There follows a guest post from our in-house doctor drawing on his long experience of working in NHS hospitals to explain why the NHS won’t be resuming normal service for a good while yet. Some of the problems it’s facing were unavoidable, but others were of the NHS’s own making.
In this week’s update, I’m deviating from my usual format of assessing Covid hospital data published by the NHS. It is clear to any objective analyst that we are on the downslope of the Omicron wave, which has fallen far short of predictions by epidemiological experts. Over half of all patients with positive Covid tests in English hospitals do not have Covid as the primary reason for admission, and this proportion has been rising steadily since the new year. There is no reason to believe this trend won’t continue.
This week I turn to the ‘recovery phase’ – where the NHS tries getting back to business as usual. Readers will be wearily familiar with senior NHS figures appearing on the media lamenting the unprecedented pressure the NHS faces. As with many facets of the information space over the last two years, this is partly true. The NHS is under unprecedented pressure – but much of that pressure is self-generated and self-perpetuated, arising from the structure of the system, or from choices made by management.
In this article I will put forward 10 reasons why the machine will not fire on all cylinders for some time, if ever. This is a subjective and observational analysis, not backed up by published data and open to challenge. Some of my points relate to cultural change, where data is hard to collate. On other points, internal data does exist but will never be widely shared or published. I hope this piece will help readers understand why we are where we are – and help them to decipher official announcements in the coming months.
- Loss of efficiency due to Covid protocols: Regulations in respect of Covid testing and periods of self-isolation before surgery are hampering efforts to restore normality. Operating Theatre utilisation rates in many trusts are running at 70% capacity. If a patient tests positive for Covid and is cancelled at short notice, it is not possible to fill the slot because waiting patients don’t fulfil the self-isolation criteria. So, the theatre slot remains empty and is wasted despite the huge backlog.
- Poor management of chronic conditions in the community: Many patients arrive for surgical pre-assessment ill prepared for an operation. This causes postponement and short notice cancellations. The need to optimise poorly controlled underlying conditions before surgery consumes yet more medical resources. In normal times, chronic disease management is the function of the Primary care sector, i.e. GPs.
I can’t resist using at least one graphic this week. Graph 1 (reproduced from the Spectator) shows the change in procedure volume for hip and knee replacements in various European countries. The data is from 2020 and not complete, but it is a reasonable approximation of the trend. Readers may wonder why England seems to perform badly in comparison to our peers when the NHS is the envy of the world.
- Cohorting of patients: In 2020 discussions took place about how best to minimise in-hospital transmission of Covid. At the time, these were very reasonable concerns. Broadly speaking, the options split into admitting Covid patients only to specifically designated hospitals, or admitting Covid patients to all hospitals but separating them into specially controlled areas. The latter solution was preferred. Accordingly, most hospitals now have green, amber and red zones depending on the testing status of each patient. Patients testing positive for Covid while in hospital therefore need to be moved into Covid only ‘red wards’, while negative patients are in green zones and patients waiting for results in amber. When moving patients around hospital (on trips to the radiology or endoscopy department, for example), infection control protocols are mandatory. Zoning regulations play havoc with specialist nursing rotas and are in any event of questionable effectiveness in reducing in-hospital spread of Covid. With the advent of the much less dangerous Omicron variant and the knowledge that over 50% of patients have incidental Covid (plus the reasonable expectation that this percentage will continue to rise), there is a good argument for scrapping this system. Nevertheless, it will be hard to revert to normal practice any time soon, for reasons I expand on below.
- Cultural shift in relation to ‘safe working’: This metric is hard to measure, but I am convinced ‘safetyism’ is a real phenomenon. By inculcating a culture of fear in the workforce about the risk of catching Covid, friction is introduced into every facet of normal organisational function. Simply put, everything takes longer than it should because of restrictive protocols imposed by infection control departments stemming from an overabundance of caution. The ostensible and commendable purpose is to reduce the spread of in-hospital infection. The side effect is to make routine tasks like wading through treacle – everything takes longer, so fewer patients can be processed per unit of time. The overall effect is similar to throwing a handful of sand into a gearbox.
- Exploitation of ‘safe working’ by health unions: Readers will be familiar with trade unions exploiting ‘health and safety’ regulations in industries other than health. The long running dispute between the RMT union and South Western Railway about the necessity for guards on trains is one example. Arguments about provision of PPE, enhanced rest periods for staff and extended periods of sick leave do have a rational basis, but trade unions push legitimate concerns to extremes and are frequently antagonistic to management. Such behaviour exacerbates the general difficulty in returning to business as usual. The British Medical Association is frequently the most egregious transgressor in this area. Institutionally left wing, its main purpose appears to be permanent opposition to the government of the day rather than supporting coalface clinicians in delivering best medical care.
- Difficulty in discharging patients from hospital: The phenomenon of ‘bed blocking’ is well known in the NHS and the reaction to Covid has exacerbated the problem. Care homes are still licking their wounds from spring 2020 when the NHS forcibly discharged patients known to be infected with Covid into the care system. Unlike the NHS, most care homes are privately run entities, and not protected by Crown Indemnity from risk of prosecution. Not surprisingly, many homes are reluctant to take previously Covid positive patients from hospitals. Workforce shortages in the care sector, worsened by vaccination mandates, add to the problem. As a consequence, the number of ‘purple patients’ continues to mount – designated medically fit for discharge but stuck in a hospital bed. But there are still not enough of them to require housing in the temporary Nightingale facilities, which remain largely empty.
- Vaccine mandate antagonism: The mainstream papers are reporting today that the vaccine mandate for healthcare workers is about to be scrapped – if true, this is excellent news. If someone was actively trying to mess up the healthcare system, I can’t think of a better way to do it than forcing workers to take a drug they believe to be unnecessary. For clarity, I am fully vaccinated and boosted because I consider it reduces my personal risk of becoming seriously ill with Covid. On the other hand, I completely understand colleagues who take a different view. The data shows that vaccination does not prevent transmission of the virus, hence I don’t understand how vaccinated staff pose less of a risk to patients than the unvaccinated. Regardless of the data, the issue has provoked serious conflict between individuals and between staff and management in the health service, which will persist long after the argument has been resolved and the mandate binned. In a team sport like healthcare, this has profoundly adverse effects. The vaccine mandate plan will not have been conceived by politicians, but probably within the U.K. Health Security Agency. The faceless medical bureaucrats responsible for this policy really should have the courage to explain themselves in public – I won’t hold my breath.
- Long Covid: Post viral fatigue is a well-known phenomenon. It usually resolves within a few weeks. Long Covid is probably a variant of this. The symptoms attributed to ‘Long Covid’ are legion. Unfortunately, in the absence of a specific objective test for the condition, the diagnosis is purely clinical and largely made on the basis of self-reported, non-specific symptoms by the patient. A recent study from Oxford using xenon to track gas exchange in the lungs has suggested some abnormality in gas transfer in a small number of patients, but the precise mechanism and characterisation of ‘Long Covid’ remains opaque. The potential for exploitation is obvious and requires no further comment.
- Workforce ‘enthusiasm fatigue’: A grumbling workforce in the NHS is nothing new, but the last two years have worn many of the best people down. Fresh haranguing by managers to meet arbitrarily-imposed targets in the face of even more pointless regulation reinforces a sense of institutional indifference. Many employees have become demotivated and sullenly resistant, choosing to do the bare minimum rather than resign or retire. Achieving unprecedented productivity gains in these circumstances is probably unrealistic.
- Workforce shortages: Workforce shortages in critical skill sets has long been a problem in the NHS. Covid has accelerated this trend by precipitating early retirement among senior staff, incentivising career changes for those considering it anyway and encouraging some highly skilled staff such as ICU nurses to seek redeployment into less stressful specialties. I understand applications to study medicine and nursing have risen recently – attributed to the crisis inspiring young people to contribute to their communities. This is welcome, but one should point out the very long lead time between enrolling on a course and becoming an experienced clinical decision-maker (minimum 15 years in most medical specialties). I’d be surprised if the rate of new entrants compensates for the brain drain at the other end of the age spectrum.
I apologise to readers for a fairly dismal and dense piece today. I do believe these points to be an accurate summary of the challenges faced by coalface clinicians in their efforts to retrieve the situation. None of these issues will be widely aired in the mainstream media. The extent to which we ‘learn to live with Covid’ will depend not only on lifting of restrictions on wider society, but on liberating real doctors and nurses from burdensome and pointless professional regulations. Based on my prior experiences, I’m far from optimistic at this point.
To join in with the discussion please make a donation to The Daily Sceptic.
Profanity and abuse will be removed and may lead to a permanent ban.
Thank the gods for that! Expel the toxic turd. Is this the part where she cries ”racism”?!
expel and deport all these uglies, these anti white racists, these half bred, half wits.
surely there exist nirvana’s created by non whites they can flee to
It seems to me that it’s a scary time to be working at the BBC for anyone with strong opinions of any sort. After all, it would seem she got fired for her anti-semitic views.
I don’t like the idea that people get fired just for having opinions, even when I find them distasteful, like in this case.
Who decides what’s off limits? Where does it end?
I can remember when David Irving was interviewed on the BBC’s on Hardtalk. Just him for 30 minutes.
Let me ask, what do you prefer, the world in which the BBC interviews a holocaust sceptic or the world in which the BBC fires someone for being a holocaust sceptic?
As almost always, with you 100% on this one. Think employees in general should be protected by law from action by their employer relating to “speech” not directly relevant to their job. The example I give is a car salesman Tweeting that their brand of cars is crap, or something along those lines. The problem of the BBC is really entirely separate from this woman – the state has no business running a media empire. The BBC is utterly captured by the political left, sacking her makes no difference, she just upset the wrong people. If the BBC were privately owned and funded, they could be as left wing as they like. This gives the appearance the BBC is cleaning house – it’s not.
I remind you of some words I received by email from a “dis/mis information” colleague of the notorious Ms Spring, regarding their coverage of anti-lockdown protests. I think it gives a clear picture of how the anointed see the world, their role in it and ours.
“Of course those who believe in conspiracy theories are not going to call their beliefs conspiracy theories, and are going to call themselves mainstream, moderate people.
We viewed footage of the speakers and spoke to people who were there.
We have no obligation to give a platform to erroneous ideas. We don’t, to take an extreme example, broadcast the manifestos of mass murderers alongside police statements so that people can “make up their own minds”.
I’m not saying the people there were violent. Some of them were (as the story reflected) were drawn by legitimate concerns. But the speakers (Mr Icke and others) were not expressing mainstream views that would benefit from airing and debate.”
It would be hilarious if it weren’t so frightening.
That’s EXACTLY what they’re supposed to do.
What I found interesting is that he was quite happy to share this view with me – I am sure that he believes 100% that he and the other anointed are eminently qualified to decide what views are suitable for us plebs to hear.
But they are happy to make programmes on mass murderers using gory detail for the purposes of entertainment and boosting ratings.
Would my 6 downtickers care to explain themselves? For example, if you think I am endorsing this woman’s views, then I am not (I haven’t looked at what she said in detail and don’t much care one way or another). My starting point is any speech is allowed beyond libel and slander. I don’t think we can pick and choose what kind of speech is allowed by employers and what isn’t based on what we agree with – then we’re as bad as our enemy, surely?
Stop moaning. I’ve got 8 (for now). 6 is nothing.
There is another aspect to this.
Within many organisations there is a proviso that employees must not bring the company / business into disrepute. I believe this woman by going public with her frankly nasty and offensive opinions has done just that. The BBC is after all supposed to be impartial – a joke I know – and if this Queva woman had kept her views to herself none of us would be any the wiser. However, she decided to go very public and it would not be unreasonable for some people to conclude that her comments were actually sanctioned by the BBC. So it is possible that the BBC has acted with the aim.of safeguarding its “impartiality.”
Ms Queva possibly assumed her grossly offensive views would be ignored by her bosses but that reflects more on her intelligence levels than it does the BBC attempts to stick to its Charter.
I have no sympathy for this woman and I believe in this instance a sacking was all she deserved. Her commentary has been crude, vindictive, malicious and in these febrile times frankly dangerous. Without doubt there has been a recruitment issue with this woman and evidently she was a quota appointment – black and female – but she was appointed to a reasonably high profile position and doubtless a significant salary for what appears to be a non-job. The least she could do was to act in a manner befitting her relatively senior position.
Whatever the rationale behind the BBC decision the sacking was the correct outcome.
The trouble is hp that the same rationale could be applied to a BBC employee saying that sex is immutable and men claiming to be women are not women. Who decides what is “grossly offensive”?
I understand your point tof but if you take the shilling you act by the employer’s rules. Or bugger off.
Well IMO it should be illegal for employers to sack you for speech not connected to your work. I have faced this danger as I know I have views on certain subjects that our former owner would find “hateful” – for example that Black Lives Matter is a deeply dangerous organisation, and that we should stop talking about race and “racism”. Views that you may well agree with and feel I should be able to express without fear of losing my job. “Employers’ rules” can be used to protect all sorts of damaging narratives from being questioned.
Well, that’s all nice and dandy but what consequence is the guy who hired her going to face? Or the people who weren’t able to communicate clearly what is or isn’t acceptable in her position beforehand? IMHO, that’s the millipede chopping off an insignificant leg for the benefit of itself. She has accidentally annoyed the wrong people. But I don’t think this kind of behind-the-scenes powerplay should exist. Had she claimed all men were rapists, she’d have gotten away it. Had she claimed all Germans were genocidal Nazis, she’d doubtlessly have gotten away with that as well. Etc.
In the end, she did nothing but voice an opinion some people consider really disagreeable while some other people certainly very much agree with it. The proper reaction to that is speech and not disciplinary action.
“ So it is possible that the BBC has acted with the aim.of safeguarding its “impartiality.”
WTGR, the BBC’s output is littered, daily, with “science decided” bias, BBCHYS vs subjects which they know will attract vicious comments, and do, which they then will only moderate if you are A) on their automatic watch list or B) someone complains and it might, but only might, get removed. Some comments are very clearly libellous which in very many cases are left published for hours. Let’s not forget that The BBC is a lynchpin of TNI – enough said.
If she thinks the holocaust is a hoax, her work colleagues could have taken the opportunity to counter the information her view is based on as part of what used to be general office chat.
It’s curious that this is considered problematic:
“The BBC Three executive also shared a video suggesting Israel wanted a mosque to ‘collapse'”
Yet the Israeli media has articles such as:
“‘Whoever died at Nova was fat’; PE teacher rants about October 7 during class”
“It was also reported that the teacher said “Death to the Arabs,” and “Kahana tzadak” (Kahana was right,) according to student testimonies.”
https://www.jpost.com/israel-news/article-784608
Well if there is to a be a world with unlimited Free Speech fair enough. I could live with that. After all, how can I disagree with people if I don’t know what they think——-But that is not what we are getting. Try criticising Islam and see where that gets you. Probably with your head in a basket.
Seconded. She’d doubtlessly have gotten away with this when she had stuck to publishing abuse about English people and white people in general. That she accidentally stepped onto the toes of a group with enough leverage at the BBC for this to have consequences for her shouldn’t matter.
Has she made a cringing non-apology and claimed that she’s suffering from mental health issues yet?
I am sure she will be polishing her race card. Dianne Abacus will be out next.
I am so grateful to the Daily Sceptic which gives me the opportunity to read your statement.
I find it pretty obnoxious and the accusation that jews murdered 67 million people in Russia extremely bizarre.
But I’m glad that you had your say and that I got to read it and I can safely report that at least for now it hasn’t made me anti-semitic. Not even a tincy wincy bit.
I thought Coup D’etat was a better name. Jon Smith is a bit plain. ——I thought you couldn’t afford 5 quid a month though? Or are you just having another flying visit ?
ha ha ha ha….I am so glad you have paid another fiver, I love a good laugh. ——Why don’t you try comedy for a living?
‘Prophet Orwell’ was another flash in the pan from one of my other haters. I mean, nothing says that you’re a rational, decent, well-balanced person like resorting to a name change so you can carry on singling out and targeting certain posters for extra abuse and harassment. All the while projecting your evident psychological issues onto that person and imagining you’re fooling anybody.
A certain Cypress Hill classic springs to mind…
It’s ok I can deal with a spot of name calling and trust me they get it back with change. ——-But all that name calling does is show how insecure you are and often how weak your argument really is.
I really hope the DS leaves all your comments on and. doesn’t “moderate” you.
Your comments and your style only seem to increase my sympathy for Jewish people.
Well done——You showed that all people are bad at times. What makes you think no one realises that? There have been atrocities all over the world. You seem to think that everyone else’s atrocities are not worth a shit because Jews did some of it. ——–I hate all atrocities mate, and your specialist subject included.
This discussion has been truncated it seems.
Despite my pleas.
I don’t understand it.
People with gross and offensive ideas should be allowed to express them, especially in the way that Jon Smith or whoever it was was expressing himself. He and his ideas couldn’t have been more off putting.
Censorship is just incredibly self defeating.
“Censorship is just incredibly self defeating.”
Jon Smith had previously commented that Zionists control the media. Censoring him added weight to his argument.
Who lifted the “ weight “ to be added …?
Apart from calling the Holocaust a hoax every other statement by her is correct.
Wars of conquest have occurred in all times and ages, hence, singling out Jews as invader species is nonsense. If anything, Jewish people are responsible for substantially less wars of conquest than many others as the Jews didn’t have a state and thus, also didn’t have a miltary force of their own, for most of the last 2000 years. I’m also pretty certain Jews and people who aren’t Jews can interbreed, hence, calling Jews a species is wrong.
There has been a Jewish state in the last 2000 years: the Khazarian empire of the middle ages adopted Judaism and wielded significant trade and military power. See “The Jews of Khazaria” by Kevin Alan Brook.
Being “intermarried” might raise questions:
https://daytonjewishobserver.org/2011/10/knesset-member-intermarried-but-not-interfaith/
Please spare me this somethingload of speculative history about a past we have no records of. If you want to waste your time with this, please feel free to do so. I don’t.
Interesting that the Jewish Quarterly Review was not so dismissive.
https://doi.org/10.2307/1455583
If you think that’s interesting, spend your time with it. I don’t.
The idea that a major empire showing religious tolerance which adopted Judaism should be of interest when it shows an alternative to the historic divisions that are raised to stoke present-day conflicts.
As far as Palestine is concerned Jews are invaders.
By 1800 there were 7,000 Jews in Palestine. This compares with 268,000 non-Jewish Palestinians.
By 1890 there were 43,000 Jews in Palestine. This compares with 489,000 non-Jewish Palestinians.
The UK government with their Balfour Declaration in 1917 to Lord Rothschild gave the green light for European Jews to go to Palestine.
Before 1917 the number of Jews in Palestine between 1914-15 was 38,754 (it is unclear how many of these were European Jews). This compares with 683,389 non-Jewish Palestinians.
By 1922 there were 83,790 Jews in Palestine. This compares with 673,392 non-Jewish Palestinians.
By 1931 there were 91,398 Jews in Palestine. This compares with 944,423 non-Jewish Palestinians.
By 1945 there were 553,600 Jews in Palestine. This compares with 1,210,920 non-Jewish Palestinians.
By 2014 there were 6.2 million Jews in Palestine (Israel). This compares with 6.1 million non-Jewish Palestinians.
As far as Palestine is concerned Jews are invaders
Obviously. Even twice, when we consider biblical stories. But in this respect, they’re in no way different from the Assyrians who invaded ‘biblical’ Israel, from the Athenians who invaded Melos during the time of the Peloponnesian war, from the Aztecs of central America who invaded every other state in the region or from the Brits who – at one time or another – invaded pretty much every country which ever coexisted with Great Britain. And this is by no means an exhaustive list.
Some Jews consider areas such as the Gaza their home, it’s an entrenched belief. The Knesset channel has some good examples. I can’t see David Cameron changing their mind but then he’s probably not been dug-up for any genuine diplomatic reason.
https://twitter.com/knessett
It was not that long ago that asking a lady of African origin wearing African dress where she was from was considered intolerable racism. Seems the goal posts have shifted
So basically, she’s not so much anti-Semitic, but hates everyone (including whites) who isn’t like her. This is narcissism. As for the Free Speech Union – speech is free so long as they agree with you? Free speech should be exactly that. You can’t legislate against bigotry.