A Moscow must have…

Primary Care Training_NHS General Practice A Moscow must have...

The practicalities of running a service during a national crisis are coming home to us all.

All the table top exercises you did on that management away-day… well, I bet you wish you’d taken it more seriously!

Utility-service outages, explosions, terror attacks… done ’em all!  Military law, the Civil Contingencies Act 2004.  Civil unrest, collapse of civic society.  Yup, I bet you’ve covered the landscape of simulated disasters!

I have… but there’s nothing like the real thing, and…  

… there is nothing like the real thing when it’s a pandemic, as it gathers pace.  It took 67 days for the first 100,000 cases to emerge but just four days for the third 100,000 cases. 

So, let’s do what we’ve been taught.  Take time-out for a sit-rep.  Where are we?  Dunno… we’re flying blind.  

On Monday we only tested 5,605 people.  Yesterday, 6491.  

We’ve know the Coronami was on the way, since China reported its first infections in December.  Our first case was the 28th February.  That was a 60 day warning we let slip through our fingers.

Right now we’ve got people working who shouldn’t be.  People who are self isolating and needn’t be.  We have carriers, hot spots and gender specific issues that we have no idea about, until someone dies and then, all we can do is count backwards.

We don’t know what’s happening because we aren’t testing enough people, frequently enough.

Transmissions are happening we can’t count, passing the parcel to whom… we don’t know.

I have no idea why there is such an obvious gap in our defences.  Is it lack of foresight, planning, resource, stupidity, neglect, technical capacity, people, money or the will to ‘get testing done’.

We have good people doing great jobs so what is the problem?

We’ve had six weeks of promises, ‘ramping-up’, ‘huge-effort’, promises, dissembling and dodging the question.

If the government were sensible they’d tell us what their problems are.  Companies, people, organisations, individuals would help… of that I am certain.

If there are issues about chemicals and kit… tell us.  There will be manufacturers here that will turn their skills to providing it. Like they’re are making ventilators.

If most of the makers are overseas, there will be global competition for supplies… tell us what’s needed and let’s make it here.

If PHE is overwhelmed let’s create testing hubs in factories, school labs and leisure centres.

If we really want to know what’s what, let’s start making our own antibody test and find out who is safe to go back and keep the economy ticking over.

When you were doing your desk-top, war-gaming, the first thing they teach you is; admit your problems. If it’s not right, admit it, fix it, move on.  The second thing you learn is; look after your key workers.

Not testing will impact key health-workers the most.  

It doesn’t matter how many weddings the government tells us to cancel or how far apart we stand, if we don’t test NHS staff they will be super-spreaders when we don’t know it and sit at home, when we don’t want it. 

This is not a policy, it’s a lottery.  At any other time the duty-of-care police would be on the case.  Not testing puts lives at risk, squanders resources and throws away precious knowledge.  

Skilled emergency planners learn to prioritise.  They learn about Moscow…

… management guru, Dai Clegg’s tool for getting our thinking straight.  

Moscow is actually, MoSCoW.

Use it when all deliverables are important and it’s tricky to place one above another.  Figuring out which-and-what will deliver the biggest benefits the quickest.  Biggest bang for the bucks.  The acronym stands for;

  • Must have,
  • Should Have, 
  • Could have
  • Won’t have… and they are all linked to what Clegg calls, ‘the time-box’.

Must have’s; are vital and have to be delivered in a time-box (time-frame).  Not to do so is a failure and failure will have its own ripple effect and consequences.

Should have; important but not necessary in the current time-box.

Could have; desirable but not time-tied.

Won’t have; the least critical and gives the lowest return on effort.

Once you have MoSCoW sorted, you know what to do first.  As events evolve so the time-box changes and the priorities will move.  By keeping the priorities calibrated with the MoSCoW tool gives you a far greater clarity.

Where does testing fit into Moscow?

Let’s pretend we were starting a war-game from the beginning.  We’re doing battle with a virus.

Who catches it, how is it spreading, where, how fast?  Can we protect key workers?  Where shall we deploy our resources?  What policies do we need?  By when?

The answer; testing, testing and testing again.  The absolute biggest bang for the buck.  

How long have we got, what’s the Time-Box… make that from the ‘p’ in pandemic.  The ‘f’ in the first-case.  The ‘n’ in now.

Testing, a Moscow must have.

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.