Category: Health Systems

Brexit Was Always Going to Be An Idealistic Train Wreck – But Now It’s Even Worse

Fail to plan, well you know the rest

Brexit was always a macabre comedy. We have stumbled from one blunder to another. Applied smoke and mirrors during negotiations because we lacked any defendable position. Used the word unfair a lot. Gone to Brussells with threats and returned with absolutely nothing. The EU actually have a defensible negotiating stance. Unfair to be that prepared. wouldn’t you say? If it wasn’t going to be hard enough clawing our way from under the rubble of failed negotiations, we now have been deeply layered by manure. It’s a Covid addition. You can argue we weren’t to know, but that’s the problem with crap plans. They’re, well crap.

This morning the government announced crisis talks to avoid pre Christmas food shortages. Merry Christmas and a happy Brexit might complete the announcement.

No Food and Possibly Vaccine

The new strain has worried mainland Europe to the extent that they have effectively closed not only personal travel but trading routes. The ones which carry just in time food for our shops. It was timely for the government to tell food stores to stock up. Let’s hope they listened.

Not only are we locked down in our homes, bubbles burst, but we may also be facing food shortages. And a lot of other stuff for that matter. Germany has put these new measures in place until the end of January. Belgium and France are still deciding the length of their embargo. The vaccine comes from Belgium. Where’s that? Greasy spoon outside Calais?

Needless to say, it looks like this will stretch past our decree absolute with our former partner the EU. It was always going to be a challenge to sort out how something as dysfunctional as the no-deal Brexit would work. Let’s inject a little reality into the picture; it wasn’t ever going to work. There are many in the train’s first-class carriage slamming down lashings of Port who don’t want it too. They most likely have their wish, we will proceed from chaos to complete shambles in one move.

If incompetent politicians weren’t enough

We are not in a good place. The Brexiteers who told us a little pain was necessary to get to nirvana and a trade deal with Equatorial Guinea, are about to perform surgery without anaesthesia. It’s probably a good thing we aren’t having people round for Christmas. We wouldn’t be able to feed them.

History tells us that ideologies are dangerous. Only they would think that executing on no plan during a pandemic was good for the country. Not to mention trying to deliver a flawed plan in a perfect environment. It was already highly likely we would feel that good Brexit pain in 2021 and lots of it. Given the current state of our borders, that’s guaranteed and there may be much worse to follow.

At The Present Rate of Inoculation – It will Take At least 14 Years To Complete the Task

Number of Inoculations in a Week Heralded

The government announced this week that they had administered 138,000 Covid vaccinations in one week. To be fair, they are just getting started so that number should move up. The US Centres for Disease Control by comparison, is projecting 7 to 10 million people receiving the vaccine. Taken on its face. The UK rate of 138,000 compared to the US is pathetic. The media loves to compare raw data and ignore population size difference, so let’s be fairer. If we agree that the US population is roughly 5 times that of the UK, our rate of inoculation adjusted for the US population would be 685,000 per week. Roughly one-twelfth of the US rate. At our current rate of inoculation, it will take 14 years to administer a two-part Pfizer jab.

The Math

Let’s define our variables. Total UK population is 68 million. Roughly 16 million Brits are 17 or younger. That group will not initially receive the vaccine. Which leaves us with 52 million people who need the vaccine. Again, let’s keep this simple. It will take 377 weeks to administer fully the first of two inoculations needed for the Pfizer vaccine if it is to be effective.

If we translate that to years? More than seven to administer the first half of the Pfizer vaccine to the entire population. 14 years to complete the task. Let’s say the University of Oxford’s one-part vaccine is approved. Currently, there has been little news surrounding where it might stand other than positive sound bites from the company. For argument’s sake, let’s say it does. People will only need one jab, and let’s also assume we are able to quadruple our jabs per week. We are down to 94 weeks to complete inoculating everyone above the age of 17. Just shy of two years.

Hold on I hear people say. What about all those Pfizer folks that have already had a jab? They haven’t gone away. In fact, those who need the second jab will be at the front of the queue. It’s reasonable to assume it could take a month or two to work through that backlog if the Oxford vaccine became available today. Without a 30-day booster, the recipients of the first Pfizer jab start all over again. Either way, they are still in the count.

The Reality

It is unlikely that the NHS will have the internal capability to significantly increase the rate of patient flow related to administering the jab in the near term. They have few options that would allow that to happen which don’t require putting others in their care lives at risk. The NHS could do a number of things to free up capability to administer more jabs. They can ignore those presenting at A&E. They could cancel needed operations. Delay diagnostics for potential cancer patients and others with life-threatening conditions. There is any number of variables. All of them translates into pain, suffering and potential death for those they should be caring for.

In another post, I outlined a very effective way to administer the vaccine and free up the NHS to care for the patients who need it. If we don’t address this problem now, it is very likely we will still be talking about ways to get out from under the pandemic a year from now. Also, thousands will die needlessly, businesses will continue to close and we will have buried ourselves in a mountain of personal and national debt.

The Future?

The elephant in the room is how long will the jab be good for? Even scientists don’t know the answer to that question. What if we have to start all over again in six months?

90 Year Old Woman Receives First Covid Jab

But why are we forcing our nation’s most vulnerable to run a gauntlet of disease to receive a potentially lifesaving vaccine?

The UK’s health system has significant access issues.  It is also entering the winter period during a pandemic.  And the NHS can’t cope with seasonal flu numbers even in a normal year.  It remains to be seen how the winter flu season coupled with Covid will impact NHS Trusts performance.  Firstly, on the positive side, there are indications that the incidences of flu are significantly lower than in previous years.  The fact remains that even with lower flu rates, NHS hospitals will be struck by their annual winter crisis overlaid by the pandemic.

The government has decided that the best way to distribute the new Covid-19 vaccine is to hand it to an already overstressed, and in some cases dysfunctional system.  Descriptions of the planned distribution indicate it will revolve around patients having to access large hard to access NHS Hospitals.   To complicate matters, the Pfizer vaccine requires recipients to take a second jab 30 days later to be effective.  

We still have not fully calculated the impact that Covid has had on patients when care was denied or delayed.  There is reporting suggesting that waits are conservatively being pushed much further than a year.  We may never know the real number of deaths caused by delayed diagnosis and treatment. As it is hard to capture undiagnosed people who never entered the system.   

What we do know is that the UK routinely scores at the bottom of measured cancer survivorship. Even before the pandemic began.  In 2019 when compared against six comparable national health systems, the NHS was last. The main reason the UK languishes at the bottom of performance charts for cancer survivorship is access to diagnostics.  

Long waits for scans from machines that typically reside in large NHS hospitals are killing patients.  When the impact of Covid is finally measured, many thousands will have lost their lives. Many from not being able to access simple diagnostics.  This will also apply to the millions who suffer from diabetes, heart disease, and other chronic diseases. The disruption of just administering a jab is not what the struggling NHS needs.  Even if it delays one person’s scan, who then goes on to die, it should be seen as one too many.  The reality is that it will most likely impact thousands.  

This approach also relies on the struggling NHS ambulance service. Transport those who can’t make it on their own to the place where they will receive the vaccine. This, at a time when isolation from potential exposure to the virus is the most effective way of preserving life.  Picking recipients up with others at risk in enclosed vehicles. Then transporting them to places riddled with disease and the virus itself, is inviting infection.  It’s exactly the best way to spread it to the elderly.

On the face of it, it makes sense to take people to hospitals. Use already scheduled appointments as a way of distributing the vaccine quickly.  The reality is much different; The NHS will have to re-task staff to administer the jab. Allocate space in already crowded hospitals containing potential super spreaders.  It is by far the best way to distribute the vaccine for the NHS.  And there’s the problem.  Transporting the elderly from relatively safe nursing and private homes into bug-riddled facilities is precisely the wrong thing for patients.  Requiring them to congregate in small vehicles with others is again, the wrong thing for elderly patients.  It is a recipe for disaster.  

The explanations for the current vaccine delivery will revolve around the NHS knowing who requires the vaccine.  An insistence they have the medical facilities needed to safely administer jabs. And the logistical capability in the form of NHS ambulances to transport patients.  The NHS has the necessary cold chain equipment to store the highly volatile vaccine.  All true.  The reality?  During the winter, as the NHS itself admits, the service tips into crisis.  This year’s predictions are for catastrophic impacts on patient access and care.  That includes the poorly performing ambulance trusts.  Relying on an ‘in crisis’ institution to deliver the most important inoculation programme in 100 years is folly.  By its own admission, the NHS can’t provide care this winter for many who should have access to its services.  

The NHS’s growing dysfunctionality has forced a 20% increase in NHS patients turning to the private sector for care. They pay out-of-pocket to access orthopaedic, gynaecology and ophthalmology surgeries as the NHS queues only continue to balloon.  Average cost is on average £12,000. Admittedly, we have a long tradition of stepping outside failing state services to access quality.  That is certainly so with our willingness to pay taxes and send our children to very expensive private schools.  There is a difference between a middle-aged couple gainfully employed choosing to send their children to a private school. And a pensioner who has contributed their entire life to the NHS, paying to restore their ability to walk or see.

The NHS solution centers around its already overwhelmed infrastructure.  Requires the patient to take the risk.  The government should have thought this through out of the proverbial box.  Injections are not rocket science.  With the changes by the MRHA allowing allied health professions not in the NHS to administer jabs. There now exists a deep pool of health professionals to draw from.  The cold storage of the vaccine at -70c is technically challenging. But that issue must have already been resolved by the companies who deliver the vaccine to hospitals.  So, if cold storage is mobile the rest of the delivery supply chain is easily transported.  Why didn’t we work from a position of protecting the patients and targeted distribution?

By taking the vaccine to patients. We free up the already struggling NHS to take care of those they are currently unable to. Or at the very least, not let care slip for even more patients.  We de-risk the exposure of the vulnerable to the virus. Cut out the need to use unreliable, overcrowded ambulances from the process.  As stated, this is not a complicated problem requiring the use of specialized medical facilities, or even doctors’ surgeries. Vaccines for children are given in schools.  There isn’t any reason other than the storage requirement that this vaccine can’t be administered from mobile clinics.

An immediate rethink needs to occur around the future delivery of the vaccine.  Possible solutions may involve the armed services, private sector, or even practices of physiotherapists as fast, safe, and unencumbered providers.  Taking a patient’s exposure from multiple people in high-risk in crisis facilities to one person in a safe setting. Be it their room in a nursing home or a socially distancing compliant mobile clinic, should be a priority. We must take the vaccine to patients and not require them to potentially put their lives at risk to accommodate an overwhelmed NHS.