Shifting the Blame

In the midst of daily terrible news, at last yesterday brought real hope in the form of a convincing win for new leadership of the Labour Party and common sense prevailing at the MoJ regarding releasing 4,000 prisoners. 

Especially in the midst of a world pandemic that threatens not only life but the very future of all our political, economic and social structures, it would seem sensible to just draw a veil over the last few years. Many will feel there is at last a competant leader of the opposition that looks and sounds more like a prime minister than the present shambling occupant of No10. In the end that's all that matters, the public getting used to the idea there is a viable alternative in waiting and that can't come quickly enough. 

I honestly don't think there are words strong enough to describe how dreadful the Tory media machine has been this week in trying to shift the narrative for blame away from the government and on to the NHS, such as this in the Telegraph from the cringing and obsequious former editor Charles Moore:- 

The inflexibility of our lumbering NHS is why the country has had to shut down

"Why are we clapping the NHS? It is right and just to clap NHS workers, but that is not the same thing. Virtually everyone has reason to thank good nurses, doctors and paramedics. But if we are to praise large organisations for how effectively they have dealt with the coronavirus crisis, we should be clapping vigorously for Sainsbury’s, Tesco, Waitrose and Morrisons, who have responded nimbly to sudden extra demand for one of life’s basics – food. We should give only rather tepid applause for the efforts of the NHS to look after another of life’s basics – health.

As its name suggests, the National Health Service is there to serve the health of the nation. In this crisis, the roles have reversed – it is seen as the duty of the nation to serve the NHS. “Protect the NHS. Save lives,” says the slogan, in that rather surprising order. Children are made to recite it like a prayer. How are we to do this? We must help the NHS by avoiding hospitals and surgeries, we are told. The Government’s policy of lockdown is in significant part dictated by the demands not of patients, but of the NHS, and by its lack of adaptability and readiness...."

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The paywall prevents much more, but readers will get the drift. Despite the spin, we all know it has been ten years of deliberate under-funding of the NHS that have left us unprepared for the pandemic. This from the Guardian in December 2019:- 

The number of hospital beds has fallen to its lowest level ever, despite the head of the NHS warning that bed closures have gone too far. The health service in England has cut so many beds in recent years that it has just 127,225 left to cope with the rising demand for care, which will intensify as winter starts to bite.

In total, 17,230 beds have been cut from the 144,455 that existed in April-June 2010, the period when the coalition Conservative/Liberal Democrat government took office and imposed a nine-year funding squeeze on the NHS, even though critics cautioned against it because of growing pressures on the service.

The 127,225 figure is the smallest number of beds available in acute hospitals, maternity centres and units specialising in the care of patients with mental health problems and learning disabilities since records began in 1987/88.

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Given that the dire consequences of this under-funding are becoming acutely apparent, the servile Tory media have started to collude in shamelessly trying to shift the blame and attention has particularly focused on the gross lack of life-saving ventilators. The Charles Moore article goes on:-

"Behind that ventilator comparison lies a story. Three weeks ago, the NHS belatedly admitted within government that it had failed to get enough ventilators. The Cabinet Office stepped in to help procure. Thanks in part to the energy of the distinguished surgeon Professor Lord Kakkar, University College Hospital, Formula I and Mercedes Benz got together to produce the CPAP (Continuous Positive Airways Pressure) machines that are one up on normal oxygen masks but less invasive than the full, intubating ventilators. Next week, the repurposed Mercedes Benz F1 factory in Brixworth expects to produce 1,000 CPAPs a day.

In his skilful performance at the daily virus press conference on Thursday, the recovering Health Secretary, Matt Hancock, obliquely expressed his frustration. He exclaimed how well “non-ventilator companies” had come up with inventive solutions to produce ventilators fast. He issued a “call out” to British life sciences, laboratories and universities to do likewise for antibody tests."

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There is indeed a story to the lack of ventilators and the blame lies firmly with a Tory government. This from The New Statesman of 16th March:-

Government documents show no planning for ventilators in the event of a pandemic

After failing to prepare, the UK now faces a grave shortage of the machines that will keep critical patients alive.

In October 2016 the UK government ran a national pandemic flu exercise, codenamed Exercise Cygnus. The report of its findings was not made publicly available, but the then chief medical officer Sally Davies commented on what she had learnt from it in December 2016.

“We’ve just had in the UK a three-day exercise on flu, on a pandemic that killed a lot of people,” she told the World Innovation Summit for Health at the time. “It became clear that we could not cope with the excess bodies,” Davies said. One conclusion was that Britain, as Davies put it, faced the threat of “inadequate ventilation” in a future pandemic. She was referring to the need for ventilation machines, which keep oxygen pumping in patients critically ill with a respiratory disease such as coronavirus.

Despite the severe failings exposed by Exercise Cygnus, the government’s planning for a future pandemic did not change after December 2016 – at least not formally. The government’s roadmap for how to respond to a coronavirus-like pandemic has long been available online, and the three key documents – the 70-page “Influenza Pandemic Preparedness Strategy”, 78-page “Health and Social Care Influenza Pandemic Preparedness and Response” and 88-page “Pandemic Influenza Response Plan” – were published in 2011, 2012 and 2014 respectively. These plans were tested and failed, yet these documents were not rewritten or revised.

They share a glaring shortcoming: not one of them mentions ventilators, which are now in such high demand that Matthew Hancock, the Health Secretary, told British manufacturers on 14 March, “If you produce a ventilator, we will buy it. No number [you produce] is too high.” He urged firms from Rolls-Royce to JCB to stop what they do and to begin making ventilators.

The government does not have a stockpile of ventilators, as the documents made clear and Hancock has confirmed. All three of the plans refer to stockpiles, but only of antivirals, antibiotics and personal protective equipment for NHS staff. Aside from face masks, the only mention of equipment in Public Health England’s Pandemic Response Plan is to do with IT staff being trained to use smart boards. Medical devices are not mentioned in any of the documents.

Hancock’s entreaty to manufacturers was the first time the government has publicly recognised Britain’s urgent need for more ventilators – six weeks after the first cases of coronavirus were reported in the UK on 31 January. But the necessity for the devices in any pandemic has long been clear. As the 2011 preparedness strategy puts it, “Critical care services… are likely to see increases in demand during even a mild influenza pandemic. In a moderate or severe influenza pandemic demand may outstrip supply, even when capacity is maximised… it may become necessary to make decisions concerning priority of access to some services.”

“Plans to increase capacity of these [critical care] services are an important aspect of planning,” the document continues, but these putative plans are strikingly absent from the government's otherwise extensive documents. And Downing Street officials have, according to the Sunday Times on 15 March, found such planning to be non-existent. Pre-existing pandemic plans, an official is quoted as saying, “never went into the operational detail”.

Britain now faces a grave shortage of the machines that will keep critical patients alive. By combining government statements with publicly available documents, that shortage can be estimated. The government expects between 60 and 80 per cent of the population to contract coronavirus, or between 40 and 53 million people. Assumptions laid out in 2018 by the Scientific Pandemic Influenza Group on Modelling, or SPI-M – a working group of 10 academic teams – predict that 4 per cent of cases will require hospitalisation; this is in line with estimates for Covid-19, the disease that is caused by the virus Sars-Cov-2, both commonly referred to as coronavirus.

SPI-M's modelling also assumes that a quarter of those hospitalised will need a ventilator; this, too, aligns with the World Health Organisation's findings on coronavirus in China, and may even be an under-estimate. In short, at least 1 per cent of all cases can be expected to need ventilation, or between 400,000 and 530,000 people. Modelling released on March 16 by a team at Imperial College, which has informed government planning, suggests a 1.3 per cent rate. That rate has risen after new data from Italy.

The government has said that it expects 95 per cent of all cases to occur over a nine-week period, with 50 per cent coming during a three-week peak. This reflects modelling by SPI-M in 2018, available online, and the course of the 1957 influenza pandemic in the UK. This means that during the peak, which is expected to arrive in Britain in late May or June, 15 to 20 per cent of all coronavirus cases will hit the NHS every week for three weeks. Assuming only a 1 per cent rate, rather than the higher rate in Imperial's latest modelling, the number of patients needing a ventilator would therefore range from 60,000 per week to more than 100,000.

The United Kingdom has 5,000 ventilators. Many are sure to already be in use, as ventilators are deployed with intensive care beds, and Britain’s intensive care beds run at 70 to 80 per cent capacity most months. Each ventilator will typically be required for at least ten days, making the gap between demand and supply more acute over time.

On 25 February, Bruce Aylward – the epidemiologist who led the recent WHO mission to China – returned from Wuhan, where the crisis began, and gave a warning to the world. China, Aylward explained, had done something extraordinary. It had managed to wrest control of an exponentially expanding epidemic. “When you spend 20, 30 years in this business,” Aylward said, holding up a graph that showed the improbable slowdown in cases across China, “it's, like, ‘Seriously, you're going to try and change that [curve] with those tactics?’”

The UK has not attempted to emulate China's response, or those of other countries such as Singapore, Hong Kong and Taiwan that have successfully curbed, or held back, Covid-19. But the government’s high-risk strategy is informed by a belief that coronavirus cannot be stopped and that the success of others in checking it is only temporary – because the virus will return once people resume normal life. The government’s strategy is led by Christopher Whitty, the chief medical officer for England. Professor Whitty is an epidemiologist and is recognised as brilliant in his field. “He is a very thoughtful and careful man,” Deirdre Hollingsworth, a leading epidemiologist at Oxford University, told me.

Whitty is not only respected but has long prepared for a pandemic. As the professor of physic at Gresham College – a position which dates back to the 16th century and reflects his standing – his 2018 lecture series was on how to control one.

He now has a real-life pandemic to control, and his bold strategy is increasingly being doubted. He recently told a parliamentary select committee that the NHS will “flex” and cope in the face of coronavirus. But with a bewildering absence of ventilators, inexplicably unmentioned in official plans and already in short supply, it is not clear how.

Harry Lambert