UK Inquiry Module 3: Impact on UK Healthcare Systems

[elbows]

The efforts in Southampton to come up with a practical hood-based personal respirator system during the pandemic was briefly referred to by Dr Barry Jones today. I am quite impressed by this work and if deployed at great scale and embraced by the pwoers that be, it could have helped to somewhat bridge the chasm between our own official guidance in regards health worker protection, and the 'full bunny suit' stuff we saw from a handful of countries that learnt the right lessons about SARS, MERS etc years before the pandemic and understood how to protect workers and massively reduce transmission within healthcare settings. I am no fan of people shrugging and sticking to shit guidelines in the pandemic just because our capacity for certain 'very highest standard' things could not be scaled up in time, and so I really like stuff that can be scaled up that is much better than nothing, much better than just leaving people with surgical masks or a botched FFP3 fitting programme.

https://research.uhs.nhs.uk/news/southampton-personal-respirator-approved-for-use-beyond-pandemic

 

[elbows]

Doesnt look like Im often going to get a chance to quote from evidence even when I really want to.

One of todays witnesses struggled badly for prolonged periods of their questioning, in my opinion. Dr Lisa Ritchie OBE (National Deputy Director of Infection Prevention and Control, NHS England).

Had to ask for numerous questions to be repeated, sometimes gave garbled answers, awful management speak, narrow and thoroughly unconvincing, unwilling to give any answers that would have inconvenient implications for guidance going forwards.

No wonder the fucking IPC Cell, which she chaired during a crucial year-long period, came out with such shit advice in the pandemic. Because, broadly speaking, all the shit we heard today is mostly a simple story of expediency in a management context. In this case a nursing management context from the infection prevention and control angle, but I wont single them out completely because their shit stance was enabled and supported by all the other forms of shit expediency higher up the chain. And as the likes of Chomsky often pointed out, these people are selected for these roles in the first place because they wont ask awkward questions and will willingly do what the establishment requires of them. In some cases actively driven by shit priorities, in other cases the right priorities but entirely misplaced faith in what actions and guidance will genuinely support those priorities rather than undermine them.

She got an OBE for her work in the pandemic, no surprise there.

I doubt anything revealed in the last week will be a surprise to those unfortunate enough to have had to work under these layers of management within the NHS.

Nor is this something restricted to the NHS, because a lot of the crap was enabled by crap international guidance from the WHO. I expect the same expediency will have been at work at the WHO, mixed in with some additional angles including those of international politics and 'diplomacy', dodgy prior orthodoxies within the relevant specialisms, and the malign impact of horrible dominant economic ideologies.

 

[elbows]

The most useful thing she said was that infection prevention and control issues are quite far down the pecking order of research.

 

[elbows]

Over the last day we have heard from the Chief Nursing Officers of the 4 UK nations. I cannot do proper justice to these sessions, but subjects included:

Impact on staff mental health, inability of relatives to visit patients (including in the maternity context), the awful decisions that had to be made in regards changing the nurse-patient ratios in critical care, focus on problems of availability of PPE in first wave rather than spending more time on the question of whether the PPE guidance was actually good enough, concerns about use of blanket DNACPRs and how reports were still coming through later about such misuse later despite diktats from the top against such use.

Ruth May (England CNO during the pandemic) was particularly scathing about the effect on nursing staff number that removing the bursary in England had, and was keen to highlight how we must have more nursing staff in place to deal with a future pandemic. She also described how unwilling she was to allow such awful nurse-critical care patient ratios in subsequent waves as were allowed in the first wave. When it came to the airborne and PPE angles of infection prevention, her evidence was no more impressive than other witnesses that I already criticised. But when given the opportunity to discuss what she would have most liked to have been different, and what should be different in a future pandemic, she did at least highlight that having broad access to proper testing from the start in order to help reduce nosocomial spread is crucial. The fact that there was an extreme gown shortage in the first wave and that gowns hadnt been part of the existing pandemic stockpile was also discussed, with Ruth May very unhappy with the temporary change of guidance to allow aprons instead of gowns at the peak of the gown shortage.

During questioning about the blanket DNACPRs, the chair did step in at one point and made reference to the idea that these hadnt just been used to deny people resuscitation, but that in some cases there are suggestions they were used to deny treatment more broadly, although she hadnt heard much direct evidence about that yet.

We are now hearing from professor Susan Hopkins, chief medical adviser of UKHSA and formerly PHE. It will take me a while to report back on this since I havent been able to watch it all live and am playing catchup. Its already clear that there will be plenty about the airborne stuff, the PPE and the IPC Cell.

 

[elbows]

Hopkins trod on a landmine this morning by saying that the evidence for FFP3 masks being more potective against covid than surgical masks is weak.

I havent watched that part of the session myself yet, but her words about that are being used to question her very tersely this afternoon.

Its becoming clear that one stance the defenders of the really shitty mask advice are clinging to is that 'masks are just one component of infection prevention'. Lack of formal evidence versus common fucking sense is also on display, and this is one of the reasons her FFP3 evidence comments have gone down very badly indeed.

 

[elbows]

Press coverage of this module after the opening day or two has been very poor or entirely missing, but no surprise to see that Hopkins FFP3 facemask stuff has now been reported:

Evidence for high-grade face masks was weak, Covid inquiry told

UKHSA's Prof Susan Hopkins said respirator masks may have worked no better than thin surgical masks.

www.bbc.co.uk

What sometimes gets lost in these stories is that a lot of the debate gets bogged down in what counts as good evidence. There has been a disgusting lack of effective high quality studies of certain kinds which could actually provide the sort of evidence the likes of Hopkins would require. One consequence of this is that certain expedient stances are given cover to hide behind, and so we have to be very careful about how statements in regards evidence are interpreted.

If we move the required level of evidence to a different place, set the bar differently, for example using data from particular real-world experiences of particular hospitals during the pandemic, then we do actually end up with the sort of indicators that led plenty of those hospitals to adopting much more widespread use of FFP3 for very good reasons. This does not satisfy a certain level of scientific rigour, but is still not anti-scientific, enables precautionary principals to stand a better chance of being adhered to, and injects a healthy dose of common sense.

Three infection control specialists who also have practical roles within the NHS system are being questioned today. This mask evidence topic came up and although it was not phrased in exactly the way I just did, the angle I just took did come up, with a suitable, sane, conclusion if you pay proper attention to everything that was said. When asked about evidence form and quality they had to answer certain questions in the same sort of way as Hopkins, but when it came to practical reality and recommendations for the future, they were recommending FFP3 for all sorts of scenarios. By considering the full picture, they had a degree of credibility that others lose through narrow rigidity of a dangerous kind. I will find time to quote just a tiny bit of that later.

 

[elbows]

Next weeks timetable revealed, Whitty is giving evidence next thursday.