From John in Brighton: The Jab

10 February

Back to to the 60’s  again and this time The Fab Four. I know The Marvelettes had the first cover but for me it’s The Beatles version that sticks. With apologies to the songwriters: Mister Postman, look and see   Oh yeah Is there a letter in your bag for me?  Please Please Mister Postman There must be some word today
From Matt Hancock so far away

Normally the arrival of the postman makes my heart sink rather than skip a beat – which bill haven’t I sorted? But Valentine’s Day is only two weeks away and that can only mean one thing – an invite for my vaccine as I’m highly vulnerable and in the so-called top four priority groups,.Currently it is quoted that 75% of adults in the UK would take the Covid vaccine. We should acknowledge peoples’ reservations whatever they be but for me it was a no brainer and the sooner the better – they could have told me injecting dishwater or bleach was effective and I’d have signed up for it. The first step on my release from Colditz. Saturday, there he is and still bearing a bit of Pat’s (my puerile metonym for all postmen) warmth, I rifle thro’ his offerings. The excitement gives way to despondency – junk mail, good news is no bills but the bad is no call up.  But Monday’s 1st February – odds on for a letter next week.  

But within an hour Jackie rings to tell me that all our food bank volunteers are now eligible for the vaccine even though I haven’ been able to partake for a while. It felt like I was slipping thro’ the back door but any flicker of guilt was about as transient as a flash of lightning. So I’d wasted half an hour of my life composing various letters to Matt if I didn’t get the vaccine on time but that’s a price worth paying. Not only that but she’s got the link and before you could say “Covid pandemic” I’m booked for my jab, as they say in the demotic, twenty four hours later. So by the time Pat next trudges up the garden path my immune system will already be grinding into action like a machine that’s sat furloughed for months on end. 

My biggest dilemma was how to get there – buses have been out of bounds in my mind as potential hotbeds of corona, memories of hours wasted queuing for the hospital car park rule that out and parking round the hospital is notoriously difficult with the traffic wardens about as sympathetic to hospital attendees as Boris Johnson is to hungry school children. Despite the strong wind  I opt for the bike as the safest and allowed an extra quarter of an hour in case of a puncture – there’s no way I’m not turning up on time for this. Triple check I’ve got the credentials – letter of invite (the decision to get a Smartphone six months ago is justified in one fell swoop), passport for photo ID and of course the mask.  Credit to the set up – well staffed, clear written information and a doctor on tap to discuss any uncertainties, social distancing and within an hour of the jab I got a text with date and time for my second dose. In reality not a jot was changed by the vaccine and safety measures remain absolutely imperative but psychologically there was a considerable uplift with a feeling that this was the start of moving forward – as Mao Tse Tung said “a journey of a thousand miles starts with a single step”.

For every please with which we importune the postman we need a thank you. First off thanks to Edward Jenner for introducing the first vaccine which was against smallpox which was killing 10% of the population at the time. He is said to have saved more lives than the work of any other human which epitomises the efficiency and safety of human vaccination. Thanks to Blossom the cow who provided the cowpox material for his early studies – her hide is on the wall of the St George’s Hospital Library if you want to pay homage. Fast forward 250 years and thanks to the brilliant Oxford team and volunteers (“other research labs are available”) for producing an effective and safe vaccine with such alacrity. Thanks to the MHRA for fast-tracking official approval. Double thanks to the Government – firstly for the foresight in ordering such a plentiful supply and more importantly for bypassing chumocracy and not putting Dido Harding in charge of rollout. Thanks to the JCVI for providing a clear strategy of prioritisation and to all the NHS teams who put that into practise in double quick time.  Thanks to all the staff and volunteers who cheerily gave up their Sunday lunchtime for the greater good. Thanks to Boris and Matt for not making guest appearances at my vaccine hub.

Should we feel guilty for ordering so much vaccine whilst European politicians and citizens are clearly at one in feeling aggrieved as they lag so far behind? And the third World is hardly out of the starting blocks. No we shouldn’t – we criticise the litany of errors, delays and U-turns so lets lavish the plaudits on those who so swiftly secured our vaccine supply. I’ve lost count of the vaccine supplies so my penultimate thank you is to the BBC who say that the UK has ordered 407 million doses from seven different suppliers. That’s surely well more than we need so could we start passing some to the EU who are clearly desperate – good for ongoing relations surely? I’d say no – we’ve got the worst death rate anywhere and surely the least we can do is start to redress that by ensuring full immunity to our population as soon as possible. And here’s a bit of cognitive dissonance – I voted to remain in the EU but I wouldn’t give them our superfluous vaccine. I’d pass that to the developing world who cannot afford the vaccine and where malnutrition, overcrowding and other hazards leave them sorely at risk and medical facilities are so limited. Last November we made a temporary (time will tell) cut to our overseas aid budget so perhaps this is the least we can do as a gesture of recompense.
So final thanks and let’s raise a glass to the world-beating, life-changing little prick……no, of course I don’t mean him.

From John in Brighton: 100K

4 February

Let me take you back to 30 July 1966, 21 years after Churchill’s famous V sign as the Germans were defeated and exactly fifty before we gave the other one to the whole of Europe. It was the one and only day that England have won the football World Cup, ineffable joy and Wembley was packed to the rafters. One hundred thousand people from all quarters of the nation (and probably a few West Germans to boot) packed into the stadium antedating its downsizing. That’s a lot of people, that’s a lot of Covid deaths. Now we’re top of the World again but for the wrong reason when comparing Covid deaths per unit number of population. The National Archives record that just under 70,000 British civilians lost their lives in WW2 and that lasted six years. The Spanish flu of 1918-19 claimed 228,000 British lives – God forbid that we get anywhere near that. One interesting fact is that the 20-40 year olds had a much higher death rate than the over 75’s which is ascribed to their healthier immune system but still seems to be something of a mystery.

100K and rising needs some answers. There will be a national inquiry and I can see the logic in delaying until the country is a little less dystopic and housebound and NHS staff whose input would be crucial are not the blue-arsed flies that is currently the case. On the other hand a public inquiry needs to give all parties a voice, be transparent and honest and to be timely for if delayed too long it loses its value and personnel move on and responsibility gets diluted.   Take the dreadful Grenfell Tower fire on 14 June 2017.  Theresa May was gushing in praising the emergency services – “extraordinary men and women who put their lives on the line”, “the bravery of entering a burning building”, but it didn’t end there. “We have seen sterling work from people across the public sector including teachers, nursing staff…..” so at last politicians really do appreciate them.  But not sufficiently to stop May, Johnson, Gove, Hancock, Sunak and I hardly need say it Rees-Mogg along with 317 others voting on 28 June, a mere fortnight later, to cap a public sector pay rise at 1% and actually cheering loudly when the motion passed (the little shits).  To seek out the unsafe buildings up and down the land she promised “we can test more than 100 buildings a day and the results come back within hours” – numbers a bit different but a familiar ring except that she didn’t say it was world-beating. But it’s deeds not words that count and still many people live in unsafe buildings. And “we quickly decided there has to be an independent public inquiry … ” which still was ongoing when suspended due to Covid in March last year as the three year anniversary hove into sight. Could there not be a target date for reporting at perhaps two years after the setup date with clear and dated action points? 

Announcing the dreadful statistic last week Boris Johnson offered an apology which felt somewhat pious to me based on his track record of disingenuity. The Government did everything they could he went on to tell us – surely he doesn’t really believe that? Or perhaps he’s sufficiently deluded and he does. His personal experience in intensive care may have been a Damascus moment and public service workers should be valued more tangibly than a public display of his joining the weekly clap . Maybe Michael Gove has vamped the mood music – “following the science” – enough to realise that experts should be listened to. We could list a litany of errors along the way and these were well covered by the panel and public participants on last week’s “Question Time”. With the exception of government minister Gillian Keegan who sidestepped and stonewalled and put it all down to learning lessons and easy in hindsight  as opposed to errors. But I feel that denial such as her’s and Boris’ exacerbates public anger and they’d gain a modicum of sympathy and respect if they said  that they were confronting an unprecedented situation which evolved and developed rapidly and acknowledge that they had made some errors on the way. 

Coming back to the 100K, many will have passed on without the intervention of intensive care. But a piece in this week’s Observer gave me pause for thought. It was written by an anaesthetist describing the challenge and stress of passing a tube into the airway of two relatively young Covid patients – he said he’d never pursued the outcomes but I do wonder, surely you’d want to know.. But moving laterally it roused thoughts in me of the patients’ perspective – separated from family, possibly no last words and potentially a final experience on the planet of being anaesthetised for intubation and you never wake up…. save in the sweet bye and bye if indeed there is one. If that doesn’t reinforce staying at home and social distancing then nothing will.

But case rates are fortunately falling and there is an overoptimistic minority and, in the immortal words of Kenneth Wolstenholme “they think it’s all over, well it…..” certainly isn’t.  But amidst the gloom and doom there shines one luminescent star, a statistic of staggering achievement and of which the government and many others can be rightly proud – 10.5million have now received their first dose of vaccine. Our gratitude is due to all of them, our condolences to the 100,000 and their relatives.

From John in Brighton, UK: Dilemmas

27 January 2021

First off having renounced my contributions to COVID2020diary as the year expired should I rise like a phoeniix amidst the ashes?   Or in zeitgeist lingo it’s a bit of a U turn – call me Boris if you like but I’d rather you didn’t. After all it is my first and he must be nigh on double figures and mine’s hardly the end of the World, unlike some of his for many poor souls. Would that all dilemmas be that simple –  I’ve decided to make some sporadic contributions to the ongoing saga that is COVID2020diary. Perhaps that could mutate as efficiently as the corona virus and re-emerge as COVID2021.

The driver to write is when a major event happens and it has as evidenced by two esteemed co-diarists covering different aspects in the last three days.
Immunisation, vaccination, a little prick (no, not him) or the jab as favoured by TV reporters. The name matters not but it’s significant on two accounts, the first being that for the first time, as far as I recall, we should be espousing praise as our vaccination programme outstrips the rest of Europe put together. To my surprise Michael Gove hasn’t (yet) claimed that it’s down to Brexit but that most incompetent of ministers Gavin Williamson was quick to say how it shows what a great country we are.  On that score yes Gav….shame about our childrens’ education. I have an alternative theory and it’s arguably Boris’ coup de grace for the whole of Covid to date. He appointed the rather vapid Nadim Zahawi as vaccine deployment minister and he is sufficiently inert that for once it’s left largely to NHS staff to organise and administer vaccine roll out. This has been done much more by locality than Test and Trace which I’m sure underlies the significant progress albeit with pockets of pique from those who feel left behind.

In this neck of the woods the relatively elderly folk of Chichester are understandably carping today at the absence of a vaccination centre within their city. But it’s gaining pace on its very ambitious schedule and I’d suggest it’s probably the jewel in the corona of Covid management to date – mind you it’s nothing but tat to date as the current statistics bear testimony to.  There seems to be a very clear algorithm of priority based on clinical need and having so far administered a first dose to 4,266,577 despite the NHS being at breaking point is an amazing achievement. I’m in tier 4 so should be called up by Valentine’s Day apparently. My daughter being on a respiratory / Covid placement got her’s last weekend and took a gulp at the last line of the contraindications booklet – “we don’t know of possible long-term effects of the vaccine” so we bear no responsibility,… just sign here. A bit of potential grist to the anti-Vax cohort.

So there’s the second dilemma – to be or not to be when the call up letter comes? The very few deaths after vaccine have been reported in the elderly with serious underlying disease and are probably unrelated and meanwhile a centre for “long Covid” is about to open locally.  So notwithstanding a small risk of adverse effects from the vaccine the scales are heavily tipped in the direction of “ayes to the right”. Bring it on.

My third dilemma is the most tricky. They’re crying out for volunteers to support the roll out of the programme. I can almost see Lord Kitchener’s chilly stare and index finger pointed at me. My country needs me, how can I refuse? First off I decide that if I have the vaccine – Pfizer, please as it looks to be a bit more effective and wait three weeks then I’ll take the risk even tho’ I’m “highly vulnerable”. Then there’s the acid test aka daughter who won’t go in the same house as me or even share the car for a brief trip. I break it gently and…..she doesn’t throw up her arms and tell me I’m mad but a much more muted “I wouldn’t but I can see why you would ”. That’s as strongly a yes as I can hope for. So I send an e-mail to express an interest as long as I’ve been immunised. Perhaps they’ll fast track me or perhaps they’ll tell me the last thing they want is to risk burdening the NHS with yet another of the clinically vulnerable.

The automatic response from the Mass Vaccination Team Sussex tells me they’re inundated with applications so there’ll be a delay before I get a response. Anyway too late…forget it for the moment and watch the news at 6 last night. First the good news –  over four and a quarter million have received their first dose of vaccinations to  date serves only to fuel my enthusiasm to contribute. Then the bad in that 1610 is the highest number of deaths in a 24 hour period since the pandemic began. Then we have the second of Clive Myrie’s very powerful reports from the London Hospital – Monday’s interspersed the grave diggers amongst scenes within the hospital and yesterday he kicked off with a visit to the hospital mortuary.

And doubt is being cast on the 89% protection afforded by a single dose of Pfizer vaccine with Pfizer themselves saying the single dose only prevented 52% of infections and it needed the second jab to reduce infections by 82% and severe disease by 89% (the provenance of our Government’s figure). If this information is accurate (my source is the Daily Mail online hence my slight reservation) then it puts a cat amongst the pigeons for ongoing prioritisation. Indeed the WHO have said that they do not support the UK approach and the second dose should be given within 3-4 weeks or a maximum of six. And of course we follow the science…..when it suits. 
It’s not so cold out today but regarding my volunteering my feet are feeling about as icy as Kitchener’s eyes….

From John in Brighton: The Last Post

31 December.

As this annus horribilis draws to a close so too by definition does the Covid 2020 diary and unless the pandemic shows a major change of course I anticipate this being my final contribution. Covid is ubiquitous and we have all been profoundly affected in different ways and have varied memories of the year. Herewith a few of mine.

The bellwether tinkled in early February and arguably the country’s first case was a businessman from my patch in Hove who acquired the virus in Singapore and transiently it felt good – our local NHS was praised for their handling of the case. Positive feedback to my erstwhile colleagues and hopefully that’s the end of it I thought…..if only. 

The pandemic has brought the very best out of people as communities and individuals have gone out of their way to provide food and money to those in need. To counteract the misery of loneliness strangers would befriend or shop for the isolated and vulnerable. And it was fascinating to me to see how factories and businesses could change course – aerospace producers transmogrified overnight to deliver face masks and booze distillers poured out bottles of hand sanitiser. Boris Johnson chose VE day in May to summon “wartime spirit” and the country responded in spades. And it was a WW2 survivor Captain Tom – sorry Sir Captain – who stole the limelight marching with his walking frame to raise money for the NHS. Target one grand, result £33 million which is quite incredible – an unprecedented response to an individual fundraiser I’d suggest. Wish I’d thought of that – he’s got Christmas in Barbados and Route 66 next!

But sadly the less positive side of human nature also declared itself. The selfishness that is panic-buying from paracetamol to toilet rolls to food and the powerful clip of exhausted and tearful intensive care nurse Dawn Bilborough has stayed with me and may have concentrated a few minds.  Back in March she ended her shift with a visit for food at her local supermarket only to find the shelves matched Old Mother Hubbard’s cupboard. Then more recently are reports of fraudulent workers claiming furlough payments despite being active in employment we can but hope that there’s the odd new year shock as HMRC attempt to track the culprits. 

Thursday evenings, noted for Top of the Pops in my youth and more recently Question Time, became Clap for the NHS night. Covid shines a light on the amazing dedication and skills that are sometimes taken for granted but perhaps will be acknowledged a little more henceforth. But equally we saw how another band of dedicated workers went the extra mile or more in care homes up and down the land even to the point of leaving their families for days on end to minimise the risk to residents. A flurry of deaths at the care home just round the corner from me hit the TV news and such a stark reminder helps to focus safety measures. Seriously underappreciated and underpaid let’s hope that this skilled and caring group will now receive the recognition and reward that they deserve. Call me cynical but I fear not.

No government in living memory has had to confront a pandemic such as this and deserve some slack …. but nevertheless there must be questions asked over some of the decisions. I could double the length of the blog but instead will select my cardinal cock-up – cronyism. The flaw in Michael Gove denouncing experts was clear to see in appointing party donor Baroness Dido Harding to lead Test and Trace when she has no background in healthcare whilst there are public health doctors up and down the land chasing infections, contacts and advising on management. And we wonder why it was a shambles? Not only was T&T key to cutting infections and deaths but the ensuing imbroglio served to further undermine public confidence.

In amongst the doom and gloom were sporadic moments that made me smile. The cartoonist’s gift horse with Dominic Cummings mistaking Barnard Castle for Specsavers and more specifically watching him squirm as he sat in the Rose Garden trying to exonerate himself – in most peoples’ eyes unsuccessfully. Just this morning I added a coda to my giggles hearing that Dom was invited to turn on the Barnard Castle Christmas lights …..but declined. Then there was the occasion Andrew Marr interviewed Oxford vaccine pundit Sarah Gilbert and concluded “professors give you such clear answers” which in reality applies to most scientists and medics – a snigger as I contrasted the evasive, duplicitous bluster that he gets from many politicians who ultimately have command control but not the responsibility of front-line workers in all the public services. Then there was Matt Hancock suggesting that Premiership footballers should donate from their inflated salaries – which many did incidentally – but his pleas paled against Marcus Rashford’s campaign to feed children adequately which triggered one of the Government’s many U-turns. Probably the side-splitter was Donald Trump proposing we inject bleach and especially the look on the medic’s face as Trump turned to him for support.

Word and paradox of the year? For the former mine would be unprecedented which we’d hear often several times each day as the pandemic gripped the World. And the latter is all but a double-paradox – prior to last year the question was whether, despite our potentially being more connected than ever, we were in reality feeling more isolated. Two key factors are families moving geographically further apart and increasing use of social media to communicate as opposed to face-to-face meeting. But this year where would we have been without Zoom and Face Time?  My lips are coated in the crumbs of humble pie as I acknowledge that social media and technology have their merits. And online bridge (along with the bicycle) has been a mainstay of preserving sanity as a shielder in my personal Colditz with the offspring ensuring strict adherence.

Is there any silver lining to the pandemic? If we seek it out and act then I’d suggest yes. To borrow a bit of football VAR demotic then there is one that is “clear and obvious”. The good deeds and community spirit was heart-warming – not the royalty, rich and famous but of Tom, Dick and Harry and their female counterparts. Hopefully this can be sustained. A second is more subtle and refers to the relationship between the human species and the rest of the animal kingdom. There is strong evidence that the corona virus of Covid was acquired from an animal with bats the top suspect and possibly via an intermediary host. Other serious virus infections have been acquired from animals – HIV probably from chimpanzees as bushmeat in Africa, Ebola possibly in the same way and for SARS the virus (another corona) was also possibly from bats. The Covid variant may more specifically have entered humans via the wet markets in Wuhan. Spending more time out of doors we learnt to enjoy the natural world much more but equally we need to respect it – reviewing the way we farm, manage and market our animals may prevent a new virus in the future. Conflate this with addressing global warming and our descendants will be forever grateful. 

As far as I recall I didn’t personally know any of the 72,548 UK deaths due to Covid but that doesn’t preclude a feeling of sorrow for they and their families. May they find peace in the sweet bye and bye. But someone very close to me died at the end of November and the collateral damage of Covid has been acutely felt as there was very little opportunity for close interpersonal contact over the last year which is when most needed as a terminal illness insidiously progresses. Having lost a hard-fought battle it seems apt, despite the absence of a military link, to dedicate this Last Post to Chris…

Ending on a positive note approval for the Oxford vaccine is announced this morning. Let’s hope for annus mirabillis in 2021. It surely can’t be any worse…. lingering virus, Brexit, can it?

If this does prove to be my final waffle then let me thank Brenda and Anne for the opportunity to share some thoughts and occasionally vent my spleen. 

From John in Brighton: Only Turkeys vote for Christmas relaxation

21 December

My Christmas plans are hardly affected by the announcement forty eight hours ago. After much mulling (no wine involved) I’d decided a walk was on but indoor contact better avoided.  In fact I’d pretty much concluded that a month ago before the recent surge in cases. And what is more I felt back then that the Government policy of five days relaxation was both illogical and dangerous. And it was compounded by BJ refusing to change tack until the last minute and talking with a forked tongue exhorting extreme caution and having a “jolly careful Christmas”. For one day of relaxation we’d need five of further lockdown was the previous message. To my mind that’s facile and I’d like to know the evidence base seeing as we “follow the science” (except when it doesn’t suit). I visualise a spiky haired BJ negotiating with spiky coated virus for a bit of yuletide leniency but with about as little success as the Brexit talks. That’s not the viral modus operandi – leave a window just slightly ajar and it’ll be in, thank you very much. Would you leave the door unlocked with a mass murderer on the prowl? The banality could be demonstrated by an analogy – I really want to get from A to B quicker over Christmas so Boris could we please add 10mph to all speed limits for five days? Only if it keeps the people happy, boosts the economy and shuts up 70 of his restless back-benchers so I can’t see that happening. Call me cynical if you like but I think one new mutation has enabled another – in his policy. With the flaws exposed he’s offered a  “get out of jail free” card as this could be blamed as the trigger for the change. Yes it’s true that numbers have escalated but they were still high before with the R only just below 1. And for all the talk of following the science he ignored SAGE advice at the end of November advising that relaxation could lead to a surge in cases and a third lockdown. Perhaps another 5:1 ratio might help and tho’ I say it myself I think my science trumps Boris’.  Supposing the payback for a lockdown Christmas was surviving to see at least another five in the years to come then I’d go with those odds. 

As inferred in previous blogs my personal view has always been that the priority should have been control of the virus. First and foremost this protected the NHS and minimised death rates.  Restrictions needed to be tougher and sustained until there was a definite decline and / or vaccination became available. Business and economy, eat out to help out and relaxation could follow as and when. After all the second world war lasted over five years and we eventually recovered to the golden age of the 60’s. But BJ is a libertarian and is seeking public adulation and endearment so he prioritises the popular policies. Counter-intuitively in the cold light of day he may actually have lost a lot of public backing as people realise we have the worst outcomes for both health and economy compared to most other countries.

Maybe I am in a position to see things differently to most people. I’ve been shielding and very cautious since the outbreak started so will be minimally affected by tighter restrictions. Secondly I spent nearly forty years confronting so-called NHS “winter pressures” when the beds run out, difficult and potentially risky decisions are needed and staff burn out. Historically the NHS is at its busiest in January and February which is when a post-Christmas surge would hit – Covid will exacerbate this perennial problem. Instead of just clapping we should institute policies that genuinely minimise extra workload and risk. Churches can stay open even in Tier 4 but containing viral spread should not be sacrificed on the altar of a day or two of fun and festivity.
Then add to that the Government pledge to address the huge backlog of just under 4.5 million people awaiting hospital treatment including a 123 times increase in those waiting for over a year. The greater the Covid numbers the less will be the capacity to do that. And of course our yuletide saviour alias the vaccination programme is going to need significant input from NHS staff. The ultimate tragic irony would be if that was stalled as all hands were needed to care for Covid cases.

Yes every individual has a responsibility to act in both their own and society’s best interests by adopting all the safety measures. Despite reports of breechers I believe that the vast majority do and perhaps an undercurrent of fear of infection is more helpful than threats of fines. But equally important are the government setting appropriate rules that are proportionate, logical, clear and consistent and strictly adhering themselves. I’m not convinced that has always been the case.

I have no doubt that many will disagree with me and will see me as some miserable old Grinch….but nevertheless I could live with that. I certainly don’t want to catch the virus…I could die with that. Only a right turkey would take unnecessary risk however appealing in the short term.

From John in Brighton: Had Enough of Experts? Not for Test and Trace

25 September

I see the sporting world as a vignette of the wider world and in many ways with lessons to teach us. One is that at the highest level mediocrity will not triumph and we should all strive for the very highest standards that we can. Which tenuously links to one association with Covid and also one of Matt Hancock’s numerous own goals when he called on the extortionately paid Premiership footballers to donate to support good causes in the crisis. Well they did Matt but we didn’t hear of any MPs, many of whom are extremely wealthy, doing the same. Ironically in the sporting world we’d have been spared his little homily as his performance in a “results business” means he’d have been sacked by April Fool’s day.

It’s no coincidence that many football managers have a track record of playing the game because it means they understand the way it all works, the skills, the psychology, man management. In a nutshell they are experts, But it’s not just in football of which I have not partaken but medicine in which I have. I recall Andrew Marr interviewing Professor Sarah Gilbert who leads the Oxford Covid vaccine research team and ending the interview “Professors do give you very clear answers”. Too many pat answers from politicians Andrew but it’s not just professors  – people who really know their subject are authoritative. The nub of medical knowledge and advice is that it is “evidence based” and I’m sure the same must apply in all other fields. Clearly that is deficient with a new disease like Covid but that should not serve as an excuse for incompetent management. I’d happily advise on childhood diseases and safety but not on road planning (even though I drive), A level exams (it’s too long since I partook) or pest control in agriculture (despite my enjoyment of nature). And if I’m on a flight I’d prefer the pilot to be an expert, in an inferno a well-trained fireman, repairing the roof an experienced tiler or defending me in court (might be best if Matt and Boris don’t read this) a knowledgeable lawyer. In fact whatever the trade or skill then good training, experience and honed judgement are prerequisites for the best outcome. I don’t understand the Tory’s’ beef over Britain having had enough of experts. Presumably when you’ve got a multi-talented polymath like Dominic Cummings as BJ’s chief adviser there’s no place for experts.

And has the flaw ever been more crudely exposed than in the Test and Trace system? Since Adam was a boy health care has tracked down infections, chased and managed epidemics and provided advice to protect individuals and communities. Since the end of the 19th century there has been a legal requirement to inform the authorities about certain infections albeit the list has evolved and currently stands at 31 (including Covid of course). Or there may be esoteric viruses which are fortunately sufficiently rare to be listed in their own right like lassa and ebola. Then, and I claim no expertise in this, there are animal diseases which also carry statutory notification rules. All that a doctor needs is clinical suspicion of a notifiable disease and they must inform the so-called “proper officer” or health protection team in writing or by phone if it’s urgent. As a backup laboratories identifying a notifiable organism are obliged to notify Public Health England. Either way PHE are currently charged with the lead in identifying possible outbreaks and epidemics as swiftly as possible with local experts taking a lead role. As a result there is a long history of experts up and down the land with well-honed  skills in disease notification and management. A Godsend, you’d think, as the basis for a Covid test and trace service. For the sake of argument take a dozen or so of these public health doctors perhaps working in their own region but coming together as a National team, relieve them of some other duties and let them focus on developing a national test and trace service. And after years of NHS “efficiency savings” (cuts to you and me) I’m sure they’d do it for a lot less than the £10 billion on offer. But Boris and Matt invite Dido Harding to lead the 15 strong NHS Test & Trace Committee which contains just one public health doctor with the appropriate expertise. “I can’t think of anyone better than Dido” said Hancock when she was appointed. I can think of plenty Matt if you’re interested but I might be deemed a bit too expert to proffer an opinion. Was that another of Matt’s own goals or does he still feel that after her astounding statement to Parliament that nobody was expecting to see a sizeable increase in demands for tests. Really? Only the best part of 66.64 million of us. Even BJ, the Tory version of Wilkins Macawber as opposed to an expert soothsayer said on the BBC just a day after Dido that he’d been saying for weeks that a second wave was inevitable in this country. Why have such a centralised arrangement if they don’t talk or does she just dismiss a lot of Boris’ hot air? And Hancock goes to nil-3 by now stressing that only those with symptoms should go for a test and maybe rationing is needed but just two months ago in July he was urging everyone with any doubt about infection to get tested. In the absence of any credentials of value I can only assume that Baroness Harding has coughed up another Tory donation because it’s hardly on merit that she’s been promoted to head the new National Institute of Health Protection which replaces PHE. To me this seems so ridiculous that if it weren’t so serious it would be laughable. Back to the football and Dominic’s pre-empted the one about the ref needing to go to Specsavers …even if he had to go 250 miles for his eye test which equates to many people’s trip for a Covid swab. So it’s back to the other old favourite and a chant for Boris and Matt “You don’t know what yer doin’  “. There’s been a string of U-turns so one more wouldn’t go amiss – that whatever the field expert advice and leadership is integral to the best advice and support to the Government.

From John in Brighton: Prioritising Protection – Health or Self?

3 September

What were you doing on 30 April 2018? No, me neither but I know what Amber Rudd was doing – she was clearing her desk as Home Secretary having tendered her resignation. She had misled Parliament over Windrush deportation targets and despite her being misinformed by Home Office officials she took ultimate responsibility and acted with integrity. Isn’t that what you do as an MP? Make a significant error and you fall on your sword or get invited to revisit the job centre? 

Not any more it seems. Take failing Grayling who firstly demonstrated an inhumane streak and incompetence as Justice Secretary banning prisoners from receiving books – overturned by the courts. Then his coup de grace as Transport Secretary was to award a £13.8 million contract for a ferry service to a company with no ships. But all is forgiven by Boris if you support Brexit and Grayling was all but offered the opportunity of a hat trick of blunders being lined up as the new chair of the intelligence and security committee but fortunately a  modicum of democracy was restored when colleagues decided otherwise. Then there’s conduct and example – Dominic Cummings visit to Barnard Castle for an eye test is well documented but less is made of Robert Jenrick’s earlier breech of lockdown travel restrictions in order to deliver his parents’ medications – really? Every pharmacy I know will deliver to those who are in need. Not to mention his rather dubious / illegal fast-tracking of Richard Desmond’s planning application – a £45 million saving for a £12,000 donation to the Tories amounts to good business for Desmond but questionable judgement by Jenrick. But all is well ‘cos he supports Brexit. Then more recently Gavin Williamson as Education Secretary whose only experience in the field was in his upbringing (but don’t worry, the country’s had enough of experts) made such a pig’s ear of the exams that it was less a matter of if but more of when he’d resign….or not. Surely Boris will show him the door – except that Brexit support overrules crass inability. And fortunately there’s a let -out clause called Ofqual. Despite Williamson’s directive that grade inflation was a red line no-no and Ofqual producing an algorithm to ensure that applies Gavin ducks responsibility. It’s left to Sally Collier the CEO of Ofqual to resign and for Boris Johnson to sack Jonathan Slater who was the most senior civil servant at the Department of Education stating a need for “fresh leadership” – right idea Boris, wrong man I’d say. Do you spot a theme – it’s not about ability, experience or integrity but more a matter of passing the Tory Toady Test. Get behind BJ, speak up for Brexit and nothing else matters.

But what about Covid which is our primary focus? In fairness to the Government they have been dealing with an unprecedented (surely that will be word of the year) situation. Some things have gone well – the speed of knocking up Nightingale Hospitals was very impressive albeit they were underutilised, Rishi’s furlough scheme has been a lifeline to so many people (the sting in the tail of paying for it is yet to come) and…..and…Boris was a regular Thursday clapper. But there are serious questions over other aspects – the shortage of PPE for NHS staff and others at varied frontlines was disgraceful, the late institution of lockdown whilst initially opting for “herd immunity” undoubtedly cost lives, the disdain for the elderly serving them a death sentence by discharging to care homes without so much as a diagnostic test, the grossly inadequate number of tests performed and the  pratfall of the “world beating test and trace” app to name but a few. In a nutshell we have a dubious twosome – no, even worse than Johnson and Cummings – of the highest number of excess deaths of a given time period compared to that expected and the largest recession of any G7 country. Calls for an independent enquiry have been accepted but mothballed until the pandemic is over. The Government can point to a ready-made lightning rod claiming that they have always simply followed the science notably the SAGE committee or Chief Medical Officer Chris Whitty. 

But last week Matt Hancock added an additional protective shell against criticism by abolishing Public Health England citing failures in PHE’s testing and tracing as a focus of BJ’s disappointment. It is to be replaced by the National Institute for Health Protection which will bring together health protection with a primary focus of infection, biosecurity and NHS test and trace under unified leadership and with an immediate goal of tackling Covid. Bearing in mind Germany’s more favourable outcome it is to be modelled on the Robert Koch Institute but I’m left wondering whether we wouldn’t achieve more if we cloned our leader on the Angela Merkel prototype. The slight irony is that Baroness Dido Harding has been the lead on test and trace since early May (along with a Government allocation of £10 billion) and she is to be the initial executive chair of the new body. I don’t get it – the Government can’t pursue the much needed Public Enquiry into the management of Covid whilst the pandemic remains active but they can make significant changes to the healthcare strategy. Actually I think I do get it – MH and BJ recognise that errors have been made including more U-bends than a plumbing superstore and they are trying to detract from Government responsibility as much as they can. The last significant pandemic in the UK was swine flu in the summer of 2009 and of course we should learn lessons from Covid as there’ll surely be another in the years ahead. But the new Institute drops all the PHE responsibilities for the quotidian conditions – reducing smoking, sexual health, drug and alcohol misuse and obesity which a mere six weeks ago BJ told us was a priority issue. In a parliamentary Q&A session on Tuesday Alex Norris, Shadow Health and Social Care Minister, asked Hancock about these more generic health issues. His answer was that it would all be embedded fully across the health system including the NHS and they will ensure the best and right organisational structure to deliver this. That all seems very nebulous to me and with the demands on the NHS my suspicion is that without clear national leadership it just won’t happen. Jo Churchill, Tory Health and Social Care Minister, went on to call our current obesity strategy “world beating” which I find risible and it begs two questions  – who says?  and so why change it? I acknowledge that managing pandemics is important but prevention is better than cure in healthcare and I suspect more lives could be saved in the long run with better management of the common conditions. It feels to me that BJ and MH are attempting to cover their own backs by passing the buck at the expense of the Nation’s health and if they agree with my interpretation then I would hope that the large national bodies – BMA, RCN and Colleges for example would take the politicians to task.

The imminent winter could be both challenging and interesting in equal measure. If we’re back to normal by Christmas then BJ isn’t quite the turkey he currently seems.

From John in Brighton: More Lock-up and Lock-down

19 August

Bonjour mes amis! Relief abounds for the thousands who have successfully retreated across the Channel before the quarantine deadline. Self-isolation in the UK means not leaving a place of your choice which is likely one’s own home but could be friends or family. Is that vigilantly policed? Sky News suggested last week that nine people had been fined at the Border but only one beyond this since its introduction on 8th June. Employers may sometimes make concessions but are under no obligation to do so. My sister is now an Aussie national and is currently over in the UK. Although she lives a little North of Brisbane which is relatively spared of Covid on her return in early September two weeks of quarantine will be mandatory. That’s assuming you get in – some states set strict weekly caps on the number of international travellers. Self-isolation is literally a lock-up spent in a hotel room, no visitors, eat in the room and to boot you pay for it. Employers have no obligation to pay you. There’s no government bail out. Strict but on the face of it logical and importantly effectively saying that the virus is still with us and any complacency is misplaced.

Some returning British travellers are requesting Government compensation where they have lost out following sudden changes in the quarantine rules. Some travel insurance policies booked before 1st March did not exclude Covid but most of those after that date did. Hence travellers would have been informed of this and must have been aware that the virus is capricious, it is a pandemic ie very widespread and possibly worldwide and so pending further outbreaks travel arrangements, restrictions and regulations could change in parallel. It is surely the individual’s decision whether they deem the risk worth taking or not and I’d challenge whether it is the Government’s responsibility to pay compensation even where the rules have unfortunately changed whilst they were on foreign shores. Sure it’s tough. Lockdown has been difficult. People are desperate for a break, a change, a summer vacation before the winter creeps up on us and, God forbid, the possible second wave. But it is still a personal choice where you opt to take that break. This is different to the situation with employment where people were asked by Government to work at home if possible and if not and there was health risk then to abstain with the support of the furlough scheme. The economy is in a dire state, furlough has been relatively generous and is now extended to October and surely we can ill afford adding numerous payouts as a variant of travel insurance. Surely preference  should go to paying those identified by track and trace to isolate, many of whom can’t afford to and hence the low pickup rate.

If there is any Government responsibility I’d point the finger at Boris Johnson who conflates a libertarian ideology with an attitude so positive that it makes Wilkins Micawber look gloomy. He perceives himself as a modern-day Churchill rallying the troops but fails to tick a single box. Do you recall that speech at the end of April when he talked of wrestling the virus to the floor and pressing home our advantage?  We were deemed on track to prevail in Phase 1 of the virus and were moving on to winning Phase 2 like battles en route to winning a war.  Nearly three months later on July 17 you could hear the champagne corks popping up and down the land. Gyms and leisure settings could imminently reopen, by September all schools and colleges will reopen full time, from October sports stadia and conferences and hey pretty much back to normal by Christmas. Music to our ears! I wonder how many people booked a break in celebration.  On the other hand how many Cassandras like me felt this was too much too fast? Then there’s the mixed messages with the ongoing importance of staying alert and maintaining social distancing but the gradual relaxation of lockdown continues …except that from August 8 masks became mandatory in some places notably museums, galleries, cinemas and libraries. On the other hand masks are not mandatory in pubs and restaurants although social distancing is. The Eat Out to Help Out Scheme was used for over 10.5 million meals in its first week and it is hard to think that there would not have been some risk of social interaction as a consequence.

My concern, and I hope I’m wrong is that there is potential sophistry at play. 1. New cases of corona virus and deaths are gradually falling, 2. the pandemic is passing and therefore 3. we can progressively relax the restrictions. The flaw is that the fall is largely due to the restrictions and not despite them. An analogy in my speciality would be to say that many diseases are all but non-existent and so we don’t need immunisations any more – the resurgence of measles with a small drop in MMR uptake shows just how careful one needs to be in distinguishing the chicken from the egg. In the same way Blackburn and Leicester should  be seen as warning shots (to continue BJ’s ridiculous analogy of the virus and warfare) when our guard drops and not as unfortunate isolated blips. 

A firm line, no ambiguity and consistent policies may be more painful in the short term but could reap benefit in the long run.

From John in Brighton

9 August

Whose sage? Which SAGE?

Well I’ve just had a flashback to my salad days. Flicking thro’ the Observer recently I recognised  a physiognomy from yesteryear – the rugged features unchanged but the black hair now all but grey throughout. Some July that year – the Toxteth riots in Liverpool and Princess Di married Charles. Lest that’s not enough then this should clinch it – cricketing history was made as England became the first team this century to win a test match after following on as soon-to-be-Lord Botham and the late Bob Willis did for the Aussies at Headingley. It speaks for our extraordinary times that Sir Ian gets his upgrade not for the  worthiness of cricketing prowess, his wine label (bit pricey even in Tesco)  or charity walks but for backing Brexit. Does it get rescinded should that all go pear-shaped?
So whose face could be so powerfully redolent of my younger day? Tony Costello my erstwhile SHO (aka dog’s body) colleague at the Childrens’ Hospital in the Hackney Road. Mutual support as the East End children poured into the Casualty (the term A&E was still not widely used) like a tsunami. He was passionate about cricket and our only breaks were very brief test match updates on Tony’s crackly trannie. He was clearly very bright, quite opinionated considering our relatively callow status but with a much-needed sense of humour. SHO’s are like stem cells in the blood – common origins and the potential to develop in multiple different directions. For Tony the stellar heights of Professor of International Child Health at UCL and a Director at the WHO. Meanwhile I was happy to spend 25 rather more prosaic years at the busy coal face on the South coast. Either way we had a perfect training ground for both – . plenty of patient contact and the pre-gentrified Hackney was a melting pot, so perfect for an initial dabble on the international front. We’d occasionally splash out on a curry from Brick Lane, just around the corner, which had yet to become a household name following Monica Ali’s 2003 novel.  
Tony is a member of Independent SAGE, a name which I find confusing and would suggest is ill-advised. It is a self-selected group of experts created with a view to encouraging more open presentation and discussion of the scientific facts around Covid. The group is independent of the Government (unlike the Scientific Advisory Group for Emergencies [SAGE]) and does not answer to it but is chaired by Sir David King, a former Government Chief Scientific Adviser. It shares its work with the Government and the public but whether the former listens may be another matter. They recently wrote to Chris Whitty advising that we pursue a Covid-zero elimination policy before any further easing of lockdown and Whitty publicly then said we’d relaxed as far as we could but will the politicians be of a piece? An effective Test and Trace scheme is key to this – £10 billion for a “world beating” system that misses 25% of cases surely begs some questions. The recent little pockets of escalating cases might be interpreted as a bellwether of a potential second wave and give backing to the harder line. It’s easier to pass judgement and opinion when you have no responsibility for matters fiscal but on the other hand a second wave might well shut the economy down again – surely it’s better to pre-empt that. In his Observer interview Costello was open in some of his criticisms and two comments of note were a suggestion that some of Matt Hancock’s decisions verged on the criminally negligent and  that about 50,000 of our current excess 65,000 deaths were preventable with more competent management .
My reflections move on to how different is the NHS now. Progress in treatment in all specialties has been phenomenal. But it’s not all been rosy. A year after Hackney Roy Griffiths, Deputy Chairman of Sainsburys produced a report and so another-Lord-to-be Ken Clark began the insidious mushrooming of NHS management along with a move towards a more business- based service. It has always been a dilemma in my mind as to how much financial implications should dictate care. Clearly money must be used judiciously but the new world of purchasing and commissioning, business plans, contracts and efficiency savings (euphemism for cutbacks) was one that at times felt like a foreign land to some of us. The Patients Charter gave power to the elbow for patients but some are much better at speaking up and making demands and it encouraged a litigation culture. The introduction of targets seemed to further distort priorities at times and especially in areas which are harder to measure and may explain why mental health really doesn’t have parity with the physical despite repeated governments purportedly making it a priority. The NHS has increasingly become a political football which is detrimental to the service, the staff and the patients.
Notwithstanding all this the septuagenarian NHS remains to my mind one of the jewels in the crown of this country and one which we should respect and cherish if it is to survive.  One thing that undoubtedly hasn’t changed is the enormous commitment of the staff many of whom are seriously underpaid and go well beyond their contracted  hours of employment driven by a sense of duty and desire to do the best for patients. The pandemic has shone a light on this as rainbows have appeared in windows and the Thursday clap became a weekly ritual. The pandemic is going to leave many scars but hopefully there will be the shimmer of a silver lining as well. A weekly clap and supermarket priority slots are welcome but don’t pay the rent or bills and we need to ensure that all public service workers are appropriately rewarded for their skills and commitment. I await with interest whether Boris Johnson does do the right thing and tangibly rewards the service that saved his life.

Oh, it was 1981 by the way.

From John in Brighton: DNA

28 July

Potentially an existential issue – but not the double helix and its crucial role to life but rather the future of the restaurant industry. Within a fortnight of the hospitality services resuming, albeit with reduced numbers and other restrictions, restaurant hosts up and down the land bemoan those who book and then don’t materialise at the appointed time. I suspect this is not a new issue but more sharply focussed in these straitened and challenging times. The most outspoken was Tom Kerridge who had 27 no shows at his bar and grill restaurant on a single Saturday night. He emphasised that such selfishness could be the tipping point for the industry which is “already on the verge of collapse”.

Welcome to our world Tom. DNA’s, Did Not Attend, have been a perennial problem in the NHS for as long as I can remember. An outpatient clinic appointment is booked for a certain date and time but the patient is conspicuous only by their absence. Figures vary from place to place and between specialities but on average 8% of appointments (just under 8 million in 2017-8) are not honoured. With each missed appointment typically costing approximately £120 that represents around £1 billion to be coughed up. Not to be sneezed at (even with a mask on). Speaking on Question Time exactly five years ago Health Secretary Jeremy Hunt expressed a personal preference for charging patients for missed appointments. The complexity of administering this and, I suspect, political unpopularity led by the other Jeremy meant it went no further. At the same sitting he also denounced patients who simply failed to take their prescribed medications which is another chronic wastage – so be grateful Tom, at least people swallow your food. The year after Hunt’s rant the body termed NHS Improvement was set up and in a report on “Reducing DNA’s” cited clerical errors and patients forgetting as the commonest reasons amongst several. To counteract these factors many clinics asked patients to ring in and book an appointment personally and then followed later with a reminder text a day or two before the consultation….but sadly not a panacea and still appointments go to waste.

Another ploy in the NHS is to book one or two extra patients in expectation of the absentees – bad news if it’s neither raining nor the World Cup and everyone turns up. But that’s less practical in the restaurant trade and especially with enforced social distancing. And the NHS is not a business whereas a restaurant’s bottom line and staff livelihoods depend on maintaining income. The current white hope for NHS appointments is to give patients the option of booking and changing appointments online. If it works in hospitals then perhaps it could be an option in hospitality as well. But until then a more immediate potential solution is to ask for a deposit at booking with a full refund should cancellation occur at least forty eight hours prior to the meal. To no show with impunity is ignorant and rude – maybe a forfeit would concentrate the mind. Interestingly, but perhaps unsurprising, is that psychologists have demonstrated that people value things more if they have had to pay towards them. The only difficulty I can envisage is the client taken genuinely ill on the day of the booking.
At the end of the day surely a key factor is that both action and inaction have consequences and we all have a personal responsibility for “doing the right thing” as the Tory mantra so often tells us. The NHS may be free at the point of delivery but that doesn’t mean that financial considerations are irrelevant and we all need to use the service responsibly and judiciously. Equally the patrons of restaurants have a duty to respect those providing them with a service and whose livelihoods depend on it.