Thursday, 30 April 2020

We're long past the peak but they don't seem to want us to know that

Readers will know I got sufficiently bemused by how Covid deaths in hospital are shown on the daily briefing to do my own analysis (Spreadsheet Phil, 17 April). At first I couldn't understand why they didn't show a rolling 7 day figure to even out the acknowledged reporting delays at weekends. But I realised that there are much more general delays in reporting. For example, of the 546 deaths in hospitals in England reported on Tuesday 28th April, 93 occurred on the  27th, 213 on the 26th, 79 on the 25th, 50 on the 24th,  23 on the 23rd and 16 on the 22nd. Beyond that there are single figures of deaths on various dates stretching all the way back to 19 March.

Some deaths will be unexplained at the time and only attributed to covid later but, in the absence of being able to ask Chris Whitty, one can only wonder how they can discover that a hospital death from over a month ago should now be attributed to covid-19.  But then, as my own local health board in Wales recently realised it was only reporting covid deaths monthly, producing an enormous blip in the figures, there are obviously lots of things that can and do go wrong. One wonders what the folk in Betsi Cadwaladr health trust, from the CEO downwards, were thinking as they watched the bulletins about the daily figures. Day after day on Wales Today they were saying that the number of deaths in the trust area was not being announced because it was so small it might identify the victims, which is a comment that gets stranger the more you think about it. Quite a few folk in the trust must have been aware that there had been many more deaths in its three major hospitals than were showing in the published figures. One can see why it is a failing body that has been in special measures for 5 years.

Whatever the quality of the data, you can see the raw figures for England each day on the NHS England website* broken down by region and trust. In order to try to understand what is actually happening I've prepared my own chart, showing English hospital deaths by the day they occurred and the day they were reported, the latter being the main COBR graph that we see on TV each day. I stop at 23 April as the deaths by day of occurrence are still totting up significantly for 4 or 5 days. After that you could add sometimes 10 or 20 but it wouldn't affect the overall picture very much.

What's clear is that we passed the peak around April 8-10. Which is actually a little before many  experts were predicting the peak would occur back at the start of the month - they were saying it would be Easter Sunday, April 12th. The real decline won't be quite as steep as my red line above as extra deaths for the days towards the right hand side get announced with the daily figures over the next month, but it will probably only affect the slope a small amount.

I can understand that the government don't want to broadcast the fact that we are already more than  two weeks past the peak. They need to be sure the decline is sustained (it is) but there are also other factors. There is a lag in patients coming through hospital at different rates, for example. They won't want behaviours to slip in anticipation of relaxation of restrictions. And deaths is only one of the five tests: it would be embarrassing if they had to say the tests were all met apart from security about provision of PPE, which most of the cabinet presumably used to think meant Politics, Philosophy and Economics, ironically the subject of Matt Hancock's Oxford degree.

Embarrassing but not actually surprising when I read that the demand for PPE has been 20 times that of a seasonal flu epidemic and China is currently exporting a fifth of its capacity because of its own needs. Hindsight is all very well but I challenge anyone to say that, if asked in advance how much PPE should be stocked for a pandemic, they would have said "oh, at least 20 times that we could need for a major flu outbreak".

One thing puzzling me is why journalists aren't asking whether the peak has been passed more clearly, indeed asserting that we have passed the peak when questioning ministers, especially given that I assume they have access to somewhat more research and analysis capability than I have. Some journalists have certainly realised it: David Smith noted last weekend that "the peak in deaths and new infections seems to have been around April 8th"**. Indeed, Smith goes on to say that the peak came "before the effects of the lockdown and reflected the voluntary social distancing that preceded it".

Wow! Smith says the government's initial response was slow, uneven and lacked leadership. But then, as he also notes, when China locked down Hubei province most folk thought that was something only an authoritarian regime could do. After all Public Health England moved the risk to the British public from "very low" just one notch to "low" on 22 January. Even when Italy moved to lockdown on 9 March there was still an element of "it could never happen here". Smith thinks the government lurched suddenly from complacency to lockdown as no-one would blame it for putting public health first. And, as I've suggested, the response to lockdown and the chancellor's measures has been a bigger shutdown than the government thought would occur, as many businesses that were not required to shut still decided to do so. I would add that the message reinforced every day has been "thanks for what you're doing, keep it up, stay at home" not "stay home but go to work if it's not something we've specifically banned and as long as you can maintain social distancing".

One can read into Smith's words (he doesn't explicitly say it) that he thinks the government panicked and went further than, with hindsight, they should have done. And, because they put the "fear of God into people" the public responded to an even greater degree. The result? The biggest hit to the economy not just since the financial crisis but since the Great Frost of 1709.

Do I agree? I'm not sure yet and I've already criticised many commentators for excessive use of hindsight together with some rewriting of history. The first real social distancing restrictions other than exhortations weren't until schools were closed on 20 March and pubs and restaurants were closed on the 21st, only three days before the first effective day of lockdown, the 24th. So I think it's a bit difficult to assert with confidence that the peak at 8 April would have happened without the lockdown. In due course we may be able to tell more by looking at examples like Sweden, where they haven't gone as far with lockdown and have relied more on social distancing advice, the position we were in from March 20-23.

The new step announcing all deaths in the daily press conference from yesterday will further disguise the fact that we have passed the peak and buy ministers time for the lockdown review next week. It will do that because the "all covid deaths" data must be even more erratic than the surprisingly erratically hospitals only figure. I thought they were right to stick to hospital deaths as they are more readily measured and represent the vast majority of cases. And it's the trend that matters.

But as with testing, where Hancock felt he had to pluck his 100,000 number out of thin air presumably on the basis that it's a big number, I think ministers felt the pressure about deaths in care homes in particular. They know as we do that many of those deaths have been advanced by very short periods but they daren't say so because of the inevitable media storm that would result. So when Jonathan Van-Tam carefully answered a question yesterday by saying that, in time, the excess deaths figure will prove the most reliable and meaningful I'm sure he was factoring in that, looked at with the perspective of time, many of the care home deaths would effectively drop out of the statistics as they would have happened in the same year anyway. So when you compare the total deaths with the 5 year average the excess deaths figure should show all of the impact of the epidemic, both directly from covid and indirectly from delayed cancer treatment and the gamut of other knock-on effects, but care home deaths that have effectively been advanced just a few months wouldn't cause a blip.

Unfortunately, troubling though it is, the care home issue is not the big story or issue here that the journalists have made it. I say that having had elderly three close relatives in die in care homes over the last decade, all having had minimal quality of life in their closing years. (I may in due course write about how I think the elderly really can be shielded, which is relevant to a broader population than care homes).

Of course, passing the peak doesn't mean we're out of the wood. In most previous pandemics the second wave has been more deadly. This is probably why the government is signalling that we'll take baby steps out of lockdown. As it seems we have to wait 6 weeks to know whether we can go further it could be a very slow exit.

I also have to declare that I got something wrong (what do you mean that's normal?). I said only 3 days ago that the current situation was outside any living person's experience. I was forgetting Hong Kong flu, even though I lived through it. What, you don't really remember it either? There were two waves, in 1968-9 and 1969-70 which caused some 80,000 deaths in the UK. Much of the post stopped being delivered and trains and buses ran to heavily reduced timetables because so many drivers were sick, people of working age being the most severely affected. Clinical staff also caught it and, for a while, the NHS was overwhelmed. The second wave was deadlier with the biggest weekly death toll,in the first week of 1970, being over 20,000, bigger than any weekly total so far in the coronavirus epidemic. It's all very being wise after the event and saying that care homes were going to be the problem - lessons learned papers from flu epidemics note that a lesson from 1970 was"not to ignore the likelihood of a seriously depleted workforce to implement policy"***. Of course there are proportionally more old people now, but that epidemic hit working age people harder, others have hot children hardest.

I'd heard of Hong Kong flu but I don't remember any consternation in January 1970. I was probably preoccupied with Everton's imperious procession towards the League title and my impending A-levels. Of course 1970 was very different from now. We didn't live with 24 hour news and the death figures weren't briefed out daily. We had hospitals and you didn't have to pay for health care, which probably still struck our grandparents (if not our parents) as a novelty. If they got overwhelmed because of something unforeseen it wasn't "somebody's fault". There appeared to be no consideration given to special public health measures (presumably the cabinet minutes have long been released) and certainly not to banning sporting fixtures. Phew! Over history it's been Everton, not Liverpool, that has been worst impacted by events (champions in 1939, team broke up; champions in 1985, Heysel stadium disaster precluded them from competing for the European cup won by the mighty Steaua Bucharest and then leading to loss of the manager and key players including Gary Lineker). It hadn't occurred to me that 1970 was a near miss......

Now that would have been a disaster.

** David Smith's Economic Outlook column is in the Sunday Times each week. His column "Lockdowns are difficult, ending it will be the hard part" appeared on 26 April. The stuff on Hong Kong flu also mainly comes from Smith's column, though he got it from a book by Nicholas Timmins: The Five Giants, A Biography of the Welfare State.

*** Journal of Epidemiology and Infection, July 2008.

Monday, 27 April 2020

Second peak or ripple?

I strikes me that part of the psychological problem at the moment is that the current situation is outside the experience of anyone alive. Oh, sure, Spanish flu was just over a century ago so a very small number of people still around were alive then. But they were too young then to remember it now. We look to our leaders and they don't currently have answers. The sobering fact is that we don't have much more at our disposal yet than they did in the middle ages combating plague: keeping apart and isolation. They didn't use the phrase "social distancing" then but that's what it is.

We can have hope because we do have much better hygiene standards, with cleaning products and (when available) protective clothing. The bane of our modern life, the single use plastic, is suddenly appreciated again, though I wish some of our hard pressed carers wouldn't chuck disposable plastic gloves away on the pavement. Mrs H and I have seen that rather a lot, even spotting a discarded blue plastic glove towards the top of 'one of the most important and historic hills in Wales', the 320ft bump behind our house (quote from a Welsh walking guide). And the scientific skills and know how that have been developed over the last century hold out the hope of developing strategies based around testing and, hopefully, vaccination.

There has been a lot of pressure to roll out testing but Hancock and his experts have been right to say that we need confidence in the tests. They have been rapidly developed and its not yet clear how accurate they are.

So we have to buy time for the scientists to do their stuff. And balance the needs of restarting the economy with the inevitable further waves of infections. Not just a second wave, pandemics of the past have never been like that. Which is why I worry about the fifth of the government's five tests for easing restrictions. I've heard several ministers describe it as  "there should be no risk of a second peak", which strikes me as being as unachievable as Gordon Brown's tests for joining the euro. As soon as we ease the restrictions the infection rate will increase again.  Whether that will be a second peak depends on whether we can keep the curve fairly flat, with R never going much more than 1 and generally less. One could argue, semantically, that this wouldn't mean a second "peak" I suppose, more of a ripple. But it will still be an increase.

I couldn't easily find the government announcement for the precise wording of the fifth test. But, while most sources describe the it as being avoiding a second peak (for example BBC say "being confident any adjustments would not risk a second peak") LBC quote Business Secretary Sharma saying the the test is:
“We need to be confident that any adjustments to the current measures will not risk a second peak of infections that overwhelm the NHS." (My emphasis).
Which is at least in line with the government's rationale for entering lockdown.
So therefore I don't accept the suggestion in the New Statesman* that the five tests have been deliberately set to remain unmet until Boris Johnson returned so he can adjudicate between a divided cabinet on how to end the lockdown.

Our own observations are that, while most people we encounter follow what have become the polite social distancing protocols - dancing aside, stepping off the pavement or clambering up a grassy pathside bank to make space - some younger people seem to be in a world of their own and plough past at one arm's length. (Cyclists - just because you're on a bike is no excuse. If the space is narrow you might, heaven forbid have to dismount, shock, horror! And just because you're on the road and I'm on the pavement doesn't mean that you aren't too close!).

So when the restrictions ease I think it is inevitable more people will push the boundaries and behaviours will probably slide a bit. My guess? Somewhere between a second peak and a ripple. The question that follows is whether that would lead to cycles of loosening and tightening.  As neighbouring countries all seem to be planning something a little bit different there should be plenty of experience captured over the next couple of months to learn from, though disentangling cause and effect may be difficult.

Unfortunately the political concensus that has held for a month seems to be fraying as the opposition see opportunities to chip away. There will be plenty of good ammunition in due course from the inevitable inquiry - and well before the next general election. So I find any game playing rather tiresome and rewriting of history even more so. While there were some calls for the UK to move into lockdown earlier than it did, they were muted. For example, shadow health bod Jonathan Ashworth has claimed he was doing so. I've checked what you said Jonny boy and the only thing I can find is from the Commons debate on 23 March hours before the lockdown was announced when the strongest thing you said was "something has to change". Your new leader called for "further compliance measures". And by then the government announcement was no doubt already being drafted if not ready to roll.

Not exactly shouting it, were you Jonathan? Shabby, mate.

I will accept politicians and journalists saying "why aren't we doing x or more of y or z" as long as they recognise that most people in the fray are overloaded so prioritisation is essential. Trying to make themselves look wise after the event?  Spare us your sanctimony, people are trying to do an important job.

Sunday, 26 April 2020

Justifying their existence?

There has been a lot of pressure on the government to start saying what the future will look like as lockdown restrictions are eased. It had so far not engaged in that discussion while rather oddly refusing to say that it won't say anything. It just ignored the question. Which has caused a lot of irritation in many quarters. But today Dominic Raab, while revealing some of the options under consideration on Andrew Marr's show (schools will be required to separate pupils, offices must have fewer staff present, non-essential businesses would have to follow the supermarkets and create two metre gaps between customers - all stuff we'd long since already guessed) resisted pressure to set down options for easing the lockdown within a few days. He said that would be irresponsible and "only create more uncertainty in the public's mind". The government has decided so far to treat us like children and stick to the simplest of messages. To my surprise I don't have a problem with that.

Meanwhile the Welsh and Scottish authorities tried, as is often their inclination, to bounce the UK government by making statements about their policies for easing lockdown. I've had a quick look at the Scottish statement* and, while it's refreshingly clear that we won't return to the old normal for a long time, it uses a lot of words to say not very much. Oh there's plenty of stuff about the principles they will apply but the only bit of meat I could find in there was this:

We are likely to require that gathering in groups, for example in pubs or at public events, is banned or restricted for some time to come. And good hand hygiene and cough hygiene must become fundamental habits. We cannot afford to have exceptions. Each one of us will have to adapt to this as the new normal, at least until we are sure that we can be more protected by a vaccine or treatment.

Wow, tell us something else we hadn't already long since figured out. I was surprised this announcement didn't produce even more frustration than the UK government's studied silence. It gets a raspberry from me, but then everything Nicola Sturgeon says usually does, while accepting that she is a formidable political operator.

Which is more than I can say for almost any of the Welsh politicians. There have only been two in the five years I've been paying attention who have made any favourable impression on me. Carwyn Jones, who was first minister for 9 years, always came across as competent and assured, until the knives came out after the suicide of Welsh Assembly member Carl Sargeant. Jones was accused of mishandling allegations of inappropriate behaviour against Sargeant. It's never been clear to me that he did anything wrong but it was the first time he ever appeared rattled. The other? Vaughan Gething, the confident and apparently competent Welsh Health Secretary who blotted his copybook the other day by failing to mute his mic and being heard swearing at a Labour colleague in a virtual Welsh Assembly meeting. As the gist of it was "what the ****'s the matter with her?" and it might well have been a stupid question (most of them are) I am hoping he will survive. After all if you've got a problem with Raab, Hancock and Gove you want to see and hear the bunch of underwhelming prats who run Wales.....

Anyway the Welsh administration also mooted that it might make some "careful and controlled, small changes" to the restrictions. Again they didn't say what they might be - they had more questions than answers. Literally, as they posed seven questions to consider before decisions are made:
  • Would easing a restriction have a negative effect on containing the virus?
  • Does a particular measure pose a low risk of further infection?
  • How can it be monitored and enforced?
  • Can it be reversed quickly if it creates unintended consequences?
  • Does it have a positive economic benefit?
  • Does it have a positive impact on people's wellbeing?
  • Does it have a positive impact on equality?

 Leaving aside the last point as being empty virtue signalling (after all, if it helps most people then should it matter if it doesn't have a positive impact on equality?) there's nothing wrong with this list of questions except, per Monty Python, that they are all statements of the bleedin' obvious.

So the only interesting thing in the Welsh pronouncement for me was personal. It included the concept that the restrictions would be eased in stages "like a traffic light in reverse".  The first, red, phase would have few restrictions removed, the amber zone would see more relaxation and only at green would we reach a situation "much more like the lives we had before the crisis hit".

The reason this was interesting for me was simple nostalgia. The "traffic light" red-amber-green concept has become widespread in public and business life, for example in food labelling. It was work colleagues of mine who first persuaded the government to adopt a traffic light system for categorising risks back in the 1990s. As the company provided consultancy and advice to the defence and environment ministries (and probably some others as well) I can't remember what the specific application was though I remember the people. I think they chuckled when I suggested a traffic light approach to some management reports and, when I looked askance they reminded me where it came from. They weren't claiming to have invented the concept - though they would have been in the vanguard of it - just to have promoted its deployment. But as the earliest references to traffic light systems on Wikipedia date from around 2007 and this conversation was definitely several years earlier (I think 2001 and I'd left the company by 2007) I don't doubt their version of events.

While there isn't anything wrong in the Welsh administration's approach, as usual it just doesn't add any particular value. The performance of most Welsh (and I think Scottish) public functions lags England which I suspect can be explained by competence more than scale. The Betsi Cadwaladr University Health Board is responsible for the north Wales NHS and has just distinguished itself by contributing to a blip in the covid-19 death statistics in Wales, having retrospectively reported 84 deaths apparently after realising that they were still reporting monthly rather than daily. This is only the latest in a long line of failings by a body that has been in special measures for 5 years. The best thing that could happen for the Welsh NHS would be for it to abolish itself and hand responsibility to the English NHS.

Anyway, in preparation for deploying its traffic light easing, the BBC reports that Wales has just tightened its restrictions on exercise. It has reverted to discouraging people from driving "any significant distance" to exercise, the English guidance having been clarified as a drive much shorter in time than the period of exercise. If they just want to keep the English out, why not close the border? They say "busy places like parks should be avoided" when the UK government has encouraged local authorities to keep parks open. The point that caught my eye, however, was for cyclists. The Beeb says they should only go "a reasonable walking distance from home" noting that why isn't spelled out but "the rules say an accident a long way from home could put more pressure on the NHS". Eh? If you need to call an ambulance why does it make any difference whether you are near to your home or not?

This is bananas. Personally, having been buzzed many times by cyclists on the dual use north Wales coastal path who seem to feel social distancing doesn't apply to them and often approach at frightening speed from behind, I'd be more worried about cyclists doing laps of their locality. I watched a lady older than me and walking towards me nearly jump out of her skin the other day when a cyclist going in the same direction as her sped past at around 20mph at less than arms length. Motorists are told cyclists are entitled to their wobble so surely walkers are allowed to change direction and go across the path (good job she didn't). Cyclists often complain about motorists buzzing them. What's sauce for the goose....

The Scottish and Welsh administrations seem to spend as much time trying to justify their existence as doing what they were set up to do. They do not bring greater local accountability. Many people in north Wales feel the Cardiff administration is remote and generally irrelevant. And on occasions harmful. The husband of a former Conwy MP died of covid in hospital recently having been admitted to a general ward. His first test sample got lost and he was dead by the time the the result from the second came through. His widow is campaigning that samples should be sent to Liverpool (80 minutes away) rather than Cardiff (4 hours).

We had - still have - a perfectly good method for local government and accountability without devolution and the regional assemblies: they are called councils.

But perhaps the oddest development was the news last night that the government is planning to establish a series of regular meetings with senior medical directors of the major sports in a bid to return to action as soon as possible. It was described as a "quickening of the pace" and intended to help sport resume within weeks "if progress was made". I haven't missed sport as much as I thought I would and I found this news almost depressing. We haven't heard of equivalent discussions in other areas of business and activity, though I accept that doesn't mean they aren't taking place. However, if that's what the government think is most important, we are in real trouble.

Friday, 24 April 2020

Has Rishi Sunak been too generous?

I noted a few days ago that I was uneasy about the number of businesses that appear to have decided it is in their business interests to go into hibernation, temporarily cease trading and take advantage of Rishi Sunak's bold schemes which he described as the most generous in the world. (What Is Essential? 20 April). It's not clear the chancellor expected this degree of gaming of the system, potentially hitting the economy even harder than he allowed for. Evidence is building that some of the help to individuals and businesses may be too generous to enable the economy to function as effectively as it could, even in these difficult circumstances. But I accept that each business has to take its own decisions about how to best get through to the other side.

Meanwhile the furlough scheme, underpinning 80% of normal wages has not been without criticism because of details such as how agency workers are paid. Apparently a large chunk of their regular earnings are paid as if they were discretionary bonuses which don't count as 'normal' pay. There are myriad other issues as well but I don't criticise Sunak on that account - it had to be a simple, one size fits all scheme that could be implemented quickly. The problem is simply that resources which could have helped the economy and the national effort to tackle the virus have been kept locked up because many furloughed people don't need to work. They can volunteer or indeed do work for another employer - provided their contract with their current employer allows it*. None of my contracts of employment - at least none that I can remember - would have allowed this. The point about an emergency is that the government can change almost anything though I understand they would be reluctant on things like this.

The most vivid example of the impact is the requirement for seasonal workers to pick fruit and vegetable crops which requires 70,000 pairs of hands each year. 99% come from the EU, nearly 60% from Romania and Bulgaria. The government apparently hoped that some of the people laid off would work in a "land army" of seasonal workers. Well 35,000 did apply - a worthwhile half the requirement. But then the chancellor announced his furlough scheme. Only 20% of them completed the application process and only 3,000, less than 10% of the original applicants, are committing. "We think it's partly because the chancellor's subsidy schemes mean many people no longer need farm work" said an agricultural recruitment agency**. So planeloads of Romanians are being brought in.

Wherever the chancellor looks there must be problems. So while the food sector is generally flat out, dairy farmers are having to pour away milk and are getting a fraction of their cost price from the supermarkets. One such farmer normally supplies milk to Costa Coffee and BA. At the moment they don't qualify for government support but within weeks but will soon run out of cash to buy feed. Given there is a groundswell of opinion about becoming less reliant on imports it would be unfortunate if we have eaten much of the dairy herd.

Meanwhile he has businesses who don't qualify for the support so far offered lobbying hard, Virgin Atlantic being one. I'm not sure I would bail out Virgin but not because it's majority owner is rich or it's other main shareholder is the large American company, Delta. My reservation is that I can't see air travel returning to anything like normal for a very long time. It may be that a structural reduction in the capacity is inevitable. If so, how long should we bail out the weaker companies for?

Some have argued that allowing firms like Virgin to go under would mean we pay higher prices in the future on the Atlantic routes dominated by a BA-American duopoly***. But the planes and slots would still be there for another business to enter and undercut them if the market is lucrative enough. Oh I feel sympathy for the staff alright, but if the jobs aren't there long term they aren't there.

So I can understand why Sunak is sitting on his hands on this one at the moment. It's his job to see that the economy is in a position to restart. That doesn't mean bailing out every firm. The measures taken to deal with the economic impacts of the financial crisis protected a lot of weak companies which is not in the best interest of the economy long term. It would be unfortunate if the economic and financial measures taken to deal with the medical crisis leave us with a legacy of too many weak companies, shuffling into the future like zombies but without the strength to flourish. It might be better in some cases to let the weakest companies go to the wall and prepare a bold and visionary scheme to encourage entrepreneurs to start new companies in the recovery.

While uneasy I'm not yet critical of Sunak and the government's approach. They had to act quickly and it would have been worse to announce something inadequate and to have had to bolster it. Sunak is trying to support the economy and the population in general and he can't worry too much about some things falling through the cracks. But as we move forward into easing restrictions he may have to get smarter. It won't be easy but we all have a vested interest in him getting it right.

And if Sunak had been significantly less generous he could have been on the end of rants like American comedian Vic Dibetto's, whose in-car video has been viewed over 10 million times on social media. It's a fabulous, passionate, red-faced expletive ridden tirade about what he thinks the US government should be doing. You can find it in lots of places: as well as showing the video the Guardian **** gives some background. As a buddy said on facebook "can we hire this guy to ask the questions at the UK daily government briefing?"

It would be more fun to watch than the questions our journos ask.
** Lettuce help - Romanians come to the rescue of farmers, Sunday Times 19 April
*** Alex Brummer, Virgin deserves a lifeline, Daily Mail 23 April

Tuesday, 21 April 2020

Alexanders galore

I wrote recently about the bountiful crop of Alexanders (smyrnium olastratum) which grow abundantly around here and turn out to be edible (We'll be ok if celery and leeks sell out, 13 April). I noted that it can be found on waste ground, adjacent to ancient ruins and in hedgerows, especially near the sea. Well here's a lovely display on waste ground adjacent to the river Conwy estuary near some ancient ruins that, I think, were once called a "golf course", featuring rather curious earthworks which must have had a purpose at one time.

And here's another crop nestling at the base of a blackthorn hedge adjacent to a different ancient structure called a "railway".

That stretch of railway is still in use although no-one here knows why as it was hardly used by anyone even in the long forgotten days before the "lockdown". We assume it's some sort of job creation scheme for train drivers and signallers who, after all, are amongst the lowest paid and neediest in society. (Sorry that's not irony, it's just not funny in both senses).

I wondered about trying to make Alexanders soup. I found a couple of recipes, one with herbs and creamed another supplemented with parsnip. But Mrs H squashed the idea with a resounding "yuk". I guess you don't know which dog has been peeing on them.

Why wasn't it made someone's job in February?

I tend to think there is an awful lot of wise after the event hindsight being deployed by commentators in the discussion about our preparedness for the pandemic. But it may well be the case that the UK was slow to act from late January till March.

It's clear the UK led the world in pandemic planning - at least we did 10 years ago. One adviser to Singapore noted that their plan had been based almost entirely on the UK's plan. The difference was it had been implemented.

But ours had been implemented too: Alan Johnson, Secretary of State for Health 2007-9, noted that the WHO described our preparations as "amongst the best in the world" at that time. Mind, one of the points praised was the concept of "sleeping contracts", ready to be activated when required. Which just shows that no plan is perfect as, in a rapidly spreading pandemic (and this has been rapid) those sleeping contracts might remain asleep as the suppliers of PPE for example may well be maxed out.

If there has been a problem it may well have been what some would call bureaucratic inefficiency. The governement is aware of at least 6000 companies who have offered to help with supply of PPE.  One company boss, having been contacted by NHS Supply Chain*,  noted that he provided quotes to supply surgical masks, protective suits, eye protection and sanitising gel and pledged to provide samples within three days. Having heard nothing he has supplied quotes every 7 days as market prices of raw materials change. Actually he has heard back from the NHS: they complained that his updates had confused them. 

A spokesbod said that the government was processing offers from 6,000 suppliers. One might reasonably jump to the conclusion that they haven't had enough people working on this and, if so, since there must be an awful lot of buyers around the country on furlough then we haven't been maximising the use of our national resources. (The way furlough is working was a worry of mine in yesterday's post).

Eventually the inevitable inquiry will give us answers. But in the meantime I was alarmed to read that Matt Hancock has just appointed a "PPE tsar" to lead a national effort and "get a grip" on the supply of protective equipment for NHS workers. Horse and stable door come to mind.... And I was even more alarmed to read that Hancock's time has probably been spread to thinly, having to bring together efforts on expanding testing, sourcing and delivering PPE and increasing hospital capacity including efforts to buy and build ventilators. 

Wow. I had blithely assumed that chunks of this would have been delegated or reassigned. It is believed Michael Gove has argued for a wartime style ministry of supply to co-ordinate some of this workload. Well he would, wouldn't he but Gove is probably under-utilised currently and he won't be the only cabinet minister in that category. I can perhaps understand (though not accept) that Hancock would have resisted any move by Raab to reassign parts of his normal duties. But Boris Johnson didn't go in to hospital until 5 April, long after I would have thought we should have moved into emergency mode in terms of management of the various elements of this crisis.

I am reminded of a chap who was my boss for several years who was ex-military and a very sharp cookie indeed. I am certain he would have told Hancock "you've got enough on your plate" and pointed at specific other people identifying which ones would be responsible for PPE supply, ventilator supply and providing extra hospital capacity. This would cut entirely across normal lines of management in the NHS and Public Health England, but so what? A good thing probably as we've also heard PHE has been overly protective of its role and slow to react.

Now of course Hancock will have had people dealing with all of these various things. But they've still  been taking some of his attention. Said boss of mine believed strongly that if an issue was sufficiently important it required 100% of somebody's attention to manage it. I can recall a time when I had charge of a group of around 500 people, with a divestment of one large activity to another company in negotiation and myriad other issues to manage. My boss decided that resolving a particular commercial issue with the Ministry of Defence had become mission critical. There were several millions of pounds at stake and the dispute needed to be cleared up for the divestment to go through, avoiding potentially troublesome indemnities. I was told to leave everything to my (very capable) team of managers and spend 100% of my time on this single issue. At first I didn't see how I could spend all my time on the one issue and was spotted chairing a short review with part of my team. My boss was apoplectic: he went, as they say, apeshit. When he said 100% he meant 100%. He didn't care if I worked a 25 hour week instead of my normal 60 hours plus as a result. He wanted me thinking about nothing else and distracted by nothing else. And I did nothing else for about 3 weeks. We got our settlement (£3 million - I thought we'd do well to get £1 million) and the divestment went through. No other milk got spilled as a result.

So I would have thought that a big hitter should have been put in charge of each of those key deliveries to the NHS, none of which would take up much of Hancock's time under normal circumstances. And it should have been done a long time ago, way before we went into lockdown. I remember another piece of advice I received from a wise mentor early in my career: if you want to make sure something is done, make it someone's job. (He meant their whole job).

I said at the outset that I thought a lot of hindsight was being deployed. In case I am accused of the same I have checked my whatsapp message log as I recalled a message I sent to my sons while I was on holiday a while back:

"I've been reading what a prof from the London School of Hygiene & Tropical Medicine, a co-discoverer of ebola, has to say about corona virus. He thinks we could be in for a huge number of cases, given its quick spread in China. You guys live in populated areas and travel on trains. I predict a run on face masks so buy early! Mind they don't do much good.....the main advice is lots of handwashing and stay 3ft** away from people.... lecture over."

The date? 11 February. I also said masks were readily available (at that time) on Amazon. If I knew masks would be in short supply by 11 February why was Hancock appointing a PPE tsar in mid April?

* NHS Supply Chain is a limited company wholly owned by the Secretary of Sate for Health and Social Care which manages the sourcing, delivery and supply of healthcare and food products to the NHS and social care organisations in England and Wales.
** 3 feet was the initial advice

Some of the quotations here come from "Hancock hands kit shortage problem to 2012 Games boss" in the Sunday Times, 19 April

Monday, 20 April 2020

What is essential?

The government was, apparently, surprised by the degree of compliance when we went into lockdown, as it had been a bit sketchy up to then. So how's it going? From my own observations many over 70s I know are determined to go out for their own shopping. Traffic seems very quiet on some occasions and quite busy on others. As well as my own observations, monitoring traffic going over the causeway and bridge towards Conwy from my breakfast table, Democracy Man (aka Tony) has given regular facebook updates on activity in Sefton which he monitors during his government approved exercise (by bike)*. It sounds as if there is more traffic in Sefton, which caused Tony to wonder whether there is more business being undertaken than we thought. One of his followers suggested black market activities, but then (stereotype alert) Sefton is on Merseyside.....

Such spot observations could be misleading - the official stats** show that when we moved to lockdown on 24 March the total volume of traffic fell from around 70% to just below 40%. And there it has pretty well stayed, with dips at the weekends and Easter when it goes down into the 20s before bouncing back to the high 30s when folk who can work do and the rest of us decide we have to go out to shop.

I've been pondering what work is allowed and what isn't. I've heard of people left without a bathroom, the job being stopped after the old one was stripped out. And yet the government advice*** clearly says that work in people's homes can continue, provided social distancing is observed. Friends in the north west have a bomb crater back garden as their landscapers walked off the job when lockdown started. Meanwhile neighbours of ours have had serious landscaping works start last week, with the team not always appearing to my eye to social distance. But then it is a family business so maybe they all live together. Meanwhile a stonemason would be perfectly willing to start work pointing the wall that holds my house and garden up a Welsh hillside, which he could readily do while maintaining much more than two metres distance. Except that he can't get cement because the local builders merchants are closed. The neighbours' landscapers have sourced concrete blocks from Anglesey, 35 miles away.

I'm not sure why many of these decisions are being made by the individual traders. Most builders merchants closed following the PM's 23 March announcement in which he said (I think) that only "essential" businesses should remain open. But that's what he said, the regulations don't say that. Others decided their products were on the government's essential list and have remained open. The government guidance says you can travel to work if you can't work from home and that you can work away from home provided you can social distance and not breach the shielding of vulnerable people.

The guidance is clear that all retail outlets had to close with "notable" exceptions. The list of such exceptions is actually quite long, and includes "hardware shops and equipment, plant and tool hire". I note that it is entirely silent on wholesale businesses. So my assumption is that builders merchants could legally remain open to supply the trade and anyway could argue they supply hardware and equipment. 

This leads to an obvious conclusion: Democracy Man is right that there is a lot more "work" that isn't banned than we have realised. But a lot of work that isn't banned has shut down. Is that what the Chancellor wanted I wonder? Either way, it's probably because of what the chancellor did.

Rishi Sunak has had a lot of plaudits for his budget and then his emergency coronavirus measures. It's notable that, just as Alistair Darling's measures (like taking equity in banks and increasing liquidity by quantitative easing) were followed by the US and EU so, pretty well, were Sunak's. It's clear that prompt and radical action was needed and that, in the circumstances, a one size fits all type approach would have to be adopted. There has been criticism that small businesses can't access the aid they were offered and, as with PPE, there seems to be a sheer volume problem of dealing with all the enquiries. But I am uneasy. My concern is that many businesses have decided that it is in their interest to close, rather than because they were told to. Maybe they see advantage in closing and furloughing their staff. In which case there could be more (safe) economic activity than we have at present and less call on the government's purse. Which of course is ultimately our money.

When the time comes to relax the restrictions - I don't expect they'll be totally removed for a long time - it may prove difficult enough for the government to define what is allowed and what isn't without companies gaming the system.

I also have a little voice at the back of my brain saying that one of the great strengths of a market economy is its ability to rapidly move resources to meet demand. Except at the moment some businesses can be tided over and many individuals can get most of their normal income without working. Which means that they don't need to consider alternative opportunities, be that covering for migrant workers who can't travel (so crops may rot in fields) or helping to deliver PPE or other essentials, like all those goods that are being ordered online (haha). There is a massive opportunity cost in keeping people idle even when they can't do their normal job. This can only be done for a very short time or it will be economically destructive.

Many of those goods available on line include things that can't be bought in the shops and so presumably aren't "essential". In terms of shops the official guidance says "basic necessities". Hmm, basic....

For me the public service that has not covered itself in glory during the lockdown is the police. Although pragmatism has ruled for the most part there have been random acts of officiousness, like the PC recorded telling a householder that their child should not play in the (fenced) front garden, through to two officers, shoulder to shoulder (though maybe they live together) telling a hapless sunbather to move with no other person within 50 yards, through to the Derbyshire police shaming dog walkers they've filmed by drone.

Some police forces have seemed determined to get people's backs up. The prize went to the Northamptonshire Chief Constable who suggested that, should people continue to break the rules he might resort to road blocks and searching people's shopping trolleys. Good luck with defining "essential" in a shopping trolley, mate! Which of these items would cause Plod to issue a ticket?

Champagne, whisky, smoked salmon, caviar, a pair of socks or a tin of paint and brushes?

Well, obviously anything you can eat or drink seems to be essential, however non-essential it really is. So all of those things have become "basic necessities". The socks are on sale at Asda supermarkets but not at clothes shops, though of course you can buy online, so I imagine Plod would consider them a basic necessity. The item that could be a problem is the paint and brushes which could get you a fixed penalty. Even though you haven't made an extra journey.

The government and its advisers accept that there are all sorts of health disbenefits from the lockdown, including mental health risks. Doing manual tasks like painting and decorating can be very therapeutic. So if you live in Northamptonshire my advice would be to get a note from your GP, if you can get them to answer, to prescribe painting for your well being. Or use the Rod Liddle defence: take a loaf of bread and a bottle of domestos in with you when shopping for your potentially non-essential booze. Another defence suggested was to say that you came for flour, pasta and alcohol gel handwash and didn't want to waste your journey by going home empty handed.

Mrs H had suggested to me that the police could be doing sterling work right now smashing county lines or trapping paedos by monitoring social media, whereas they seem to be driving around aimlessly looking for something to do. Until last week when we heard a siren from the estate down the hill from our house. On looking out we saw a large police van (you'd call it a riot van if it had the shutters on) which was travelling slowly away from us with its blue light flashing and sounding it's siren every few seconds. Two police officers walked either side in hi viz. Two walked ahead in the type of outfits worn by football mascots or Disneyworld staff. People were pouring out of their houses to see what was going on and leaflets were being handed out. We despaired at what seemed to be a terrifically good way of kiboshing social distancing. Presumably somebody thought this was a good idea. And even if it was a junior officer they got somebody more senior to agree. Good grief....

The government presumably decided that the guidance can only be detailed to a certain extent and beyond that the public have to be trusted to act like grown ups. Which for the most part they have. Police acting as children's entertainers doesn't qualify as grown up for me and certainly not essential.

* more substantial musings appear on his always fascinating blog at
**  The daily COBR slides can be found on 
***  The (English) government advice on which businesses can remain open is at

Sunday, 19 April 2020

A time for wisdom

On our daily permitted exercise yesterday Mrs H and I debated whether the government was switching it's key parameter from the ability of the NHS to cope to minimising deaths. Nothing explicit has been said but with the NHS currently living within its expanded capacity (it seems the Nightingale hospitals have barely been used other than to test them out with small numbers) the key statistic ministers are saying they want to see responding is the number of deaths coming down.

The Sunday Times reports today that the inner quad of four senior cabinet minsters (Raab, Gove, Sunak and Hancock) may not agree on what to do next. Sunak, supported by several other cabinet ministers outside the quad, is concerned that most businesses have only one to three months of cash reserves and significant problems will result if the lockdown isn't eased soon. Gove backed him up in cabinet last week, saying he agreed with Sunak and had concluded that "we need to run this hot", but Hancock doesn't agree.

I had been reflecting that, if the NHS has significant capacity in reserve, restrictions could be eased as the government had said that was the single most important issue. On the other hand finessing the restrictions to try to stay comfortably but not excessively within that capacity won't be easy and it does mean accepting more deaths than continued lockdown.  I sense ministers were relieved the daily death total dipped after approaching but never quite reaching 1000 and I wonder if that has become a psychological barrier they don't want to breach.

Dominic Cummings has returned to work and isn't one of the "let's get going again" hawks having read a lot about Spanish flu, when countries that came out of lockdown sooner not only lost more lives but also took bigger economic hits. Chris Whitty is in that camp. A cabinet source told the Sunday Times "The problem of running hot is that there is a delay of several weeks between taking action and seeing results. We want to avoid the situation where you relax the rules and then have to tighten them again". (Such relaxation and tightening was considered almost inevitable in the "hammer and dance" strategy I commented on previously, see post of 7 April).

It seems to me they are getting ahead of themselves here. We have the luxury of being behind a lot of other countries in the progress of the outbreak - a good couple of weeks behind Italy and Spain for a start. We can watch what happens as those countries (and France and USA too probably) start to ease restrictions. We can also look at countries like Sweden and Denmark which did not go as far with restrictions in the first place. Ministers had said now was not the time to decide on how to ease restrictions and they were right: it's a decision that doesn't need to be made yet.

Usually when I've met senior people from business, the civil service and politics I've been impressed at how sharp they are. They size up issues very quickly and see more angles while someone is introducing the subject than anyone involved in the preparatory work ever thought of. And they often instinctively balance risks and opportunities in coming to an almost instant conclusion about what they think is the best course of action. Which generally turns out to be sound - but not always. In business people often say they'd settle for being right 80% of the time, because what matters is moving forward quickly.

But quick decisions aren't always wise. Slow decisions might not be wise either: they may be informed by more information though that might just add more confusion. I get the feeling that if we wait for the scientists to give clear advice we might wait too long. I've seen some strategically catastrophic decisions taken at snail's pace.

The high flyers I've met who struck me as wise were also sharp, but not necessarily as sharp as a razor. Oh they could see all the angles pretty quickly too but sometimes they would sense that the issue wasn't as clear cut as others were making it out to be. They'd fairly rapidly decide the best course of action, even if they couldn't necessarily explain all of their logic. When in time it turned out to be a good decision, especially if it hadn't been the majority thinking, we'd say what a wise leader we had. (Or maybe lucky, as in give me lucky generals).

This is surely a time for wisdom - and luck, in terms of the decision makers' hunches. The wise thing right now is to watch what happens elsewhere.

The Sunday Times also reports that the phrase "exit strategy" has been banned in Whitehall after one epidemiologist pointed out that the only virus ever to be eradicated was smallpox. D'oh! I'm with the journalists on this one: they haven't been asking for an exit strategy from the virus, they've been asking how we move out of the lockdown, as everyone knows that the virus will still be around at some level at that point. Don't they?

If we can't have wise people in Whitehall can we at least have folk who understand English and logic?

Friday, 17 April 2020

Spreadsheet Phil

Spreadsheet Phil was Philip Hammond's nickname amongst his staff at the Treasury. I've purloined his monicker for the day and put together one of my punk spreadsheets to try to understand the NHS data for Covid 19 deaths by day of occurrence. As I expected the data comes through slowly and a bit erratically. If you take the raw data from the NHS England website*  you can understand why the experts are saying we're not at the peak yet and why they'll need to be some way past it to be sure.

Taking yesterday's data as an example, for England 740 deaths were announced of which 151 took place on 15 April, 314 on the 14th, 122 on the 13th and the remainder on earlier dates stretching back to early March.

Here's an extract from my cumulative table showing how the deaths we knew about for a particular day (horizontal heading) tot up over the following days (left side column):

APRIL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
2 84 0 0
3 263 87 0
4 397 286 99 0
5 448 400 280 97 0
6 462 425 350 285 69 0
7 495 462 440 464 341 81 0
8 512 485 503 557 503 387 135 0
9 531 515 534 604 560 487 419 140 0
10 544 530 564 643 603 557 573 496 117 0
11 553 543 581 671 635 606 634 657 442 115 0
12 555 544 584 675 640 616 660 709 562 423 121 0
13 557 549 590 680 645 625 673 737 611 516 443 118 0
14 558 554 599 693 655 631 692 750 636 579 575 437 122 0
15 558 557 599 698 657 638 699 771 653 606 637 540 399 113 0
16 559 558 604 699 660 643 704 782 674 624 660 589 521 427 151
17 559 558 604 699 660 643 704 782 674 624 660 589 521 427 151

It looks to me like it takes about 4 days for the deaths on a particular day to be known within 20% and more like 8 days for the data to become fairly settled.  Given that we'll want to see the figures falling for several days in a row that means we'll be more like 10 days or more after the event before the stattos are sure that we're past the peak.

And then the relaxations that make sense depend on whether we got R down to 0.9 (so not much scope) or 0.5 (quite a bit of scope), which Whitty hinted at on Thursday.

What is striking is that (if I've understood the NHS data and manipulated it correctly) the total deaths by day (bottom row of figures, not reliable after about April 10) aren't anything like as peaky as most folk seem to think. You can see why the experts aren't sure we're at the peak yet.

I also think that, from the comments of some journalists, they expect the cumulative deaths curve to flatten and then turn down and decline. Which ain't exactly going to happen unless the Easter resurrection becomes a widespread phenomenon.

They'd be better leaving the politicians to concentrate on consulting their experts and getting on with the work that needs to be done.

Fat chance but I think I'll do that for now.

Ventilator Blues

Following my rant a couple of days ago about dumb questions by journalists (A Duty Of Care? 15 April) the journalists haven't upped their game yet. At yesterday's briefing they plugged away trying to get the First Secretary to speculate about how restrictions might be eased when the government has evidently decided not to play that game. "It's all over the papers, why don't you join in?" was the gist of what one of them said. Raab stuck to his boring brief when perhaps he should have gone off piste and said yes, we read the papers and you can speculate. But if we start listing possible ways of easing then some folk will be disappointed if and when we take different decisions, so we're just not going to do it. This would have the enormous benefit that, on future days, he can refer back to this answer, cut the journalist off, not allow an undeserved supplementary and move on.

They are also still hung up on whether the total number of deaths announced daily is right, rather than what really matters, the trend. So I got nerdy and looked up yesterday's official stats. If you go to the NHS England website* you can see all sorts of detail on the daily deaths announced and on the totals to date, the latter broken down by health trust. The daily total for England logged between 5pm on 14 April and 5pm on 15 April was announced on 16 April as 740. These deaths are then attributed to the date of death: 151 on 15 April, 314 on 14th, 122 on 13th, 49 on 12th and then reducing numbers stretching all the way back to 9 March. (The ones so far back are presumably due to corrected dates or reattributed reason for death).

So with this noise on the line you can see why the precise daily total can't be taken at face value. And as these are deaths in hospitals, which are much easier to count, you can also see why looking at the daily total for all deaths, not just in hospitals, could be misleading. The numbers will still be catching up with delayed reporting over the long Easter weekend so the decline from daily numbers of over 900, while encouraging, is not yet a firm trend. I still think a rolling 3 day or even weekly total would be a better indicator.

Meanwhile the print journos aren't getting better either. The Daily Mail Health Editor started her report yesterday by saying:
"Fears have been raised that care home residents who are seriously ill with coronavirus are being kept away from hospital after national guidelines suggested they should only be admitted if 'appropriate'."
Is she suggesting that such patients should be admitted to hospital if it's inappropriate? I guess the incipient mental health issues in the community that people have been warning about are becoming apparent....

One wonders what the Chief Medical Officer would say if he were to be asked what, in his judgement, would be the proportion of residents in care homes for whom hospital treatment might be appropriate in the event they contracted coronavirus and became ill enough for hospitalisation to be considered. Actually one doesn't, he would of course avoid the question. But if you could get him to speculate... Well Chris Whitty here's my guess given my experience of visiting care homes over a 7 year period. Very few of the residents I saw in that time would be strong enough to survive pneumonia and coronavirus is much worse for the elderly with multiple pre-existing health conditions. So I would guess that the percentage for whom such a trip would make sense must be very low, possibly of the order of 10%. OK, that's a guesstimate but I'm adamant that, in the phrase the medics use, for the rest hospitalisation would not be in the best interests of the patient.

Mrs H and I have seen first hand what the medics can do for such very frail and often highly mentally incapacitated patients when they deploy all possible means and end up extending an already extremely poor quality of life in an even more limited capacity. In the words of a doctor who appeared at the bedside of a relative who nobody expected to survive the previous night "there's been too much intervention". Spotting me and Mrs H he quickly started talking to the nurses in a more coded way, though I should have interjected "absolutely right, mate". Such experiences have at least prompted me to make a "living will" type document with the health and welfare power of attorney lodged at the solicitors for if and when the day comes, so I'm never "saved" in any such circumstances.

I'm left contrasting the apparent desire of some to want to try to save all life, however degraded and at whatever cost, with the  debate on assisted dying. I guess folk just have very contrasting values and see the world in very different ways.

Which leaves me singing along today with the Rolling Stones Ventilator Blues. I know, it's actually about gangsters or something but it's kind of relevant especially since it's from Exile on Main Street -  shouldn't that be exiled from main street at the moment?

Don't matter where you are, everybody, everybody gonna
Need some kind of ventilator, some kind of ventilator
Come down and get it
What you gonna do about it, what you gonna do?
What you gonna do about it, what you gonna do?
Gonna fight it, gonna fight it
Gonna fight it, gonna fight it

So that's journalists and people who want to send their dear old demented and very ill mum or dad with coronavirus to hospital randomly berated. Tomorrow's target? Plod probably even though that's admittedly an even softer target.....

Wednesday, 15 April 2020

A Duty of Care?

Readers may have noticed that I get irritated rather easily. The latest object of my ire is the journalists who ask such dumb questions at the government's daily press briefings. This leaves me with some sympathy for the two stooges either side of the minister of the day, who are there partly to show the  government is "following the science" when they mean they are paying attention to what the particular scientists they have appointed are telling them, there often being a range of views in the scientific community on any particular issue that hasn't yet been fully understood (and even sometimes when it has). Not to say that's an unreasonable approach. After all you pick the "right" people for the jobs and then you can ask them questions: you don't necessarily take their advice at face value.

So back to those journalists questions. Why so irritating? I suppose because the answer is often either obvious or can't possibly be known yet. The particular case in point over the last couple of days has been the hoo-ha over the numbers of deaths in care homes and the community.  Under pressure, yesterday's medical stooge said that the aim was to try to get the ONS data for all deaths reported on a more timely basis. I'm not sure this would be the best use of resources. After all, deaths in the community are reported at varying times after the date of death depending when the death certificate is registered. Unless or until you set up a totally new method for collecting it from doctors instead of registrars. So any attempt to gather data on a daily basis will fail and will be subject to retrospective correction.Which brings me to the other point. While the total number of deaths is important and each one represents a loss to a family, the thing that matters for government policy and decision making is the trend. As around 90%* of the covid-19 deaths are occurring in hospitals you don't need the precise daily total to take decisions, especially since the whole approach is based on the capacity of the NHS to cope. Therefore it is hospital admissions and intensive care load factor that matters, not the total number of deaths.
        *Though in Scotland it seems it's different - 25% of fatalities have been in care homes and 13% in the broader community

For the decision about whether to tighten or release restrictions it doesn't matter a jot whether our data directly compares with that of France, for example. What matters is that our data is consistent. The relevant comparison with other countries is the gradient of the curve, not whether we are above or below France or Italy at the same stage as the data will inevitably have been gathered in a different way and small differences in the totals will be meaningless.

I imagine it has been drummed into the various ministers and experts not to say that, at least not in that way, as they would then be panned for appearing heartless and implying that the other deaths "don't matter".  But, as even hospital deaths are not always reported promptly, especially at weekends (we learned the other day that a death on a Sunday might not, in some cases, be reported until the Wednesday) I have been wondering for some time why they don't use a rolling three day total to smooth out these reporting timing issues. I guess that, behind the scenes, there are lots more graphs which ministers see. They may feel that anything other than the simplest presentation is beyond public comprehension, but that swaps one problem for another. And even smoothie "dishy" Rishi Sunak with his excellent presentational skills seemed, to my ears, to get tangled over a statistic yesterday. I suspect he read out something from the autocue that he hadn't challenged because, as he said it, it made no sense, referring to the cumulative total of hospital deaths so far being part of the now falling number of patients currently in hospitals.

So am I saying the deaths in care homes don't matter? No I'm not, but I'm wondering why these issues weren't raised by the journalists three or four weeks ago if they care so much about it. Any readers (and I know there are several) who have or have had elderly relatives in a care home or who require care at home will no doubt like me have thought about how difficult things will be for those vulnerable folk. And also for the now almost equally vulnerable people looking after them if the people in their care get covid-19.

So I'm not going to accept that the world has just woken up to this issue. My now departed uncle, before he briefly went into a nursing home, had carers coming in to his house several times a day for an extended period. Before we went into lockdown I said to Mrs H "Roy would have been a sitting duck" because there was a rotating cast of carers and social distancing isn't possible in the context of personal care.

If you were going to fully "shield" these people their carers would have to have been in isolation with them. Some folk caring for a family member have done exactly that but in general it is not a practicable approach. In a care home context staff would have had to live in, where there was accommodation available, or be isolated by some other means. Probably not practicable to any degree. And surely that is the test: to use the phrase from health and safety legislation what is "reasonably practicable" a phrase which, in such law, implies a prior assessment of the risk and the costs of potential mitigations.

Mrs H and I are grateful that our relatives did not live long enough to experience the stress of this situation. I can't imagine trying to reassure a person with dementia who, confronted with a carer in a face mask, becomes startled. Which, in many cases doesn't just mean frightened but violent. We were always grateful for the care provided by the staff at various care homes, working under considerable difficulty even under normal, pre-covid-19 conditions. To expect them to do any more than the best they can in theses circumstances would be unreasonable. This is a disease that has much higher potential for old people than the young (aren't we relieved it's not the converse?) and it was obvious from the outset that there will be a heavy toll in care homes. The average length of stay in a residential care home before the usual one way ticket out in a wooden cardigan (a phrase we learned from a nurse at such a home) used to be about 15 months. It will be shorter for nursing homes. There is a reason: the individuals are generally very old, frail and more likely than not they have dementia at least to some degree (after all, everyone with marbles tries the damnedest to stay out of one). Many of those people have an extremely poor quality of life and would not live for very long. I struggled at the outset to see what could be done to protect care homes - and I still do. I salute those who work there and, personally, I would not expect them to take unreasonable risks with their own health, which might mean scaling back normal standards of care.

One of the problems for care homes is protective equipment, where the government is struggling with the problems of scale, which will be familiar to many engineers especially those with a process industry background. Just because you can do something doesn't mean you can do it on a hundred or a thousand times larger scale, at least not like clicking your fingers. PPE now needs to be distributed to 58,000 locations instead of two hundred odd hospital trusts. With hindsight the contingency stocks should have been held more widely across the country and probably at many of the locations were they are now needed. Perhaps this requirement, stemming from the speed of progression of the outbreak, should have been identified in advance. Quite possibly it was but it was but on risk grounds it wasn't thought necessary.

Of course, while the government is the means of last resort here, the care homes are privately run. We will learn in time whether they decided they needed contingency supplies of PPE and other equipment. After all it wasn't just governments who were warned about possible pandemics.  And these concerns aren't new. In the 1990s the concern was avian, or bird, flu - H5N1 I think. The directors of the company I worked for became convinced that this risk was sufficiently real to hold large contingency stocks of tissues and handwash. This wasn't just out of concern for employees: they saw a potential commercial advantage if the company could come through an outbreak in better shape than competitors. "Those who aren't ready will go bust" I can remember being told as we got swamped with supplies for which we had to find storage. A year or two later we were told to run down the stocks, which saved us having to worry about those that had been filched, or just diverted into use as normal supplies. And therein lies part of the problem: checking that stocks are still there, in good condition etc would have to be done. Perhaps care homes could and should have had adequate supplies for several weeks, though such provisions of materiel aren't necessary for a standard flu outbreak.

Which leads us to preparedness and the exercise to check out NHS readiness called Cygnus and run in 2016 by Imperial College (yes, those guys again). The NHS reportedly "failed" this test, which is not as damning as the journos make out. Such exercises are usually failed, the reason you do them is to identify weaknesses. I am reminded of my time in the nuclear industry where we had big emergency exercises on each nuclear licensed site, witnessed by observers from the regulator, on an annual basis. The year I had charge of a team and facility with two baby nuclear reactors I was committed to being at another site on the day, about which I wasn't too unhappy as the exercise was going to be based on a hypothetical incident in our building, one of many on the site, which would have meant all sorts of restrictions on the working day. Some of my people would have taken part in the exercise, run by the site management. So when I got back to the office the next morning I asked my PA, a redoubtable and highly competent lady, how the exercise had gone, expecting she would have some idea, if only from gossip. "Not too well" she said "two people died". I chuckled and said that I hoped these were imaginary casualties in the exercise and not for real. She looked briefly worried and said she wasn't sure. I laughed louder and said "I think I'd have heard if they were real but you'd better get Malcolm (who was my safety officer) round to tell me about it". It was indeed the case that two of my chaps had been handed cards during the exercise saying, effectively, "you're dead, sit there and shut up".

The team in charge of the emergency response, working from a building a couple hundred yards away had struggled to identify what scenario was unfolding based on the alarms they had been told had gone off and other indications. They never got to grips with the incident in which a fork lift truck driver had suffered a theoretical heart attack, ramming a drum containing lightly radioactive liquid which had set off the alarms and led to the building being evacuated. A person in protective gear was sent in. He was given a card which said "a drum has fallen on you - you're dead" and the fork lift driver was then told he had expired before help arrived. Meanwhile the incident controllers struggled with whether to send in more rescuers, potentially exposing them to risk, and were given more information which was deliberately confusing. Time was called before they understood what had supposedly happened. Lessons were learned - that was the whole point. I never saw an exercise in which they weren't, even if the conclusion was that the incident had been handled well.

So I draw no particular conclusion from the fact that the NHS failed Exercise Cygnus. The correct question is what was done to follow up. Which might mean actual actions being taken but in some cases might involve assessment and judgements that the necessary actions aren't cost effective given the risk. Some reports say the exercise was "ignored", though that can't be the case as there is also evidence that various authorities did take some action as a result of the exercise. And it's not automatically the Health Secretary (at the time it was Jeremy Hunt) who is to blame if the NHS did ignore it as the NHS, at least in principle, was given operational independence about 8 years ago, a bit like the Bank of England was given by Gordon Brown in 1997. Which hasn't freed it from political interference of course. But all this is for later, there are more important things to be doing right now.

I think I'd start by inviting journalists not to try to get the government to compromise the quality of the data it is getting by changing the basis for it in mid air. I'm not sure yet how well the government is doing - for the most part getting an act together after a slow start in January and February I feel - but I think the journalists are having a nightmare. My number one target - Hugh Pym of the BBC who was clearly given a low profile job that wouldn't lead to much exposure because he wasn't up to economics, politics or foreign affairs. None of which would matter if it wasn't always the Beeb whom they invite to ask the first question. Why?

PS Pym and the BBC asked first again tonight of course. Hancock did ok, journos not as bad as on some days. I'd have preferred more frankness on some points but he knows that would lead to a media storm.