Deaths/Million of Population

UK: 495

Some countries which are much more densely populated than the UK have much lower Covid-19 deaths/million rates. These include Bangladesh (2), South Korea (5), India (2) and Israel (31). (Source Worldometer, 14 May 2020).

Why has this happened? Who is responsible? Is new leadership now required in the UK?

Covid-19 Care Commissioning/Purchasing/Supply Chaos

Clinical Commissioning Groups, NHS Trusts, NHS England, Local Authorities, care homes and now DHSC/eBay are all purchasing Covid-19 supplies including PPE.

Where is the control? Where is the order? Where is the leadership?

On 1 May 2020, somewhat belatedly, The Department of Health and Social Care (DHSC) apparently wrote to all NHS Trusts stopping them from purchasing supplies. This includes PPE. I’m sure NHS Trusts are not intentionally stupid. They have been buying PPE themselves because the DHSC/NHS England/CCGs were not commissioning/purchasing/supplying PPE!

The latest supply channel is a joint venture between DHSC and the shopping and auction site eBay. The venture is very new and according to ’Health Service Journal – on 6 May 2020 had supplied just 400,000 PPE items to only 1,400 of the 58,000 UK care service suppliers.

Ealing Council Leader Julian Bell is alleged to have announced in a Unite Zoom meeting on 12 May 2020 that Ealing Council had been successful in purchasing PPE for four West London Councils’ ‘local care services’. Following recognition of this, Councillor Bell said the Council would soon be the purchaser of all PPE for all London Councils’ local care services. All this seems quite odd when one considers that the vast proportion of care/nursing homes are privately owned. Shouldn’t the owners of the homes be expected to provide PPE for their staff? Surely the same logic applies to the vast proportion of domiciliary care staff who are employed by private companies – their employers should surely provide them with PPE, not Local Authorities.

On 15 May 2020 ‘The Guardian’ reported on the shambles at the Government’s outsourced PPE depot run by Movianto. Apparently PPE equipment was being stored in a smoke damaged Merseyside warehouse found to contain asbestos. In late March 2020 the Government ordered Movianto to begin distribution of the £500 million PPE stock. However, because of poor management and staff sickness progress was slow, errors were made and as demand grew apparently it became chaotic. The army was called in to sort it out. It didn’t help that during this period the American parent company sold Movianto to a French company. Questions are being asked as to why DHL lost the contract in 2018 and why Movianto, a loss making company for every year since 2010, had managed to win the £10.5 million/year contract. 

Local Resilience Forums (LRFs) Claim Government’s Approach to Them for Covid-19 Has Been ‘Top-down, Uncommunicative and Controlling’ 

There are apparently 42 LRF’s in England and Wales. They have been tasked by Government to respond to Covid-19. A review by Whitehall, revealed in ‘Municipal Journal’, is very critical of the Government. The leaked report cited withholding vital data and intelligence on the progress of Covid-19. Research was carried out by Nottingham Trent University for the C-19 Foresight Working Group – a cross-party Government committee.

Local Resilience Forums – which most people have probably never heard of – were introduced in 2004 in the Civil Contingency Act to provide the means to those involved in preparedness to collaborate at a local level. There is just one LRF in London (serving 9 million residents!) and it’s based at the London Fire Brigade, London SE1.

Will the Government Mishandle Covid-19 Local Testing/Contact Tracing/Isolation/Quarantining?

Sadly this is likely. 

Public Health Professor Allyson Pollock at Newcastle University and a member of the King Independent SAGE team has on numerous occasions emphasised that the Covid-19 national epidemic is not homogeneous. It is in fact hundreds or thousands of local Covid-19 outbreaks that are active in this country – all at different stages of ‘diffusion’.

The key to contact-tracing is local knowledge and meticulous research on the ground. This suggests using Local Authority resources, GPs and the myriad of volunteer groups which already exist in all towns and villages throughout England.

Allegedly Government outsourcer Serco has assembled/is assembling 15,000 tracers (Call Centre staff?) and 3,000 clinical support staff (recent NHS retirees?). ‘Health Service Journal’ reported on 13 May 2020 that much of the national test centre data/results were not being shared with GPs and Local Authorities. Will Deloitte who run these national test centres hand this test data to Serco?

Yet another ex-McKinsey & Co employee is joining the fray and in a top position too. Baroness Dido Harding has been appointed leader of the Government’s Covid-19 Test and Trace Taskforce.  Her stint at McKinseys was in the 1980s. However she became notorious for her performance when CEO of TalkTalk for seven years. Her handling of a cyber attack resulted in losses of £60 million, four million customer accounts allegedly hacked, and a loss of 95,000 customers.  Baroness Harding also seems to have kept her role as Chair of NHS Improvement. Maybe with the merger of NHS England and NHS Improvement (NHSI), the NHSI Chair’s role is effectively redundant.

The Government’s (as yet unnamed) contact-tracing App is still on trial on the Isle of Wight. If it ‘fails’ – on ethical or technical grounds – the Apple/Google App, being used in Europe, is waiting in the wings. And, according to ‘The Times’ of 14 May 2020, there are 43 Covid-19 contact tracing Apps in use worldwide.

National Audit Office (NAO) Describes £8.1 Billion NHS IT/Digital Transition Spending as Inadequate and Confused 

+ 54% of NHS Trusts reported that their staff could not rely on digital records.

+ NAO recommends spending 5% of the total annual NHS budget on IT/digital transformation. NHS is spending 2%.

+ Interoperability between new and legacy systems, especially with repeated changes in national strategies has created a fragmented environment.

+ NHS management of digital transformation at a national level is confused.

A New Post Covid-19 Healthcare Plan Being Hatched for London

‘Urgent Action: System Plans for London’ is the title of a 29 April 2020 leaked memo to the five London Integrated Care System (ICS) Chairs and Senior Responsible Officers (SROs). The author is Sir David Sloman, NHS London Regional Director.

The memo asked all these bosses to rapidly review their ICS plans in terms of new Cocid-19 challenges and future care strategies. It also asks them to report against 12 expectations contained in a ‘Journey to a New NHS‘ paper along with a set of slides. They had to reply by 11 May 2020. Why the rush one wonders? 

The backdrop to all this is multifarious. Firstly in terms of previous plans we have at least the October 2019 ‘London Vision’, the January 2019 national ‘Long Term Plan’, and the November 2017 ‘London Care Devolution’, and the five London regional October 2016 ‘Sustainability & Transformation’ Plans. In terms of statutory significance the ICSs have no legitimacy at all. In fact in at least one London region (NHS North West London) its ICS will not be formally born until 1 April 2021. (In NHS NWL for example, the only statutory legitimacy lies with the eight CCGs. Ealing’s CCG is strangely quiet at the moment. The last we heard from the Collaboration of the 8 CCGS was that all but Hillingdon CCG were ‘partnering’ with other CCGs. No doubt they are all trying to reduce their combined 2018/19 annual ‘employee benefits’ of some £10 million).

A bit more NHS NWL flavour here is also relevant. In May 2019 NHS NWL outlined there would be 8 ‘Place Teams’, 8 ‘Local Committees’ and 8 Integrated Care Parnerships (ICPs). One year on, one wonders what’s happened to plans for them? Or is planning and strategy a London-wide only approach now? 

It really does seem an age away in 2013 when NHS bosses were preaching about local commissioning, by local GPs with local knowledge. Their bible then was the 2012 Health & Social Care Act – which ominously is the existing legislation that is being blatantly ignored in spirit and possibly in actuality.   

Now to the content of the memo. A quick glance at the 12 expectations:

1. How are you going to deal with non-Covid-19 acute elective and non-elective work? In other words how are NHS Trusts going to carry out the jobs they are paid to do? 
2. A consolidation and strengthening of specialist services. Cancer, paediatrics, renal, cardiac and neurosurgery listed. Does this suggest mergers and closures?
3. Increase web, telephone and video triage. Never mind the quality – it’s cheaper than actually having to travel from home and meet a patient in a clinical ’setting’.
4. How will you separate emergency Covid-19 from emergency ‘other’. (Given that some emergency other patients are locked into the ‘stay at home’ paradigm and think NHS UCCs and A&E units are awash with the Covid-19 virus).
5. Develop virtual by default Primary Care and Outpatients. See 3.
6. Minimise inpatient length of stay and faster Delayed Transfer of Care. See NHS NWL ‘Shaping a Healthier Future’ case study – seven years and £1.3 billion spend made little progress on this minimalisation.
7. Address health inequalities – see similar unmet aspirations like Climate Emergency and clean drinking water for all the 7.7 billion inhabitants in our world.
8. Same expectation as in 2. 
9. Merge corporate support services and clinical support services. Cost savings here.
10. A workforce plan. Good luck with that one. Too few doctors, nurses, consultants, mental health staff at all levels, and too few support staff. Too many commissioners.
11. A plan to ‘join together’ NHS institutions and Local Authorities. With different business models, goals, budgets, culture, politics and a shared desire not to open up financial books to each other – little progress on this front visible over the last seven years. No mention of ‘Integrated Care Partnerships’.
12. Public engagement including ‘deliberate’ forums (e.g. NHS NWL 4,000 EPIC hand-picked sounding board – which is an attempt at regularly polling a representative sample of the 2.4 million NWL patients).

Revenue and capital cost estimates were asked for. A three phase implementation over 18 months was proposed. But the NHS never meets its timescale projections. A new bit of jargon emerged – ‘London Vision the Touchstone’…….

The 32 London boroughs commission all London’s social care. However it’s clear from comments heard from the London Borough’s of Ealing and Hammersmith that they have not been asked to comment on these NHS ‘Systems Plans for London’. Yet another painful example of the long running disconnect between healthcare and social care.

A final postscript on NHS London supremo Sir David Sloman. Google can’t find anything about his life prior to 2009. In 2017 he was admonished by the Government’s data protection agency for illegally giving details on 1.6 million patients to Google Deep Mind.

Is the Care/Nursing Home Business Model Broken Beyond Repair?

Most care/nursing homes in England are privately owned. There are 17,000 nursing and residential care homes in England housing 400,000 people (NHS England, 2019). A lot of homes are part of care groups both small (e.g. Abbey Healthcare) and large (e.g. Four Seasons). Some are run by charities (e.g. St David’s, Castlebar Hill, W5). Care is commissioned by Local Authorities (LAs). The homes are regulated by the Care Quality Commission (CQC). Each home has a contract with a local GP practice. Many GP practices are commissioned by NHS England (NHSE). Some GP practices (e.g. the 75 in Ealing) are commissioned by the local Clinical Commissioning Group (CCG). Where local CCGs have been replaced by regional Integrated Care Systems (ICSs) could it be that the succeeding ICS is the commissioner? For over two years now the Department of Health has had social care responsibilities – so the DHSC has overall responsibilities for care/nursing homes. The care/nursing home acronym soup or tangled spaghetti looks like LAs, CQC, GPs, NHSE, CCG, ICS, DHSC.

‘Reuter’s’ data analysis up to 1 May 2020 shows at least 20,000 excess deaths in care homes in England and Wales during the pandemic. Is it any wonder then that when the Covid-19 history books are written one of the most painful chapters will be on unnecessary care/nursing home deaths.

Who?

Who can we blame for this in the UK?

Who is infected and who is not infected? We don’t know.

Who can we believe when it comes to guessing a route to a post-Covid-19 world? 

What?

What exactly is Covid-19?

What is the ‘right’ approach – herd immunity or flattening the curve? The world jury is still out on that one.

What Covid-19 performance metrics (cases/deaths/vaccines/the ‘R’ number) will trigger lockdown unlock processes?

What long term impacts on people’s health and lives will be caused by weeks/months of social isolation?

Why?

Why did this happen? Malevolent Chinese Government forces at work? ’Wet’ animal markets in China? A plot by Bill Gates for world domination? Take your pick.

Why was the UK Government so unprepared for dealing with a pandemic?

Why did the UK Government seemingly ignore World Health Organisation global pandemic alerts in January and February 2020, and  react too slowly in March 2020?

Why do some infected with Covid-19 die? Others are sick and recover? And others apparently display no symptoms whatsoever?

Why did we start testing and tracing and then stop doing it?

Where?

In my body, my house, my street, my town, my city, my country – and in fact everywhere?

When?

When can we all have our lives back?

When will it end? Will it ever ‘end’?

When will all UK citizens be tested for having, not having or having had Covid-19?

When will a Covid-19 vaccine become available?

When will all UK citizens be vaccinated for Covid-19?

When will the Government spout Covid-19 numbers I might believe?

When will I next visit a pub and enjoy a pint with friends?

Which?

Which businesses might survive Covid-19?

Which scientists and academics should we trust with their theories, proofs and evidence? 

How?

How will we rid ourselves of Covid-19? 

How many people are actually dying from Covid-19 – in hospitals, in care/nursing homes and at home?

How many people have died or are dying of serious non-Covid-19 illnesses/diseases because Covid-19 measures have taken priority over beds, staff and equipment and curtailed treatment/operations?

How long might immunity last after recovery from Covid-19?

How might society change after Covid-19 is brought under control? For better or for worse?

Can We Rely on Anyone’s Numbers?

+ 81,661 tests for Covid-19 carried out in UK on 29 April 2020 (Prime Minister). But 36% were retests, (DHSC)

+ On 30 April 2020 Covid-19 test target (set by Health & Social Care Minister on 1 April 2020) number of 100/000 UK Covid-19 tests/day was not met.

+ 674 people died of Covid-19 in the UK on 29 April 2020 (Prime Minister). But data from all the 11,300 UK care homes will not have been included. It takes some 10 days for ONS to collect and count all deaths recorded on Death Certificates for any one day.

+ As of 28 April 2020 there had been 21,678 Covid-19 deaths in the UK (John Hopkins CSSE). Clearly not accurate, as up to date care home/nursing home/at home deaths not included (ONS).

Covid-19:  17,756  ‘Extra Deaths’

Extra deaths attributable to Covid-19 and the date at which the outbreak took hold is being analysed by Dr Rodney P. Jones of Coventry University. The most recent data is for 17 April 2020 and includes:

UK:  17,756  commenced on 6 March 2020

London: 3,991 commenced on 21 February 2020

‘The unintended consequences of Covid-19 may be worse than first appreciated’.

More at:

http://www.hcaf.biz/2020/Covid_Excess_Deaths.pdf

Mortality monitoring throughout Europe data source:

https://euromomo.eu/

Thanks to Roger Steer of Healthcare Audit Consultants Ltd for this information.

We Need a State Owned UK Care Organisation – Free at the Point of Use

The Covid-19 pandemic is posing the biggest threat to the UK’s survival since World War 2. If we survive Covid-19, we must re-organise ourselves nationally to fight subsequent pandemics and give us all a better chance for sustainable lives, health and happiness.

There must surely be a single business model for delivering care in the UK.  A singles state owned and run public service free at the point of use. Care includes Primary healthcare, Secondary healthcare, mental health, community healthcare, social care, care homes, hospices, nursing homes, palliative care, Public Health, GPs, consultants, pharmacies and support staff. All the people and all the bricks and mortar in England, Scotland. Wales and Northern Ireland to be included.

Large London Hospital Rejecst Using NHS Covid-19 Wembley Test Centre

The Royal Free NHS foundation Trust runs the Royal Free Hospital, Barnet Hospital and Chase Farm Hospital. It employs 10,000 staff. In a long article in ’The Guardian’ of 29 April 2020 it was reported that the Royal Free had declined to use the NHS Covid-19 Test Centre set up in the IKEA car park in Wembley. The Royal Free is swabbing its staff at work and sending samples to the Frances Crick Institute for analysis. Reason quoted by the Royal Free for adopting this approach include Wembley Test Centre results having been lost and the hospital having no faith they would get an accurate result. It says the chain of command is opaque and the centre is not run by clinicians but is run by Deloitte – a firm of accountants.

Complaints about Covid-19 test Centres by other NHS Hospital Trusts and NHS staff around the country include five hour queues, delays causing cancellations, leaking test vials, wrongly labelled samples and lost test results.

There was no competitive tendering for contracts to set up and run the 30 Covid-19 UK Test Centres. (This trashes the CCGs procurement requirements of the 2012 Health & Social Care Act). Outsourcers who mopped up these Test Centre contracts include Boots, Serco and Sodexo. 

£60,000 ‘Life Assurance Scheme’ for Grieving Families of Front-Line NHS Hospital Staff and Social Care Workers Killed by Covid-19.

More questions than answers.

+ Exactly who will receive the cash? The closest relative?

+ Is this cash offer being rushed out to head off any possible legal action by loved ones who feel the NHS/Government failed in its duty of care to keep NHS staff safe at work? One does wonder what the small print on these Scheme contracts might say about cash acceptance if no litigation.

+ The veracity of cause of death statements on Death Certificates. Doctors at one NHS Trust have been told there’s no need to list Covid-19 on Death Certificates of Covid-19 patients (‘inews’ 17 April 2020).

+ Why £60,000? Just how was this figure arrived at?

The First Ten Medics to Die on the Covid-19 Front Line were Black or Asian

This fact released by the British Medical Association is further amplified by the Sky News research in mid-May 2020 that 70% of the first 54 front line health and social care workers to die of Covid-19 were from the Black, Asian and Minority Ethnic communities (BAME).

BAME people make up 44% of NHS medical staff. However the 2011 Census tells us that the BAME population in England and Wales makes up just 14% of the population. The UK’s Intensive Care National Audit and Research Centre revealed that 35% in a study of almost 2,000 Covid-19 patients were from BAME backgrounds.

Lots of reasons being postulated to explain the heightened dangers of Covid-19 to members of the BAME community. NHS England has issued guidelines to try and shield BAME NHS staff where possible from Covid-19 exposure. Research on the BAME Covid-19 profile is being undertaken by UK Government and by Middlesex University.

Apparently all the England and Wales Covid-19 death totals were wrong up until 20 March 2020. On this date the Office of National Statistics (ONS) got involved and added the not-in-hospital Covid-19 deaths to the hospital Covid-19 deaths. 

One does wonder just how accurate and consistent is any of this data. Apparently the first UK death certificate which recorded a Covid-29 death was on 28 December 2019. Were there any Covid-19 tests available on that date I wonder? Still suspicions and rumours abound about the accuracy of Chinese Covid-19 death figures especially in the virus source city of Wuhan.

Also does it really matter (statistically) if 400 or 5,000 died yesterday as long as the data collection methodology remains constant so trends can be spotted (eg green shoots or no shoots at all).

Our National Testing Programme for Covid-19 is a Shambles – but Maybe This is Intentional

As of 1 April 2020, just 2,000 out of 500,000 front-line NHS staff had been tested. Out of a UK population of 67,886,011 only 163,194 people have been tested. There are around one million patients registered at the 167 GP surgeries in Ealing, Hounslow and Hillingdon. Policing these people’s social isolation is a total number of Police (including admin) of 1,100.

This is at such a level of unbelievable incompetence it suggests to me that this is actual Government policy. The ‘Herd Immunity’ approach may still be being pursued by the Government. Herd immunity means letting a large number of people catch the disease and hence develop immunity to it, to stop the virus spreading. 

The World Health Organisation (WHO) is not in favour of a herd immunity strategy. Some experts say the herd approach is experimental at best and dangerous at worst. 

Professor Graham Medley, the Government’s chief pandemic modeller, has broken cover and is advocating ‘Herd Immunity’. ’The Times’ and the ‘Daily Mail’ of 4 April 2020 quote Medley saying that the Herd Immunity approach is the only way out of mass isolation for weeks (months?). He claims mass isolation is leading to mass unemployment, domestic violence, child abuse, food poverty and mental ill health. Decision day for the Government is 13 April 2020 (21 days into lockdown).

‘The First Casualty When War Comes is Truth’

This quote is attributed to Hiram W. Johnson, a US Senator, in 1917. However ‘The Idler’ magazine of 11/11/1758 expressed very similar sentiments.

It was Secretary of State, Health and Social Care, Matt Hancock MP who told the House of Commons on 23 January 2020 that the NHS is fully prepared to deal with any cases of Coronavirus.

When I know I’m being sold to, I become suspicious. On 2 April 2020, Hancock delivered a sales presentation to the nation on TV and radio. He gave us all his word that by 30 April 2020 100,000 Covid-19 tests would be taking place nationally each day. I suspect very few people actually believed him. His boss Boris Johnson MP on 18 March 2020 told us all that we are moving up to 25,000 Covid-19 tests per day and aiming very soon for 250,000 tests per day. I’m unsure whether we can trust any of the Government’s Covid-19 figures but allegedly some 10,000 Covid-19 tests were carried out on 1 April 2020. So, in just 29 days we are going to increase daily testing rates 10 times over? The likelihood of this is on a scale of challenging to impossible. 

What was the most excruciating for me last on 1 April 2020 was Hancock thanking the general public, NHS staff and Public Health England over and over again.

Public Health England (PHE) – Hero or Villain?

Set up in 2013, PHE is responsible for ’protecting the nation from public health hazards’. PHE is the Government body responsible for disease testing. It has an annual budget of £4.5 billion and it employs 5,500 people.

On 21 February 2020, PHE declared that Corvid-19 posed only a ’moderate risk’. At that time there were 2,236 Covid-19 deaths and 75,465 Covid-19 cases in China.

There are press reports of PHE shunning co-operating offers for testing support from leading UK scientific organisations. These bodies include Oxford University Sir William Dunn School of Pathology  Francis Crick Institute and Queens Medical Centre in Nottingham.

As of 2 April 2020 only 2,000 of the 500,000 frontline NHS staff had been tested. There are just too many stories of NHS staff driving miles and queuing at a PHE test centre only to be turned away because they had not made an appointment.

If the Government’s covert approach is to ramp up testing slowly – then PHE is a hero.  If, in fact, the Government does want to test 100,000s daily than PHE is a villain.

242 PHE staff earn £100,000+/year. Yvonne Doyle, PHE London Director, earns £275,500/year.

159 Corvid-19 Deaths at London North West Healthcare NHS Trust Hospitals (LNWH) 

LNWH has registered more Corvid-19 deaths in the UK than any other NHS Trust. These deaths took place at Ealing, Central Middlesex, Northwick Park and St Mark’s Hospitals. This figure is massively larger that of any other NHS Trust.

I suspect most of the LNWH deaths took place at Northwick Park Hospital (although rumour has it that least 5 deaths were at Ealing Hospital).

Why has this happened at hospitals in Brent, Ealing and Harrow? Corvid-19 cases’ number are high in Brent (321), Ealing (265) and Harrow (251). The towns are 3rd, 7th and 8th highest out of the 32 London Boroughs (29 March 2020 PBE data).

But no-one can or should ignore the recent NHs hospital past in these three towns. From 2012 to 2019 the disastrous NHS NWL ‘Shaping a Healthier Future’ programme ripped beds, functionality, staff and the heart out of Secondary healthcare. Huge debts were racked up and management walked (or were ‘pushed’). The recently departed LNWH Chief Executive announced her departure seven months in advance. Her very recent replacement is a one year interim. The departed LNWH  Chair left at very short notice and his replacement is a part-time 70 year old auditor. 

Hancock Helps Pharmacies with £300 Million

On 2 April Matt Hancock threw out a short lifeline for Pharmacies. With many (all?) GP surgeries closed to walk-in patients, it’s clear that patients are walking into Pharmacies. NHS England has been promoting Pharmacies for some time now as an alternative to GP surgeries. The lack of GPs and increasing numbers of elderly patients were two of the reasons for this.

Local Pharmacies tell me of increasing numbers of customers. Patients and Pharmacies talk about drug shortages and angry confrontations at Pharmacies. The National Pharmacy Association (NPA) says the network of Pharmacies is ‘financially extremely fragile’. The NPA says there has been a surge in demand for prescription medication. This has added to pressures caused by the NHS drugs tariff being considerably lower than the prices Pharmacies pay to suppliers.

Missed Opportunities: October 2016 to July 2019

Cygnus, October 2016

The three day Cygnus exercise demonstrated NHS hospitals could not cope with a major flu outbreak. The Government report on Cygnus has never been published.

UK Biological Security Survey, 2018

This survey report addressed the UK’S preparedness to deal with a pandemic. It stated ‘….we may with a pandemic fail to maximise or to tackle issues as quickly as we need to’. The survey results were ignored by the Government.

July 2019

A Government Inquiry into preparing for emerging infectious diseases was postponed due to Brexit debates.

The Government must act NOW to protect people from self-harming and potentially harming their loved ones by leaving their homes and travelling to perform non-essential work. For example travelling to build luxury flats for foreign investors to buy is not essential work. It’s just not worth anyone risking their lives, health and wellbeing and the sustainability of their loved ones.

However if cash is not quickly made available to these ‘stopped’ travellers so they can feed their families and pay their essential bills, surely there is a real risk of looting, muggings, break-ins, rioting and public disorder. Not to mention mental health problems especially involving substance abuse. This risk is high anyway as allegedly over 500,000 new claimants (who have been put out of work by Covid-19) are now trying to get Universal Credit (UC). New UC claimants have to wait five weeks for any cash so all 500,000+ of them will apply for emergency loans. Organised nationally (like Covid-19 commissioning – see below) these loans will be slow arriving (think Covid-19 test kits and protective clothing here). Will this result in rapid cash? I think not. The possibility of imminent chaos is frighteningly on the cards.

No Clinical Commissioning for Covid-19 by NHS North West London (NWL) CCGs

The March 2020 report by the outgoing NHS NWL Accountable Officer Mark Easton makes no mention at all of Covid-19. The report, dated 25 March 2020, would have been ’presented’ at the Ealing CCG Governing Body meeting (now cancelled) on that date. Just what is a CCG entity for if it’s not commissioning for Covid-19? The Ealing CCG Chair’s March 25 2020 report also makes no mention of Covid-19. 

With 100s of patients dying, 1,000s infected and 10,000s thrown out of work by Covid-19 – how can local and regional NHS commissioning bosses be doing nothing about Covid-19? Well, the only logical assumption is Covid-19 commissioning is being done – very badly – by national Government.

So it’s the Government which is directly to blame for the non-arrival locally of Covid-19 test kits, and Covid-19 protective clothing for care staff and the dearth of Covid-19 ventilators and ICU beds.

The 2012 Health & Social Care Act, so hated by many of us, did actually set up local healthcare commissioning entities. Not only are these structures being variously unpicked this year and next year and replaced with regional Integrated Care Systems – they have been completely ignored for Covid-19 commissioning. One does wonder whether this genius thinking emanates from Dominic Cummings or perhaps from the wunderkinder at McKinsey & Co.

And don’t tell me the Government wasn’t warned about what was to come. On 30 January 2020 the World Health Organisation (WHO) declared the novel coronavirus (2019-nCoV) outbreak a public health emergency of international concern. Respiratory challenges for sufferers were also identified and announced by WHO in January 2020.

Where are the CCGs and ICSs Nationally in the Covid-19 Pandemic?

Lots of bosses and experts quoted on TV, radio and national newspapers. NHS Trust and hospital bosses, ICU Leads, doctors, Royal Colleges, BMA, NHS Providers, academics, nurses, GPs and patients – but no local or regional commissioning/purchasing bosses. I have yet to see or hear a CCG or Integrated Care System (ICS) boss being interviewed or quoted. Surely these are folks being paid £100,000/year to commission/purchase healthcare and social care services. Are these folks quietly in the background attempting (and possibly failing) to maintain an adequate level of NHS non-Covid-19 commissioning/purchasing?

Where are the Covid-19 Test Kits?

Johnson and Hancock keep telling us on TV that the tests kits are coming. But also on TV, radio, social media and blogs we hear they have not arrived.

Do you Know Anyone Who Has Been Tested for Covid-19?

No – me neither. We don’t know exactly who has Covid-19 and who has recovered from it. Horror  stories  are emerging of NHS hospitals with up to 50% sickness absenteeism. No-one knows if staff are Covid-19 sufferers or have other non-Covid-19 ailments.  

We Have Absolutely No Idea of the Number of UK Residents Who Have Contracted Covid-19

‘The Times’ helpfully publishes each day the number of Corvid-19 case recorded by UK Local Authorities. However the data is about as useful as a chocolate teapot as so few people have been or are being tested.

Where is the Covid-19 Protective Clothing?

Johnson and Hancock keep telling us it’s ordered and that they are having problems with logistics. The reality appears to be a chronic shortage of even barely adequate Covid-19 protective clothing. NHS staff are having to risk their lives in treating Covid-19 patients without appropriate protective clothing. Anecdotally healthcare and social care staff are setting up their own charities to buy Covid-19 protective clothing. Staff are visiting DIY stores (if open) to buy (possibly inadequate) industrial protective clothing. Staff are even building their own face masks, especially those with full face ‘splash’ screens.

GP Surgeries are Closing Their Doors – Pharmacies are being Flooded with Patients

This is putting Pharmacists and their staff at risk and under pressure. Seemingly their commissioner NHSE/I /DHSC appears to be doing little or nothing to help in terms of protective clothing, testing regimes and kits – or even sympathy.

How will the 560,000+ NHS Volunteers Be Organised?

Surely not by central Government. And what Covid-19 protection will they be given and who will give it to them? It’s obviously sensational that so many citizens have volunteered. But if national Government’s organising of testing, protective clothing, ventilators and adequate ICU beds is anything to go by, it could be a frustrating time for these wonderful, altruistic citizens. 

Where is the Covid-19 Leadership?

No – not Professors. This is no academic puzzle. No – not scientists. This is no Biology class. No – not management consultants. In my region McKinsey & Co were paid at least £34 million for NHS  strategy advice (leadership even) which proved to be disastrously wrong and led to over £250 million being wasted. 

This is a national and international emergency not seen since WW2. Where is our Winston Churchill? I’m sorry but Boris Johnson does not fit the bill, nor does Matt Hancock. And Sir Simon Stevens seems to have completely disappeared!

Who Must Share Responsiblity For NHS NWL Being Run Down 2012 – 2019?

It really is now time during quiet reflection in social isolation to name names of the sponsors and flag wavers for the 2012 ‘Shaping a Healthier Future’ (SaHF) and the 2016 Sustainability & Transformation Plan (STP). Before we do this roll call, let’s remember what SaHF/STP did to ill-prepare north west London for the 2020 Covid-19 pandemic:

+ Reduced bed numbers

+ Downgraded and demoralised Central Middlesex, Charing Cross, Ealing and Hammersmith NHS District General/ ‘Major’ Hospitals

+ Difficulties in hiring permanent staff

+ From September 2014 to 2019 NHS NWL Accident & Emergency performance was often amongst  the worst performing in England

+ Wasted anything between £260 million to £1.3 billion

+ Creating enormous NHS NWL deficits. For NHS NWL CCGs the deficit is £90 million. For the major NHS NWL Trust Hospitals it’s £164 million.

Rollcall

+ Signatories to 2012 SaHF:

CCG  Chairs

Dr Ethie Kong, Dr Ruth O’Hare, Dr Mark Sweeney, Dr Mohini Parmar, Dr Tim Spicer, Dr Amol Kelshiker, Dr Ian Goodman, Dr Nicola Burbidge

Many of the above earned over £600,000 2012-2019. Some are still in post.

Consultation Document Cheer Leaders

Dr Mark Spencer and Jeff Zitron

Chief/Accountable Officers:

Rob Larkman, Clare Parker, Mark Easton

The star earner here was probably Rob Larkman. In his swan song year of 2017/18 his pocket money was £250,000. 

2016 STP Co-Conspirators

Tracey Batten and Carolyn Downs

In 2016/17 Tracey Batten earned £295,000.

NHS England Bosses

David Nicholson 2011 – 2014

Sir Simon Stevens 2014 – 2019

Secretary of State for Health & Social Care

Jeremy Hunt MP 2012 – 2019

Lead Management Consultants

McKinsey & Co

Dr Penny Dash, Senior Partner Europe, 2013 – 2019

During 2010 – 2017 The company billed NHS NWL £34 million

Other Management Consultants

During 2010 – 2017 they billed NHS NWL £38 million.

With no spare hospital beds, hospital doctors, GPs, consultants, nurses or support staff of all types – the NHS is ill-prepared for any unexpected spike in illnesses – never mind one based on a new virus with no vaccine.  With Local Authorities having been starved of funds over the last 10 years, the level of Public Health services available locally is akin to a small plaster failing to stem the blood from a major gushing wound. Mental Health and Social Care services (in Ealing for example) can hardly cope now, so sadly if the epidemic strikes hard, suicides, self-harm and paranoia will ramp up.

Given the worst case – and following Japan’s and Italy’s policy – all schools in England could close down. People may be loathe to travel on planes, tube trains, trains or even to leave their homes. In fact the tube and bus networks could be shut down. Industry and commerce could slow down considerably.  

Bringing aged ex-NHS staff out of retirement might be useful or in fact practical in a few cases but maybe bigger challenges will be staffing levels, the financial viability of care homes /nursing homes and palliative care (80+% private) and sustainable care for the elderly infirm.

However all this could be scare mongering. The shape and size of the Coronavirus impact on the upcoming budget might panic people or might be seen as Coronavirus a convenient excuse for more austerity.

Collaboration of NHS North West London (NWL) Clinical Commissioning Groups (CCGs) Meeting on 20 February 2020

31 NHS executives crammed themselves into too small a room in Uxbridge. Some 10 or so members of the public just squeezed into the back of the meeting. This informal, non-statutory group spent almost two hours mostly listening, but sometimes discussing, NHS NWL issues. The issues included assurance, strategic objectives, planning, quality and finance. These folks are loosely responsible for £3+ billions to be spent 1 April 2020 to end March 2021 on healthcare and social care services for over two million people. Also discussed was the commissioning of a paediatric glucose monitoring system diabetes Type 1 children’s device. This discussion topic seems as unlikely as discussing the colour of the shoes of the accused in a murder trial.

Some surprising ‘facts’ emerged:

+ NHS NWL says its Long Term Plan (LTP) will not require sign off by NHS England/NHS Improvement (NHSE/I). This is very hard to believe. It’s still in draft form some 14 months since the national LTP was published. With 2012 NHS NWL Shaping a Healthier Future (SaHF) abandoned a year ago and the 2016 NHS NWL Sustainability & Transformation Plan side-lined by the 2019 national LTP, surely NHS NWL is currently ‘flying blind’.

+ Dr Penny Dash, newly crowned head of the NHS NWL integrated Care System (ICS), has apparently already begun attending NHS NWL meetings. One wonders whether she is still the European healthcare boss of McKinsey & Co. Apparently she will soon begin to work part-time for NHS NWL and will curtail ‘most of her interests in McKinsey & Co’. This casual indifference to conflict of interest is only compounded by the knowledge that NHS NWL paid McKinsey & Co £34,680,896 million (up to November 2017 on public record) for management consultancy advice on the disastrous 2012 – 2019 NHS NWL SaHF project. The fact that the formal NHS NWL ICS supremo role only becomes ‘live’ (albeit informally) on 1 April 2021 just seemed to be lost on the 31 senior NHS NWL executives present.

+ There is no development plan for Ealing Hospital. I know this as I specifically asked this question. Outgoing NHS NWL Accountable Officer Mark Easton passed on the question and handed over to Dr Mohini Parmar, ECCG Chair. Her answer was quite forgettable waffle.

+ The only NHSE capital grants are for building works at Hillingdon and St Mary’s Hospitals. (On 10 February 2019 the ‘Sunday Times’ estimated the combined urgent repair bills for these two hospitals was £309 million.)

+ The ECCG Managing Director failed to appear at this meeting. This was the third consecutive public meeting /meeting in public she has failed to attend. At none of these meetings was any explanation forthcoming for her absence. As she costs the public purse some £150,00/year surely some clues about her absence are in order.

Johnson Admits He Has No Plan for Social Care

The Prime Minister’s big lies continue in the care sector. Johnson famously attached himself to the infamous ‘£350 million per week for the NHS when we leave the EU’ mantra in 2016. Even more recently his free car parking in NHS hospitals is turning out not to be a universal truth either.

Matt Hancock MP, Secretary of State for Health and Social Care, has recently written to all MPs and Peers in the House of Lords wanting views re social care to be shared. This is really quite ‘rich’ given the failed promises of a Government Green Paper/White Paper/any coloured paper stretch back  over two years with six failed publication dates. 

Worryingly social care statistics include:

+ 122,000 staff vacancies

+ 1.4 million people going without any care

+ 143,000 older people face catastrophic lifetime costs of £100,000 or more 

+ Local Authority bosses predict the funding gap for services of almost £6.5 billion by 2025.

The Government, clearly now desperate, is seeking cross-party talks to tackle the social care crisis – but not until May 2020!

NHS North West London’s EPIC ‘Fiddles While Rome Burns’

‘Engage Participate Involve Collaborate’- EPIC – is NHS NWL’s latest time and money waster. EPIC self-describes itself as ‘leading edge, paradigm-shifting approach to resident engagement’. It’s quite worrying to imagine that NHS bosses actually believe this to be true.

A 6 March 2020 NHS NWL paper presented at the North West London Joint Health Overview Scrutiny Committee Meeting on 9 March 2020 in Twickenham treats us to 2,500+ words on this NHS England £10,000 grant funded initiative. Launched in December 2019, EPIC is a 12-15 month programme. At its heart are 4,000 residents who have been chosen as a representative sample of residents/patients across the 2+ million in north west London. Not only is this group to be used as a ’sounding board’ for NHW NWL commissioning and service delivery process changes/improvements, EPIC expects it to ’co-produce’ them. Astonishing.  No doubt some of the 17 or so public relations staff still employed at NHS NWL are beavering away on EPIC.

Dubious EPIC ‘Partners’

One big ‘own goal’ in EPIC is the major role given to Healthwatch. In Ealing and Hounslow Healthwatch is a busted flush as their secondary paymasters are their local CCGs. You just can’t hold NHS institutions to account if they are paying you money. Healthwatches across England are also compromised in attempting to hold public health, social care and integrated healthcare and social care services to account as their primary paymasters are their Local Authorities.

Another bloomer is employing the Consultation Institute (CI). I visited them in Peterborough in 2013. They are an interesting bunch but their credibility was completely blown when they ‘blessed’ the seriously flawed 2012 NHS NWL ‘Shaping a Healthier Future’ engagement and public consultation process.

And let’s not use language sloppily. Healthwatch and the CI are just hired hands in EPIC.

NHS NWL Engagement and Public Consultation Track Record 2012 to 2019

Frankly this has been very poor. Campaigning groups did their research, analysis and trumpeting over and over again (2012-2019) about the flawed nature of SaHF but were consistently ignored.  The question must be then – will EPIC improve on this? In 2019 NHS NWL produced its draft NHS NWL Long Term Plan (LTP). Ealing Save Our NHS (ESON) produced surely one of the most detailed critiques of the draft LTP. ESON summitted this 2,400+ word document to NHS NWL in October 2019. As of 10 March 2020, ESON had received no response from NHS bosses. So much for engagement and public consultation. So much for ’dialogue’ which EPIC bangs on about. 

Motherhood and Apple Pie

+ Audit of public engagement

+ Learn and build on existing good practice

+ Involvement Charter

+ Community voices

These are surely just displacement activities, when in fact there has been no meaningful engagement; there are no examples of good practice; the charter will have no teeth; and the existing knowledgeable community voices are being ignored by EPIC and are being excluded from EPIC.

ESON, Brent Patient Voice and Hammersmith & Fulham Save our NHS have all had their applications to join EPIC ignored (rejected?). Activist members of these groups have been researching, writing and campaigning on behalf of their residents for eight years. For EPIC to ignore them completely devalues the ‘paradigm-shifting’ approach.

Reality Check

In NHS NWL there are chronic shortages of doctors, nurses, consultants and support workers of all types. There are major shortages of hospital beds. Mental health and social care services are very thin on the ground.

It is almost too insulting for words to contemplate a horde of NHS NWL public relations folks spending public money ‘prosecuting’ EPIC when the debt levels and consequent cost cutting activities across the region – in commissioning and in service delivery – are immense. Never mind the, at best, enormous pressures Coronavirus will place on primary, secondary, community healthcare, public health and social care services.

I plan to gate-crash the next EPIC meeting on 1 April 2020 – that is assuming that NHSE/DHSC allows the meeting to go ahead. 

In reviewing EPIC I must declare an interest. From 1983 to 2004 I ran my own public relations company in what is now called the Tech industry.

500,000 Police Call-Outs to Deal With Mental Health Issues in 2019

Think tank Parliament Street has disclosed that the Police’s dealing with mental health incidents has increased by 20% since 2016. The Metropolitan Police force recorded the highest call-out numbers at 39,584. This works out at over 100 call-outs every day in London in 2019. For years the Police have been pleading that they should not be the ones to be first responders for mental health problems.

NHS England (NHSE) Hires UnitedHealth for £7 Million to ‘Rank’ Patients

The ‘Daily Mirror’ (23 February 2020) published this story. UnitedHealth of America is a $242 billion revenue private healthcare company. NHSE has asked UnitedHealth to rank patients into high, medium and low risk groups. It’s a nine month programme operating in Dorset, Berkshire, Cumbria, Lancashire and Leeds. Ranking patients in terms of illness is common practice in the USA. In fact UnitedHealth ranks/assesses patients for America’s insurance-led system.