Cowper’s Cut: Beyond The Big Suck

Rarely have I been so relieved to be right as in my prediction in my last column that the peak of covid-19 demand would come in the next week. The ONS data also points to this.

Terms and conditions apply. Obviously, not all regions have necessarily yet had their peak. Likewise, it will feel yet more challenging for those areas of the north which never saw the same attenuation of covid-19 demand.

But it’s a significant moment. We know this was very largely achieved by a totally untenable repurposing and stretching of an already-stressed workforce. Diluting ICU staff-to-patient rations to problematic levels. And of course, reducing or stopping other activity, which will mean unmet needs backing up: you know all of this.

There’s not much to say about the ‘NHS not overwhelmed’ debate, other than to note that it definitely hasn’t been underwhelmed. And as for the ‘Protect The NHS’ slogan: well, at some point the public is likely to ask themselves why the NHS needs protection. The French and German systems are not using comparable slogans. The Opposition is missing a massive open goal here.

I cannot imagine how tough these past weeks and months must have been for NHS staff across almost the whole spectrum of jobs. Health policy guru Taylor Swift asks ‘are we out of the woods yet?’: of course we are not out of the woods yet, but at least the napalm drops of acute covid-19 demand seem to have stopped setting fire to the place.

But we are starting to get beyond The Big Suck.

You did that.

Thank you.

You’re doing the vaccination programme too (with help from the Army), which should be a big part of the route out of this (and we also need a “comprehensive suppression strategy”, in the words of consistently-right Professor Devi Sridhar).

Thank you again.

The vaccination programme is currently operating with a push model. Areas with lots of 80+ people left to do are being prioritised for vaccine supplies. Areas who are giving the vaccine to those in lower priority groups will see (or are seeing) their supplies reduced.  As well as this, the NHS Commissioning Board is rightly deploying a deprivation premium. There’s a recognition that people in deprived areas have higher mortality from covid and that people get older faster in those areas.

The programme will move to a pull model as soon as supply exceeds capacity: realistically, this might start happening in March. Right now, as I have previously written, the issue is that capacity exceeds supply.

Consequences

There are A Lot Of Consequences to the current state of things, which we need to discuss in the coming weeks. The biggest is the consequences for the workforce, and how it will impact the return towards more normal NHS performance (tl, dr – hugely).

The significant media has started to notice: you can read it in the nationals, or regionals, or specialist media.

But politics and policymaking have not stopped over the past week, and still matter majorly, so what follows will be a whistle-stop tour of all that.

Munchkin alert!

My colleague Sharon Brennan followed up on the issue of care home discharges, and wrote this important piece on our dear chums the Treasury Munchkins’ role in matters. Once again, this is fertile ground for a competent Opposition. It is staggering to see the Treasury mindset, acting like accountants when economists are required.

Those of you keen to compare governments’ responses to covid-19 may find the CoronaNet Research Project a useful resource.

Test and trace

TAT’s latest data shows that local authorities’ public health teams are five times more effective at contact tracing than the outsourcers.

“In the most recent week, the median number of contacts provided per case managed by local HPTs was 10, an increase from 8 in the previous week. For cases not managed by local HPTs the median was 2, and this has been approximately constant since the start of Test And Trace.”

Cases managed by local HPTs are being done by public health in local authorities: the others are done by Serco/Sitel and sub-contractors under Deloitte, as Professor Colin Talbot’s schematic confirms.

Is this being reflected in the outsourcers’ payments?

TAT was the subject of the Commons public accounts committee hearing this week.

The session saw Department For Health But Social Care permanent secretary Chris Wormald bend reality rather forcefully, by claiming the government’s 100,000 tests a day target was met by the end of April 2020. That claim was untrue, as HSJ readers know: the numbers were cheated by altering the definition, as HSJ revealed at the time.

Indeed the DHBSC’s former senior principal statistician Jon Hannah publicly criticised this at the time.

“I don’t want to get into the specific detail of individual contracts”, DHBSC’s second permanent secretary David Williams told the committee when asked about TAT consultants’ £7,000 day rate.

He should have been pulled up on that refusal to answer immediately: answering detailed questions was literally what he was there to do. Mr Williams carried on with un-evidenced round objects about consultants “dropping their usual public sector day rate”. That, too, went unchallenged, which was disappointing: chair Meg Hillier MP is usually far sharper than this.

Mr Williams told the committee that the 1,000 Deloitte consultants on TAT’s books in early October has ‘now come down to about 900’: their average daily fee is ‘about £1,000’. What A Triumph. If you’re working for Deloitte.

Baroness Harding played a lot on the newness of TAT as an organisation, which is not unfair. Less evidently well-founded was her assertion that “we had forecast an increase in demand for testing demand in early September … (but) the rise was larger than we expected”, which was not really what she was saying in September or November 2020.

The committee was not paying enough attention, and the noble Baroness’ rewriting of history was allowed to pass.

Mr Williams was instantly uncomfortable when asked about red flags on companies profiteering. He ummed and erred considerably, ending up with “not to my knowledge”.

Mr Williams also revealed that 20 per cent of 207 new contracts for covid-19 procurement (worth £1.3bn) have been made *without* tendering or competition under the legislation. Contracts are for “test consumables, lab capacity and so on”. That’s since November 2020 and the last NAO report.

As ever, you should read the Health Foundation’s Adam Briggs on the latest Public Health England surveillance data.

Fellow data expert Dr Duncan Robertson made astute observations on the pandemic:

“Maybe the Government should have followed the science after all. Compare the case rates: (a) at the end of June; (b) in September when SAGE advocated a circuit breaker; (c) the latest data - January 2021”, and is also highly helpful on the infection fatality rates of the new variant.

The NHS Commissioning Board: towards glasnost

The communications policy change over Christmas by the NHS Commissioning Board towards letting the media access hospitals has been quite the thing.

Before Christmas, hospitals were basically being banned from letting the media in to observe the growing crisis in covid-19 pressure on ICUs. Since Christmas, this policy has rather evidently been reversed.

The changed decision was the correct one, but then the original attempt to manage media interest in what everybody well-informed knew full well was under way simply made the NHS Commissioning Board look control-freakish. Trying to news-manage pandemic demand has been unhealthily reminiscent of the government’s pitiful attempts to “comms it”. It was as baffling a strategy as it was counter-productive, and it was extremely counter-productive.

Glasnost may lead to perestroika, I guess. We shall see.