narrow definition of politics based on an idealised vision of family, community and country on which so much of its actions are based. In other words, politics as usual. Given this, it is arguable if Labour will critically examine its demonstrable role in facilitating the new government’s threats to the constitution and its retributive stance towards conventional crime. There are two reasons for this.

First, and most obviously, Tony Blair’s three governments, through their infantile mantra of ‘tough on crime, tough on the causes of crime’ also followed a retributive path which led to the over-policing and over-criminalisation of working class communities and black and minority ethnic communities, in particular, and the under-criminalisation of corporate, white collar and state crime, Even introducing the Human Rights Act failed to curb the coercive, punitive and non-accountable interventions by the state into the lives of the powerless while simultaneously refusing to take seriously the criminal activities of the rich and powerful. A better and more truthful slogan might have been: tough on working class crime, not too tough on the causes of white collar and corporate crime.

Second, there is Labour’s definition of what constitutes politics and what is deserving of political action. The party might want to consider that its focus has become so myopic and narrow to the point where issues like the constitution, the voting system, prisoners’ rights, the environment have not been classified as ’real’ politics by it or the trade union movement. Blair’s governments had the ideal opportunity to introduce a system of proportional representation, which, done properly and with principle, could have revolutionised and democratised the society in ways which would have been historically unprecedented.

In Gramscian terms, the Conservatives are now beginning a ‘war of manoeuvre’ – ‘a swift, full-frontal assault, capable of winning a knock-out blow especially in the wake of successful positional campaign’. What does this mean in terms of the immediate future? For Tim Bale:

Johnson’s victory this week constitutes the first battle won.  His splash-the-cash policy platform – “more bobbies on the beat”, sorting social care, and almost everything else on the agenda of the Daily Mail and Telegraph readership – is the second.  And his appointment of Brexiteer ultras to the cabinet, and members of Vote Leave’s campaign machine as government advisors, is the third.

Conclusion: An Apocalyptic but Contestable Future

In November 1968, the former head of the FBI, J. Edgar Hoover remarked that justice was ‘merely incidental to law and order.’ Although articulated at a different historical and cultural moment, Hoover’s comment captured something fundamental about the atavistic attitude of the powerful, and many state servants, towards delivering justice in England and Wales today. However, as Stuart Hall argued in the wake of the Thatcher-inspired, and what appeared to be irrevocable shift to the right in the 1980s, ‘history is never closed but maintains an open horizon towards the future.’ For Hall, ideologies are fluid, and through contestation they are open to more utopian outcomes where alternative possibilities can be turned into radical, political probabilities.

In the bleakest of times, Hall’s point remains a key lodestar in guiding political interventions and actions. It was reflected in Roger Cohen’s argument in the New York Times in the aftermath of the election: ‘[t]he fight for freedom, pluralism, the rule of law, human rights, a free press, independent judiciaries, breathable air, peace, decency and humanity continues – and has only become more critical now that Britain has marginalized itself irreversibly in a fit of nationalist delusion’.

This comment stands in marked contrast to the highly militarized, heavily masculinized state, (and, indeed, the wider highly militarized, heavily masculinized, political culture of which Johnson was a clear beneficiary), which is likely to confront the population in England and Wales as the apocalyptic reality of the post-Brexit settlement begins to materialize. Despite this, Cohen’s argument is something to hold onto for the future as nothing is irremovably fixed in a political sense forever, not even Conservative Party majorities.

Part of the title is taken from the song title of the same name by Creedence Clearwater Revival.
Thanks to Kym Atkinson and Helen Monk for discussing different aspects of this blog with me.