Category Archives: Health

Serco Killer

…qu’est-ce que c’est?

For the benefit of the confused – and, frankly, who isn’t these days – the NHS Track and Trace “system” is no such thing. The CJJ “government” slapped the NHS logo on a privatised service run by various companies with no previous Public Health experience or expertise. Here are the villains of the piece:

Sitel

Sitel is a US company, headquartered in Florida, which runs the T&T call centre. They call their core business “Customer Experience Management” which they seem to like to abbreviate to “CX”. They work across a wide range of industry sectors and their expertise seems to be call management. Their website is full of bullshit management speak like “omnichannel customer service solution” and “incomplete or stretched channel strategies”. Obviously, halfwit impressionable people like Matt Hancock find this all very exciting.

So, how well are they performing? Assuming that the call centre is the original point of contact for those with positive Covid test results, activity since June has risen from around 4300 per week (73% of positive cases given) to nearly 13,000 in early September (83%). Although they seem to be learning on the job, Sitel are still failing in the relatively straightforward task of making contact with one out of six of the people on a list.

Serco

Serco (of escaped prisoners and invoicing for dead people’s security tags fame) manage the contact tracers. Here’s an example of one of Serco’s earlier failures working for the Home Office on immigrant removal centres such as the notorious Yarl’s Wood in Bedfordshire. To give a flavour: one incident there in 2018 involved 100 women going on hunger strike in protest at their detention and treatment by Serco staff. The company even denied that the strike was happening. So, transparency not great then.

Yarl’s Wood

Serco have made their fortunes hoovering up former public sector work privatised by successive Tory governments. Its CEO was paid £4.5m in 2018 (the most recent I could find). No wonder Boris Johnson complains he can’t manage on a measly £150,000 as Prime Minister!

So, how good a job are they doing at contact tracing? The trend figures are as follows: in June, around 91% of positive cases’ contacts were reached, this has fallen erratically to 74% in early September, having been below 70% for much of September. So the overall system over the 3-month period has found 62% (i.e. 78% of 80%) of potential contacts, well below the target of 80% to be effective.

Deloittes

The other main player bringing the name of the NHS into disrepute is Deloittes, one of the Big Four auditor firms who, like their three competitors, suffer a massive conflict of interest by making most of their profits from consultancy work – much of it for the UK government. Their main task is to coordinate – don’t laugh – the so-called “pillar two” laboratories: the “Lighthouse Labs”. My observation of lighthouses over the years is that they provide a brief flash of light, then all is darkness for most of the time before the next flash. Seems an appropriate name.

The pillar two labs are run by a mixture of private companies and universities. The ramp-up has been considerable: three labs initially, currently five, with four more planned. The reality has been a fiasco. And, sadly, all too predictable. Schoolchildren returned to school in early September (in England), the government has been exhorting people to return to work and to “Eat Out to Help Out”. All of these led to a lot more social mixing and a lot more opportunities for the virus to spread. Just a few short weeks ago, Hancock was advising everyone, if they had “any doubt”, to get tested. Then, just a few days ago, the same Matt Hancock was blaming the public for too many of them coming forward for tests. The press reports of people booking tests – if they could get one – hundreds of miles away are well reported elsewhere. Matching test sites with available slots to geographically close people who need tests seems beyond the capability of the government’s chosen contractor.

The number tested has been increasing. On the government’s own figures, the number of tests has increased by 57% since June. The official figures mix up those tested for current virus infection with antibody tests (which show past infection). So the volume figures must be treated with caution. But, to be of any use, test results must be turned round quickly: within 24 hours or even less. This is because people can pass on their infection before any symptoms show: this has been the particularly dangerous feature of this virus.

Here, it all gets a bit complicated – presumably deliberately – by a government keen to obfuscate things. We need to get into the world of pillars. No, not pillocks, but you could be excused. Pillar 1, in the public sector, is, roughly speaking done by NHS staff on NHS staff or key workers. Here, there’s good news: around 90% of test results are returned within 24 hours. Pillar 2 is the private sector work done on the rest of us: the general public. On speed, it’s mostly bad news. Using government figures, the proportion of Pillar 2 test results received in 24 hours in early September was only 58% at a “permanent” site and 69% at the mobile “pop-up” centres. Only 17% of home tests get test results within the target 48 hours; for “Satellite” (basically Care Homes) it’s a pathetic 8%, taking an average of 83 hours – half a week – for Care Home managers to get test results. In mid-June, they were averaging 28 hours. No wonder Care Home managers and staff are complaining again!

Keir Starmer’s comment that the government has “lost control” of testing seems entirely fair comment.

Public and Private

There’s worse. These figures actually flatter considerably the performance of the private sector companies. Wikipedia talks coyly of the privatised system working “in parallel” with experienced contact tracers working in local government for Directors of Public Health. These are the people who actually know what they’re doing with expertise built up in the public sector over many years, dealing with flu, AIDS and sexually transmitted diseases. The public sector figures are combined with the private companies in the performance statistics. And, surprise surprise, the public sector people do a much better job: 93% of contacts reached compared to only 61%.

I used the word “coyly” in the last paragraph. The truth is that the centralised, privatised system set up by Hancock and co. has, for the most part, treated the local PHE teams as their enemies, starving them of vital information for them to do their job. Central government has had to be dragged kicking and screaming into cooperation with local authority Public Health staff. A local mayor told me of the extreme difficulty he had getting the information his PH people needed to keep his local population safe.

 A further example was when the Deloittes logistics people sent, literally, an army of military staff to set up a mobile testing centre in the middle of a West Midlands town. The local Director of Public Health was given no prior warning, the exercise led to pitifully few tests – there was even talk of soldiers accosting people in the street to take a test, to boost the numbers reported by Hancock. The exercise caused traffic havoc and the DPH spent much time and effort to get a more workable solution.

In fact, my understanding is that the contract specifications signed with the private companies were not even designed to feed actionable data to local PHE teams. Dogma and a blinkered approach in Westminster led to serious – and deadly – fragmentation.

Isle of Wight on the Night

Oh, and the NHS Track and Trace app worked well, didn’t it? Version 2, totally redesigned, is due for launch tomorrow, but it seems to be a secret for now. So, not world beating, then – again.

Fragmented, Disjointed

As you will see above, a system as fragmented as this is bound to fail. Compare, for example, Germany’s much more successful approach, building on an existing regional expertise in public health.

But there is another, more fundamental, way where there is a discontinuity. Back in 2016, I wrote a blog post entitled In Praise of Public Service Values. The main point I want to emphasise from that post is this. When providing a public service in the public sector, everyone in the organisation has broadly the same purpose: to provide the best possible service to the public. If that service is privatised, those at the top are more fixated on short-term profit and the company’s share price. Somewhere between the bottom and the top, messages – and priorities – get mixed and confused. No wonder that privatisation of “naturally” public services nearly always leads to a worse service.

 Dido, Queen of Carnage

And presiding over all this is Dido “Dodo” Harding, Tory peer and general waste of DNA. I’m deeply indebted to the brilliant Guardian journalist Marina Hyde for the above formulation in the paragraph header. For the less-well classically educated (which includes me), I have included a link here which explains the joke. (For good measure, Christopher Marlowe, one of Shakespeare’s contemporaries, wrote a play about her.)

But note this: don’t let the useless, incompetent buggers like Dido/Dodo, Sitel, Serco, Deloittes and their army of sub- and sub-sub-contractors sully the reputation of Our NHS. During this Second Wave, it needs more than just our applause.

Talking Heads

On Monday, medical advisers Chris Whitty and Patrick Vallance had their own TV programme to explain to us all just how fucked we were as a country and how careful we must be over the next 6 months. I confess I did not have the stomach to watch Johnson confuse the whole thing the next day with his incoherent babble. I’m up to HERE with mixed messages.

So, in summary, I add:

Fa-fa-fa-fa-fa-fa-fa-fa-fa-far better
Run, run, run, run, run, run, run away oh oh oh oh
Yeah yeah yeah yeah!

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Tories’ Triple Betrayal

75 years after the end of World War II in Europe, the Johnson government is inviting the people of Britain to “celebrate” the Allies’ victory over Nazi Germany. So, what kind of “victory” has that turned out to be?

I quote just one statistic at this point, coronavirus deaths (as of yesterday): Germany 7277; UK 30,076. For comparison, population sizes are Germany 80 million, UK 66 million. So, per capita, the death rate differences are even larger. And Germany’s pandemic started a couple of weeks earlier than the UK’s.

So, if our Government had managed the outbreak as well as the Germans’, pro rata, we would have 24,000 fewer deaths. So, who is to blame? I will argue below, the answer is Tories, Tories and Tories.

Three Waves

Spanish Flu 1918-19

The Spanish Flu pandemic (which, incidentally, wasn’t Spanish) occurred in three distinct waves with the second worse than the first. The graph above clearly illustrates this point. (NB: the figures along the lower axis are dates: shown, rather confusingly, in US “semi arse about face” month/day format.) It is mainly because Wave 2 was biggest, reinforced by current epidemiologists’ modelling, that the Government is being cautious about lifting the current lockdown restrictions.

I argue below that, similarly, our present predicament comes about as a result of Tory Governments’ mismanagement and bad policy making, also in three distinct waves. As a result, the country was far less prepared than it could – or should, in my view – have been.

Wave One: 1980s and Thatcher

My wife has just delivered a load of face masks and headbands she has sewn for use by frontline staff in the fight against the pandemic. This is all too reminiscent of the pre-Industrial Revolution period in the late 18th and early 19th century. People spinning and weaving cloth in their own cottages. So, what accounts for our apparent regression?

Wave One and the first betrayal were started forty years ago by Margaret Thatcher.  She may be remembered for a number of things. For now, I will concentrate on three: monetarism, anti-Trade Union legislation and the City Big Bang deregulation.

The graph below shows the trend during the 18 years of Thatcher and Major Government. The steep drop in the period 1979 to 1982 is mainly associated with the Tories’ flirtation with monetarism. For a period, this was treated almost like a religious belief within Tory ranks and was responsible for the needless destruction of many jobs, particularly in manufacturing. The second steep drop around 1990-91 was at the time Thatcher was ousted and replaced by John Major. Although the primary causes of this recession were global, civil unrest and rioting occurred in such diverse places as Birmingham, Oxford, Tyneside, Cardiff and Bristol.

Manufacturing jobs decline

The second factor was the anti-Trade Union legislation passed during the Thatcher period. A fairly neutral account is found here. With the benefit of hindsight, it is clear that this started a long period of change from relatively secure and well-paid manufacturing jobs to the insecure zero hours and sham self-employment we see today. The people in this insecure workforce are really at the sharp end of current lockdown policies. The “treat them like shit” attitude, too prevalent in today’s employment practices, was an inevitable result of weakening the countervailing power of the Trade Unions.

The third factor was the so-called Big Bang. In the prevailing orthodoxy of the time – still largely present in today’s Johnson cabal of True Believers – the financial centre in the City was “liberated” from the old-fashioned practices of yore. As a result, financial services grew in parasitic fashion into the monster we see today, with its abuse of power and prevailing attitude of personal greed. I covered this topic in more detail in my 2015 post The City: Paragon or Parasite? Its general thesis is that what’s good for the City is generally bad for the rest of us. “The rest of us” includes those trying to make a living from manufacturing.

The upshot of all this is our over-reliance on imported goods (such as panic-bought substandard PPE flown in from Turkey by the RAF). A weakened manufacturing base has left us dangerously vulnerable in times of need on items such as ventilators, PPE, testing kits: all the things that the government is still playing catch-up on, 2 to 3 months after they should have been aware of the seriousness of the threat from coronavirus.

This constitutes the Tories’ first betrayal of the people of Britain: the 40-year weakening of our capacity to make the things we need in times of crisis. (A possibly similar argument could be made about the food we eat, but that’s another story.)

Wave Two: Decade of Austerity 2010-2020

Wave Two and the second betrayal cover the last 10 years of Tory-led government and the Osborne-led religion of austerity. A nation was persuaded to believe that the New Labour government was responsible for the 2008 global recession and the solution was austerity. Translated this means punishing the weakest and poorest in society whilst letting those responsible – organised finance – to escape scot free. Despite some eye-watering spending announcements by Rishi Sunak, many of the tenets of austerity are still in place in the mind set of Johnson and his gang.

What concerns us here is the cumulative effect of austerity over the last 10 cruel years: the graph below shows the trend. The overall figures disguise the fact that local government has been squeezed even harder (by 40%) than public spending overall. And, of course, apart from the last few desperate weeks, NHS spending was frozen (in real terms) for much of the decade.

Decline in public sector

In the 2010s, the government split Public Health from the NHS and then (as I said above) squeezed local government very hard. Casualties would be care homes, public health resources and support services for vulnerable and disabled people. Cuts in benefits, including for those with disabilities, have weakened our collective resilience further.

A new and shocking example has emerged with the past 24 hours. During the years of austerity, Channel 4 News has revealed that 45% of PPE stock was allowed to get out-of-date. This includes 80% of respirators. In 2009, following an outbreak of swine flu, £500m was spent building up a national pandemic stockpile. Channel 4 “has also obtained evidence suggesting the stockpile had shrunk significantly over the last ten years, while the UK’s population continued to grow.” In short, we were less prepared for pandemic than at the end of the last Labour government.

To make matters worse, the government was forewarned. In 2016, Exercise Cygnus simulated an influenza-type pandemic and predicted that the health service would collapse through a lack of resources. The Daily Telegraph reported one government source as saying that the results of the simulation were “too terrifying” to be revealed. Eventually, the Guardian leaked the findings (redacted to exclude sensitive personal information) on 7 May this year.

In summary, Tory led government policy decisions weakened the UK’s preparedness for a corona-type pandemic systematically and repeatedly over the last 10 years under the cover of austerity. Income and health inequality widened over the same period, leaving the most vulnerable even more so.

This is the Tories second betrayal of its people.

Wave Three: Johnsonian Dogma 2020

And so we turn to the recent past with Johnson as Prime Minister. The story doesn’t get any better.

All but the most stupid and the most ideologically zealous supporters of Government policy – the two groups are not mutually exclusive – have noticed by now that the government was asleep at the wheel in the weeks before the pandemic took off. World Health Organisation warnings as early as January were ignored. WHO advice to do “testing, testing, testing” was similarly dismissed by a government that was riding on a wave of hubris following the UK’s “departure” from the EU on 31st January.

Despite Ministers’ untruthful denials, it was UK Government policy right up to 20:00 on 23rd March that “herd immunity” was the best approach, making the UK an outlier in Governments’ approach to the pandemic around the world. Then we had the “screeching U-turn” and lockdown. By this time, of course, it was too late. It has been a game of catch-up ever since. Oh, and repeated instances of over-promise and under-deliver: on PPE, testing, contact tracing, whatever.

Conservative dogma had led to an over-reliance on the private sector and the bypassing of expertise in local government and other local arms of the public sector. A good, i.e. bad, example was last Thursday when Health Secretary Matt Hancock crowed that his “100,000 tests” target had been met. This was only achieved if you count test kits posted out (but clearly not yet used) on that day. Also the army was called in to set up “mobile testing centres”. In one instance for which I have an impeccable source, the local authority had not been forewarned of the army’s arrival and “caused chaos”. It seems that at one point, random people were approached in the street and offered at test. And all to meet a politically motivated target. Following the science, my arse! And, as we well know, in the days since, on at least 5 occasions, the number of actual daily tests have fallen well below 100,000.

Other countries have done better, and more consistently, than the UK. And another thing. Local GPs and Public Health officials around the country have NOT been given geographically-based test results numbers, essential for the next phase of tracking clusters and tracing contacts. Perhaps this is because the government handed the contract for manging testing to Deloittes – yes, that Deloittes, one of the accountancy and consultancy big four who have repeatedly failed, big time, to spot companies on the brink of going bust. The system for getting feedback from Deloittes to key local expertise doesn’t exist yet.

This illustrates a continuing weakness in the Government’s approach: too much is attempted to be run from the centre and/or by private companies with no relevant experience, rather than use expertise in local authorities. So, even as I write, the Government continues to screw things up, avoidably.

The third wave of government betrayal continues, unquestioned by a loyal and sycophantic press (with the honourable exception of the Guardian).

 Celebrate?

And so to today’s bread and circuses. We are invited by those who govern us to celebrate an event which happened before 99% of us were born. By inference, even to applaud our government’s “success” as Johnson called it on Monday. Try telling that to the grieving families of the 24,000 individuals, disproportionately black, brown and poor, who have died too soon thanks to Conservative government failures over the past half a century.

Citizens of Britain: you reap what you sow.

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Gove in the Time of Corona

And so it has come to this.

Last Monday, Michael Gove stood in for the self-isolating Boris Johnson at the No. 10 pandemic briefing session. The country found itself dependent on the most duplicitous, scheming Cabinet Minister to explain the current situation and to tell us what the Government – collectively the most incompetent in my lifetime – is doing to tackle the outbreak. And yet we have no choice but to – sort of – believe he is speaking the truth.

Playing Catch Up

testing for coroavirus
Testing…

There’s wide agreement, including in some traditional Tory supporting newspapers, that the government screwed up its handling of the crisis, at least in the first few weeks. So the UK has been playing catch up since Johnson’s U-turn on 23rd March. The lack of testing kits and ventilators are the two most glaring examples. But the food supply industry, and in particular the supermarkets, have not exactly bathed themselves in glory. The government seems to be still too ideologically inclined to believe that the private sector can do more to adapt than is actually the case.

We’re in the psychologically disturbing phase where all the key numbers, and in particular deaths, are still rising daily. It helps me personally not to over-obsess on them. I also look out for good news stories to act as some kind of reassurance. As “MD” in the latest Private Eye points out, since January 1st, 159,987 people have died in the UK, 158,759 from causes other than the coronavirus – and therefore not newsworthy. (I guess the article was written on Monday: the numbers have changed, but the broad point still stands.) It’s clearly important that we keep a sense of proportion in all this. I’m sure that’s a struggle for a lot of people, including me at times. I’m hoping that the fear factor, which affects behaviour such as panic-buying, will subside, once the numbers start to stabilise and then subside.

Irrelevant

It’s a tragedy for the country that the Labour Party has boxed itself into a corner of irrelevance as a result of the extraordinarily extended self-indulgence – as it now feels – of a leadership contest. The result is due to be announced later today as I write. Everybody expects Keir Starmer to win. It would be great if he and other talented Labour Party leading figures were invited to join a government of national unity, at least until the crisis is over. Stranger things have already happened in the past two weeks, announced mainly from the lips of the new Chancellor, Rishi Sunak. He’s the only Cabinet member who has emerged in this crisis for whom I have any grain of respect. He has been clear in his announcements, bold in some decision making and shown a willingness to rethink as new information emerges – or there’s a strong backlash from sections of the community: small businesses, for example.

There’s a sense in which the people and the formerly hated “experts” have pushed the government away from a disastrous policy stance up to 22nd March into something more in line with what is needed. There’s a wish in the air that somehow, sometime, we may all end up living in a kinder, fairer world when this is all over. But any further thoughts on that must wait for another time.

Testing, Testing

I think we all agree that the key to getting out of this is testing. That’s both much more testing for live coronavirus cases, starting with all frontline NHS staff, and a reliable, easy-to-use antibodies test kit to retrospectively test those who’ve had symptoms but has not yet been positively tested owing the current lack of kits. Matt Hancock has promised 100,000 tests a day by the end of April. We, the people, aided and abetted by the right politicians and the media, must hold his feet to the fire to deliver on this one.

Stay safe, stay well.

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