High court opens pandemic blame game 29 April 2022 The High Court judgement that the policy of discharging untested hospital patients into care homes as Covid-19 erupted in the UK was unlawful sheds light on the respective roles of advisers and ministers as they grappled with the evolving science, while Matt Hancock’s response shows his determination to blame officials for mistakes. The first wave of the virus killed more than 20,000 care home residents. The judgement – Gardner & Harris v secretary of state for health and social care – is a significant staging post for the public inquiry, which will be led by Baroness Heather Hallett. It reveals how evidence for asymptomatic transmission gathered pace and the extent to which officials and ministers were aware of it and reflected it in public statements and policy. On 28 January 2020, just under a month after China notified the World Health Organization of what we now know as Covid- 19, the Scientific Advisory Group for Emergencies – SAGE – concluded “there is limited evidence of asymptomatic transmission, but early indications imply some is occurring”. In February and early March, scientific papers around the world gave increasing indications that asymptomatic transmission was occurring. Ministers knew there was growing evidence for it – health minister Lord Bethell told the Lords on 9 March that “large numbers of people are infectious or infected but are completely asymptomatic and never go near a test kit”. Read the full article at Civil Service World __________________________________________________________________ Ockenden exposes typical NHS failures 31 March 2022 Donna Ockenden’s final report on maternity failings at Shrewsbury and Telford Hospital NHS Trust once again exposes common problems underlying health service scandals: failures in leadership and teamwork, failure to follow clinical guidelines, failure to learn and improve, and a failure to listen to patients. The inquiry identified “significant or major concerns” in the care involved in nine maternal deaths, 131 stillbirths, 29 cases of hypoxic ischaemic encephalopathy (HIE), and 70 neonatal deaths, as well as around 65 cases of brain damage which were often diagnosed years later. Failures identified by Ockenden include poor antenatal care for vulnerable women, repeated failures to correctly assess fetal growth, reluctance to refer women to tertiary centres to address fetal abnormalities, poor management of multiple pregnancies, poor management of gestational hypertension, failure to recognise sick or deteriorating women, failure to act on abnormal fetal heart patterns and failure to escalate concerns. Shortcomings in leadership and teamwork—important factors identified in Bill Kirkup’s investigation into failings at the maternity unit in Furness General Hospital, Morecambe Bay—included a culture of bullying and a failure by the board to face up to problems. One staff member who tried to raise concerns “was referred straight to occupational health. It seemed that as I dared to raise a concern I must obviously be mentally unwell… This whole conversation was held in public.” Read the full article at BMJ __________________________________________________________________ Javid plan will unleash new NHS chaos 2 February 2022 The reported plan by health and social care secretary Sajid Javid to introduce “academy” style hospitals risks triggering organisational chaos in the NHS while failing to address any of its underlying problems. According to the Times, barely six months after returning to the cabinet Javid is planning to force failing hospitals to become “reform trusts,” similar to academy schools, to address wide variations in performance across the health service. It is possible that chains of hospitals will be run by leading NHS managers, or even outside sponsors. Everything about this plan is flawed. It shows that a decade after Andrew Lansley’s disastrous attempt to use market mechanisms to drive improvement in the NHS, this government has forgotten all the painful lessons of the cost, political damage and impact on services of ill-conceived top-down NHS reorganisations driven by ministerial whim rather than evidence. The reform trust plan is being stitched together just as parliament is considering the Health and Care Bill, which aims to dismantle the worst excesses of the Lansley reforms and provide the legal foundations for the local integration of services. Javid’s new plan risks unleashing yet another major reorganisation of the health service before the current one is even bedded in. Read the full article at BMJ __________________________________________________________________ Sleepwalking into two-tier healthcare 27 July 2021 The pandemic has driven both the NHS and a growing number of its patients towards private healthcare. Heightened awareness of the health service’s frailties, fuelled by repeated warnings that it could be overwhelmed, has prompted a surge in private medical insurance. As the UK drifts into a possible future of two-tier healthcare, with the wealthy given more chances to skip the queue, we need to ask whether the founding principle of the UK’s health service – free at the point of need – is being eroded in front of our eyes. There are about 90 private healthcare providers in the UK, such as HCA, Circle, Ramsay, Bupa, Spire and Nuffield Health. The industry is worth about £9bn a year, compared with £177bn of government healthcare spending across the UK in 2019. It includes hospitals, clinics, diagnostics and imaging and urgent care; typical work is general surgery, oncology, obstetrics, trauma and orthopaedics. Its customers are medical tourists, NHS referrals, people with private medical insurance and self-pay individuals – so-called “out of pocket” payers. This last group includes people paying for one-off operations to avoid waiting for NHS treatment. Ramsay earns about 80% of its revenues from NHS referrals, Spire 30%. The need to clear the operations backlog has made NHS trusts a lot less squeamish about working with the private sector. Read the full article at the Guardian __________________________________________________________________ Pandemic drives global workforce crisis 16 July 2021 Before the pandemic, the World Health Organization projected that there would be a shortage of 18 million health workers by 2030, compared with demand for 80 million. While lower- and middle-income countries would feel most of the pain, no-one would escape. The pandemic looks likely to attract some people into healthcare careers while driving many more out. In the UK, inspirational stories about the contribution of nursing to the pandemic response has led to applications for nursing degrees jumping by a third to a record 60,000 this year, with surges in both school leavers and people looking for a mid-life change of direction. But there is compelling worldwide evidence of healthcare staff suffering from depression, anxiety and insomnia during the pandemic, while industrial disputes and strikes have been seen in at least 84 countries, largely driven by poor working conditions and lack of PPE. By September 2020, health workers accounted for roughly 14 per cent of all recorded Covid-19 cases globally, despite making up less than three per cent of the population in most countries. Research by the International Council of Nurses found that one in five national nursing associations reported increasing levels of nurses quitting, while 90 per cent reported increased numbers of nurses planning to leave once the pandemic subsided. Read the full article at World Healthcare Journal __________________________________________________________________ Errors undermine pandemic response 29 January 2021 The annual analysis of Whitehall by think tank the Institute for Government reveals how the response to the COVID-19 pandemic has been repeatedly undermined by avoidable ministerial failures. Whitehall Monitor – now in its eighth edition – gathers and analyses a huge array of data on all aspects of government performance, such as spending, staffing and ministerial activity. Its findings – in areas such as procurement, working with devolved and local governments, and public communications – lay bare just how poorly ministers have handled the pandemic. The numbers bring home the enormity of the policy and operational challenges faced by ministers and civil servants. Government spending hit £1 trillion (US$1.3tn) in 2020/21 for the first time, according to the research – an increase more than £200 billion (US$275bn) on the previous year. This includes £147 billion (US$201bn) supporting households and businesses, alongside £22 billion (US$30bn) on a test and trace system which, according to the government’s own scientific advisers, has only had a “marginal impact” on reducing transmission of the virus. The bill for personal protective equipment (PPE) illustrates how ministers jettisoned standard procedures for handling public money. The total for PPE has reached £15 billion (US$20bn), according to the Monitor. Read the full article at Global Government Forum __________________________________________________________________

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