Over the next week or two the Government will be announcing the first relaxation of the lockdown that has confined us to our homes for the last month. The rationale for the relaxation is that we are doing well in our fight against Coronavirus.
Which begs the obvious question – how well we are actually doing as a nation? If the Government are doing so badly, why is the NHS doing so well?
Are we doing badly?
The Government has made a massive mess of handling Coronavirus. Our total death rate is likely to be the highest in Europe and our death rate per 100k among the worst in the world.
The Government was too slow to realise the scale of the problem, and allowed mass events to go ahead while other countries were shutting down. Boris himself attended a rugby international while Spain was in total lockdown.
When the Government did realise that it had made a mistake it panicked. It announced a series of eye catching, but badly thought out, initiatives which achieved very little; Nightingale hospitals were built without a clear model of care which left them without any patients. Formula 1 teams and vacuum cleaner manufacturers were recruited to build ventilators which never worked. 750,000 volunteers were recruited, without any system for allocating them to tasks, leaving the majority of them idle.
When these problems became apparent the Government denied they existed. Johnson, like Trump, claims success despite of the facts, and when people pointed out the facts they both use the same tactics; claim the facts are lies, and if that doesn’t work present those presenting the facts as traitors.
These are 2 of the newly elected Tory MPs for Durham joining in the monstering of NHS staff who spoke out about the lack of PPE:
Partly this is the consequence of the Dominic Cumming style of Government – the belief that an elite group of unaccountable posh boys can do better than the UK Civil Service and the entire cadre of NHS managers put together. All mixed in with some silicon valley mumbo jumbo learned from a copy of Wired magazine they read at the airport. Move fast and break things, or some such nonsense.
This was always a stupid idea, but was entertained by Ministers and journalists who came from a similar social background to Cummings and his mates.
Don’t underestimate how much social background matters in modern politics; – the coalition Government was formed so smoothly because Cameron’s Tories and Clegg’s LibDems were from a similar social background. Cobyn’s key team of marxists all shared a similar public school privileged upbringing. The current Government are uniformly privately educated and expert at sounding knowledgable without any actual study or expertise.
But largely it is a consequence of electing Governments that prioritise managing the news cycle rather than managing reality. That is exactly what the current government has done throughout the crisis; manage the message rather than the pandemic.
How badly are we doing?
When we entered lockdown the Government target was to keep deaths under 20,000.
HMG are declaring just short of 27,000 dead. This means we are on course to exceed Spain, France and Italy as Europe’s worst effected country. The ONS data is next due on Tuesday, and while they lag behind the Government numbers I expect them to show that by the start this week we had exceeded 30,000 deaths.
If we use excess mortality as the measure the number of deaths is much higher. The Financial Times modelled mortality using this method and calculated 42,000 deaths.
You can see the same pattern in the ONS data; for example in the week ending 17th April 22,351 people died. 8,758 of these deaths mentioned coronavirus, however the total number of deaths was 11,854 more than the five-year average. In fact it was the highest weekly total recorded since comparable figures begin in 1993.
The FT methodology would also indicate that deaths in nearly all countries are higher than their respective Governments are suggesting. The FT methodology is robust, but it will be a long time before we are able to get a truly accurate picture of excess mortality using this method.
We won’t know for a few months but for death rate in the UK is likely to be in the worst 3 in the Western world, if not the worst.
Given all of that it seems rather churlish then for Boris to claim “our apparent success”
We are however doing a lot better than lots of similar countries in one respect; health service performance. The NHS is coping much better than the US, France, Italy and Spain. While Spain and Italy have had horrific experiences with overwhelmed hospitals the NHS is coping much better.
We started with fewer emergency care beds than any comparable system but this weekend our CCU beds are half empty while Spain and Italy are overwhelmed.
Why is the NHS doing so well?
I have a few hypotheses, all of which may be true to an extent:
- It is the nature of the beast.
The NHS is monolithic, bureaucratic and highly inflexible. It offers terrible customer service, and booking a routine elective procedure is much harder than any other healthcare system. It is highly resistant to change and is decades behind other comparable health care systems.
This isn’t an accident, it’s a feature. The NHS was created after WW2 and it is highly robust. The elements that make it resistant to change make it resilient in a crisis. While other healthcare systems have adapted and offer more responsive services, better elective care, the NHS offers last man standing emergency medicine.
It might be a world view stuck in the 1970s but the current crisis plays to the NHS strengths.
Professional idiot Charles Moore fumbles towards the truth for the Telegraph, only to miss the point. The lumbering inflexibility of the NHS saved the country, it didn’t doom it
2. We have sacrificed performance for quality
The NHS has lived through a decade of below average funding. During that time it has been under pressure to maintain system performance and achieve access targets. The way it has done this is by reducing quality, and, as a consequence getting worse outcomes.
This has been pretty obvious to anyone watching health outcomes in the UK. Mortality and morbidity statistics are getting worse and the poorest are suffering. We are falling behind every comparable health system for our outcomes of care.
The NHS has coped well but has produced shockingly bad outcomes. Our hospitals are performing well, but we have record death rates.
3. The way the NHS is funded gives it an advantage in a crisis
The easiest way to illustrate this is to look at the US:
The US spends $3.6tn a year on healthcare, and yet in parts of the country their hospital system is on the brink of collapse. In rural areas hospitals are being closed by for-profit providers, most recently across West Virginia and Ohio. I always believed that the USA was closer to socialised healthcare than anyone on the right of American politics would like to admit, but that it would take a brave leader or a pandemic to get them to recognise that.
Coronavirus has exposed the central problem with market based heatlhcare. It is incredibly hard to make a profit out of providing A&E/ER emergency services, because they are expensive, unpredictable, and difficult. They requires 24/7 staffing regardless of patient volumes, which makes them by their nature expensive and inefficient.
That’s why there are no private sector A&E providers in the UK, and the only one who ever tried (Circle healthcare) handed back their contract after 18 months.
The way to make money is by elective healthcare – planned operations and procedures. This is much more predictable, and it is easier to control costs and make profit. You know how many patients you have to treat so you can plan the staffing and resources in the most efficient way. In the US where money determines access to healthcare it is highly profitable to sell lots of health treatments to the wealthy while denying healthcare to the poor.
Right now hospitals have had to cancel elective work in order to deal with coronavirus cases coming through ER. Profitable elective work has stopped, loss making non-elective emergency work has boomed. Rich patients are staying at home and deferring procedures for fear of the virus.
This is a problem for any country with a similar healthcare market. It is particularly profound for the US where many of the individuals being treated will be unable to pay their bills, landing hospitals with billions of bad debt.
US healthcare companies are making big losses as a consequence, and many of them are running short of cash despite a $175bn bailout from the Government.
4. The Government has abandoned people in social care and domiciliary care to protect the NHS
I accept this is a harsh assessment, but the death rate in residential care terrifies me.
When we were developing hand sanitiser for the NHS we did a deal with a local company for some 60ml personal dispensers. The man who owned the company had a relative in a nursing home in North Durham where 15 of the residents had died. We swapped some jerry cans of hand sanitiser for some 60ml dispensers.
The look on his face when he talked about the home his relative was in was haunting. He looked terrified. I think he would have swapped his BMW for hand sanitiser.
The terrible death rate among people in nursing and residential care is replicated among ethnic minorities and the very poor.
I don’t think that this was a concious decision by the Govrnment to sacrifice marginal groups to protect politically senstive services and populations
Instead I think it is the result of a series of bad decisions made by Governments over the last 10 years. Resources were directed towards key groups of voters and politically important services like the NHS in order to keep politically promises like this one:
But the cuts still happened and they hammered social care and domiciliary care. Public health was moved out of the NHS into local government and it’s budgets were slashed. Initiatives to tackles health inequalities were scrapped and health outcomes for the poor and ethnic minorities declined.
We have been failing significant parts of the UK population for so long that we accept that failure as being a natural part of how society operates. Even when we see the starkness of the disparity of outcomes between rich and poor, white and ethnic minorities, vulnerable populations and the rest of us we have become used to it as a consequence of our political system.
I think that all of those 4 factors play a role in explaining why the NHS is outperforming the Government by a massive factor.
The gap between the performance of the Government and the performance of the NHS is so huge that people are starting to get crazier and crazier as they try and resolve their cognitive dissonance.
The Daily Mail, rather than acknowledge the failings of a Government they have uncritically supported has decided to buy their own PPE and give it to NHS staff:
Helpful though it might be it is still a daft gimmick from a newspaper that has tied itself to Government lies and now finds it hard to untangle itself.
If this goes on much longer I confidently predict that the Daily Telegraph will attempt to solve the PPE crisis by recycling gear from 80s acid house ravers.
The whole sorry show ends with Boris proudly clapping the NHS for saving his life and his career. The Government will never accept responsibility for it’s failures and will set up scientists, NHS leaders, Doctors and Nurses to take the blame for their failures while joining in with applause.
If we let them get away with this they will make the same crass errors the next time we face a crisis. And the next
And the next
Stay safe and stay home.