There have been difficulties scaling up the NHS response to the virus outbreak. The NHS is a vast institution with a huge budget and many staff. It rightly needs some well paid managers to run it and deliver on the general tasks set for it by government.
In England we have NHS England and Public Health England at the top. I have written recently about the senior management of Public Health England. NHS England is run by seven executive directors on salaries of around Ā£200,000. In 2018-19 NHS England made 31 people redundant in the band Ā£100,000 to Ā£150,000 and made 29 redundant in the band Ā£150,000 to Ā£200,000. This implies it was not short of management. It had 24,000 employees to manage and direct its Ā£114 billion budget.
It would be good to hear more from them about how they prepared with Public Health England for the kind of emergency we now are living through, and to learn more of how they organise their supply chains to scale up deliveries of PPE and medical equipment when needs demand.
There is also considerable management skill in the operating parts of the NHS at local level. Each area has a Clinical Commissioning Group with senior management to acquire and provide health services locally. A local District General hospital is organised as a Trust with a team of Executive Directors, as are the Mental Health and Community services through a separate Trust.
So the NHS has senior CEOs, Finance Directors, Medical Directors, Nursing Directors, Strategy and Operations Directors at the England level, and at the local level by main activity. The issue today is how they work together to ensure the smooth delivery of crucial supplies to hospitals, surgeries and care homes, and where ultimate management responsibility lies in each case. We need well paid high quality management, but we do not need excessive overlap or too many advisory rather than truly executive posts.
Given the numbers and the pay levels of these managers shouldnāt we expect them to take some Ā responsibility for delivery on PPE, equipment and capacity planning.
April 20, 2020
Good Morning,
When the Covid 19 pandemic is fully over, there should be an independent investigation of the NHS and Government as to its preparedness and actions to prevent, mitigate, manage the outbreak. This is hardly the time.
What there should be going on, right now, is an analysis of the effect of the Pandemic on our nations defense capability. ( I don’t think even the Chinese Communist Party would have hoped to put a US carrier battle group out of action with a little virus, but there it is for all to see) Our government needs to review and ensure that our defensive capability is well able to maintain a very high standard of preparedness right now, while we are distracted and possibly compromised. Are we safe from external forces?
April 20, 2020
I think that it would find that they are pretty well in the clear.
You see, those innocently-named “general tasks set by government” can mean anything, but it is they which dictate the framework within which these managers must work.
And it will be all about priorities.
I will leave the reader to speculate, as to what priorities a Tory government of recent flavour might set, or clearly imply.
April 20, 2020
By “they”, I mean NHS management rather than government.
If you remember, the Government were not elected on a pandemic preparedness ticket, but to “get brexit done” and to “save” the country from Labour.
So, quite legitimately, arguably, the Government can blame its voters.
Many people do.
April 20, 2020
You didn’t mention a pandemic from Communist China in any of your posts prior to this situation.
You never said once “We should be preparing for a pandemic starting in Communist China. It is our greatest threat.”
I blame the Communist Chinese government. They lied and lied and lied and so did the WHO.
Against this no government anywhere should have been dealing with *any thing* other than preparation for a devastating virus from a Communist Chinese government …
Let’s reverse the situation: A Remain decision in 2016, a Labour government… no Brexit.
Do you think they would have been preparing us for a pandemic brought here on the back of lies from Communist Chinese government and would have stockpiled enough PPE ?
And if so WHY did you never mention it ?
April 20, 2020
Martin is a hindsight genius.
Sadly never any warning on here prior to our Government actually taking the advice of their scientific experts.
April 21, 2020
No, the Government are off the hook, arguably.
It’s your fault.
They gave you for what you voted, and you didn’t ask for an epidemic-resilient NHS.
You asked for something very silly and destructive instead, to the exclusion of all else.
April 21, 2020
Ridiculous post from you Martin.
Did anyone who voted in any recent election for any political party specifically vote for “an epidemic resilient NHS” ?
Presumably you did because you were able to predict the future.
If only you hadn’t kept your vision secret all these years.
April 20, 2020
Mrs May PM and Mr Hunt Secretary of State for Health and Social Care, from 2012 until 2018 during the pandemic planning perhaps they should start preparing their answers now.
April 20, 2020
Especially since the outbreak and the actions needed to deal with it were specifically and precisely enumerated in 2005.
Google George W. Bush Urged Us to Prepare for Future Pandemics in 2005
April 20, 2020
Good thing there are 12 battle groups.
April 20, 2020
PHE is a socialist centralist quango with a giant Ā£4.5billion budget.
Much of this goes on pay and expenses for know all executives, with 242 staff on six-figure salaries ā sounds like the Enironment Agency and its Ā£1.5 billion taxpayer budget in addition to the whopping inflation busting increase from Local Authorities (640 useless director types on more than the PM!) that included an additional cost for flood defense! How many times must we pay for socialist state fat cats!
The economy is currently being silently wrecked by the Tory govt. People will wake up to find that austerity and all the claims made by the Tory Govt. over the last ten years is going to far worse this time around! What lies and excuses are we going to get this time around to pass the blame … all decisions led by economists!
How about a three word strap line? We fcked up.
April 20, 2020
My aunt’s home Italy is in Pizzighettone in Lombardy.
135 people have died there out of a population of only 6500.
That’s over 2% of the population dead.
Not 2% of those infected. 2% of the entire population.
My cousin moved my aunt to a care home in Rome last year, and now can’t see her.
Please note that this is not “seasonal flu”.
April 20, 2020
I hope you will be able to see your aunt soon and that she will be OK.
CV19 is not flu but has flu like symptoms. Compared to other viruses of past, such as Hong Kong Flu, it is not especially deadly although quite infectious.
Of those 2% of those unfortunate souls, what age ranges where they ? I am hearing that many elderly are the ones most at risk and that they are making up the large percentages of deceased ?
April 20, 2020
MB. Italy and the UK are already heading for 40,000 deaths attributed to Covid over the course of the epidemic which will probably be 13 weeks. Italy has over 20,000 already. These will include most who had other conditions but could have lived for many years. No one knows what these numbers are yet or even how many people have already been infected without knowing it.
The ONS calculated overall deaths for the 13 weeks before the epidemic got going at about 1700 per week. That’s about 22,000 with many not in hospital and spread more or less evenly throughout the year. Please note that the 40,000 is approximate and additional.
April 21, 2020
Stred,
No, the figures you quote are not correct. UK deaths are counted with the Chinese virus not from it. There is a huge difference. Also care homes and private houses not counted and death certificates made without seeing deceased person.
April 20, 2020
I doubt I will be able to hold my Mum ever again.
April 20, 2020
Good morning.
Depends on what you mean by, ‘rightly’ ?
Alexander Johnson MP has a country, and its dominions, with a population of some 70 million people, with a turnover of some Ā£2.8 trillion. When he and those he appoints to the government get it wrong, both the people and the turnover suffer. As we shall soon see. So if you are using people and budgets as a means of determining salary, either these people in the NHS and PHE are getting too much or, the PM is getting too little. What is it ?
The problem lays ultimately with government. As President Harry S. Truman had displayed on his desk – “The buck stops here !”
I would like to ask our kind host a question. Does either the PM or Conservative Party HQ tell him how to micro manage his constituency ? I ask this because, reading what he writes, he seems a very capable and hardworking MP who manages his constituency office well. The problem with all this large state bureaucracy is, that it is top heavy and centralist. We need to make all English NHS Trusts independent and decentralise them. That way the buck and finger can be pointed further down and we save a lot of money.
Reply No I am not told by the party how to run my office as my office is an MP office to serve people of all political views equally
April 20, 2020
Reply to reply.
Thank you Sir John. And that is the point. You and your staff know how to do your jobs. I think it high time that all these large overseeing bureaucracies with their vast managers and committees were done away with and NHS Trusts were able to manage themselves. The Conservative idea of Free Schools seems to be rather a good one to follow.
April 20, 2020
no give the buying power to the patients not to unaccountable trusts.
better still copy the Australian or New Zealand healthcare models in their entirety…
April 20, 2020
@Mark B: “We need to make all English NHS Trusts independent and decentralise them. That way the buck and finger can be pointed further down and we save a lot of money.”
Absurdity on stilts!
That would cost far more, gone are the massive savings obtained from bulk purchases etc, in standardised training that follows, also gone will be assured interoperability between health areas, to the extent that staff might not even be transferable without training.
Nor would it stop the finger being pointed at central govt for when such an idea falls, as it would, the electorate will simply still point the finger of blame at central govt for such a reorganisation of the NHS, just as they are now!
April 20, 2020
Jerry
The problem is they do not use the bulk buying power of the NHS now.
All of then Trusts purchase on an individual basis according to my knowledge, gained from those who work in the NHS, so they end up all ordering at different times and paying different prices for the same equipment
April 20, 2020
NHS Trusts are already pretty well independent entities Mark – each would be a large company in it’s own right if viewed as such. We have a problem in this country in that we so revere the concept of the NHS that we are totally incapable of seeing it’s flaws.
Any politician who dares to criticise any aspect of the NHS is instantly attacked as being uncaring/fascist/uncharitable/ignorant. The Left keep banging on about the NHS “being betrayed/sold off/underfunded” etc. But the truth is that whilst there are many things that work well – there are clearly things that do not – but they are very hard to debate because of the highly politicised NHS environment.
How many times this week alone have we heard of shortages & mismanagement directed at the “Government” with no attempt whatsoever to enquire where those shortages are or whether problems are in specific areas. It’s all down to “Government” – because it’s unthinkable it could actually be the NHS that’s failed,
Both myself and my wife have been received major surgery and treatment for serious ailments in our local NHS Trust – and we couldn’t be happier. My Mother was treated in a neighbouring NHS Trust and we were appalled at the differences we saw in the treatment and care between the two.
There was no standard of ‘Care’ for Mum – it depended entirely on the individual nurse, some were wonderful and some frankly much less so (Yes – I’m afraid not all Nurses are Angels). But in my view it came basically down to staff management – like any large organisation – customer care (be it in a hospital or shop) is about training and culture. In the NHS there are seem to be large differences between the management in different Trusts I’m afraid and most folk don’t want to believe this or the media report it.
April 20, 2020
Dear John, as an NHS doctor I would very much like MPs from the Conservative party which has spent a lifetime underfunding and sneering at the public sector in general and the NHS in particular to pipe down while I and my colleagues are trying to save lives. Thank you.
Reply Conservative MPs have always been very supportive of medical staff and the NHS and have every year voted more money.
April 20, 2020
Thank you ā Mother Theresaā And herein lies the truth. People in the NHS are pathologically opposed to the Tories refusing to accept any positives merely blaming them.
Apparently āsaving livesā means criticism.
April 20, 2020
SallyG
I have found from personal and family use that the Clinical front line staff of the NHS have usually treated our family and friend’s in an excellent manner, once you get through the often frustratingly long waiting periods.
The real problems from my experience is with the supervision, administration, and management side, which appears to be absolutely dire, records and files lost, appointments made for holiday periods, when you have advised them in advance by email, telephone, letter and at reception of those dates.
Dealing with Social services, which I know is not part of the NHS but which often liaise with it, are usually an absolute farce.
I have family members and freinds who have worked in the NHS, both on the front line, and in administration, and they absolutely agree with my experience.
They tell me that staff who are absolutely useless do not get fired, they get transferred to another department and sometimes to a supervisory role where they then create havoc, and purchasing is done on an ad hoc basis.
I have also been told by more than one Consultant, that some delays are caused for internal political reasons, when I have asked the right questions.
Is the NHS value for money ?
No one knows, because it appears to be free at the point of use, it can and sometimes is, often abused by some patients
April 20, 2020
@SallyG. Are you suggesting that the NHS is well managed at every level?
The Public Sector relies on a productive earning self reliant Taxpayer. When those in the Public Sector have earnings and rewards far in excess of the median earner in the private sector, it should be correct they question of value for money and its accountability.
April 20, 2020
I know from personal knowledge that the intransigence of NHS bureaucracy In this situation has made your life more difficult. Physician heal thyself.
April 20, 2020
More money – or at least the same money – when you take into account inflation? Or actually less money? Because this is a actually important.
If I earned Ā£25,000 in 2000 and had a 1% pay rise every year – but inflation was 2% every year I would be poorer. Even though on paper Iād richer.
How about a pension style ātriple lockā for NHS funding to guarantee its income in future? If it is good enough for the old people who happen to mostly vote for you, it must be good enough for the doctors and nurses who keep them alive.
April 20, 2020
Andy
The NHS pension scheme is one of the very best it is possible to belong to and get.
Simples.
April 20, 2020
I wondered how long it would be before your gerontophobia kicked in. Have you ever made a comment without displaying hatred, and oddly, perhaps envy of older people?
April 20, 2020
SallyG,
The NHS will always be “underfunded” it [the NHS] could be funded to all of UK GDP and some and still ask for more.
A decision will need to be made politically and by the general public as to what is expected of the NHS i.e. are there self inflicted heath problems that should not be covered?
The current issues with the NHS seems to be down to management lack of planning on how to handle a pandemic – not that that should necessarily mean holding huge stocks of what ever that will deteriorate over time, but ensuring supplies can be accessed at short notice when needed, ideally from UK based manufacturers
April 20, 2020
@JR reply; That might be so, but even a 100% increase on very little is still going to be very little!
If the govt, in the last 10 years, had been doing such brilliant job of correctly funding the NHS, getting rid of failing management etc, putting in robust supply chains etc. why is the govt having to “fire fight” on a daily basis, when even the traditional support of the right wing press can not be counted on?…
April 20, 2020
What right wing press is left?
April 21, 2020
See my reply below.
An free at the point of use health system which is so successful at keeping old people alive and which indulges an avoidable obesity epidemic and related illnesses cannot be considered underfunded will NEVER have enough money.
April 20, 2020
Labour was the only Government that cut the NHS funding , and Andy Burnham, then Secretary for Health, said it was irresponsible for David Cameron to promise to maintain funding the NHS after the financial crash.
The NHS is not a religious deity , its a man made organisation, and it’s only right to question the functioning of it. I presume there are purchasing departments in the NHS, so why has it become the job of Ministers to purchase scrubs? And don’t cry poor for the NHS is reportedly spending Ā£80 million on diversity officers, is that beyond scrutiny? 1.4 million people work for the NHS, don’t tell me that there isn’t a problem with bureacratic inertia there.
Most NHS staff are dong a magnificent job, but we do see a lot of NHS people getting in front of cameras who later turn out to be Labour supporters and activists, allowing the NHS to be politicised won’t be doing the NHS much good.
PS neither is it great to be told of PPE shortages, only to see NHS staff doing dances in videos in the PPE gear.
April 20, 2020
As someone who knows GPs, who have not been able to obtain anything like enough PPE suitable for virus filtering or testing, and living with someone who trains doctors and is familiar with virus control, it is only helpful to NHS doctors and private carers and their patients and residents to question the reason for the failure of management. It is a pity that there are so many doctors who believe in a monolithic soviet style management in the UK. No other country in the world believes in this chaotic and wasteful system. And many other doctors agree, though equally against as US system too. A Swiss or German system avoids these disaster whereby the UK has come last the international tables for testing and PPE.
April 20, 2020
SallyG: Sadly, the bitterness directed towards the Conserservative Party is misplaced and should be focused on the mushroom of managers operating within our public service. Their role is to support the work of their teams of specialists and to direct the organisation’s resources to where it will be most effective. Whether it’s ensuring the provision of a pen or specialist equipment, cleanliness of the workplace or allocation of staff to where needed, etc, it is ultimately their responsibility to ensure the support structure is in place so you, as a specialist, can carry out your duties as expected in a safe and effective manner. “Safe and effective” doesn’t mean a wasteful one size fits all policy.
The issue across ALL public services is that management teams have a penchant for making grandiose plans, but fail to build in adequate and timely controls to check whether the measures are needed, adequate or even working. They appear to believe their instructions are automatically implemented as envisioned, whereas regular, formal documented checks by management teams in key areas would often indicate otherwise and at a far earlier stage. This is a basic failure of management and means uncontrolled and obscene wastage of resources and specialists who cannot place their trust in the support structures, so spend their time and energy doing two jobs, their own and the support role. In summary, everything goes back to the quality of the management.
April 20, 2020
Dear SallyG
Seem like you never actually read what Sir John wrote before issuing your sanctimonious outburst.
April 20, 2020
Sally – -given the average GP salary and delegation of duties down their staffing, and the hordes of Consultants who protest about funding yet split their time between security of NHS whilst making very handsome fees for very average use of their significant skills, plus the strife and protests from more junior doctors trying to avoid weekend working which quietened down after a pay deal….you really shouldn’t join in any criticism.
April 20, 2020
I was a medical rep from 1967 until I retired in 1999. I have seen the NHS degenerate into a top heavy monolith that has doctors at the bottom of the heap, and managers doing what they like and feathering their own nests. Political correctness supercedes everything else, and the whole thing is like a hole that we all pour money in
April 20, 2020
The NHS has been very well funded. It has successfully sustained an ageing population into very old age and has indulged an obesity epidemic which had become the number one killer in the UK according to the NHS.
It was already fighting an epidemic when COVID-19 hit and one that caused most of the comorbidities that it preys upon.
Thank you for your good work.
April 20, 2020
That “thank you” came out wrong. I meant it sincerely for those in the NHS on the COVID front line.
April 20, 2020
Now is the time to be supportive when medical staff in your own constituency are having to work without adequate PPE and are suffering the consequences.
Pull your finger out John Redwood, investigate the facts and get your colleagues in Government to give this material support now it is needed. Material help and supplies are needed now by those working in the NHS. Words and rhetoric do nothing for them in the current crisis.
Reply I have regularly pressed those who place orders and pay the invoices to secure more. I do not have a budget to buy the PPE myself and send it to those NHS facilities that need it.
April 20, 2020
Thank you for your reply John, keep pressing. No one expects you to pay out of your own pocket although many NHS workers have had to do this. The govt has to provide the money to which we know we will have to contribute, you can explain the problems here in West Berks, Royal Berks Hospital, private hospitals now supporting Royal Berks and local care. You are in a position to apply pressure to the purchase and supply chains and ensure expeditious and appropriate supply to each NHS Trust. Even to manufacture where we still have this capability. Extraordinary times require extraordinary measures. Tomorrow is too late when today a nurse becomes infected for want of a face shield because the patient coughed when all she/he had was a mouth/nasal mask. The govt has to now explain why the promise to supply of PPE promised from Turkey has not come about. Suppressing bad news helps nobody. What happens when this runs out.
“Pull your finger” was not meant in malice, more out of the frustration. The govt has to get on top of this today, tomorrow will be too late for so many.
April 20, 2020
SallyG, I do not think anyone is sneering at the brilliant doctors and staff, but the criticism is fully justified of incompetent management and bureaucracy, which brings the whole NHS down. I speak from experience after having a minor procedure last year after a considerable delay. As I sat recovering, having had brilliant treatment, I was asked to fill in numerous forms and questionnaires. Most were pointless or complete rubbish and the nurses agreed with me!
April 20, 2020
Yes.
Whereas Drs and nurses have wholeheartedly embraced the leftist agenda favouring some patients and treating others incredibly badly. Clap? Not I!!
April 20, 2020
Conservatives have never sneered at NHS staff, and after Labour blew our finances up, and not for the first time, the Conservatives exempted the NHS from any cuts, which meant all other areas had to take disproportionately larger cuts.
Thank you for what you are doing though, and keep safe.
April 20, 2020
Funny you are working so hard. All my friends and acquaintances who are doctors and specialists in the NHS are gardening as āthere has been no surgeā. Deaths from CV19 (excluding pneumonia; flu; other patients who would have died of their various killer diseases and who caught CV19 as well) in the U.K. now running at 1,600 deaths.
In terms – hardly a blip.
April 21, 2020
Three doctors in our street kicking their heels too. This sight has never been seen before. They are all three hard, conscientious, and senior workers.
April 20, 2020
If you think the NHS is & has been underfunded could you name which national health service this country should follow. Brcause those countries I keep on reading here that are doing better don’t follow the Anglo Saxon model here were treatment is free at the point of delivery. The country that comes near the top Sweden has a public health system that is funded through taxes levied by the county councils, but partly run by private companies.
Sweden also has a smaller private health care sector, mainly in larger cities or as centers for preventive health care financed by employers.
April 21, 2020
I long to know what would happen to a health secretary of either party who proposed we go over to the German system: insurance based, localised, heavily interlaced with private enterprise and labs, and topped up by the taxpayer. I suspect he wouldn’t get home in one piece. As for suggesting we go over to the Singaporea, Taiwanese, or South Korean systems, you can forget it. Yet every day HMG is beaten over the head with the supposed superiority of these systems.
April 20, 2020
Well done. An MP who refuses to been silenced on the incompetence of this bureaucratic monolith. Silencing criticism of this pro-Labour organisation isn’t healthy and it can lead to abuses being covered up to protect its position
Johnson’s indicated by his actions that he believes the NHS should become a deity beyond reform, beyond criticism and beyond blame. It is evident that Johnson’s acting politically. That is most shameful but governments, politicians and State bodies will take full advantage of their important role in times of crisis to promote their interest and insulate themselves from future reforms
The entire edifice created since 1997 by that virus elected by the naive British people in 1997 remains fully intact, continues to expand and shows no signs of acting apolitically and taking responsibility for its actions.
Your PM has given this pro-Labour, political organisation a free-pass. Well done Boris. Another Tory PM acting beyond reason and good sense. Cameron, May and now Johnson. A litany of liberal left capitulation
Your party is now captured and owned by the left. From Trans-activism and identity politics fascism right through to State organisations that still remain unreformed and wedded to Labour.
The Tories might be in government but they’re only partly in power until they dismantle Labour’s client state and halt the collusion between Labour, the BBC, the NHS and other State bodies
April 20, 2020
Tory’s in power? More like closet Socialist there to protect vested interest
April 20, 2020
The problem is that law requires NHS trusts to implement āminimum standardsā set by PHE. PHE only set a minimum standard of having a pandemic response plan and not what that plan contained. As a consequence there are over one hundred different pandemic response plans. You can google them. These plans are all different and all cost a lot of time and money to write.
PHE should have specified a stxandard plan. For example how much PPE to have per nurse in storage or how many ventilators in storage. This could then be monitored centrally by trusts submitting a standard spreadsheet saying what their staff/patient profile was and what their equipment was.
The NHS need to get a few banking regulators in to create a more cost effective and robust framework.
April 20, 2020
PHE Was created as a firewall to protect Ministerial responsibility. But like all bureaucracies they too pass down responsibility to others. The classic, “Not me guv’ !” mentality. The blame game is on and we will get nowhere as everyone will deny it was their respsibility.
April 20, 2020
@Javelin; “The NHS need to get a few banking regulators in to create a more cost effective and robust framework.”
You mean like those banking regulators who created all those cost effective and robust framework pre 2007…?!
Many a front line nurse might well suggest that is exactly the sort of management the NHS has been suffering from, robust inflexible frameworks that do not actually work on the front line because the regulator has never actually worked on the front line – in the same way as many a lowly bank clerk or even manager could see the 2007 banking crash steaming towards them even though they were being required to carry on selling such problematic ‘products’.
April 20, 2020
Look, the NHS doesn’t even use e mail for appointments. They prefer to send two identical letters by standard post. What hope organising such contingency plans? The whole thing should have been overhauled years ago.
It’s a shame Thatcher ran out of time.
April 20, 2020
With reference to email (and Texts):
Some departments do and some don’t, the inconsistency is a big issue.
April 20, 2020
There’s Patient Access and Mjog and NHS Direct and a letter and a phone call but which is going to be used for my appointments?
April 20, 2020
Ever used the āPatient Accessā app? You will have to put your name, NHS number and the code for the surgery (that the surgery will provide if you go in person asking for it).
Right now, it is stuck and does not work but till mid-January it was still possible to get an appointment with a GP in my surgery with that app. Obviously the appointment was for the following week but there was no snail mail involved. And this was so much better than trying to get anything via a phone call as the recorded message was always that the reception was extremely busy.
April 20, 2020
@SJS; “the NHS doesnāt even use e mail for appointments.”
That migh6t be because many people do not use email, some do not even use computers, whilst even those that do still prefer a sealed envelope for highly personal correspondences, rather than a virtual Post Card that can be read at any point in the delivery process – especially so with some of the “free” web based email services that could be mentioned!
April 21, 2020
87% of UK people have an active email address.
April 21, 2020
@Edward2; Oh right, so the other 13% can go whistle for an appointment?!
Then what of those 87% -a number I suspect you have, in the best “Andy” style, simply plucked out of the ether, how many of that 87% are actually personal, rather than work based or accessed via a shared computer (such as a Library) that they might not have access to when sick or other wise confined, how many are insecure or unreliable?
On the other hand a postal letters have a 99.999% delivery rate, they go direct to the personal home/recorded address and is as secure as the State allows the mail service to be.
The Royal Mail, even when postal address fields are garbled or missing, still have a very high delivery ratio, get a email address wrong it either goes to the wrong mailbox or bounces, and not always back to the senders mailbox.
April 20, 2020
It would be helpful if the UK were rather less dependent on imports for critical areas such as medical care. We could have thriving domestic strategic industries if we hadn’t decided to outsource everything.
I hope our govt has a long hard rethink about the tax and regulatory system that has driven so many manufacturers abroad (or even out of business completely).
April 20, 2020
The short answer to your question must be Yes. I do not know enough about the inner workings of the NHS to make a useful comment. My own experience of very large commercial organisations, which operate globally, is that delegation of responsibilities to smaller units with broadly defined responsibilities works better than a huge monolith dominated by bureaucratic rules. Control of the smaller units can be achieved through clarity of objectives, and the means to achieve them, coupled with key performance indicators. For those in charge, if they succeed their business will grow and they will be rewarded. If they fail they will be replaced.
April 20, 2020
Yes, I agree. We need fewer links in the chain and more localism and empowering of small groups.
April 20, 2020
For every front line worker, the NHS has an administrator. Even the front line workers find themselves spending a large amount of their time doing paperwork.
So the NHS is an organisation that delivers a little bit of healthcare, but mainly bureaucracy.
April 20, 2020
What part has the medical negligence legal profession played in the development of the bureaucracy of the NHS ?
I recollect reading somewhere that 25% of the NHS budget is spent on professional negligence claims. Surely it is not as high a % as this ?
April 20, 2020
Plenty of money for legal costs, plenty of money for executive salaries and golden goodbyes, plenty of money for PFI payments.
No wonder there’s no money left for PPE stocks.
April 21, 2020
If they had piled up PPE in warehouses, they would have had to throw it away before it was used. Don’t you remember how the first scandal was that it was out of date? Even a very good administrator can’t time a pandemic.
April 20, 2020
I guess this topic and final question indicates that politically the mud is beginning to stick. The answer to your question is yes but as a tax payer I expect the government as budget holder to be undertaking the performance management and as with MOD procurement, Universal Credit systems roll out, Network Rail , Home Office, etc, it has proved woefully inadequate/inept.
Presumably you recruit the people.
You shovel vast amounts into it and revel in the political kudos but are incapable of linking them to efficiency.
You stress test the Banks within in an inch of their lives and dump the consequences on shareholders and customers. Yet stress testing for the NHS seems to be unknown or the results ignored because they were too difficult/costly to deal with.
Always tough as a Boss at the top suffering because of inefficiency down the line but your job is to ensure It doesnāt happen.
So again in answer to your question, yes but the key one of you is why are we having to ask it in the first place?
April 20, 2020
Not quite: it is up to Government and the Dept of Health to set budgets and objectives, it is up to NHS top management, and the CEO in particular, to answer to Government for NHS performance.
April 20, 2020
I worked for an American multi-national agricultural machinery company( including tractors and… Harvesters on the shop floor in Northern England, drill, grinder and spanner work, mass production. Not one second was wasted by anyone, not one second.We never saw Management. SubsidiZed meal, heavily, in the works cafeteria(multiple choices )with a steak half a plate thick as your hand or thicker and all the food you could eat, 3 courses. A social club was provided in the evenings and afternoon with beer etc.Pretty good pay and you WORKED. Fair days work for a fair days pay, certainly . I love American management. I do not like anyone elses on the entire planet.I do not like NHS management , worked for them for a little while at the bottom of the nursing tree. Enough!Saw enough!Heard enough!
April 20, 2020
Its the difference between ‘lets get it done’ and ‘you owe me because’.
April 20, 2020
Yes, there’s something in the North American culture which promotes optimistic and highly organised systems and management. Also full use of technology. It is the opposite of what we all sense being present in the NHS. I would still sweep out the management level NHS people, bring in North American management and procurement styles. The practitioners would be happy – well paid, productive and organised.
We’re good at being inventive and creative, and getting ourselves out of deep holes which we usually dig for ourselves. That’s our culture, not managing and organising these huge organisations on a day to day basis.
April 20, 2020
I haven’t seen any mention of the POTUS task force daily briefing. There’s a lesson to be learnt there – optimistic, enthusiastic, informative, forward-looking, energised and heartening. Whether you choose to believe every word – that’s up to you – but as the delivery of the message of ”can do” it’s an eye-opener.
April 20, 2020
Directors and senior managers in the NHS are responsible, but itās Government Ministers who are accountable and set the overall requirements. Itās at Government level where your criticisms should primarily be levelled.
April 20, 2020
Very true and very much in agreement.
April 20, 2020
Yes it is governments should have changed to structure of the NHS so it encouraged private competition and does not kill it. It should charge all who can afford to pay for a start. It needs to respond to patients needs. The current structure and funding system is idiotic and can never be efficient.
April 20, 2020
@MPC; The govt lays down procurement contracts and approved suppliers, NHS directors and senior managers can only buy from such sources (the same happens in the MOD for example), as I understand it such people can not just write new contracts with non-approved suppliers – even though they have the necessary local or field knowledge to do so.
April 20, 2020
Hi MPC
Are you implying that directors and senior managers in the NHS are responsible without being accountable – in which event the biggest mistake of government may be that it has not made them accountable.
April 20, 2020
and the electorate must then make the Government accountable! Seem fair?
April 21, 2020
Yep
April 20, 2020
No, you don’t fire the shareholders of a company when things go wrong, you fire the executive. Otherwise what’s the point of them?
April 20, 2020
MPC, do you know what the government “set” as “the overall requirements”?
When the top-level NHS Managers, all paid more than Jeremy Hunt MP who was in charge during the pandemic planning, concluded their planning:
1. What stocks were they required to store for UK use? What stocks did they store?
2. Did they plan in for the private care sector? If this wasn’t in their remit who selects the private care homes that take in the State sector paid clients Councils or the Health Department Minister in charge?
3. Who determined the hospital stock level The NHS Managers or was Jeremy Hunt MP left to allocate a budget and therefore how much stock did this buy?
4. Who was on the NHS supplier list? Who chose the suppliers? How many British Companies were on it?
5. Was there a plan to ‘manufacture’ extra stocks in an emergency worldwide pandemic?
6. Did anyone think of involving University Textile/Chemical Professors to ask about speedy creation of re-washable, specially treated fluid repellent, fabric to roll out to the textile industry in the UK with patterns?
7. Were any British Universities asked about creating a lightweight protective face visor and mask for pandemics or chemical warfare?
If none of these things were included in the risk assessment who is at fault the experts in the NHS or the MP and his team?
April 20, 2020
I don’t see why there have been difficulties scaling up the response to the panic virus. Since normal patient care has collapsed leaving most hospitals quieter than ever before and home death rates have soared because people are too scared to even seek care for real illnesses they have very little else to do except scale up the response. How much extra work is it to simply write “Corona virus” on every death certificate anyway?
April 20, 2020
John, you have done a sterling job in this post. I was a member (and often Chair or Vice Chair) of a number of formal patient-oriented NHS committees for many years, and was frequently stunned by the depths of incompetence and self-interest on the part of management.
It is only fair, however, to add that in some instances where lower-level management attempted to introduce manifest system improvements, the nursing staff would often dig their heels in and refuse to change antiquated administrative methods ‘because we’re used to doing it this way’, to the despair of more senior staff.
April 20, 2020
Well a lot of NHS Management are āpromotedā medics. Doctors in my opinion have very distinct thinking patterns. It is vital for the work they do. It is not transferable. Thatās why Doctors and nurses āhave a callingā. Itās not just a job.
We are now experiencing the disaster of politicians ābeing lead by the noseā – sorry āscienceā. Billions wasted, millions deprived of control of their life! Truly outrageous!
Please note, Sweden will have herd immunity in May.
April 20, 2020
Like most of the public sector there is never anyone accountable. Disastrous decisions like IT failures always go unpunished.
These institutions are riddled with left wing staff who’s only remit is to expand their scope.
Why have they taken over all the private hospitals and in effect shut them down.
April 20, 2020
Release the private hospitals to do the normal operations and NHS referrals that are still needed.
This is a national emergency yet neither the army nor industry are properly engaged. PPE could be produced in UK companies and logistics via the army.
There is no visible Pandemic Programme Management with comprehensive agreed set of requirements.
Waste of time releasing lockdown whilst anyone can walk into country infected, need 21 day quarantine and/or tested to prove they don’t have the Chinese virus before quarantine ends, medical insurance to cover costs and repatriation if they do show symptoms.
#NoddyinToyland
April 20, 2020
Rhoddas – far too sensible and straightforward. Every possible facility should be used, private and public, military and civilian. Isn’t this what the US are doing?
April 20, 2020
Why would the army have to provide logistics when there is a fully trained, half-used low cost experienced transport sector including Parcelforce the ex-nationalised parcel delivery arm of the Royal Mail?
April 20, 2020
No one is accountable?
Is that why Greg Dyke lost his job, over the lies told by one of his reporters, Andrew Gilligan?
I think that it all depends on the circumstances, but in general you have a point. Unlike in France, no one in the UK went to prison over the HIV-contaminated blood products for instance.
But in the private sector, neither did any banker, did they? And I doubt that anyone will over Grenfell Tower, sadly.
April 20, 2020
Andrew Gilligan, he who described the Blair Govt briefing paper on Iraq’s weapons of mass destruction as ‘sexed up’? Where were the lies there?
Greg Dyke lost his job because of the resulting embarrassment for Blair, not because of any untruths. Rather like Edwin Curry losing her’s when she admitted eggs were full of salmonella. Later turned out to be correct but again it was the embarrassment to the Govt that did for her.
April 20, 2020
That said, would you blame the military command for the Suez fiasco?
April 20, 2020
The IT failures are entirely consistent with putting a civil servant with an Arts degree in charge. When a car company decides it needs to build a new car in a new factory, does it decide it needs an Arts graduate to organise it? No, because it doesn’t want to go bust by employing someone with no useful skills and not having manifested any of the abilities necessary for organisational management. Corona virus is a project being run by Arts graduates and failing on every front as one would predict.
Instead of taking pro-active decisions to limit the spread of this disease like first world countries such as South Korea and Taiwan, they have decided to put the onus entirely on us by constraining our ability to lead a normal life and then hoping that something will turn up to save the bacon of a bunch of low grade Arts graduates who are totally out of their intellectual depth.
April 20, 2020
Ian Wragg
ā Why have they taken over all the private hospitals and in effect shut them down.ā
**** And our local private hospital is virtually empty. Every time patients are due to arrive….only one or two arrive. Why? No-one knows.
April 20, 2020
12 month incarceration plan of the over-70’s by this person named Hancock?
I always read Con-Woman to get a truthful and no-holds barred interpretation of British politics and of those that have infected our nation and increasingly our private realm. It is an eye-opener to see how far Labour and the Tories have proceeded with laws that I never knew had passed and now sit on the Statute books of this once great nation
The UK’s become a most abhorrent place to live and the CV-19 event has exposed the inner nature of the British political State and the sinister nature of those that populate it
I have believed for some time that the Tory-Labour duopolistic would lead to a degree of authoritarianism. Labour had to be replaced by a true conservative party. That’s not happened and we now live in a country that’s been ravaged from within by progressive fascism and direct pressure activism. Gramsci is looking down on the UK with a huge smile on his face
Well done Cameron. Well done May. Well done Johnson. We are now a moral wasteland
April 20, 2020
Can anyone remember the last true Conservative Party in the UK?
April 20, 2020
err….no?
April 20, 2020
Yes, I remember the Thatcher interlude.
April 20, 2020
Much truth in this alas.
April 20, 2020
Ā«Ā The UKās become a most abhorrent place to live …Ā Ā» As others have said it in the past about Andy et al, nobody is forcing you to stay in the UK. There is a vast world out there, so show a bit of consistency/fortitude and leave. There might even be a number of us on this blog to wish you āBon voyageā.
April 20, 2020
Do you live in the UK and support UK businesses, pay local Council taxes and pay our VAT and pay other taxes Hefner?
April 21, 2020
Edward2, Yes to all your questions. BTW your ārebuttalā does not seem to consider what Dominic had originally written. But this seems to quite a common feature of your daily interventions.
April 21, 2020
What rebuttal are you referring to.
I only asked because I thought you once wrote about your home in France
April 20, 2020
The buck has to stop somewhere, and that is with Government. Was it not a Conservative government, with Andrew Lansley as Health Sec, that abolished Primary Care Trusts and replaced them with CCGs in 2012? Who retains oversight and therefore responsibility for the workings of CCGs? If the procurement process fsiled, so did the oversight. Stop trying to pass the buck.
April 20, 2020
Indeed politicians are the people who should ensure that the NHS is actually serving the public and that money is spent wisely. They have failed but an organisation structured as the NHS is will always be second rate. It is one of the worse systems in the world for such a developed nation.
April 20, 2020
@Irene; Totality agree, John’s suggestion (smoke-screen) is akin to blaming Army General’s for not having enough tanks built, something they can but only ask for but not deliver themselves, that buck stopping with Govt. procurement/requisitioning policy – even more so during ‘wartime’ when normal procurement routes become unavailable or unreliable.
It is now clear, the govt having acknowledged the fact, that private companies who can adapt their production lines here in the UK to make PPE offered their help weeks ago but such offers fell on deaf ears in Whitehall.
April 20, 2020
The decision to not use private companies was one Public Health England made.
The management relationship between Army generals and the Ministry of Defence is a very different one
April 20, 2020
It is quite common knowledge that businesses have offered to make or are able to procure PPEs and have been ignored.
So why have ministers not stamped on those departments doing the ignoring, and insisted on all offers of help being on their desk first thing in the morning? And then metaphorically ākicking arsesā?
April 20, 2020
Not the army āgeneralā but the arms procurement section of the defence force – which is exactly where the blame lies. The NHS procurement and pandemic planing was very badly botched. But then that is what you nearly always get from a top down, dire, socialist, state run monopoly.
April 20, 2020
@LL; But who ultimately controls such procurements, yes govt and their polices, and that is why the buck will always stop with the govt.
Also the problem is not due to a UK state run monopoly PPE factory unable to supply but the failure of private supply companies in being able to supply their products.
April 21, 2020
“It is now clear, the govt having acknowledged the fact, that private companies who can adapt their production lines here in the UK to make PPE offered their help weeks ago but such offers fell on deaf ears in Whitehall.”
Our local news has been reporting on an existing manufacturer of medical supplies who ramped up production to meet demand. Of course, they had to get a very expensive loan from Lloyds to do it which took weeks, because the government funds were once again unavailable from the bank…
April 20, 2020
As you suggest, before you get to the functional level the administrative extent of the NHS is vast. Just click on NHS England and begin to explore. Eventually you get to a level where it marches on but is unreadable. I know the military are bad for the number of senior ranks they carry but the NHS is unbelievable in quantity, unfathomable job titles, and any indication of what they actually do. Very few would be much use in an ambulance. Until your piece today I had no idea of just how top heavy the NHS is. There has to be a better way of running it.
April 20, 2020
Sometimes it seems that far too much is expected of the NHS. It is supposed to be everything to everybody – a one stop shop for everything from fertility treatment to gender reversals.
Is it any wonder that the NHS staggers sometimes, and fails to come up to expectations?
Different governments have applied pressure and multiple changes to the NHS, but there has never been true leadership on tackling the many issues.
Yes, there is the perception that the NHS elite managers are over paid, with many job hopping around trusts while achieving nothing worthwhile for patients or staff.
The structure of the NHS has become far too complex – Simplify this and things will work better – and don’t change the rules every few months.
April 20, 2020
As Germany’s semi-privatised health service is apparently doing better than the NHS based on a superficial look at the data one would hope that their way of organising should be studied to see what lessons can be learned. It won’t be of course, the only conclusion we will draw is that the organisation of the NHS is just fine but it needs more money.
April 20, 2020
Another drink for an alcoholic? Don’t start with your conclusion and work back.
April 20, 2020
Roy Grainger
Sorry Roy but you can throw money at the NHS in its present mode of operating until hell freezes over and you will change nothing.
Have worked with doctors heading up multi functional units who realised that it was not more money that they needed it was to identify and eliminate waste. They said they didn’t have the time to address it fully. I interviewed their staff on the premise that as a patient and just asked the relevent questions to what they wanted answers for. They soon found out where the waste was perceived to be by the staff.
April 20, 2020
Exactly, but the main problem is that it does not charge and is a top down state monopoly that kills nearly all competition. It regards patients not as customers but as liabilities to be deterred, rationed and put off attending wherever possible.
April 20, 2020
Like most state organisations funded in the way it is they end up being run more for the benefit of senior management that that of patients. This despite that fact that many medical of the front line staff are indeed dedicated and hard working.
April 20, 2020
medical and front line staff …..
April 20, 2020
This seems to be a monolithic structure of management that whichever way you spin it would it is actually physically impossible for it to manage the day-to-day requirements at the front end. Yet that exactly what they(NHS & PHE) and Government pretend they are capable of.
It is suggested that with over 2.5million people employed/involved in the NHS it is also the Worlds Largest employer.
The top management, the highest paid are actually employed by us the Taxpayer, yet don’t seem to be accountable to us in anyway.
No large cooperation would be run like this and expect to survive – so why do we their employers permit.
April 20, 2020
You’re right that the lack of accountability is the immediate cause of the problem.
However, self-interest and lack of accountability run up through the ranks of quangos, Civil Service, the political party duopoly, parliament, and ultimately the electorate.
The electorate gets the government it deserves – it has lazily taken its freedom and sovereignty for granted, allowing its representatives to become its masters instead of its servants, even coming within a whisker of letting Corbyn into Downing Street.
April 20, 2020
A public sector monolith. Ripe for privatization.
No wonder OUR NHS cannot be reformed, in the private sector it would collapse in months, deservidly.
April 20, 2020
It is not a monolith.
It has been broken up, and the units largely privatised, although overall management remains in public sector.
April 20, 2020
Where the weakness remains.
April 21, 2020
The foot-and-mouth clean up in the Netherlands, using direct public sector labour cost six hundred pounds per farm.
In the UK, outsourced to the private sector, it cost a hundred thousand pounds per farm.
I’d expect similar problems in general with out-sourcing.
April 21, 2020
Complete nonsense to compare the costs of clear up between two differently sized industries in UK and Netherlands
This has been debunked several times on here.
You shouldn’t believe everything in the Guardian
Anyway what has that got to do with the way the NHS is managed?
April 20, 2020
Of course, who can afford Ā£170 BILLION pa except the British taxpayer? It canāt be āprivatizedā. The Govt must allow a real health insurance for which companies bid by block (ie they are not allowed to cherry-pick the healthy people). They bid by ānumerically equal constituenciesā. Then the insurance people will keep the delivery up to the mark.
Expect the NHS employees to squeal!
April 20, 2020
So with highly paid NHS executives, enormously skilled in management and sourcing, why do we need a government-appointed czar? Or perhaps looking at this the other way round, why do we need a stream of NHS managers if we have a few czars in key areas? Surely the czars, combined with a small army of minions on Ā£30-Ā£40k per year would be sufficient?
April 20, 2020
Sir John,
Professor Sarah Gilbert of Nuffield Department of Medicine, University of Oxford was on BBC Breakfast again this morning, although she didn’t actually say it, it’s clear that her department will need quick access to funding in order to ensure that their research continues at pace.
Can you talk to whoever is necessary to make this happen?
Reply Government has promised to back this
April 20, 2020
The basic problem with the various organisations running the NHS is that failure is an option because there are rarely any sackings.
April 20, 2020
The NHS needs radical management and top level structural reform
Along the lines of the Police Force. Fire Service and the Military
No internal markets, no trusts, no commissioning group…. just a single vision, direction, purchasing, career etc
With the whole of the NHS employed by and only the NHS e.g GPs and Senior Consultant Doctors are self employed
April 20, 2020
And please stop today the ludicrous recruitment model that nurses need a degree
What they need is an entrance test, dedication, a vocation and a caring nature
Iād suggest that there are thousands of young people who would make excellent nurse but fail due to the barrier of a degree
April 20, 2020
What they need is intelligence to carry out highly medical and clinical care.Many years ago Nurses dictated much of the clinical treatment . With the influx of Dr’s from other countries where the Nurse is in effect a carer the perception changed.
Don’t get the Nurse confused with carers. I agree in some respects that the degree ill prepares the Nurse for clinical work, but how do you assess suitability. The nature of the nurse like any other serving patients should be caring , but quite frankly the last 2 decades have undermined the Nurse and now the Drs take credit for their work and the Nurses work .
As an insider for 40 or more years believe me , the Nurse needs more than just a caring nature. It is a perception which degrades the Nurse and makes the Dr more important than he really is in the NHS . Dr He/ she are treated like gods when they have often acquired their knowledge from Nurses .
We now have Nursing assistants who undertake more hands on care and need credible qualifications to attain this position and if they want to study more they can take further exams to become a Nurse.
We also have Advanced Nurse Practitioners who take over the role of the highly paid Drs and specialise providing excellent medical care.
April 20, 2020
A really poignant example of this is when I commented 12 years ago that some Nurses could pass the Dr’s fellowship exams,. The reply from a narrow- minded contributor was that Nurses couldn’t pass this exam in an egotistical self inflated manner. Nurses become Nurses because this is what they want to do , not because they are not capable of doing anything else!!! I f you look at the long stream of Nurses with academic qualifications you will understand that they are not little caring angels there to do what Dr says . They are professionals doing a difficult job.
April 21, 2020
Have any nurses passed a Fellowship exam of any credible medical specialty? Thought not. More politically correct drivel.
April 20, 2020
Maybe the answer is not to follow the academic route. Currently nurses do a 3year degree and doctors a 5 year degree. Forget the old ways of doing things and design a national medical training programme vocational based for both nurses and doctors. Everyone follows the same route. In the military everybody is a soldier first.
Year 1 auxiliary nurse Year 2 general nurse Year 3 doctorā¦followed by specialist courses
April 20, 2020
Thousands of Native British applicants turned away because itās cheaper for the NHS (seriously more expensive for the country but nobody gives a monkeys about that) to bribe foreign nurses and Doctors to leave their own people and countries.
The NHS is truly a disgrace from every perspective.
April 20, 2020
fully agree
April 20, 2020
Five live last night at 11 o’clock (available on BBC sounds or iplayer) had an illuminating interview with a senior doctor from the North west area. He was upbeat for the first time in 8 weeks’ of interviews, believing that the first peak had been reached (in the North West) and that cases and deaths would drop quickly. He had not had a fatality all day which he sounded delirious about.
He said that in the North West the NHS hospitals did not have a PPE problem – care homes maybe – but not hospitals.
@Lifelogic I am afraid he also said that no patient that had been put on a ventilator in the North West had recovered, there were still many in induced comas but that the much vaunted ventilator treatment did not cure, just kept alive. The damage to lungs was such that getting them off the ventilators was nigh on impossible.
He then quoted ventilator recovery rates in China of 5% (95 out of 100 people put on a ventilator die) although in other countries that had risen to 14% (86 people out of 100 put on a ventilator die). So @LL your continuous demands for ventilators are actually unproductively tying up hospital beds. The new apparatus designed by Mercedes is designed to prevent to damage getting that bad I believe.
The doctor said that these patients on ventilators, taking up space, would result in services not going back to normal for several months even without a second peak.
He was chilling in his description of the lung damage to those unfortunate enough to get the disease at this severity. He was also clear about the obese being a greater burden and more difficult to treat. Although I can’t imagine too may obese patient sin either Northern Italy or China.
April 22, 2020
Well it does depend on when and who you put on ventilators are you only give it them as a very last resort?
Hancock was on about getting yet more ventilators today so one assume they still think they need more! I will listen to it.
April 20, 2020
Sir John
It rightly needs some well paid managers to run it………..We need well paid high quality management, but we do not need excessive overlap or too many advisory rather than truly executive posts.
Question; Do we really? Highly paid management does not equal high efficiency and competence. The NHS still works on the traditional flat based triangle method with all the nurses and support staff are on the bottom with layers of management leading to its apex. Too many layers and as previously mentioned staff having a reluctence even hatred against change. Perfect breeding ground for union membership and indoctrination against any change that does not fit the union agenda.
The person at the top when he/she looks down all they see is smiling faces and the further they go down through the levels all they can rely on is the heads of departments to supervisors for reports that all is happy and operating as decreed.
Through the 90s many large household name companies and industries tried to change the way they operated , because it was better for them in efficiency, staff conditions, customer/supplier realationships and finally profit increases to the shareholders.
It was at all ultimately built around empowerment to the staff. To banish gripes, speak up when waste was identified and from this methology grew what became Self Directed Work Teams. Properly trained in team leadership, problem solving and facilitation. The triangle was slowly being turned as it soon became apparent that there was too many layers of management as the real experts were thos e on the coal face. The one thing that changed opinions more than anything was giving recognition to the internal market and how one department method of workingwas a hinderance to another. Internal Customer perception surveys soon showed up the depth of feeling. Once the concerns wer out in the open it was easier to deal with. With a Chairman that basically walked the talk 24/7 change happens and it happened at a pace. He knew everything that was a burr in the bum to each department and he could then start the why, who, when, how,what whereidentification process.
All you need in MHO it is a leader with a vision of what they see as the future for the organisation and a very small team to create the mission forward to achieve the vision. But the implementation of the inputs and processes comes from the staff at the front line. In the NHS each department could become a SDWT and they run their ward to the benefit of the patients and themselves in identifying areas of waste. Any changes considered have to be proven by cost analysis before implementation. It works because the staff at the front line OWN IT. It is their way , their belief and their recognition. Its not for everybody, too many want to turn up at work leave their brain in the car park and switch on auto pilot until it is time to go home. Change has to come and from what I see soon than later.
April 20, 2020
If thatās the best response to the FT and Sunday Times articles then Boris is holed below the water line isnāt he?
Might as well give the odious Gove his chance. After all he did warn us that Boris was completely unsuited to be PM.
April 20, 2020
There is a full and detailed response to the FT article on the Dept of Health’s website, it’s worth taking a look.
April 20, 2020
Wee Nicola has just let slip that the Health Secretary chaired the Cobra meetings during Swine ‘Flu. I don’t suppose this will be picked up though.
April 20, 2020
Gove also totally unsuitable to be in Downing Street AT ALL!
April 20, 2020
It is difficult to make people responsible for PPE delivery when your suppliers let you down and there is no alternative capacity in the world.
April 20, 2020
even harder if you haven’t ordered stuff until you are desperate.
April 20, 2020
I disagree.
Most businesses of any size need to have business continuity plans in place. An epidemic was forecast in the Cygnus report and PHE have infections as a main responsibility. Any business continuity plan would anticipate that an epidemic would drive up demand for delivery of essential materiel.
What have we got from PHE for our Ā£4bn a year?
April 22, 2020
Exactly
April 20, 2020
What I would like to see is an in depth analysis of the NHS purchasing organisation for capital equipment, drugs, and consumables. With consumables , which are highly relevant in todays crisis, what is their buffer stocking policy. Do they have one. Do they apply professional value analysis in their negotiations with suppliers. Is it done on a UK volume purchase quantity or is it left to individual trusts.
All very relevant in terms of cost. value for money , and smoothness of supply.
April 20, 2020
The government appears to be totally reliant on the so-called best scientific advice from doctors and scientists working for the NHS or PHE. So far these have advised that herd immunity has been the way to go, as advised by the behavioural insights nudging unit who knew that the herd would not be able to take lockdown for long. So far the UK has come top of the list for lockdown support. Today the culture minister was roasted alive for his advice to keep going to mass events after Italy had locked down and his defence was that his advisors thought that people at football matches would be no more at risk than they would be in a pub.
After nearly every independent virologist called for a different approach and called the government’s plan risky and dangerous and almost every other expert abroad agreed with the Italian lockdown, the expert advice changed from wash your hands and carry on to stay at home and don’t go to the pub.
No-one has been told about the date that the experts actually placed orders for tests and safety equipment, or how much and what sort was in stock. No-one has been told the result of the tests at Porton Down to find out how large a proportion of the population has had the disease. We will find out eventually, but in the meantime, we are just told to accept that the expert scientists know what is going on an that ministers do too.
Now, having found that the lockdown is about to bankrupt many businesses and that the taxpayer is funding many big and other businesses to do nothing, even when the employees could work safely if the government would only tell them how to, there is a lot of criticism. But answers are deflected, along with questions about the safety equipment and tests. They are doing their best but the stuff has been bought by other countries or, in the case of the UK and Spain, swiped en route by Napoleon.
Yesterday we had the education minister passionately hoping to be able to re-open schools next month in order that children would not miss out on their wonderful state indoctrination and gender choices. Schools already provide lessons on the net and some pupils are still attending, even in ones and twos, but some poor families apparently have no access to the net. So a Conservative minister is keen on equality and they all need to return. And the experts say that there is no clear evidence that children infect each other and pass it on to the family. My expert in infection disagrees, as does anyone else with common sense. My family who are teachers will have to give up their two months of careful avoidance of infection and start again. They don’t want to send their own children back yet.
But, wheras schools do not make money or pay taxes, private businesses are to stay closed because the expert scientists and doctors are too busy to start thinking about it. The only conclusion is that the whole civil service and ministers are incompetent and costing lives and businesses.
April 20, 2020
Further to the point about schools bringing infections home. My next door neighbours became ill with typical Covid symptoms a week after lock down and the children coming home . Now one of my wife’s colleagues, himself a doctor, became ill at the same time and his children came home. He became so ill that he had symptoms as bad as Boris’s and is only now recovering. So much for expert opinion about schools not be much of a risk.
April 20, 2020
I’m not making excuses for PHE but have just looked at a list of UK based manufacturers and most of them are now involved in the making of ventilators and not PPE, and where they are making PPE it seems to be face shields and not face masks or gowns – and in their hundreds rather than the thousands we need. As far as I could see only one was involved in the development of test kits.
The demand for PPE is global and in short supply and those nations with production lines already set up in their own countries are the only ones with plenty. I ask again – just how much PPE were we meant to stock (and throw away as it is shelf-lifed) in order to have healthy trade relations with Communist China ?
In the UK it seems we knock out plenty of PPE but it is the wrong sort. Politics, Philosophy and Economics graduates.
It was a huge HUGE mistake to outsource our manufacturing base and rely on service jobs and money shifters and clever dicks in the City to keep us afloat. We are faced with the very real prospect of doctors refusing to treat COVID-19 patients and with 80 medics dead already I don’t blame them at all. We need to conserve doctors in order to keep saving lives for all other illnesses – not sending them over the top into machine gun fire. They take a minimum of 7 years to train and are not easy to replace.
Last year NICE put a value of Ā£30k on each year of extended life – this year it is Ā£infinity if it is a COVID-19 patient.
Until a vaccine this battle is lost because of the lack of PPE.
We need to get on to the next battle pronto and not be caught on the hop. How to feed this nation once the depression hits and there is a global demand for food.
We need to get non perishable food stockpiled and a rationing system in place.
April 20, 2020
I looked on the Flightradar24 website yesterday, to see virtually nothing flying into the UK (one was a plane coming from China to Heathrow coincidentally) but the skies over China was awash with planes, many on internal flights. Surely all their passengers aren’t staying 2metres apart – or are they just spreading it around?
April 20, 2020
What is the problem in China?
They have reduced infection to a tiny, manageable level, like other countries with the will.
The videos posted by countless westerners there broadly support the authorities’ accounts of life returning to normal.
Incomers from China probably present zero threat now.
April 20, 2020
So for their own sake they must be stopped from coming!
April 20, 2020
Yes I agree Lynn,
So please Martin, save these Chinese immigrants who as you tell us are all virus free, from becoming infected by coming here to the UK.
April 21, 2020
Don’t worry, they know.
April 21, 2020
Oh. So we just resume to trusting China now ? That we simply believe they’ve got this sorted merely on anecdotal evidence ?
That they’re not lying about yet another virus they’re going to inflict on us ??? The wet markets are fully open.
You bang on and on about our standing in the eyes of nations but sound like a card carrier for the Chinese Communist regime that lies and lies and lies and allows barbaric and world endangering practices.
You don’t seem to have any advice to them on their standing in the eyes of nations.
April 21, 2020
Well, I think that Australia, New Zealand, S.Korea, Greece, Germany, and all the other countries who are, like China, following WHO advice are quite plausible, Anon.
They are enjoying similar successes too.
Look, just as in “plebgate”, if you succeed in discrediting one witness, the court will be unaffected if there are others who remain in the clear.
That is your problem with this anti-Chinese ranting.
April 21, 2020
Still you accept everything China tells you.
Their low figures are looking more unbelievable every day.
April 21, 2020
perhaps little health threat but what about the stealing of IPR, the take overs of companies for production expertise and then the promised financial settlement refused, the thousands of students coming here to learn about subjects that they will return home better equipped to damage us?
April 20, 2020
We require Government to act strategically. One of the problems with Britain is the predisposition to short-termism that neglects long term planning and leads to Government responding to tactical issues that should be the purview of the managerial class. We had a pandemic review a few years ago. The fact that we appear to have prepared for the wrong pandemic (much like Generals preparing for the last war), poses an obvious question for the Health Secretary’s prior to Matt Hancock. It is scandalous that Jeremy Hunt continues as Chair of the Health Committee – he surely has too much skin in the game?
Is it not also clear that the great British public, aided by Governments with no long term industrial policy, place price above quality and have not hesitated, in unconscious collusion with shareholders, to outsource large tracts of our manufacturing to ‘cheaper’ jurisdictions? Not cheap now, is it, with supply chains collapsing and countries looking to their own needs, while profiteers are probably happily banking the exorbitant profits.
April 20, 2020
“Not cheap now, is it, with supply chains collapsing and countries looking to their own needs, while profiteers are probably happily banking the exorbitant profits.”
It was already a false economy. We’d replaced work with: welfare, pointless time in worthless education.
The levels of national debt said it all. And this does not include the emotional and financial costs of societal and familial decay. Now that the virus has hit…
All economic justification has been blown away.
April 20, 2020
The NHS needs a Dr Beeching to cut out waste. It looks like it was ill prepared for this worldwide pandemic, which is not surprising. After all the dust settles and the world has got back to some sort of normality, the NHS has to be re-organised so the it is efficient.
April 20, 2020
Oh so you want a Dr Beeching to close every third hospital, make wholesale redundancies and decide we won’t do ENT, limb problems and no more blood testing?
The railway cuts were idiotic, biased towards his mate building roads, and we are still trying to catch up for post war neglect followed by cutting everything that moved on the rails including goods! Brilliant!
April 20, 2020
Yes, but not reorganised by the same clique that have made such a shambles of it in the past.
Infinite demand for a top quality free service would need an infinite budget derived from infinite wealth, and the current pretence leads to the substandard service we now have. We need to rid ourselves of childish nonsense such as “envy of the world” and “not for sale”; all options should be open to deliver the quality needed within an affordable budget. Society has to decide whether it wants to prioritise the service it receives or the vested interests of employees, quangos and unions.
April 20, 2020
After all this there wonāt BE an NHS. There wonāt be ANYTHING.
Someone needs to speak out….. and SOON!
April 20, 2020
āThere won’t be an NHS..ā you trying to cheer us all up? Hereās hoping the NHS, EU, and UN donāt survive.
April 20, 2020
I hold no candle whatsoever for the NHS.
How does…there will be no healthcare whatsoever…no medicines..NOTHING…suit you?
Surely you understand what is happening?
April 22, 2020
The NHS is clearly better rather that no medical care at all. But that is not the choice!
April 20, 2020
You have settled on the right target here.
We have to get the politics out of the NHS. The organisation gets enough money to function, if it were properly efficient, but it is far easier for left-wing medics and politicians to simply blame the government for every failure, right down to the supply of gowns and masks. The NHS and its staff will always plead for more cash, however much it is given.
Government, the public and the press need to step back from direct involvement and hold NHS managers to account for failings. Ministers do not order masks and gowns, NHS managers and their staff do. They are the ones who should be held responsible when these items are in short supply or do not arrive. The NHS chief procurement manager should be the person answering the difficult questions about PPE at the daily press conference, not the hapless Matt Hancock. That would concentrate their minds wonderfully and I suspect that the problems with supply would then be mysteriously solved.
The rightful role of Government is to set objectives and grant the NHS board a challenging budget to do their job. The delivery and quality of the service provided should then be the sole responsibility of the service.
April 20, 2020
There will always be politics in the NHS so long as resources are finite.
Take a hypothetical example.
Imagine Ā£250m would buy all the PPE we need – but that PPE has a shelf life of just 5 years.
At the same time an experimental drug comes out which claims to cure several childhood cancers. It also costs Ā£250m over 5 years.
Which do you buy? There is not the budget for both. You have to pick. That is a political decision.
You buy the cancer drugs – and possibly save the kids – but risk many more lives if there is a pandemic. Or you prepare for a pandemic – which probably wonāt come – and the kids all die.
That is the brutal reality of health and it is why it will always be political. And it is why, however hard they try to avoid it, the politicians are to blame for this mess and it is why they are rightly the ones who will ultimately be held to account.
April 20, 2020
As a society we are restricted by our ability to tax the wealth creating sector and our ability to borrow.
The fundamental question government has to face is deciding the priorities for dividing up the competing calls for spending.
Wefare, education, defence, overseas aid, health, pensions, and many more areas.
You just call for more and more spending.
But if you were in charge you would have to decide how much to spend on each and every area of government.
April 21, 2020
“Imagine Ā£250m would buy all the PPE we need ā but that PPE has a shelf life of just 5 years.”
That is why sensible people don’t buy it all at once and expire it all at once. Implementing a first in first out policy and carrying a buffer that can be built up slowly from one year to the maximum desired to prevent stock running out when something like this happens is a standard way of doing business. It also avoids waste, and in your example frees up funds to go to Cancer research.
It is why my main firm is still running. Our stock levels are dropping, but we can keep working without immediate supply. It is only JIT systems that eliminate the safety buffer.
April 21, 2020
Al
Exactly !
April 20, 2020
Indeed, but I would go further, many politicians have degrees in PPE , but that is Politics, Psychology, Economics, the people who should have an understanding of medical PPE are medical professionals, but I wonder, when this disease was raging in Wuhan , how many of them were knocking on the door of their NHS purchasing departments giving them the benefit of their experience , and expressing the importance of a good PPE supply? Few if any I would guess. but these medical professionals demand foresight in their speciality from everybody but themselves.
April 21, 2020
No can do. Labour will not allow it. They have deliberately politicised and the weaponised the NHS. It is both the perfect stick to beat the Tories and, and nice cash cow of their unions, much like the rest of the state.
Mrs. T sorted out the unions in the private sector. Sadly we do not have anyone capable to do the same to the public sector.
April 20, 2020
Why isn’t Xi Jinping under as much BBC/MSM scrutiny as Trump ?
He is at least equal as global leader now – if not more so.
Ask the average person and they won’t have a clue who he is. The BBC have rarely mentioned him.
April 20, 2020
Anonymous,
As Soros noted, Xi Jinping is the most dangerous opponent to open society, so those against openness don’t want to scrutinise him, and he doesn’t allow himself to be scrutinised. When the Chinese Communist Party crackdown on Winnie the Pooh memes in social media you know it is to be feared – talk to individual Chinese behind closed doors outside of China. Xi Jinping has unlimited term and is to be feared.
April 21, 2020
Maybe he doesn’t post utter cretinisms on Twitter day in day out to grab the global headlines?
Such as “the European Union is our enemy”?
And no, I absolutely would not want to live in China.
April 20, 2020
Boris Johnson resists easing of coronavirus lockdown. Lifting restrictions risks second wave, PM tells colleagues – as reported in The Times today.
If the experts are advising this it is surely an indication that the NHS does not really have sufficient capacity (despite government claims to the contrary). If we have capacity we must surely slowly start to lift the lock down. We cannot wait for a vaccine.
Can we please know how many Covid patients are in hospital, how many in intensive care, how many are on oxygen and or partial ventilation, how many are on full mechanical ventilation? How many have died before even being given full artificial ventilation how many have died without even getting into hospital.
April 20, 2020
It is not a question of a second peak. It is a question of how long dad- state can stay off work producing nothing. Until the money runs out and the ability to borrow more. Boris cannot know if there will be a third, or more peaks or more viruses.
Not a good basis for getting yourself into debt. He is living in a fantasy land. Not here.
April 20, 2020
If the UK were the only country on Earth then the Government could probably get away with it.
But if it did this, and two years on there were a total of six hundred thousand dead as a result – whilst many other countries just had a few hundred – then what would you expect to happen to those responsible?
April 20, 2020
That is very simplistic attitude.
I appreciate your left wing politics is driving you to desperately try to apply blame to the UK government, but there are many more factors applying to each individual nation’s outcomes in this crisis.
Population totals and densities.
Population demographics ie ages and health standards
Standards of the health services in each nation
Border controls and immigration policies.
Discipline of the population to follow best advice from their government.
Temperature in each country, some being northern and cold some being tropical hit.
And many many more individual national characteristics.
April 21, 2020
Germany is quite comparable with the UK on nearly all those metrics – except death rate from CV. As is Greece.
April 21, 2020
There are some differences
many early patients were relatively young and healthy.
Even now the average age of cases remains relatively low at 49
In France and Italy it is 63
Germany has been testing far more people than any other nation in Europe which results in more cases being discovered in relation to deaths.
Giving Germany a lower ratio of deaths to cases.
And they have a very good health system.
One of the best in the world.
April 21, 2020
Edward 2
It really doesn’t matter whether the criticism is justified as the one in The Sunday Times, you will defend the government even if, it had been even more incompetent than it has ben this time round.
Good you have shown your real colours no matter what you are faced with.
Thank you for the proof
April 21, 2020
I look at the initial comments and look at the response.
And make up my mind.
In this instance I prefer the government’s response.
But not always.
Whereas you have nevercwaverdd from your pro EU pro Labour stance once.
Proof indeed.
April 21, 2020
Never Wavered…
April 20, 2020
Some of the answers you’re looking for are here, LL, not just for the UK but every country :
https://www.worldometers.info/coronavirus/country/uk/
Then here are the stats for the UK showing the relative ages, death rates etc for our population. It makes very interesting reading. All these figures have been taken from the BBC and Daily Mail websites :
https://www.bbc.co.uk/news/health-51979654
https://www.dailymail.co.uk/news/article-8203673/NHS-figures-92-coronavirus-victims-England-60.html
Over 90% of all deaths have been people with serious existing health conditions and 92% of the total were over 60.
52% of the total were over 80,
40% between 60-79 and just
7% were aged between 40-59.
A miniscule 0.77% were under 40.
The over 60s make up 92% of the total and would be the easiest and most likely to agree to remain isolated so it does make me wonder just why we have so seriously trashed the economy.
The NHS is clearly coping as nowhere are intensive care beds in normal hospitals being fully utilised and the Nightingale hospitals are sitting idle.
Not all of the 8% in the younger age groups will make it to hospital so if we are at the peak, as has been suggested, the NHS can presumably continue to cope if the over 60s and those younger with serious health conditions continue in isolation.
Everyone else could go back to work.
April 20, 2020
There too much politics on this blog of who may be at fault, it’s not the GOV or NHS job to warn about pandemics unfolding the GOV pays WHO for that.
I might have been a manager in the NHS in Jan 2020 sitting at my desk reading about the virus on blogs and went see my managers inform them and they tell me that they know but can’t do because of it a top-down decision, they might inform PHE who inform the GOV and told, we do nothing to WHO put out a warning.
WHO would know something was going on in China in Dec 2019 but failed to send in a team to find out for themselves and left to China to tell them and as you all know they say very little in the best of times and I dare say it would no difference hear with billions of pounds at risk.
By the time the warning was given by WHO it was to late and WHO told them to keep the airports open, it was also by that time too late order PPE because of other countries getting orders in first and supply line going down as well as factories closing and have to order form overseas to costs down with just time system.
It’s up to the GOV if they want to keep on paying WHO or do what other countries do who are near China and decide for themselves with information from their own security services.
April 20, 2020
The WHO is yet another globalist quango that should be defunded.
April 20, 2020
What about the appalling pandemic planning that seems to have no provision to make even basic medical and PPE gear quickly and locally. Surely the need for this is as obvious as the need to be able to make munitions and weapons in a war!
April 20, 2020
If this is how the NHS is structured it reminds me of nothing more than IBM before its notorious near collapse and restructure. How did they turn that company round? By removing the majority of management and reduces the layers.
A more disturbing similarity is that, just as with IBM, the workers on the ground are reporting issues and warning of failures but the management at the top never seem to hear them.
April 20, 2020
As I say, the NHS is now God, and HMG the Devil. So no, you won’t get any accountability. Only media and opposition insistence that the NHS has been starved.
If they want to know what starved looks like they should compare the Navy now to the Navy in the fifties when we were not a rich country. The Russians have been just off our coast while this has been going on, and the Chinese are continuing to annex reefs and islands. No-one is talking about this or about the daily incursions of our borders. PPE tunnel vision has set in because that is thought to be the best way this week of bringing down the government..
April 20, 2020
People are talking about the Russian warships and the Chinese annexing islands and reefs – just not the Main Stream Media!
Itās not alarming or sensational enough…..
April 20, 2020
Agreed, in fact they are trying to bring the Government down on something that hasn’t happened yet. BBC’s Hugh Pym’s question to Sunak today was. “Are you ashamed medical professionals are going to work worried that PPE might run out’. Not ‘has run out’ its ‘might run out’ . Its a speculative future scenario they are trying to hang the Government on.
April 20, 2020
The modern Management theory is a Manager does not need to know about, of have experience of the product. They just need to know how to manage people, resources and Budgets. If they can cut costs you pay them a bonus. Sometimes pay them a bonus even if they screw up.
How many of the NHS mangers at Senior Level are actual Doctors, Nurses, and clinical professionals – Medical Technicians, Radiographers, physiotherapist etc.
Nurses spend time filling in tick boxes to feed management that could be spent on patients.
Hence why the NHS is in a Mess in my humble view. Too much management, not enough Doctors and Nurses. Oh! we can reuse single use protective equipment. But not other long life items of equipment. Many a scandal in this area. Don’t mention waste/over ordering
April 20, 2020
Well, yes and no. Jeremy Hunt When Health Minister pushed for the creation of a so-called NHS MBA (Master of Business Administration), which is now taught to students with relevant Higher Education degrees in the universities of Bradford, Lancaster, Nottingham, Durham, Hertfordshire, and Open University and Manchester Alliance Business School. The program of this MBA (with various ālocalā twists) can be found/dug from the relevant institutions.
I do not know whether the NHS top executives have such a MBA, but it is usually accepted in the private sector that a MBA gives one a Ā£100k annual salary (+potential perks).
April 22, 2020
hefner
What part of the private sector accepts that an MBA gives you a Ā£100k salary?
As an occasional guest lecturer on MBA courses I can tell you that the vast majority of people studying for MBA’s are sent by large corporate employers and public sector institutions and once the MBA is awarded they most definitely do not suddenly jump to Ā£100k salaries
Obtaining an MBA is in no way an indication of any ability to manage or lead a large organisation
April 20, 2020
John McDonald,
I am neither defending nor decrying NHS managers, but I do not see why being a good clinician would make someone a good manager (of whatever ilk).
I also fear calls for more frontline and fewer managers, we once saw the cutting of cybersecurity and the WannaCry attacks because of this, and that was a close call.
I wouldn’t disagree with a reappraisal of UK healthcare.
April 20, 2020
Spot on JM! In the day, Matron ruled the roost on maintaining nursing and ward standards, but then came the Trust revolution and managers from disparate walks were hired layer upon layer – and of course, they all had to have cars!
Bonuses! Another scandal right across the economic board! Instead of there being a flat rate for a job well done and other degrees of performance, bonuses are paid as a percentage salary!
Cui Bono? Surprise, surprise! – Those at the top on 6 figure salaries! Whereas, the lower paid who may be doing first rate jobs are ‘recognised’ by the same percentage of their modest standard wage, or less! Repeat, Cui Bono?
Time to end this ‘percentage’ bonus scam!!!!
April 20, 2020
Does Top Heavy & Inefficient some up the current state of the NHS?
Dishing out treatment to one and all, not recouping money from from the Health Tourists who come here to receive free treatment, relying on China for all their supplies, it needs a serious rethink if this ever ends!
Presumably all the gender reassignments and other unnecessary procedures are carried out on the NHS??
April 20, 2020
What crouse of action should the GOV take now? from my point of view, it is important to get the virus out of the hospitals and away from the staff at hospitals so they can resume to normal service for the people.
Testing staff every day and people going into hospitals for any reason to keep the virus at bay.
The opening up of more operating theatres which they have but do not use because of staff shortages in that field must now be overcome by any means to clear the backlog, I know this cannot be done overnight but must try to do all you can. people won’t go to the hospital if they think they are unsafe and instead will die at home, the same with GP surgeries.
Now the time to start investing billions in the latest diagnostic equipment and robotics, as well as the latest cancer treatments and GPs, should be consultants by homing their skills and consultants must go down to the operating theatres to deal the backlog and bed-blocking must band from now on to get the workload done, nobody should be allowed to stay hospitals who shouldn’t be there. If you have to move GPs into hospitals to do the consulting.
April 20, 2020
As an aside – PPE
A contact of mine, to keep their staff busy(while furloughing) have now geared up to produce protective visors. These are being provided free of charge to front line and key workers
Full production of up to 3,000 visors per day should commence on 27th April. Anyone who needs protective visors or those wishing to help with distribution should email(have withheld this but can be supplied via JR).
Packing and logistics process is in place to distribute the visors.
April 20, 2020
The banding all hospitals from being sued still the crisis in the health services is over.
April 20, 2020
From the South China Morning Post. Compare and contrast the Taiwanese success with the UK response. (Six deaths there in a population of twenty four million)
“In the early hours of December 31st, Luo Yi-jun couldnāt sleep. So he browsed Taiwanās Reddit-like forum, PTT.
As deputy director for Taiwanās Centres for Disease Control, one post under the āGossipingā category caught his eye: Word of an unknown disease causing pneumonia in Wuhan, China. The post included screenshots of a notice from Wuhan health authorities. One poster even asked if this was the second coming of Sars.
Luo fired off an email to his colleagues. That turned out to be Taiwanās first warning about the disease that would turn into a global pandemic just a few months later: Covid-19.
Less than a day after Luoās email, Taiwan was already rolling out epidemic prevention measures. Border quarantine policies and screenings were implemented, and the government started communicating with the World Health Organisation and mainland China epidemic authorities.”
We had great plans here. Shame the government didn’t implement them.
April 20, 2020
Are there independent voluntary Standards Committees on these institutions?
We are told A&E appointments have more than halved is this true in the overwhelmed hospitals?
How much more PPE does a single hospital require more than usual in a pandemic is it being counted and tracked?
The majority of GP appointments have gone on-line so I don’t understand why GPs don’t have PPE aren’t they independent, small businesses not employed by the NHS, aren’t they responsible for getting their own PPE like other businesses are?
Operations have been postponed all over the UK, is this still the case even in those hospital with few Covid 19 patients?
Testing has been postponed in a lot of specialities is this true or not? Why is this are all the lab staff used just on Covid 19, if so why if the Private sector offered to ramp up tests at the start of this crisis – why try to import untested test kits from China when a British company offered to do it for you?
Private hospitals have been requisitioned for NHS use only how many Covid 19 patients are they treating? How many other NHS emergency patients with other illnesses are being treated by them and how does this compare to what they normally do?
Nightingale hospitals have been set up in quick order – but why aren’t they beds being used when some hospitals are spinning out of control without enough PPE or staff to cope. I keep asking but the newspapers don’t say which particular hospital is running out and which particular hospitals are overwhelmed – then the patients can decide to go elsewhere (or is that out of their hands? This is one of the problems of having no choice in a rationed service and no facts),
50% more Ventilators are in the system within a month how many of them are in use each day?
Some hospitals have been overwhelmed but others have empty wards reserved for a possible big intake of emergencies. Therefore, do some hospitals have too much ppe for their fortnights use whilst others are running out?
I thought Jenny Harris was very calm, measured and honest in her responses yesterday.
When the music stops I hope that a full review of the ppe news scare stories is completed, plus the honesty of reporting of whistleblower cries of ‘crisis after crisis’ is held up for scrutiny too.
April 20, 2020
Some 8 years ago I took myself off to hospital after a dog bit a piece out of the back of one of my hands. Eventually I was taken to a ward and after surgery I spent 4 days under observation. I was in a ward with patients having a number of serious illnesses and two died while I was there..
What appalled me was the callous indifference of all the nurses. One of their unfeeling practices was prior to mealtimes for one of them to stand in the ward centre and shout to us all asking what we wanted. Some were so weak they could barely speak. From what I could tell if there was no reply they were just served whatever the nurses felt like preparing.
Another example elsewhere was when my late father was being treated for cancer. There was one day his mouth was swollen and very sensitive. They served him dry cornflakes for breakfast and placed it with the milk on a tray he couldn’t reach.
As you might imagine I’m not one of those who stands at my frint door and applauds the NHS and its people. I’m sickened by such nonsense.
Where was the supervision of all this?
April 20, 2020
Alas. Governments always get blamed for everything and praised for nothing. That is how it has always worked. That is how it will always work.
The Brexiteers who are now running the country are whining about this but they had no problem with it for the last thirty years when they were the ones blaming and never praising. They are very very cross now the roles are reversed.
Indeed Mr Cummings wasted his Sunday putting out a detailed rebuttal of the Sunday Times story – which simply showed him to be as much of a snowflake as Trump. Suffering a meltdown in the face of criticism. It also showed that the Sunday Times was right and it hit a nerve. Poor Dom has failed and he is hoping nobody has noticed. Good luck with that. We noticed.
April 20, 2020
Well I read each article and unlike you I thought the Government rebuttal was very good.
Still unable to accept the Conservatives have a huge 80 seat majority I notice.
April 21, 2020
Far from it.
You can’t hide behind Parliament any more either.
You’ve got your solid-gold, Rubber Stamping Agency par excellence now.
April 21, 2020
Still can’t accept that Labour lost and will lose again.
I had to put up with 15 years of Blair and Brown.
Your turn now.
April 23, 2020
Marty
And thank the lord for that
Or else we could all be in an endless committee meeting deciding who to award procurement contracts to for delivery of essential equipment needed now
The EU has finally shown even the most deluded followers like Andy, how unfit for purpose it is. Its a dead duck.
Meanwhile I see Andy is still dribbling about nothing and making it up as he goes along. This is the Andy who claims to own a palatial mansion in France and was moving to live here , but for some reason still hasn’t . Odd that
April 20, 2020
“Given the numbers and the pay levels of these managers…”
We should indeed expect better. Perhaps one day we will be thankful that the current crisis has highlighted the failures but the fact is that management of the NHS has been shambolic for a long time, letting down good staff and patients alike. Had such performance been evident in a private company those responsible would have been sacked long ago.
April 20, 2020
PHE must be responsible for getting the PPE. It seems that if PHE make mistakes itās the Health Secretary who is blamed. The leaders of PHE must be made accountable. They do not seem to be doing a very effective job.
April 20, 2020
A paramedic has died up here in the North West. People have asked me what I am going to do when it’s all over. My response is to thank god that I am still alive. The longer this goes on and more and more die whilst we isolate , I watch the blue sky, the surges of wind and my garden heavily in blossom. I become more emotional than usual. Mozart’s requiem is on BBC radio 3 and I lose my anger and am further transported to an emotional high . I don’t like the intensity : I haven’t survived so long in my career being so emotional.I have started reading C. P. Snows ‘ Corridors of Power ‘ .. what a bore .. This life outside my window is the thing and yet so many are gasping for a breeze of the vector agitating these cherries and poplars , they themselves resembling lungs: trees with upper airways routed into history .Thank goodness lacrimosa is over and my lachrymal glands can dry.
April 20, 2020
Does anyone have any ideas when we will be able to fly to Europe for travel / holiday as opposed to business?
April 20, 2020
(I’d be happy to spend my Ā£Ā£Ā£ on holiday / travel in the UK – except that I want to travel to Europe to meet someone).
April 20, 2020
Well Romanians can come here en masse, why canāt you go to the continent?
April 20, 2020
Throwing money at a problem for 72 years for Labour/Con point-scoring ….
Labour’s Gordon Brown giving GPs massive pay without any extra productivity…
Free Health for all is unsustainable and invites draining resources from visitors….
Financial Management for non- financial managers and staff to avoid massive waste…
Targets set by politicians….
BBC accentuates sensationalism…..
Unions status quo resisting changes…
Political football….
Too big to fail…
Too big to change???
Rationing occurs because something has to give….
Blackmailing occurs to get resources by all vested interests ….
Staff burn out occurs and will get worse….
Relying on overseas nurses is robbing poor countries of staff….
– And deprives young folks in UK opportunities to train for a career….
There needs to be a radical and flexible “No holds barred” review of the whole NHS because pussy footing around means it is just going nowhere fast and is destined to fail big-time.
Tough love in the Private Sector during 72 years has been painful and the major lesson to learn is Adapt or Die.
Change is normal and natural – we cannot sustain the tail wagging the dog (aka Cart before the Horse). Remember the NHS was created in the Age of Steam and 16 years before Beacham chopping British Rail !
Instead the steam is still generated but coming out of taxpayer’s ears and pockets.
Enough is enough – time for an adult tough love – and not soon enough!
April 20, 2020
Questions, questions and no answers at all!
Why are staff being sent home from testing labs because there are so few samples to test?
Why are so many people STILL being flown into the UK while we remain under house arrest?
If we ever emerge will we find a new world out there populated and run by strangers?
Oh..apparently the NHS is now going to look after my mental well-being!!!!
Thatās all I need.
April 20, 2020
Questions, questions and no answers at all!
Why are staff being sent home from testing labs because there are so few samples to test?
Oh..apparently the NHS is now going to look after my mental well-being!!!!
Thatās all I need.
April 20, 2020
Sorry..first attempt was reject as already having been posted. So I took out an oft asked question not knowing first had actually been posted!!
April 20, 2020
The weakness of PPE is that it is largely redundand after one shifts use. This poses the question, why is the material used and the design not washable at 100 degrees centigrade. I assume hospitals have washing facilities for bed linen and autoclave equipment for other items so who decided that PPE should be dumped after one shift. Done as I infer there would be no shortage.
April 20, 2020
Seems it is, well at 60 degrees and washed three times , and it still kept is resistance to liquids.
April 21, 2020
Iain, not my recent experience. Most of it goes in the bin after one patient use and the rest after one shift use or at the wearers discretion which could be less.
April 20, 2020
Let’s get people back to office work and consumer buying etc – NOW! Even if not at fully capacity. So for example:
Everyone can return to offices as long as they maintain social sensible social distancing and wear masks indoors. We should be able to do this 100%.
We can open up non-essential consumer shops but maintain the same social distancing as in supermarkets (people are well practised now – and even if non-essential consumer shopping only rises to 50% to 75% – this is better than o%).
Let’s see how this goes, then look at opening up cinemas, fast-food joints, aeroplane flights and so on – all with sensible social distancing rules and using cheap technology and apps.
We could greatly improve our economy (in the context of the out-of-the-ordinary situation we find ourselves in) whilst really focusing on protecting the old and vulnerable in homes, hospital and care homes.
This is doable / winnable, although we will have to stagger along, we just need to plan well, work hard, and have some courage!
April 21, 2020
What is the total salary bill for top people not involved in day to day operations vs the total salary people who are involved? That will be a good indicator of whether the NHS and Public Health England are top heavy.
April 21, 2020
The more you look into these organisations the more appallingly run, misdirected, top heavy, bloated, incompetent and over remunerated they look. But this is par for the course in such government run and Quango organisations. The only control the public have over what they do or how they are run comes via elected MPs and ministers. This control is clearly virtually worthless so they do exactly what they want. They would clearly rather pay high salaries to themselves rather than do sensible and competent pandemic planning so that is what they do.
April 21, 2020
You can catch a few ailments, a few strains of colds perhaps and vice-versa, they’re family,, from dogs, not many, they are species specific,… normally.
April 21, 2020
Dear Sir John,
SOCIAL DISTANCING KEY TO TACKLING THIS CORONAVIRUS CRISIS
I am quietly sure that effective and well-thought out social distancing techniques is key to tackling this virus (other than a vaccine). But I don’t see much conversation about this from the government or in the media.
The 2 metre rule is key. But far more can be done / fine-tuning.
We need to open offices, restaurants, non-essential shops and getting people to follow strict guidelines using sensible rules and cheap tech and apps – like in China. People are also accustomed to social distancing so would be ready for fine-tuning etc.
Let’s also not demand masks in public. Sure, there are benefits but it just adds to the panic (and people don’t buy things if they panic). Although wearing masks indoors like in offices seems like a good idea.
Meanwhile be ruthless about protecting the old and vulnerable at home, in homes and in hospital whilst doing what we can to keep their spirits high etc.
Really effective social distancing means we could get our economy back on track (not perfectly but enough so that we can bounce back once the vaccine comes out and no serious long-term damage to our economy).
April 21, 2020
Please can the government look at the most effective social-distancing case studies around the world – China, Singapore, Germany and elsewhere. And come up with our own innovations for this as well. We need to do this quickly. Have the conversation quickly. Quickly put together a plan / strategy / sets of tactics for this. And get (the government / country as a whole) on with it.
Time is running out, quickly.
April 21, 2020
Blue Sky Transformation thinking is urgency required for the NHS.
It is fighting on too many fronts and expanded way beyond its basic aims.
It needs to withdraw to its Core Objective like other large organisations demonstrated and spin off its extra activities to specialise as self-funded units.
The universally proven Pareto principle aka 80/20 rule, needs to be applied to NHS management big time as 80% of problems are caused by just 20% of most things in the real world of business.
Also if you have more than approximately 15% of problems unsolved you end up pushing the problems in front and never eat into being on top of it without extra resources just as what has happened with NHS begging for 1m volunteers (God bless them!)
But the NHS has been out of control for decades and needs to get on a self-sustainable footing just like post-war Japan learned from W. Edwards Deming and Quality Circles and hopefully virtuous circles too.
April 21, 2020
Having seen the ONS weekly numbers published today, I think gloves are off with statisticians, they’re holding back no punches on publishing comments that destroy the spin being presented every night on Clowntime, wonder if MSM will ask the questions why they misrepresenting the figures so badly each night and when we will start getting the real picture and not the spin? Time indeed to recall Parliament virtually and hold them to account!
April 21, 2020
In addition: Why are they trying to detract from true figures on death comparison slide by including 2 data sets for uk values (hospitals, all settings), misleading and makes deaths look lower than they actually are…?
And what value of R they are using and how they calculate it, especially when they not performing contact tracing?