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.
Billionaires Fund Extreme Net Zero
latest leaflet to print at home and deliver to neighbours or forward to politicians, media, friends online.
https://youtu.be/QMgr0qbpB9M?si=KIPh36hrS71M0ERN
Mahyar Tousi and a short vid about the German farmers protests.
Downticker – please explain your viewpoint
Leftism
Michael, downtickers are best ignored. I have a couple of trolls always following me.
Happy and go lucky just like Canada! I wonder if the Justin Germans will get heavy handed with them too? I like food! Long live the farmers
https://www.thesun.co.uk/health/25293827/jn1-masks-covid-big-devious-new-strain/
“Professor Peter Openshaw, a virus expert at Imperial College London.”
Despite scores and scores of papers totally refuting the mask nonsense an alleged Professor from wherelse but Imperial College says that they should be reintroduced to combat a virus with symptoms identical to a bad cold / ‘flu.
Conclusion – he is a professor in name only and is decidedly not a ‘virus expert.’ And the final confirmation – he works for the Billy Gates funded Imperial College.
I rest my case.
You beat me to the same conclusion!
The problem is that measures that were once used to (sopposedly) combat a (supposedly) exceptionally deadly virus are now being proposed for respiratory diseases we’ve always tolerated without problem.
It’s as if they are desperate to reduce society’s tolerance level of disease.
That way, more control, more medications.
Bastards.
One of many predictions made by sceptics when this started was that measures allegedly brought in to “combat” “covid” would logically get extended to flu etc, given that “covid” (if it exists) is just another flu/bad cold. Another “conspiracy theory” come true.
https://www.thesun.co.uk/health/25293827/jn1-masks-covid-big-devious-new-strain/
said virologist is from Imperial College! Who would have thought it. Services to the corruption of science continue.
https://www.conservativewoman.co.uk/joey-barton-v-woke-united-its-a-walkover/
John Ellwood over at TCW with a delightful article on how Joey Barton is gunning for the wokerati – and winning. Wonderful.
Some twat government minister has decided he has to chip in
Joey Barton comments on women are ‘dangerous’, says sports minister Stuart Andrew – BBC Sport
WTF do we need a “sports minister”? What has sport got to do with the state? They can’t even do the basics.
The see you next Tuesday has said he will “speak to social media companies” to see what can be done about Barton. I hope Musk tells him to do one.
https://www.conservativewoman.co.uk/vaccine-firms-can-fool-governments-but-not-the-markets/
Paula Jardine on terrific form at TCW where she takes apart the grotesque “vaccine” industry. A couple of billions is small change but the market is collapsing.
“THREE years after the launch of mRNA gene therapy vaccines, all now proven to be both harmful and ineffective, the share prices of all three of the companies involved – BioNTech, Pfizer and Moderna – have plummeted. The invisible hand of the market is acting where governments and regulators refused.”
You can fool some people all of the time! You know the rest
”Adel Sidi Yakoub’s abusive treatment and misogynist views of women are learned from his Islamic faith and his Prophet’s example.”
In a controversial video that has sparked widespread debate on social media, Adel Sidi Yakoub, a French Muslim footballer and TikTok influencer, has publicly outlined a series of Islamic rules that he expects his future wife to adhere to. In his video titled “My wife will not have the right,” which he posted on January 6, Adel, who plays for Entente Sportive Pays d’Uzes in the Gard department, outlines what he describes as “very reasonable” restrictions.
Adel asserts that his wife will be barred from having male friends, emphasizing his role as her only friend and confidant. This is just the start of a series of prohibitions that also extend to her work and social life. He insists she should not work in an environment where men are present and should not travel without him, though he makes exceptions for family members such as her brother or father.
The footballer, who also has a significant following on Instagram with over 83,000 followers, does not stop there. He dictates a strict dress code for his future wife, forbidding her from wearing tight-fitting clothes and suggesting, although not insisting, that wearing a veil would be ideal.”
https://rairfoundation.com/french-muslim-footballer-popular-influencer-lists-his-future/
Oh Mogs, It’s so saddening to witness that video!
I know, Dinger. He’s basically outing himself as a domestic abuser before he’s even got a partner! Where is the respect? Well there is none when you demean women and view them as possessions, mere ‘things’, not remotely your equal, to own and control with zero rights, other than those you deem ‘allowable’. The saddest thing is that this would all be considered ”normal” in the Islamic culture but it’s literal abuse by Western standards. I mean, controlling what somebody wears ( anything other than a tent is forbidden, it looks like ) or forbidding them to go anywhere without you, forbidding your partner from working with men…WTAF is that other than out and out abuse of somebody’s freedom and basic human rights? Sick culture, sick attitude.
I see the resident Misogynist Society disagree though. No surprises there. They love a bit of abuse of/hostility towards women and evidently have serious psychological issues. I just hope none of them are married and/or are the fathers of daughters…. 🙁 Nasty.
Totally agree 👍
I was brought up to respect and care for women and children, protect and help them, even go to war and die for them (not the king, f him)! I cannot fathom this satanic attitude
Well would you Adam and Eve it…Hardlines has been fiddling with my post, yet again, and has erased the opening paragraph. He’s not happy unless he’s done a shift that has involved editing/removing my posts.
Obviously no explanation given though. Because that would involve basic respect. Free speech for the win, eh?? LOL Don’t stop the censorship whatever you do, Mr Gestapo!
I’m obviously on a ”list”, Dings, the way he continues to follow me around. Who knew little ole Mogs could be so controversial!? 😉
Having read the https://trusttheevidence.substack.com/p/smokescreens-part-7 , it’s statement that “In the most extreme case, barely believable, the Care Quality Commission let the nursing home provider decide the cause of death” reminded me once more of the old Harold Shipman case. The theme of the article being that they just don’t know, and by implication the ONS output was severely undermined.
The post office scandal is tragic, but really old news.
Why is it now all of a sudden mainstream news?
Because it is highlighting exactly what a monumentally hypocritical @$$#0£€ Sir Ed Davey is, and by implication the Lib Dems and the other scum infesting Westminster in general
“scum infesting Westminster in general”
liblabconsgreen!
Boy, do we need change!
He’s also a climate botherer, right dodgy geezer. Was my parents’ MP.
Because there is a film (apparently quite good) on Neflix.
Correction: it’s either BBC or ITV, not sure but basically there is a film that has recently come out about it and it is getting word of mouth traction.
If youre asking why is it being kept in the news, see Boomer Bloke’s answer.
“The Royal National Lifeboat Institution (RNLI), whose remit is supposed to be to save those in peril at sea, has become a taxi service for illegal immigrants.
The French coastal authorities make no attempt to prevent the dinghies from leaving their shores. Instead, they escort them into English waters, and the RNLI does the rest. The migrants typically arrive in Kent, on the south English coast. Although the migrants keep their documentation to get across Europe, they ditch it once on the water. Doing so prevents British authorities from determining their country of origin and thus makes them more difficult to remove. If the English Channel were trawled tomorrow, more passports and cellphones would be netted than fish.”
https://www.unz.com/article/a-special-relationship-comparing-us-and-uk-immigration/
Thanks team for deleting my other post and thereby confirming that you are neither a true advocate of free speech nor able to handle the truth.
Just thought this was amazingly humorous!
News flash- war is not good for the planet 😕!
https://www.theguardian.com/world/2024/jan/09/emissions-gaza-israel-hamas-war-climate-change
“Paula Vennells has bowed to pressure to hand back her CBE”
That showed her, ugh!
Now prison for life!
“Lloyds are paying the price for firing Carl Borg-Neal”
I’m sure 800 grand is going to bring lloyds to its knees!
“Why the Rwanda Bill doesn’t go far enough”
Go far enough? It hasn’t gone anywhere!
give us strength!
‘India’s plans to double coal production ignore climate threat”
Then India will prosper! 🙏
“Corbyn to join South Africa’s delegation accusing Israel of genocide”
Please 🙏 Jezza, start your own party! Imagine all the brain dead numptie votes he’ll take off starmageddon if he does!