Coronavirus (Non-Politics)

[OldBlueLady]

I don't know if it's been asked or explained on this thread, but without getting too political, can someone please explain to me, without being too patronising, why, when we have hospital Trusts and privately owned care homes, somehow it's the Government's fault they didn't have enough PPE in place, because I'm blowed if I can understand it?

Surely in both cases, people at the top are paid/receive huge salaries which makes them accountable for everything that goes on in their respective settings?

 

[Blue Yonder]

probably wouldn’t have made a great deal of difference. Italy and Spain had much harsher lock downs than we did and both have lost similar numbers, oh, as have France. But hey, if you want a cheap dig at the government which is exactly what your post is then crack on.

If the R rate for Covid 19 is 3 as has been widely quoted then surely the maths say an earlier shutdown would have made a very big difference in the sort term ? You can’t just dismiss it ? Whether the timing was right or wrong overall we won’t know for some time but I’m sure the decision was in good faith and based on the advice and data to hand.

 

[Blue Yonder]

I don't know if it's been asked or explained on this thread, but without getting too political, can someone please explain to me, without being too patronising, why, when we have hospital Trusts and privately owned care homes, somehow it's the Government's fault they didn't have enough PPE in place, because I'm blowed if I can understand it?

Surely in both cases, people at the top are paid/receive huge salaries which makes them accountable for everything that goes on in their respective settings?

It seems that contingency planning for out of the ordinary events like pandemics is done at a National (central government) level rather than a Trust level. I guess if it was done at a Trust level there would be different states of preparedness in different parts of the country. Someone else may have a better answer.

 

[C'mon you Shrimpers]

I don't know if it's been asked or explained on this thread, but without getting too political, can someone please explain to me, without being too patronising, why, when we have hospital Trusts and privately owned care homes, somehow it's the Government's fault they didn't have enough PPE in place, because I'm blowed if I can understand it?

Surely in both cases, people at the top are paid/receive huge salaries which makes them accountable for everything that goes on in their respective settings?

I think only when the analysis is done which can only happen once the whole thing is over including and second and third wave and comparisons with the average yearly death rate (about 600,000) and the possibly different methods of recording death then proper conclusions will be made. However I expect hospital managers are in for more criticism than they are currently getting for their emergency and contingency planing.

 

[Member]

probably wouldn’t have made a great deal of difference. Italy and Spain had much harsher lock downs than we did and both have lost similar numbers, oh, as have France. But hey, if you want a cheap dig at the government which is exactly what your post is then crack on.

If wanting fewer deaths is a ‘cheap dig’ then fine.

 

[C'mon you Shrimpers]

I think we're drifting into politics a good year before the evidence will be there. And that is never sensible.

 

[OldBlueLady]

It seems that contingency planning for out of the ordinary events like pandemics is done at a National (central government) level rather than a Trust level. I guess if it was done at a Trust level there would be different states of preparedness in different parts of the country. Someone else may have a better answer.

I think only when the analysis is done which can only happen once the whole thing is over including and second and third wave and comparisons with the average yearly death rate (about 600,000) and the possibly different methods of recording death then proper conclusions will be made. However I expect hospital managers are in for more criticism than they are currently getting for their emergency and contingency planing.

Thanks for your responses.

I think the thing is that PPE was highlighted as being in short supply right from the outset and that's what I particularly struggle with. Hospitals should have had plenty to go around for a few weeks, surely?

 

[Member]

Thanks for your responses.

I think the thing is that PPE was highlighted as being in short supply right from the outset and that's what I particularly struggle with. Hospitals should have had plenty to go around for a few weeks, surely?

Yes but it’s plenty to go around for a few weeks and in non-infectious situations. Full COVID PPE is a lot of stuff and has to be binned and replaced each time the wearer takes a break. The supplies ran out very quickly. There was a national responsibility to maintain a stockpile but this was allowed to run out before the pandemic hit. Austerity measures have been mentioned as a reason for this.

This is an apolitical comment - public health and pandemic planning hasn’t been taken seriously by many western governments of any political persuasion. Hopefully that will change. In Asia and places that have suffered pandemics in the past they’ve learned from that and been much better prepared. Hopefully we won’t let the current or future governments of this country get away with being unprepared again. We owe it to the 10s of thousands of people who’ve died in this country

 

[londonblue]

Here's a couple of snippets from my doctor friend. Bear in mind he's a consultant anaesthetist in a London hospital that has a centre for infectious diseases, so he really is on the front line:

• He hasn't been short of PPE. No-one at the hospital has. He did tell me that they were about to be trained on how to put on and take off hazmat suits just in case, but the trust ran out of hazmat suits! They haven't, however run out of PPE.
• The hospital is starting to settle down so there's less overcrowding. "Overcrowding, how can there be overcrowding given we have the Nightingale Hospital in Excel?" I hear you ask. Well, at last count that hospital (with 4000 beds) had a grand total of 30 patients. Less than 1% of capacity. Why? Because they keep closing to referrals because of a lack of staff. It's been a complete waste of time and effort.

 

[C'mon you Shrimpers]

That is the nature of emergency planning. You plan for the worst. When I was involved years ago it was that the ESSO depot at Purfleet had gone up and half the people needed to be evacuated. All this was at local level and pretty impressive. Never was likely. Much less so than a pandemic.

 

[Member]

Nightingale was necessary because you can’t instantly create bed space and ventilator wards.

however, the limiting factor was always the number of qualified and trained intensivists/anaethetists and supporting staff. The NHS coped by bringing them in from other specialities, off elective work, and out of retirement. However, there just aren’t the staff available to support the nightingales at full capacity. Fortunately it doesn’t seem like it’s been needed so far, in part because of how dramatically the NHS cut back on other services.

 

[C'mon you Shrimpers]

Pubey I respect your knowledge. However as a now happily retired at times senior manager in a local authority I've been amazed at the lack of PPE. It is so basic. It should have nothing to do with government or central planning apart from guidance about how many months stockpile is sensible. It should be local. And it is in my opinion absolutely the responsibility of local managers. If they claim not to have the money then I'd expect there to be a clear paper trail upwards explaining the difficulties. Reflecting on my time in social services it was our inability to attract staff that was the problem, for some reason few people wanted to be social workers, but we never ran out of forms or pens.

 

[Tommy2holes]

With the lack of hospitals available in the country I'd be quite happy to see nightingale become a permanent fixture.

I'm also hoping that this social bubble idea becomes a possibility in the coming weeks. Haven't seen my youngest (3) and my other half for nearly 7 weeks.

I know everyone is in the some boat but it's starting to become very wearing.

 

[Member]

Pubey I respect your knowledge. However as a now happily retired at times senior manager in a local authority I've been amazed at the lack of PPE. It is so basic. It should have nothing to do with government or central planning apart from guidance about how many months stockpile is sensible. It should be local. And it is in my opinion absolutely the responsibility of local managers. If they claim not to have the money then I'd expect there to be a clear paper trail upwards explaining the difficulties. Reflecting on my time in social services it was our inability to attract staff that was the problem, for some reason few people wanted to be social workers, but we never ran out of forms or pens.

I'm not an expert on NHS procurement and the PPE issue but here's a few things I know.

- There is a central responsibility to respond to a pandemic, given the national (and global) threat they carry. The government has committed to this over the years. If there was a terrorist threat to the UK from abroad you wouldn't blame the local police services for a limited response.

- Pandemic planning work and strategies required the national government to maintain a stockpile of PPE and other equipment. This didn't happen, or didn't happen effectively

- Every NHS trust has a pandemic plan, that covers top line management of the pandemic and services in they provide. These trusts will also have a plan to ensure access and management of their own PPE supplies.

- Most NHS trusts are bankrupt. Their funding has been cut in real terms, they don't have the ability to maintain months and months of stockpiles of PPE in the off-chance of a pandemic. PPE perishes over time so the stockpile has to be continually refreshed, and storage costs money. Remember that one of the first things that was done by the government was to wipe off the "debts" of the Trusts and CCGs. These debts are the accumulation of underfunding our NHS. Preparing for a pandemic costs a lot of money, which Trusts clearly don't have.

- given we were a bit behind other countries in terms of cases, and also a by most accounts slow to react, we were back in the queue for PPE that was becoming harder to get across the globe. There have been lots of issues in terms of sourcing and actually getting PPE - flights diverted, shipments going missing etc. A lot of PPE is made in China, and the disruption to trade and materials has made supply of PPE very difficult

- local NHS trusts only have so much ability to negotiate procurement of PPE - if there isn't any in the country, how are they supposed to track more down?


Londonblues post aligns with what I've heard from friends and family - PPE on the frontline has generally been available. However, PPE has been in short supply across the NHS and that will have caused disproportionate issues with NHS staff off the frontline getting infected and some dying - GPs etc. An issue has been PPE across the social care sector - which seems to have been a real challenge, and the private provision of a lot of care homes caused difficulties in quickly accessing PPE. Definitely an area where lessons have to be learned.

 

[londonblue]

Nightingale was necessary because you can’t instantly create bed space and ventilator wards.

however, the limiting factor was always the number of qualified and trained intensivists/anaethetists and supporting staff. The NHS coped by bringing them in from other specialities, off elective work, and out of retirement. However, there just aren’t the staff available to support the nightingales at full capacity. Fortunately it doesn’t seem like it’s been needed so far, in part because of how dramatically the NHS cut back on other services.

Yes it has. On a Zoom call we actually asked our friend whether it was needed or not, or have the London hospitals coped without it, i.e. there's only 30 patients there because it hasn't been needed. He answered that they're all struggling to cope and certainly his hospital would have referred patients there had they been able to. Because they weren't able to refer patients they've all been working round the clock with just about no time off or even a break during their shifts. He was physically and mentally exhausted.

Personally I wouldn't be surprised if he decides after this to ditch the NHS and concentrate purely on his private work.

 

[Shrimping In The House]

The UK's problem is that it has a heavily centralized, tax funded free at point of use for everyone health service. Some of the countries that are said to be handling the situation better than us eg S. Korea spend far less per head of population on health than we do so its not just about 'cuts' and 'underfunding'. Some of them eg Germany have a much more decentralized health system and a people in employment have to take out personal health insurance.

 

[Member]

The UK's problem is that it has a heavily centralized, tax funded free at point of use for everyone health service. Some of the countries that are said to be handling the situation better than us eg S. Korea spend far less per head of population on health than we do so its not just about 'cuts' and 'underfunding'. Some of them eg Germany have a much more decentralized health system and a people in employment have to take out personal health insurance.

The US has a decentralised system and spends twice as much as us (four times as much as South Korea). It’s definitely not that simple.

 

[Special Blue]

I was interested to see what Pubey was saying to Mk regarding the flu jab.
I know with covid it's a different beast but I always thought(probably wrongly now) that if you had normal flu you couldn't get it the following year as you had the antibodies.
I know tests are going on regarding covid antibodies but if no vaccine is found is the current situation something we need to get used to?

 

[MK Shrimper]

I was interested to see what Pubey was saying to Mk regarding the flu jab.
I know with covid it's a different beast but I always thought(probably wrongly now) that if you had normal flu you couldn't get it the following year as you had the antibodies.
I know tests are going on regarding covid antibodies but if no vaccine is found is the current situation something we need to get used to?

Covid may mutate into something far less harmful as per The Spanish flu....but I think they'll be a vaccine, just not any time soon.

 

[Special Blue]

I always thought with normal flu the best way to not get it is to get it if you know what I mean.
If covid was the same it would buy people who've had it time while those that haven't could be vaccinated?
So if You had flu last year you will be fine the following year(with covid who knows?).