A long way to go…

A long way to go... NHS_Training_in_Primary_Care_General_Practice

Managing disaster… alas, the world has had plenty of experience.

There are courses on disaster planning and response.

I’ve been on one.  It was a long-time ago and it was all about nuclear conflagration.  The optimistic belief there would be some levers left to pull after a lunatic, somewhere, had pressed a button.

The principles endure.  Planning is long, detailed and mind boggling in the scenarios, options and rabbit holes to go down.

There are basic rules; warning, evacuation, rescue, immediate assistance, assessing damage, on-going assistance, restoration.

In today’s Covademic make that; warning, lockdown, support networks, damage reduction, restoration. 

Coupled with; don’t fudge what you don’t know.  Communicate, communicate and communicate.  Make decisions early but be prepared to flex.  Identify what’s mission critical; assess resource, materials and capacity.  Keep focussed on the end-game and define the new normal as early as possible.

There’s a lot more but that’s the top line.  I’ll leave you to come up with your own scorecard for how we’ve done so far.

There’s also a very interesting bit.  The middle bit.  This is what they teach you… 

In the midst of the crisis the tendency is to assume; correct decisions will have been taken and everything is going to plan.  

Wrong… it never does.  

As stakes get higher, expect foul-ups, failures, bad advice, wrong decisions, cover-up, teams to fall apart, seeking scapegoats and dumping blame.

In our Covid-crisis, the middle-bit has begun. 

Thérèse Coffy a Cabinet minister for something-or-other, said the scientists gave duff advice on infection.  

Jeremy Hunt has said something about scientists… not quite sure what he’s said but I don’t think it is complimentary.  

The Science and Technology Committee

Have had a go at testing and provoked Duncan Selbie, boss of PHE, blamed for the slow roll-out of testing, to, rightly, hit back.  It was down to the DH.

On the course, they teach you, to avoid a falling-out is a test of leadership.  In BoJo, we have a showman. Not a leader.  

At this point the play-book tells you… pause, regroup.  Take time-out.  Ask; where are we, what’s worked, what hasn’t, what needs to be reviewed, what do we need more of and less of?

The advice is to use an independent facilitator, leave the egos at the front door… find a second wind.

The omens aren’t good… Coffy is a scientist and should have known what’s what, no excuses.  Hunt was the SoS and could have left us better prepared, he knows it.  The Science and Technology Committee are confusing organisational management and resource allocation, nothing to do with science or PHE.

All of them playing the Westminister game; when the music stops, make sure you’re not holding anything embarrassing.  Everyone, preparing for the inevitable inquiry.

Head-down, plugging away, persisting with more of the same, getting deeper into the mire is a mug’s game.  You must come up for air.

The next big crisis knocking on the door;  testing.  Saying we have test capacity for 200k or a million misses the point.  Is it working?  

Here are a few questions;

  • What percentage of tests are void; unclear, spoiled or lost
  • What is the percentage of home testing kits, sent out and not returned
  • What is the range of time (never ask for averages) taken for test results
  • What is the range of waiting times to get a test, from reporting symptoms at a centre, to receiving a home test
  • What is the range of time a suspect Covid-caller waits to be answered, at a call-centre
  • What is the percentage of false negative tests
  • What do staff say about the ease or otherwise, of getting a test,.

... oh, and let’s have the data broken down by region.

Then, there’s the tracing-trap we’ve fallen into; inexperienced people, online training, tensions with PH professionals, private contractors, data capture, App roll-out mysteriously delayed.  

To save lives, all of these interfaces, people and components have to come, seamlessly together and is more important than you can dream of. Why? 

Expect a second Covid-wave, slap-bang in the middle of the flu-season and we can’t tell flu from CV-19, without rock solid testing & tracing.

No one has done this before, so, everyone, calm down, there’s a long way to go.

News and Comment from Roy Lilley

Contact Roy – please use this e-address roy.lilley@nhsmanagers.net

Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.