I have some questions for the senior managers at the top of the NHS.

Why did they decide that all the main District General hospitals should become the isolation and treatment centres for Covid 19?

Why did they decide to add several mega hospitals in open Exhibition space, but prefer not to use them as specialist and isolation units all the time case numbers could be absorbed by General hospitals?

Why didn’t they opt to hire hotels with separate bedrooms with individual bathrooms for virus patients? Wouldn’t it have been easier to control infection through simple modification of airflow systems for each room in such a configuration?

How do they  keep enough non emergency surgery and treatment going when the general hospitals are so preoccupied with virus cases? What has happened to workloads for non virus patients?

Isn’t  preventing  cross infection from the virus for people needing other emergency treatment in a general hospital more difficult than if there were specialist virus hospitals?

What are plans for handling the backlog of other work as the virus subsides, bearing in mind obvious pressures on all staff involved fighting the virus cases.

We have all got used to the initials PPE, meaning  protective clothing for people working in the NHS and social care. The government has told us it wants there to be a plentiful supply, and Ministers have authorised spending to provide one. Despite this there is a persistent issue over whether supplies and stocks are adequate in a range of Health and Social care establishments.

I have spent time each day on this problem for the local organisations that report insufficient supplies and stocks. I have  badgered the government through Ministers and the Cabinet Office. I have asked the Local resilience Forum for help, as we were told they had an important role locally. I have worked with Wokingham Borough who want to source more clothing for their social service responsibilities.

As a result of the strong MP and media interest and the demands from various hospitals and care homes the centre and the regions have set up organisations to try to ease the shortage. As an alert reader will have noticed, so far I have only mentioned organisations that are trying to buy or obtain PPE. The problem of course lies mainly  with the supply. The world is short of PPE because there has been a big surge in world demand.

I have been able to pass on some leads to public sector bodies who need to buy more PPE. There are various manufacturers and stockists out there who can provide more PPE, and who want the extra orders. Some potential manufacturers say they are experiencing delays in getting their product approved and registered as suitable for purchase and use. Clearly the public sector needs to make rapid decisions, though it should see and test a sample of  the goods first.

It should not be a logistics problem. The army is doing great work strengthening public sector delivery systems. There are plenty of laid up trucks and  vans in the private sector needing work, and plenty of us would volunteer to drive a load in the backs of our own vehicles to an individual local care home if needed.

Given the will to provide more, the money to pay for it and the flexibility of manufacturers in need of work, it should  be possible to crack this problem. Companies wanting to supply need to send in urgent samples, and the buyers in the public sector need to respond quickly with orders.

The response to the virus crisis has in many ways been an essay in world government. The World Health Organisation has stood at the top of the decision tree on how to handle this crisis, acting as a source of information, a clearing house for the ideas of   those seeking to understand and tackle it, and a strong influence and guide on governments on what to do.

Most governments worldwide have followed the main precepts of the WHO advice. There have been attempts by some in the media and some in various governments to differentiate, yet the remarkable thing is just how similar responses are. The differences are largely ones of timing, subject to differing timetables dictated by the rate of spread of the virus to different locations from other hotspots or disease centres.

Most have begun with efforts to track and trace, with testing, to try to contain the spread via the isolation of early cases and their contacts. Most lost that battle and went on to the second phase, total lockdown of all but food, healthcare and some other essentials.

Now there are issues over how much success a country needs to record before it starts some relaxation of controls, and what the dangers are of a second wave or flare up in the virus if relaxation occurs.

President Trump is very critical of the WHO . He thinks they were too tolerant of China who failed to notify early or to let in WHO experts at  the beginning. He also seems impatient with their approach to treatment and medical analysis, turning  to a range of US specialist companies and experts to try to get earlier breakthroughs in treatments and prevention. He also points out that in his view the USA carries a disproportionately high burden of paying for the Organisation.

Do you think the WHO has done a good job so far? Has it given best advice?  How does the mantra of more and more testing work once the disease is well spread throughout a nation? How often does an individual have to be retested for the system based on tests to work?

As we all adapt to life at home, so the way we do things changes. Many more people buy items on line and grow use to not visiting shops other than the main  supermarkets for food. Many conduct business meetings on line through web based meetings. People turn to on line services. Families learn to talk to each other through video links.

It is boom time for  services like Zoom, Webex and the download  home entertainment providers. Suppliers of laptops and smart phones I am told have plenty of demand as families extend their range of equipment to conduct life digitally, and as firms provide employees with the kit to work from home.  Our domestic broadband capacity is being tested with much more use.

So today I am asking you to write in and tell me how you have changed your lives to live with the stay at home guidance. Which new services or activities have you found most helpful? Have you acquired any new hardware to help? What things are you now doing on line which you used to do by going out to a gym or sporting event or meeting or party?

I would also be interested in how you think people will react when we do start to see the relaxation of the lock down. Will many of you stay with more on line shopping and digital entertainment, or will you be back to shops and the events as soon as they re-open? Will your attitude to public transport be different all the time the virus lurks without  cure or vaccine?

How much damage to personal incomes has this all done so far, and what impact will that have on people’s capacity to spend again when there are more businesses able to sell us goods and services?

Once we start the relaxations of the lock down, new patterns of trade and business are likely to emerge.

There will be more suspicion of reliance on imports, given the disruption to international trade and travel we have experienced. More people are likely to want local food and products, and more businesses will take some travel risk out of their supply chains.

There will be more concerns about Chinese technology and our dependence on a lot of Chinese manufactures, given the history of the virus and the rows over Chinese involvement in 5G programmes.

There will also  be a governmental  wish to promote overseas trade again after the  big decline, with a more balanced range of counterparties. People will remember which companies and countries were most helpful during the period of virus need.

It is good to hear that the EU/UK trade talks will resume this week by teleconference. I trust the government will also pick up the pace again with the USA, Australia, New Zealand and Japan. These are all important partners, with an enthusiasm to improve trade terms mutually once we are out of the EU customs union.

With governments wanting to promote more trade and with more customers concerned about overseas sourcing, the stage is set for better deals to act as inducements. The better deals will come from the friendlier countries, which in turn will be the more reliable trade partners.

The government has long held the view that the best way to combat poverty is to help people into jobs. It is easier to get to a better paid job from a starter job than from no job at all.

The government had been very successful at creating the right conditions for many more jobs to be created. This Parliament was meant to  be about securing more and better training for the many, so they can get better paid jobs. Business will work smarter as the workforce becomes better trained, and  better supported with technology.

The current surge in unemployment is a most unwelcome interruption in this policy. People who lose their jobs or who are told they can no longer earn from their self employed businesses are suddenly plunged into poverty through no fault of their own. Many did not earn enough to save for a rainy day, and have no other sources of cash or income to fall back on. It is all very well for senior civil servants and Ministers with well paid jobs to tell them they  must not work. They can afford to because they will still be paid, and can work from home in many cases.

It is vitally important we end the rise in unemployment as soon as possible. If we can start the return to work soon  we may be able to retrieve the position more quickly. If we stay in Lock Down Britain for too long more of these  jobs will be lost for good. The UK needs more productive capacity. We need to make more things for ourselves and grow more of our own food. This needs more all the companies and entrepreneurs we now have and more besides.

I am sending this letter to Cabinet members.

Dear Colleague

It is time to review the lock down policy.

You will wish to have as your highest priority taking actions to reduce deaths from this disease. The evidence is abundant that the most at risk groups are the elderly and those with other medical conditions that makes them especially vulnerable to the severe form of the infection.

Policy should make it as easy as possible for all in the at risk groups to self isolate, to prevent infection Efforts need to be redoubled to ensure on line deliveries of food and other items to these households, and proper financial support for those in vulnerable categories who have lost jobs or income over it.

Your review takes place against the background of the good news that NHS capacity has been much increased and is well above current high levels of demand for care from CV 19 patients.

You  need to take urgent action to save the economy. None of us have ever witnessed such a sharp contraction in economic activity, with an all too rapid surge in unemployment. There will also be far too many business failures if this carries on for much longer.  You need to make sure this is the shortest lived downturn as well as the deepest.

This means a new policy of trying to get as many people and businesses as possible back to work, with sensible modifications to working arrangements to reduce risk of infection.  It should be assumed that most businesses re open, with more home working and more remote technology use.  Offices may want to have more people working from home to allow more space for each employee in the office. More business meetings should take place with remote technology even where people are in the same offices. Factories tend to use large amounts of machinery already, reducing the numbers of employees on line and usually allowing social distancing. Where they do not they may need additional automation. You could consider asking people to wear face masks when working with others.

It is urgent to start lifting restrictions. Many more people will lose their jobs if the lock down continues. Many self employed have no income from work. Many small businesses are struggling to pay their overheads with no revenue. There are limits to how much the state can substitute for the loss of income. If we go on like  this large amounts of economic capacity will be permanently lost. An advanced society needs substantial amounts of work to be undertaken so we have the output of goods and services which sustains living standards. It is time to start to get the UK back to work, whilst protecting the vulnerable and reducing the risks of catching the disease for the rest of us in sensible ways.

I write to wish you a happy Easter, despite the difficult circumstances we find ourselves in. I hope many of you can contact your friends and relatives  with suitable technology, and that you can enjoy your homes and immediate family contacts. For any who have illness in the family, I wish you   a speedy recovery.

Let me begin with some better news. On April 10th at the news conference the government showed that most recent  hospital patients  with CV19 actually fell by 2%, mainly owing to a turn down in the graph in London which still has the  most cases. Let us hope we are somewhere near the peak of numbers going into UK  hospitals. There were 20,204 in UK  hospitals with the virus on Friday ( these figures excluded Northern Ireland). There were 3335 UK wide in intensive care. These  large numbers are so far well within the stated  enhanced capacity of the NHS , though I do not doubt the big  efforts required of many  staff in the front line facilities to sustain these numbers.

For me, the daily tasks of trying to get the government to  ease problems for people financially damaged by the shut downs continues, as does the need to help the local NHS and social care providers where required.

I have stressed repeatedly to the government that their cash assistance to people and companies needs to be faster and easier to access. The initial success in getting schemes to allow workers to keep their jobs with state payment of 80% of wages , and with assistance for the self employed, was most welcome. There remain delays and gaps in provision.

The Treasury has made a few improvements and needs to make more. I have passed on frustrations with banks over access to credit lines. The Governor of the Bank of England and the Chancellor have written a joint letter to the commercial banks asking them to open the schemes and lend the money, but issues still remain.

I am  sending  in more detailed proposals for tackling the pinch points in existing financial support  and for widening access to help schemes. Directors of small businesses are not looked after, job changers can lose out, and companies placing employees into furlough are still not in receipt of any cash to help pay the wages. Ministers want to help, but it is taking time for the administrative procedures to be put into place and to operate on the scale required.

There have been issues over the supply of protective clothing for health and care workers. I have taken these up centrally as have many others  and  more is promised. Companies around the country are engaged in increasing manufacture. There is plenty of government money to buy the kit, and plenty of Ministerial will to see more delivered, but the system is stretched by the sudden and continuing surge in demands.

Many people want to see more tests done to see if people have the virus. Testing care staff who are ill or have been in contact with those who are would allow the return to work of those without the disease. Ministers have made very clear they want many more tests carried out. They  were also prepared to buy 3.5 million tests kits to see if people had had the virus and gained some immunity as well. These kits turned out not to be reliable so the order has not yet gone ahead. The tests for the disease that are being supplied are important for patients in hospital and for care workers as priorities. Government is encouraging the ramp up of more production.

The big decision to be made is how long should the lock down continue?  The medical and scientific advice is that it is necessary to limit the spread of the disease. It does do grave damage to the economy, denying many people the right to work, costing us many lost jobs and damaged businesses. I have been putting forward proposals of how we might start to lift the restrictions so more can go to work, whilst keeping strong protections for the old and vulnerable with other medical conditions who are most at risk from the virus. I am also seeking more accurate figures about the impact of the virus and the capacity we have available to handle patients. It is vital that this important decision is taken on the  basis of reliable data.

Yours sincerely

John Redwood

Now I have been sent the published  back up data for the Friday graphs shown at the news conference, I thought I should just highlight the current situation.

Yesterday’s figures for hospital beds occupied by CV19 patients showed a small decline, thanks to London’s graph falling a bit where the most cases are still concentrated. Current patient numbers at 20 204 remain high. 3335 patients are in intensive care.

These are high numbers which we all want to come down. They do  impose a big strain on the staff having to handle this unpleasant disease, which is unrelenting at this level. They do, however, show the UK  is still currently well within the enhanced capacity of the NHS to cope with the crisis. As part of the aim of policy was to avoid an unsustainable peak demand on the NHS, it is encouraging so far to see these numbers and to see the recent levelling off. Of course we  hope to see this being maintained with no dangerous relapse to a steep climb in hospital cases. The NHS handling these volumes will inevitably limit other non urgent work taking place.

The death rate is too high. Every death is a tragedy. We all want to see it going down. The nation mourns those who have lost their lives to this disease.

Soon the government needs to review progress with its object of flattening the curve of the virus spread, to consider how long we need to remain in lock down.

I am glad we are now privy to the figures the government relies on. In the daily briefings we are shown two graphs or “curves”, the trend in hospital deaths from CV 19 and the trend in hospital admissions for the infection.

It is presumably these curves that need to be sufficiently flattened to allow the government to transit to the third phase of its  advisers’ planned handling of the virus crisis.

There are several issues with the Death figures that need getting right. I think it would be good for some administrators and statisticians from government and or from the scientific community advising the government to spend some time ensuring accurate data. This should not involve medical and hospital staff time which is needed to handle the patients.

 There was a change in the basis of their compilation on March 26th, when they shifted from 8 hour to 24 hour reports, moving the numbers up.  Can they smooth the figures to allow for this?

There is the issue of whether the deaths are all recorded on the appropriate day. The day before yesterday we were told the higher number included deaths from earlier days which they thought had not been recorded at the time. Can’t the numbers to be reworked for all but the most recent by reference to the death date on the medical death certificate?

There is the possibility of double counting. If deaths are sometimes recorded promptly  before paperwork is completed, and other times when the paperwork is ready, there needs to be a check that they do not end up recording the same death twice.

The wider ONS figures are also of interest. These are higher as they include deaths not in hospital where CV19 was present. These include  some where  the deaths certified as with CV19  are based on statements  about symptoms with  no tests to confirm the presence of the virus. The figures include cases where  CV 19 is mentioned where other severe conditions mean the patient would probably have died without the virus anyway.

Hospital admission with the virus is an easier series to get right. Presumably all on admission for CV 19 treatment are tested to ensure they have it, to make the correct treatment available. Admission takes place at one stated time and date, so it should be relatively easy to get a clean series of numbers that are accurate. A simple check would be to compare bed numbers and occupancy rates by hospital and to examine any outliers.

This is such an important decision both to control the disease and for the jobs and livelihoods of the many, that the decision takers need the most accurate possible numbers.