The article below is drawing attention to fairly serious problems but I believe that the UK response to the Covid-19 epidemic is a fair and well intentioned attempt at dealing with a complex and massive event. The government and the NHS deserves our support during this period but we should be aware of the problems that are exposed and should not simply blame them on lack of funding.
Prior to the last election, when the NHS was put on a pedestal by the Labour Party, all political parties recognised that the NHS had severe management problems. The Coronavirus epidemic in the UK is exposing the NHS for what it is: hugely incompetent. Doctors and nurses are often dedicated and caring but the management has huge problems.
The fiasco over Coronavirus testing clearly proves this point. The UK has plentiful access to tests, Novacyt, one of the leading producers of Coronavirus tests is based in Camberley, Surrey. It states that on March 12 Orders are initially for eight hospitals to provide stocks in those locations for four weeks of planned testing. According to the Daily Mail "Novacyt has made £17.8 million selling its testing equipment to more than 80 countries via its Southampton-based subsidiary Primerdesign. But only £1million worth has been sold to the UK". The Health bureaucracy in the UK is rolling out these proven tests on a trial basis until 12 April.
There is no shortage of tests in the UK. The NHS has been offered tests, test equipment and facilities but has not taken up these offers. Testing is available but the procedures for directing patients and staff to test sites are not in place and test centres can be deserted or overcrowded: this is simply poor management.
My relatives who work for the NHS are reporting astonishing management failures. Staff have been immediately re-assigned to coronavirus wards that are currently empty, putting non-coronavirus patients at risk. There is plenty of Personal Protective Equipment (PPE) but it is held up at warehouses and some is even being sold on Ebay and elsewhere by criminal stores staff. Staff who buy their own equipment are being harassed by other staff in the name of "solidarity". Staff cannot say what is happening because of the fearsome reputation of the NHS when dealing with whistleblowers.
Managers are telling staff not to wear face masks except in limited, acute circumstances. This advice is based on the general efficacy of face masks over a range of clinical environments. In the case of droplet borne infections such as Covid-19 the advice is wholly incorrect. A well fitted FFP3 mask can offer a very high level of protection. Given that Covid-19 is an airborne viral infection that is most infectious before symptoms appear NHS staff should be routinely wearing quality masks during all patient contact. See references.
This face mask fiasco emphasises the need for management of the NHS by clinical staff. It should be run by doctors. When the government feared there would be a shortage of face masks they used the general data on face masks (ie: they are scarcely needed for treating leg ulcers) to stop the public buying them. NHS managers are not clinically qualified and cannot judge what is needed for the specific conditions of a droplet borne infection so imposed government propaganda on their staff rather than pointing out that the advice in the press was just to stop a run on masks.
It is crazy that at present an NHS Trust such as Salisbury has but one doctor on the executive board (University Hospital Boards are little better). Many doctors in their forties and fifties become tired of clinical practice (literally tired) and prior to the NHS reorganisation in the 1970s such doctors had a career path in hospital and health service management. This was stopped because the doctors became too powerful and could face down the government when pay and conditions were being negotiated. The government's solution was to exclude doctors from management. Would you replace the Generals in an army with CEOs of PR companies, NAAFI managers and territorials? Only if you wanted to punish the Generals but God help the troops.
The solution to our current problems is to create a consular system of management with clinical and non-clinical managers at each level and less power for non-clinical managers than at present. Half of the board of any Trust or Hospital should be doctors and the Chief Executive must always be a doctor. However, such changes are for action after this challenging epidemic is resolved. Support the NHS and government now.
References/further reading:
See Saving the NHS.
Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations US NLM
Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. PubMed
A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Pubmed
A cluster randomised trial of cloth masks compared with medical masks in healthcare workers.Pubmed
Mathematical modeling of the effectiveness of facemasks in reducing the spread of novel influenza A (H1N1). Pubmed
Prior to the last election, when the NHS was put on a pedestal by the Labour Party, all political parties recognised that the NHS had severe management problems. The Coronavirus epidemic in the UK is exposing the NHS for what it is: hugely incompetent. Doctors and nurses are often dedicated and caring but the management has huge problems.
The fiasco over Coronavirus testing clearly proves this point. The UK has plentiful access to tests, Novacyt, one of the leading producers of Coronavirus tests is based in Camberley, Surrey. It states that on March 12 Orders are initially for eight hospitals to provide stocks in those locations for four weeks of planned testing. According to the Daily Mail "Novacyt has made £17.8 million selling its testing equipment to more than 80 countries via its Southampton-based subsidiary Primerdesign. But only £1million worth has been sold to the UK". The Health bureaucracy in the UK is rolling out these proven tests on a trial basis until 12 April.
There is no shortage of tests in the UK. The NHS has been offered tests, test equipment and facilities but has not taken up these offers. Testing is available but the procedures for directing patients and staff to test sites are not in place and test centres can be deserted or overcrowded: this is simply poor management.
My relatives who work for the NHS are reporting astonishing management failures. Staff have been immediately re-assigned to coronavirus wards that are currently empty, putting non-coronavirus patients at risk. There is plenty of Personal Protective Equipment (PPE) but it is held up at warehouses and some is even being sold on Ebay and elsewhere by criminal stores staff. Staff who buy their own equipment are being harassed by other staff in the name of "solidarity". Staff cannot say what is happening because of the fearsome reputation of the NHS when dealing with whistleblowers.
Managers are telling staff not to wear face masks except in limited, acute circumstances. This advice is based on the general efficacy of face masks over a range of clinical environments. In the case of droplet borne infections such as Covid-19 the advice is wholly incorrect. A well fitted FFP3 mask can offer a very high level of protection. Given that Covid-19 is an airborne viral infection that is most infectious before symptoms appear NHS staff should be routinely wearing quality masks during all patient contact. See references.
This face mask fiasco emphasises the need for management of the NHS by clinical staff. It should be run by doctors. When the government feared there would be a shortage of face masks they used the general data on face masks (ie: they are scarcely needed for treating leg ulcers) to stop the public buying them. NHS managers are not clinically qualified and cannot judge what is needed for the specific conditions of a droplet borne infection so imposed government propaganda on their staff rather than pointing out that the advice in the press was just to stop a run on masks.
It is crazy that at present an NHS Trust such as Salisbury has but one doctor on the executive board (University Hospital Boards are little better). Many doctors in their forties and fifties become tired of clinical practice (literally tired) and prior to the NHS reorganisation in the 1970s such doctors had a career path in hospital and health service management. This was stopped because the doctors became too powerful and could face down the government when pay and conditions were being negotiated. The government's solution was to exclude doctors from management. Would you replace the Generals in an army with CEOs of PR companies, NAAFI managers and territorials? Only if you wanted to punish the Generals but God help the troops.
The solution to our current problems is to create a consular system of management with clinical and non-clinical managers at each level and less power for non-clinical managers than at present. Half of the board of any Trust or Hospital should be doctors and the Chief Executive must always be a doctor. However, such changes are for action after this challenging epidemic is resolved. Support the NHS and government now.
References/further reading:
See Saving the NHS.
Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations US NLM
Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. PubMed
A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Pubmed
A cluster randomised trial of cloth masks compared with medical masks in healthcare workers.Pubmed
Mathematical modeling of the effectiveness of facemasks in reducing the spread of novel influenza A (H1N1). Pubmed
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