Isn’t state planning great?

UK manufacturers are to export surplus medical ventilators after they produced 14,000 to treat coronavirus patients only to find that most were not needed.

Boris Johnson hailed the success of the “ventilator challenge”, which began in mid-March when he urged British industry to help produce up to 30,000 of the devices amid fears that NHS supplies could be overwhelmed.

36 thoughts on “Isn’t state planning great?”

  1. Nightingale courts are being spoken of, too.

    Remember how useful those hospitals were?

    Oh, and reducing juries to seven in number, if not abolishing them altogether, to catch-up with the backlog in criminal cases.

    Still, never let a good crisis go to waste!

  2. They don’t need them because all the patients died.

    I’ve just lost two relatives who caught Covid in hospital . One of them was just visiting ! I was speaking to another clinician yesterday who has been ordering that his acute patients be treated at home, because it is too dangerous to send them to hospital.

  3. I’d say its pretty likely that the medical ‘profession’ is probably the biggest single ‘super spreader’ of CV-19. Certainly in the UK where the NHS’s version of cleanliness is a minimum wage contractor pushing a broom about.

  4. @ Ottokring
    Not all of them, just a majority.
    Which is why I don’t clap the NHS.
    A quick scan of worldometers gives me the impression that the UK has the highest death:infection ratio in the world, more than three times that of the USA, 50% higher than Spain, more than 10% higher than Italy whose health system was swamped and to avoid imitating Italy we had lockdown and the Nightingale hospitals and …
    The NHS management made a mess – e.g. had plenty of PPE, but they sent it to the wrong places until the army took over the logistics.

  5. The death figs are a pack of lies. CCP is a bad winter flu–at WORST.

    Every year flu kills 30-50 thousand and as in HK1968 many more sometimes. They have labelled almost every death as CCP virus. Plus actually killed more with their “care” home antics.

    Agreed the NHS is useless.

  6. ” Certainly in the UK where the NHS’s version of cleanliness is a minimum wage contractor pushing a broom about.”

    Often a third-world import to whom shitting in a toilet or washing their hands is a novel idea – mind you, that goes for some of the medical staff too.

  7. “they sent it to the wrong places until the army took over the logistics”

    Interesting isn’t it. 1,500,000 NHS workers helped out by 4,450 members of the army who sorted out that logistics problem, fitted out the Nightingale hospitals and are the people we were seeing on the news doing the mobile testing. Is the army just better at PR or is the NHS truly useless?

  8. @Ecksy

    Although the specific deaths labelled or not as “COVID” are almost certainly not quite the correct ones, have to say the “excess deaths” figure doesn’t look great either… now you can argue that a portion of that is lockdown-related, a portion of that is due to people avoiding hospital (and who would have avoided hospital regardless of lockdown, they just sounded like dangerous places and that chest pain can surely wait, can’t it?) but I suspect the vast majority is genuinely COVID-related. It’s a nasty disease.

    The flu comparison is tricky because the figures there seem pretty useless too. In terms of attributable excess mortality your 30k-50k seems a bit overcooked, more like 10k-20k recently according to the FluMOMO model and sometimes less, see table 7 of https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/839350/Surveillance_of_influenza_and_other_respiratory_viruses_in_the_UK_2018_to_2019-FINAL.pdf

    But in terms of actual recorded deaths in hospital due to flu, the same document puts it as just a few hundred!

    PHE’s older estimate which for some reason is still frequently quoted is that “estimates of the annual number of deaths attributable to flu range from 4 to 14,000 per year, with an average of around 8,000 per year”. https://www.gov.uk/government/news/public-health-england-and-the-nhs-prepare-for-unpredictable-flu-season

    Which I suspect shows how big a difference it can make when you switch methodology – looking into the reports, seems these “excesses” were calculated based on EuroMOMO rather than FluMOMO.

    There’s even a “vaccine knowledge” page produced by Oxford University that reckons “In the UK it is estimated that an average of 600 people a year die from complications of flu. In some years it is estimated that this can rise to over 10,000 deaths (see for example this UK study from 2013, which estimated over 13,000 deaths resulting from flu in 2008-09)”. Obviously quoting out of date figures but the true figures won’t have shifted as much as that suggests – I can only think they somehow conflated a couple of hundred recorded hospital deaths with figures in the upper thousands for excess mortality. https://vk.ovg.ox.ac.uk/vk/influenza-flu

    Remarkable how rubbish and inconsistent the stats are for such a well-known and understood threat, though I do understand why it’s tricky to assign causation to any particular death with/from flu. If the flu stats are this dodgy then no surprise the COVID ones are problematic.

  9. “Is the army just better at PR or is the NHS truly useless?”

    The army largely consists of men and the NHS largely consists of women. That fact alone will explain why one state owned funded and run organisation can get stuff done, and another can’t. I am convinced that the gradual takeover of the NHS by women over the last 30-40 years is one of the major reasons it fails so badly. If you sacked every women in the NHS above nurse level and gave a man the same job and the same budget it would function far better.

  10. The NHS has been lousy at infection control for ages. A friend who ran infection control in a large Aussie hospital told me as much back in the 80s.

    Why have so many governments let this horrible tradition continue? A fear of challenging the Established Religion?

  11. Bloke in North Dorset

    TBF little was known about Covid-19 and how to treat it. All the evidence from Italy was that they would be needed, lots of them and quickly.

    Since then doctors have learned that the way the virus affects the lungs putting people on ventilators can be a death sentence and they are only using where they think there may be an outside chance of success and that excludes old people plus they have other treatments.

    Under the circumstances producing those ventilators should be seen as a sign of success, that they weren’t needed is hindsight bias.

    I’m also starting to take the view that there won’t be a second wave. We now know enough to drop the “novel” and rather than any second wave I think we will see a series of flare ups. What we need is. Govt with balls that does react like a scared cat every time there’s a slight increase in numbers and calmly does a contact and trace and just isolates the infected.

    As to the Army and logistics: They’re task oriented, don’t clock watch, have no interest in the petty politics of a large bureaucracy, have no political axes to grind or jobs to protect against the free market and, most importantly, are used to making decisions with incomplete information and don’t hang people out to dry if they make a decision that later turns out to have been the wrong one, as long as it was made in good faith. Of course they will succeed every time in these types of situations.

  12. “that they weren’t needed is hindsight bias.” I agree; there’s plenty of things to criticise Them for – that’s not one.

  13. AndyF: The Army’s job *is* logistics. As all the demands by the NHS for the government to buy medical supplies showed, logistics isn’t the NHS’s job. “I’ve got a medical degree, you want *me* to do the shopping?”

  14. @ jgh

    And yet when it came to Brexit, all these Medical Doctors suddenly became experts in supply chain logistics so as to lecture the proles on how we’d run out of medicine within days.

    Of course, holding two completely opposing views in your head at the same time is the only ability Lefists have.

  15. “As to the Army and logistics: They’re task oriented, don’t clock watch, have no interest in the petty politics of a large bureaucracy, have no political axes to grind or jobs to protect against the free market and, most importantly, are used to making decisions with incomplete information and don’t hang people out to dry if they make a decision that later turns out to have been the wrong one, as long as it was made in good faith. Of course they will succeed every time in these types of situations.”

    In short, they are men.

  16. Bloke in North Dorset

    Jim,

    I don’t think the feminization of the Army has got that far, yet. Iraq, and especially Afghanistan, meant they couldn’t afford to drop their standards and they didn’t. I recommend this book if you want to understand the sort of women who were serving then. I was also quite heartned watching the last series on young soldiers going through their training at Harrogate, they didn’t seem to give much there.

    There’s also a podcast (which I can dig out if you want) of a guy who was ex-SAS, having done P Company, went to the SBS and also did what he considered the Army’s toughest course, Army Diver. He then did the Royal Marine Commando Course before becoming an instructor at Lympstone where he was and instructor when the first woman passed the All Arms RM course. He was adamant that standards hadn’t been lowered. However he did say that she was on her 2nd attempt because she got injured the first time round and he thought they would have come under orders to drop standards until a female passed had she failed, even through injury.

    The stuff I saw about the woman who recently passed P Coy was that yet again standards had been dropped, but then she is a tri-athlete so quite exceptional.

    That said, I suspect that if we continue without any serious wars for a few more years the Army will lose the battle with woke politicians.

    I’m sure Jason will have a more up to date view on the current position.

  17. Anonymous coward

    @ Bloke in North Dorset, July 4, 2020 at 1:29 pm
    Spot on. *At the time* it looked like we’d need them, and had they been needed then people would have been saying how great it was that we (collectively) rose to the challenge and created them. An old friend of mine had a saying – “better looking at it than for it” – which fits this case perfectly; far better to be looking at them unused in a warehouse than having to look for them had they been needed and not available.
    It’s just too easy to be an armchair critic with the benefit of 20/20 hindsight.

    As to the forces support, yes, they stepped up and did what was needed. It’s their job to be ready for the unexpected, to be able to mobilise at short notice, and as already said – a key function of the armed forces is logistics unless you are going to wait to for the enemy to come and knock on the gatehouse door of the barracks.
    I suspect a big problem with the NHS is that it is so fragmented – with no-one responsible for looking at the big picture. So each trust does it’s own buying, and none of them have the cash to hold stockpiles of stuff “just in case”. I think there is a case for a bit of centralisation of purchasing and contingency planning – specifically to allow scope for some just in case stockpiling of essential emergency supplies. It’s is of note that defence has mostly centralised purchasing through DE&S (who were my employer until recently, so posting as an anonymous coward.)

  18. “I don’t think the feminization of the Army has got that far, yet. Iraq, and especially Afghanistan, meant they couldn’t afford to drop their standards and they didn’t. I recommend this book if you want to understand the sort of women who were serving then. I was also quite heartned watching the last series on young soldiers going through their training at Harrogate, they didn’t seem to give much there.”

    I never said that the Army had been feminised, not yet at least.

    My very point was that the Army is still largely male dominated. It still has a male ethos. Any women that get in and through the selection processes will be ones who by and large fit into that ethos. The danger will come as the numbers of women in the forces grow, and particularly as they reach the admin and policy determining ranks, and then the rot may well set in.

    However the army has one saving grace – it requires its recruits to do physically demanding things, this will tend to keep the monstrous regiment of women at bay. If they ever allow people to get into the forces without making them crawl through mud first, and go straight into office admin roles, thats where the end lies. Its obvious that men rapidly vacate careers that become feminised, and unless the Army protects its male ethos, and prevents the average women seeing it as a career, it’ll be doomed too.

  19. Let’s also remember that the army are good at logistics and near term purchasing.
    However defence procurement staffed in part by ex army bods has whole books about misallocation of resources and general screw ups.
    Lesson – all state purchasing & procurement has a better than even chance of going wrong?

  20. @Jim
    Report released yesterday said “admin and cleaners” were the C-19 spreaders in hospitals …. and lessons will be learned

    +1 on woman organising/running

    They’re still whining about shortage of PPE especially FFP3 masks…
    https://www.ppeexchange.co.uk/available
    – SPPEX13819 FFP3 masks 100,000,000 Now St Helier, Jersey JE4
    – SPPEX11779 FFP3 masks 50,000,000 Now Wiltshire BA13

  21. @Ecks, MBE

    A fatal pandemic? Most definitely not, less dangerous to all but old than Flu
    – Global deaths ‘with’: 526,260 – fewer than die in UK every year

    Only 1,355 UK deaths ‘with C-19’ and no diagnosed pre-existing life threatening condition
    Percentage of deaths with Covid-19 and pre-existing life threatening condition: 95.23% have one or more P.E.C – NHS England data
    ~45% of deaths “with C-19” were in care homes

    https://hectordrummond.com/2020/06/30/week-24-graphs-from-christopher-bowyer/

    Food for thought
    https://hectordrummond.com/2020/06/29/tim-james-a-perspective-on-the-ethics-of-lockdowns/

  22. Bloke in North Dorset

    Jim,

    “ I never said that the Army had been feminised, not yet at least.”

    Fair point and apologise for implying you did.

  23. The NHS is bloody genius at marketing. How else to explain why we have half the population clapping the sky every week, rather than roaming the streets bearing a stout length of cord and looking for people wearing white coats and a convenient lamppost?

  24. @Pcar

    The ethics point is important because even if the cost-benefit analysis comes out positive, we don’t normally say the government has the right to restrict liberty (especially so strongly). There is an ethical case the other way, seen Christopher Snowdon argue it from a libertarian perspective even, regarding the fact one person’s choices can increase risks to others rather than only to themselves and therefore government intervention of some kind may be justified, but it is still something that’s got far less attention than the debate over costs versus benefits which neglects the ethical considerations altogether.

    The weakness of your pre-existing conditions argument is that an awful lot of people have such conditions, beyond a certain age very often multiple ones, yet should still have several or even many years of life ahead of them. The actuaries who model this stuff for life insurance purposes seem pretty adamant that the loss of life-years is significant. Worth a read of the following thread and especially the linked actuaries’ report in Henry Tapper’s blog, for what it’s worth my opinion on this was similar to yours (believed most of those who died would probably just have had their death “brought forward” a year or so) but I actually (a) read their arguments and data, (b) talked to an experienced actuary about it, and I don’t think my former position is credible anymore. https://twitter.com/ActuaryByDay/status/1246866119597621248

    It is clearly fatal and clearly a pandemic. Therefore by definition it is a fatal pandemic. That leaves open the question of how serious it is, admittedly, but no point pretending it is not a fatal pandemic. Not convinced about it being less dangerous than flu to the middle-aged either, infection fatality rate data for flu is pretty awful though (as I explained above the death figures are unclear, but also the infection figures are even more unclear, so it’s a fraction with mysteries in both numerator and denominator). Comparing a global deaths figure that’s obviously inaccurate (lots of countries on that aggregate whose figures need to be taken with an enormous lump of salt, and almost no countries which don’t deserve at least a pinch) and moreover has nowhere near run to its grim completion versus annual UK deaths seems an odd comparison to me. More informative to think about UK actual vs expected deaths, and again the news from the actuaries isn’t great, even if you don’t trust UK government data all that much.

    https://www.actuaries.org.uk/news-and-insights/news/coronavirus-statistics-uk-how-reliable-data

    https://www.actuaries.org.uk/documents/england-wales-mortality-monitor-covid-19-update-week-22-2020

    They reckon it’s even worse than PHE estimate, and if we are talking 60k deaths already then even if that’s concentrated among the old it’s clearly worse than a typical winter flu. Interestingly it’s not several orders of magnitude worse (though obviously it’s had an extraordinary policy response that a typical winter flu wouldn’t get) but it’s looking like it will be several times worse.

    I’m making no comment on whether that justifies lockdown. I’m just saying “it isn’t a fatal pandemic” or “it’s no worse than typical winter flu” are no longer viable, informed arguments. “It isn’t fatal enough, it isn’t worse enough than seasonal flu, to justify the policy and societal responses”… you can arguably get some mileage out of that. But “just a flu, no worse than flu”, the time that was a plausible outcome for the UK has been and gone.

  25. Bloke in North Dorset

    MBE,

    I’ve also moved my position on the relevance of the deaths, although I didn’t start from a dismissive position, after reading articles similar to the one’s you’ve linked to. Not least because of my brother’s experience and there’s no reason he couldn’t have another 25 years even as a type 2 diabetic.

    I’ve also never liked the ‘flu comparison argument. Every year we vaccinate the old, vulnerable and key workers (using the pre-Covid definition) plus a lot of companies provide the vaccination for their staff and some of us (if I remember) pay for their own. We don’t know what a typical year’s ‘flu death toll would look like without those vaccinations and so comparing the Covid 19 deaths is an apples and oranges comparison. It could well be that there would be fewer Covid deaths. That doesn’t mean we shouldn’t be taking measures to protect the old and vulnerable.

    That said, whilst I broadly supported the initial lockdown steps once the threat to the NHS* was passed we should have been opening the economy, in the final reckoning the lockdown could well be a bigger killer.

    * I always referred to the health care system and perhaps if we hadn’t fetishised the NHS and talked about not overwhelming the NHS then people might have thought more seriously about the risks to the rest of the health and social care systems eg nursing homes.

  26. If there’s one thing the average citizen should take away from the CV-19 crisis, its that the NHS is more important than you, the patient. You can (and will) be sacrificed to save it.

  27. @BIND

    Best wishes regarding your brother. You’re right type 2 diabetes really shouldn’t be seen as some kind of death sentence.

    An excellent point re the misjudged focus but I fear everyone was fighting the “last war” based on what they saw in northern Italy. The fact the UK death toll could exceed Italy without any hospitals being overwhelmed or ventilators running out was a prospect that didn’t seem to cross their minds – maybe it went unnoticed how low COVID deaths were in southern Italy versus the nationwide spread in the UK, which the genomic analysis shows was seeded by many returnees from European holidays.

    It surprised me that the government response wasn’t prioritised to the old and vulnerable. It would have been fairly straightforward for a risk analyst/modeller to work out “90% of the stuff that’s going to make any difference will come from protecting these groups” whereas a lot of airwave noise and internal government machinery seems to have been devoted to quite petty rules that would be unlikely to make any real difference. Finding some sort of half-way house solution to stop potentially COVID-positive hospital dischargees getting into care homes, some sort of staffing solution to limit agency workers taking the virus between several care homes, some way to dramatically beef up contact-tracing teams (Germany hired tens of thousands of med school students, the UK basically accepted PHE’s message that its capacity to deal with contact tracing was no longer meaningful and pulled the plug – then also refused to deal with local contact-tracing initiatives that had identified risks from health and care workers, read a grim article on this a few days back) so that those unknowingly exposed to the virus could be stopped from spreading it to old/vulnerable. There are a handful of care homes that “locked in” staff and residents to form a seal against the outside world, perhaps more could have been done to encourage that.

    It’s not that no solutions existed but they were not pursued with zeal and there was something of a “can’t-do” acceptance of limited capabilities (not dissimilar to how PHE’s failures on expanding testing capacity were seemingly tolerated for a while before the necessarily radical change of approach kicked in) which is odd when contrasted to governmental willingness to throw the machinery of state behind the most radical reduction in civil liberties in British history.

  28. MBE ‘ fighting the “last war” based on what they saw in northern Italy’

    Probably because such planning as had been done supposed something like a new ‘Spanish Flu’. They expected something that would affect the young and healthy, hence the preemptive triage of throwing the old out of hospitals. They misread what was seen in Italy, as confirming what was anticipated.

  29. @djc

    People did keep on remarking “how young” the Italian patients were – despite them mostly being old.

  30. Trigger warning, Howard Goodall has composed a lachrymose anthem in tribute to NHS/health & care workers who have died in the fight against covid-19. It is quite dire

  31. @MBE

    The problem was Gov’t reacted to a bad flu and Ferguson’s model & figures were for same. They then followed a ‘bad flu’ despite evidence it was old and bame most at risk, with <20 almost immune

    Even as more and more evidence piled up that At Risk was not entire population, they refused to deviate from plan and instead relied on models and ignored empirical data.

    Adapt or fail : Gov't chose fail – stubborn boneheads to weak to admit "We wuz on wrong bus. All change"

    See:
    1 – https://hectordrummond.com/2020/06/08/sam-case-groupthink-a-discussion/

    2 – How Britain lost the war against coronavirus

    The government had prepared for a very different sort of outbreak
    Hugh Osmond 27 June 2020
    “…We don’t need theoretical and speculative epidemiological models now we have hard data from all around the world. We have countries that executed hard lockdowns, soft lockdowns and no lockdowns; we have individual states of the USA that responded in different ways

    Countries and states that implemented hard lockdowns suffered no fewer deaths than those that did not. The facts now speak for themselves

    So what have we learned? That theoretical mathematical models are broadly useless, with far too wide a range of outcomes to have any meaning until the outbreak is well established (by which time it is too late). Instead, the medical facts about the disease need to be closely examined as soon as they are known, and careful preparations made that address these specific practical characteristics of the disease.

    Does the virus kill old people? Then protect old people. If it can be carried asymptomatically, you need a lot of testing and infection control in hospitals

    A mathematical model will not inform these decisions. Above all, we need to make practical preparation for the disease that is — not theoretical preparations for the disease we thought might be”
    https://www.spectator.co.uk/article/How-Britain-lost-the-war-against-coronavirus

    3 – Hugh Osmond demolishes Government’s lockdown policy – today

  32. @ Pcar
    The UK government has not done a good job but it is unreasonable of Hugh Osmond to say look at the hard facts and then blame it for not acting to test for asymptomatic infections before there was any evidence that it could be passed by asymptomatic people – in fact the government testing of NHS staff as a precautionary measure even before there was hard evidence of asymptomatic spreading did reduce the spread.

  33. @john77
    He wasn’t “blaming” on that issue alone. His message is Gov’t would not deviate from Flu plan, when plan at odds with observed facts

    in fact the government testing of NHS staff as a precautionary measure even before there was hard evidence of asymptomatic spreading did reduce the spread

    How did they achieve that in March when PHE told Gov’t they could only process five tests per week and test & trace then stopped

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