For two years we’ve been told by senior NHS operatives that the responsibility for assessing the need for masks to be worn in health care settings has been ‘delegated’ to individual NHS Trusts. Decisions would be made based on the local prevalence of respiratory infections and their associated risks.
Work carried out by anti-mask campaign group, Smile Free, has found this to be a falsehood. NHS staff and service users continue to be subjected to the undocumented whims of unaccountable mask mavens; people who appear also to feel that legislation aimed at fostering a culture of openness in public life does not apply to them.
Ever since 2020, when the ‘health service’ portion of the Medical-Industrial Complex – a.k.a the NHS – and its co-collaborators, the Government, flip-flopped on the question of mask efficacy, we, the public, have been sold the sham that a piece of ill-fitting cloth can insulate us from a respiratory infection.
What we know, with absolute clarity and certainty, is that face masks serve only two possible purposes:
- As a comforter and pacifier for the frightened;
- As a means of creating compliance and conformity amongst those wearing them.
The entire schtick of mutual support and care, encapsulated in the psychological nudgers’ weasel words, “I wear mine to protect you”, is founded on a lie. As opposed to the nonsense espoused by Followers of The ScienceTM, real scientific evidence, found in real evidence-based research, has confirmed that the only contribution masks make is to increase harmful effects amongst long-term wearers.
What has the NHS’s institutional response to the facts been?
During these past three years, Smile Free has campaigned vigorously against masks. Twice, in the summers of 2022 and 2023, we wrote open letters to the NHS Chief Executives of the four home countries, co-signed by thousands of doctors, scientists, medical professionals and members of the public. We asked first that they fall into line with other community settings and remove routine ‘requirements’ for mask wearing, and latterly that they issue new guidance explicitly discouraging masking in healthcare settings.
When, or if, we received a reply, the message from the likes of NHS England’s Chief Nursing Officer, Dame Ruth May, was that masking and other non-pharmaceutical interventions were a matter of “local discretion” and may be used “depending on local prevalence and risk assessment”, a feature of the masking system we called the postcode lottery.
(‘Risk assessment’ – a decision-making tool for systematically identifying hazards and associated risks – is one component of an overall three-pronged risk analysis process, the others being ‘risk management’ and ‘risk communication’.)
Call us sceptical, but we harboured doubts about the objectivity of a bureaucratic process that relied on the overweening influence and power of Infection Control Teams. Often under the direction of a pettifogger, we suspected the activation of safety theatre that left thousands of staff and service users badgered to wear the useless face rags might lack the rigour we would have hoped for.
What did we do?
We decided to put the claims of the NHS ‘higher ups’ to the test: we set out to review measurement of local prevalence and assessment of risks arising from respiratory infections in general, and COVID-19 in particular. During the period between September 2023 and February 2024 we identified seven NHS Trusts (Barnsley, East Suffolk & North Essex, Sheffield, Sherwood Forest, South Warwickshire, United Lincolnshire, University Hospital Southampton) that had restarted the mandated wearing of masks across at least some of their estates.
These trusts were chosen because they decided – and announced – that COVID-19 infection levels were “soaring“, and because they think that masks “prevent further spread and protect patients“. (Why they think these things, we have no idea. We think there is zero evidence to support either assertion.)
Via Freedom of Information (FOI) requests, we raised with each trust these questions:
- Within the geographical boundaries covered or served by your trust, what were COVID-19 case numbers (per 100,000 people), by month, since October 2022 until the present day?
- What was the most recent date that these mask measures were subject to risk assessment and updated?
- What was the latest risk assessment document used to determine that it is necessary for you to reintroduce face masks?
- What were any and all risk assessments that have been used since March 2020 to determine that it is necessary for you to mandate the wearing of face masks?
What were the results of our FOIs?
All trusts failed to offer any statistics on community COVID-19 prevalence within their catchment service areas. Two, Southampton and South Warwickshire, were able to provide some data about COVID-19 rates amongst admitted patients; but not one collected, retained or even appeared to analyse case data from across their entire geographic field of operation. All (bar East Suffolk and North Essex, who flatly stated that “we do not have that data”) pointed at the UKHSA as holder of the information. None were able to show how they had used these actual numbers as part of a risk analysis process.
This prompts the question that if these trusts don’t record or analyse these numbers over time, how can they ever know whether COVID-19 prevalence is changing within their service area, or whether changes are suggesting increasing or decreasing health hazards and associated risks? How were they able to make any scientific decisions on mandating, or even just recommending, the wearing of face coverings as ‘protection’ against a respiratory infection?
Just as worrying is the reality that none of the trusts were able to provide evidence of formal documented risk assessments – let alone risk analysis processes – for all parts of their estates. (One, Barnsley, provided a risk assessment template that it said was used to “inform” discussions about mask wearing within its Emergency Department.)
Within this context, three FOI responses, from Southampton, Sheffield and South Warwickshire, are most illuminating, both for their candour and as a realistic representation of what has been happening across the NHS after the ‘top down’ mandates disappeared and were ‘replaced’ by local protocols in 2022.
Firstly, in answering the questions related to documented risk assessments, Southampton stated that these were:
Not held. Use of face masks would have been reviewed at meetings and we do not have a record of these.
Sheffield’s response followed the same form with its admission:
We do not have a formal risk assessment. However Covid prevalence is monitored by a trust-wide expert group who review and agree all actions required depending on the Covid prevalence level.
South Warwickshire went further and replied that:
Mask wearing was implemented in line with the national requirements to wear masks throughout the Covid pandemic, however we did step up to universal mask wearing approximately one week before it was mandated in April 2020. When the national universal masking requirement was stepped down, we did not then undertake formal risk assessments. Instead, local epidemiology, Covid incidence within the hospital, staff sickness and ward outbreaks are closely monitored and discussed each day at ‘Silver Command’. Masking is stepped up or down in line with this picture, erring on the side of caution. This continues to be reviewed on a regular basis at Silver Command. In addition, we have always supported mask wearing (either FRSM or FFP3) through personal choice.
The major takeaway from these responses is that the idea of formal local risk assessments being undertaken is a bogus one. Based only on a disproven axiom that ‘masks work’ and an unwillingness to acknowledge the real evidence about mask efficacy, there was:
- No systematic risk analysis methodology applied;
- No formal risk assessment carried out;
- No evidence of formal risk management procedures;
- No official documentation related to a risk analysis process created, stored and updated over time;
- No consideration of scientific evidence on the comparative benefits and harms conferred by masks to their wearers.
Instead, what happened is that people who believe masking makes sense imposed – and continue to impose – their views on the rest of us. Why? Because they feel no need to ever re-evaluate or challenge their pseudo-religious beliefs; and because, in the words of South Warwickshire NHS Trust, they want to “err on the side of caution”.
But that’s not all, folks
As concerning as the lack of any rigorous, data-led, local measurement and evaluation of risk from respiratory infections might be, there is a second aspect of our work that is more worrying. And that is the seeming lack of respect exhibited by some NHS Trusts for the regulations that underpin the FOI legislative framework.
Of the seven trusts that we directed our FOIs towards, three (Sheffield, Sherwood Forest and United Lincolnshire) failed, by a considerable margin, to respond within the stipulated timeframe. The worst laggard was United Lincolnshire, which was overdue with its response by more than two months!
According to the law, an FOI response must be created within 20 business days. Despite numerous nudges of our own to these trusts, they failed to comply. In the end, in the form of formal complaints, we escalated these delinquencies to the Information Commissioners Office (the ICO) who then gave the trusts a final ‘10 day’ ultimatum to respond.
Why were they so late? We can guess, but we couldn’t possibly speculate. Suffice to say the excuses given were in essence a variety of the ‘dog ate my homework’ type. Intermediate responses cited problems locating the information and the difficulty of finding a suitable senior manager to sign-off the response.
Our conclusion
We began this exercise with the notion in our minds that, when it comes to face-masking, the NHS has spent the past four years simply making it up. We feel no different now, except that we’ve now got confirmation of this inkling.
Everything we’ve heard from these NHS Trusts speaks to an unchallenged over-reliance on models, non-existent data and a Pollyanna-like mentality where being seen to ‘do something’ is better than following the well-established Precautionary Principle and waiting until we understand and, even better, have evaluated properly the facts.
It seems to us to be a disgrace that the ‘national treasure’ which is the NHS can act in such a cavalier and unaccountable manner.
Paul Stevens is a member of Smile Free which campaigns for the end of mask mandates and masking.
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