Tag Archives: government

COVID and the NHS

It’s impossible to ignore current demands to go out and clap for the NHS. It’s often been noted for some years that the NHS is the UK’s replacement for religion, and this conspicuous NHS worship certainly suggests so. Some of us find this worship mis-targeted at best. The NHS as a huge organisation is not the same as the dedicated staff looking after COVID patients. Its unpreparedness to cope with the pandemic has been the main reason the government has enforced lockdown, to ‘flatten the curve’, to ‘protect the NHS’. Given the magnitude of damage resulting from that, I did some googling to find some stats that question whether the NHS is really a world-leading health service full of heroes risking their lives to save us all.

The death rate in the UK under the NHS is far higher than most countries

The UK death rate so far, estimated at 29,000 deaths out of 66M population, is 440 per million

(https://www.telegraph.co.uk/news/2020/04/27/uk-coronavirus-death-toll-january/),

compared to 37 deaths per million in the rest of the world (https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac846c).

The UK is seeing 12 times more deaths per capita than the rest of the world!

There are very many factors that cause this terrible UK result. High population density is one, London being a global business hub may arguably be another, but lethargic and incompetent government led by poor advisers, and badly administered, relying on an poorly managed, poorly prepared NHS must account for much of the difference.

In this blog, I have done some data diving on some stats, lengthy because appropriate figures are often very hard to find.

NHS deaths are actually lower than average

The UK media frequently emphasises the number of NHS deaths but surprisingly the death rate for NHS staff is lower than for the population as a whole:

The latest figures I can find show that 106 NHS staff have died from COVID (not counting retired workers). That’s a rate of 1 in 17,452.

This compares to 20,626 out of 64.2M in the rest of the population, and adding in the estimated 40% more who have died in care homes, that’s 7.86 times higher than that for NHS workers.

However, most of those deaths are old people (86% of COVID deaths are people over 65). A like-for-like comparison should include only those of working age and exclude the ‘extra’ 40% extra older people dying in care homes.

If only deaths of working age people are included, the non-NHS death rate stands at 1 in 13,000, still a third higher than that for NHS workers.

NHS workers’ death rate is only 75% of that for the normal working age population. I offer no hypothesis to explain why you’re 25% less likely to die from COVID if you work for the NHS.

NHS staff numbers – how many are the heroes?

I have my own good reasons for being critical of the NHS, but I am far from alone in finding the current NHS worship annoying. The NHS is very bloated, badly managed, inefficient and ineffective. Many people gladly cheer the doctors and nurses but not for the useless managers.

According to

https://fullfact.org/health/how-many-nhs-employees-are-there/

1,850,000 work for the NHS, not counting dentists and opticians. That’s 4.5% of the UK working age population!

You may have seen lower figures. Some work part time, and the 1,400,000 NHS workers you often read about are the full-time equivalents. That’s probably why.

Around 900,000 of these are medical and medical support staff such as doctors, nurses, radiographers, hospital physicists, pathology staff and so on. The rest aren’t. Over the last 20 years, as a response to criticism of its near half million managers and administrators, the NHS has gone to some lengths to reduce the numbers of its staff it officially classifies as ‘managers’, managing to get the estimate down to a laughable 3.5%.

It is extremely hard to find how many ‘front line’ workers there are dealing with COVID patients. However, it is estimated that if fully operational, the 4000 bed Nightingale hospital would require 16,000 staff in ‘clinical and ancillary roles’, so that’s a neat 4 staff per bed.

25,000 beds are required for COVID patients according to https://www.independent.co.uk/news/health/coronavirus-nhs-england-intensive-care-beds-lockdown-uk-a9462276.html

If they were are all in use and needed 4 staff each, i.e. Nightingale staff levels, that would mean around 100,000 staff, 5.4% of the NHS. In practice, up to half of beds are unoccupied, and many don’t need so many staff, so that suggests that as few as 2.5% of NHS staff may be realistically considered to be on the COVID front line. 2.5%-5%. In the absence of accurate up to date figures, let’s call it a few percent.

I definitely applaud the few percent of the NHS who are working long and stressful hours doing their very best to keep COVID patients alive, taking personal risks while doing so. I am very happy to agree that they are heroes.

However, I refuse to conflate that few percent with the NHS as an organisation and thus treat as heroes the many percent of NHS managers whose negligent planning and incompetent administration got us into this mess. They deserve strong criticism and once it’s safe to do so, government should look hard at why the NHS wasn’t ready to cope with this long-predicted pandemic, roll some heads and design a new health service that is fit for purpose.

Lockdown must end very soon

It seems inevitable that the government will soon announce an extension to lockdown, and that it will be made more severe. Most of us will have several more weeks of being confined to homes, probably only except for trips to the supermarket or doctor. For many people, that means solitary confinement, in small flats with no garden. Even murderers in prison area allowed out for daily exercise.

Lockdown is due to be ‘reviewed’ soon, but it must end soon. The ongoing costs will be too damaging if it is allowed to continue, not just economic cost but extra deaths, mental health issues and lingering social and political damage

UK Health Authorities and Government negligence got us into this mess, but they are still making serious blunders

The handling of COVID by both the government, the health authorities and the police has been pretty poor so far. If you disagree, consider the following.

Experts have been warning frequently for decades that one of the biggest risks faced by humanity this century would be pandemics – every competent futurist has certainly always had it in their top three risks. They have been warned frequently that global travel and large city living would enable the very rapid spread globally of any new virus and that any time, a new outbreak could happen that would mean millions could die. Government cannot claim they did not have good warning that we would face a major pandemic. In fact, we’re fortunate this one only kills 0.66% of those it infects, it could have been far worse, it might have been 30%. Yet government and especially its Department of Health was very badly unprepared, with far too few incubators, intensive care beds, even face masks, let alone ensuring the ability to rapidly develop testing capability or vaccines. This unpreparedness goes back several governments. Hancock is doing his best and can reasonably claim he hasn’t been in that job long, but his many predecessors can’t escape condemnation. For example, I could never understand how someone who believes in homeopathy could possibly be be made Minister of Health, or why a PM would expect someone with such beliefs to have good analytical skills.

We knew COVID was a such a potential risk before the first cases were allowed to enter the UK.

In the weeks following, even though they knew large numbers of infected people were coming into the country, government did nothing. It didn’t close the airports. It made no attempt to prevent flights from infected areas, no attempt to check passengers even for obvious symptoms such as fever. It didn’t even give passengers any appropriate health guidance other than weakly suggesting they should consider self-isolating if they develop symptoms. It allowed passengers from infected area to be huddled closely together with others at passport control, greatly facilitating cross-infection. It made no attempt to quarantine anyone likely to be infected or to track their contacts. In short, government sat and watched as the virus spread beyond control, even helping it to do so.

During all that time, while it asked vulnerable people to isolate themselves, it allowed the idiot mayor of London to reduce tube services, forcing those who needed to travel into close proximity on platforms and trains, again facilitating the spread of the virus.

Faced with the choice to limit the virus coming into the UK, finding, isolating and contact tracking the manageable number of infectees, our government negligently watched as the virus became widespread. Its early policy was to achieve ‘herd immunity’, which needs 80% or more people to become infected. Many would develop serious symptoms and suffer terribly and many would go on to die horrible deaths. The estimated 250,000 deaths from a herd immunity approach contrast starkly with the few dozen that might have resulted from the alternative early action approach.

The governments response then changed to a ‘flatten the curve’ approach, still accepting that most people would be infected, but limiting the number of simultaneous cases to the small numbers the unprepared NHS could cope with. Because of their previous actions, they had little choice. They hoped that eventually, a vaccine might be developed, in 18 months or so.

When the virus seemed to be spreading too quickly, instead of reducing the rate of spread by concentrating on the gaping holes in their approach – allowing people to be crammed together in tube stations and passport control, and still letting others enter the country – they decided instead to introduce lockdown for a large part of the population, regardless of the level of infection in different areas, varying by as much as a factor of 20. Those people would suffer lockdown, while many others would still be crammed together spreading infection. In low infection areas, that lockdown could only reduce a small figure by a small amount. In other areas with high infection, a stricter lockdown would have achieved far more.

Many areas of London have very high infection rates. Given the 75% reduction in traffic, it would be extremely simple to lift London traffic controls and encourage as many as possible to use their private cars, especially for those living in the most infected areas, greatly reducing cross infection in the tube system. Instead, one of the heads of Public Health England made the comment that she was ‘slightly alarmed’ by the switch of travel from public transport to private vehicles. PHE has also stated that there is no point in wearing masks (a simple mask may not prevent you catching the virus, but they will greatly reduce how many virus-laden particles people emit when they talk, cough or sneeze and therefore will reduce the rate of infection. It may well be the case that PHE wants to reduce demand by the public for scarce masks so that enough will be available for those who need them, but if so, they should say so and not talk rubbish). I find it more than slightly alarming that people with such poor analytical skills should be in positions of decision making. Masks should be worn, prioritizing availability if need be to high infection areas.

People are still travelling between areas of very high infection and areas with very low infection. Many people in low infection areas will be needlessly infected. This will increase deaths. If we must have lockdown, there are far better ways to arrange it. Cellular lockdown, restricting travel between areas of markedly different infection rates would greatly reduce spread.

Even separating people from high and low infection areas in public transport would only require a simple ‘red and green’ trains system. Yet it seems beyond the comprehension of our authorities.

Some police forces have been intimidating people who are driving to open areas to exercise. Although a very few areas might attract occasional crowding greater than town footpaths, generally, urban footpaths will have far more joggers, walkers and cyclists, so exposure during exercise will generally be far higher by forcing people to exercise locally. That will increase cases and deaths. Closing parks and National Trust Gardens is similarly stupid and counter-productive. People will die because of that stupidity. Rather than take the side of common sense and logic, government threatens the people with stricter confinement if they continue to try to enjoy the outdoors, even when they are spread out.

Making it very hard to exercise away from other people will deter many people from doing so. Just when they have the greatest need to maintain peak fitness in case they become ill, their ability to do so is being reduced by officious police and busybodies. That will result in more deaths.

Watching such ongoing stupidity and negligence, I have very little confidence left in our government to make good decisions. I do not believe continuing lockdown is the right policy.

Lockdown

The current one-size-fits-all policy of lockdown is highly questionable, another mistake in a long line. A smarter form might have been justifiable to recover from the mess poor previous decisions got us into, but looking from where we are now, lockdown must be lifted soon, or it will cost far more than it saves.

Mental Health Costs

I was already self-isolating before lockdown, being ‘at risk’ but I don’t find isolation difficult. I’m introvert, normally work from home, and don’t normally leave my home more than a few times a month. I have a nice house and garden and a fantastic partner. So I have barely felt any change and am not suffering. Many are not so fortunate.

Many people live in tiny homes with no gardens and must find it distressing, especially those accustomed to going out frequently. Others live alone and many of them will be feeling very lonely. Still others will be experiencing relationship breakdowns, some of which will not mend when it’s all over. Lockdown will already be taking a severe toll on many people’s mental health. As lockdown continues the mental health costs will grow enormously. Some have already died via suicide and murder. Many more will follow, many will suffer extreme stress or fall into severe depression and start to suffer the wide range of ailments associated with those, especially many who are watching their business collapse.

Loneliness is a terrible problem that affects millions, particularly the old, and is known to contribute to ill health and death. Lockdown obviously is increasing loneliness for very many people, and will result in an unknown number of extra deaths.

Relationship breakdown as people are forced to live with each other 24/7 is inevitable. This is a well-known cause of stress, suicide and health reduction and will cause deaths directly and via reduced ability to deal with infection. Families of those concerned will also be affected.

Domestic violence is likely to increase similarly.

People’s energy bills will increase as they are confined to home. Many who already struggle to pay them will be greatly stressed by increased costs. Stress directly contribute to illness and deaths. If some old people who are already vulnerable have to turn down the heating because of worrying about energy bills, that will make them more physically vulnerable and mean even more deaths.

Death Costs

We now have some figures on the nature of the infection and its lethality. The Lancet suggest that 0.66% of those infected will die. If everyone were to be infected, that would be 430,000 UK deaths, and we’ve heard estimates around that before. On the other hand, the coronavirus app results suggest that as few as 25% of people have already been infected, suggesting future deaths due mainly to COVID might only be a few thousand (the majority of people dying who have COVID on their death certificate had other underlying issues and many would have died anyway, or soon).

Without testing of statistically large enough randomized samples in each area, we really have no idea and the government is flying blind. Letting everyone out and not doing anything at all to limit infection might result a few thousand or a few hundred thousand more deaths caused primarily by COVID. We simply don’t know. What we do know is that to be at the higher end, the mortality figures would need to be that high and almost everyone would need to be infected, but firstly, we can strongly limit infection by implementing sensible policies, and secondly, if we do that, we will have a vaccine in time to prevent most people becoming cases. So the high end is far too high. If we lifted lockdown now in low infection areas and later in higher infection areas after we have significantly reduce infections by better policy implementation and some optimised testing, future deaths would likely be between 5000 and 20,000, a wet-finer estimate, but probably no wetter than the models government seems to be relying on.

Not everyone lives in homes with good ventilation. Some in poor quality housing will have a higher infection rate from both COVID19 and other diseases due to poor ventilation.

Many people still rely on coal or wood fires, both of which produce particulates that can cause breathing difficulty and contribute to respiratory-related deaths.

The deaths costs from the above causes will be high, probably running into hundreds if it is allowed to continue more than another week or two, and that has to be offset against any gains. But there is an even bigger factor that will worsen if continued lockdown causes severe economic damage. As well as the factors above, some economists have done their analyses and suggested that due to the inevitable recession – up to 17% drop in GDP – far more future deaths will result from economic decline than will be saved by lockdown. For a change, even though they’re economists, I’m not inclined to disagree.

Economic Costs

In terms of saving lives, there are many ways to save lives so with finite funds, we should spend where the most lives can be saved for given funding. If we only save 5000 lives, but spend £500Bn to do so, that works out at £100M each! The NHS currently won’t provide a drug unless it is likely to add an extra year of quality life for less than £30,000. A typical 65-year old dying of COVID today would only expect to have another 20 years of life on average, so the NHS won’t pay more than £600k to keep them alive if they were dying of something that isn’t COVID. Many of those dying are much older than 65 and most have other underlying factors that make their life expectancy much less than normal. Using the same valuations,, an average spending limit of £250k seems more realistic. At £250k each, even the highest current estimate of 250,000 deaths would have a cost limit of £60Bn. On harsh economic terms, we could save more lives by helping those with other illnesses if the cost will exceed £60Bn. If you look a little further, various studies over the last decade have shown that tens of thousands of deaths in hospitals result from negligence, errors and poor hygiene. We could reduce those even more cheaply.

So the cost of lockdown makes no sense in terms of the economic cost of saving lives – there are more cost-effective ways. We could save far more for the same spend.

Social Costs

But there is still another major cost: society. If you are on social media, you will have noticed the rising tension, the conflicts between those who believe in this policy versus those who believe another one, the ones who want to comply versus dissenters, the rule violators versus the snitches.

Confidence in the police is being strained to breaking point, as is confidence in government. NHS worshippers abound, but so do those who believe shelf stackers and binmen are just as important.

Inter-generational conflict will increase. The young see their futures being thrown away to buy a few more years for the very elderly who would die soon anyway.

There will be strong resentment of the private sector worker watching their pension evaporate while the public sector worker next door has their gold-plated pension protected. People who were laid off and have to survive on Universal Credit will likely resent others having 80% of their previous income paid by the state, as will those who had to watch their businesses thrown under a bus with receive no compensation at all. Everyone will have to pay, but only some were protected.

Many of these growing tensions, resentments, conflicts and tribal conflicts will not vanish when it’s all over. Scars will remain for decades. The lingering social costs may well be as high as the economic and death costs.

Political Costs

Finally, we should consider that politics will change too.

Privacy, freedom, free speech and respect for the authorities will be permanently damaged. Social cohesion is an important part of the foundations of democracy.

Respect for the police and the principle of  ‘policing by consent’ has already been eroded by some police gleefully abusing their power like bullies appointed school prefects.

Being left with enormous bills and a trashed economy, with many businesses dead, it will take decades to recover. We already know the huge effects of austerity in politics, but are rapidly adding enormously to the already massive national debt so future austerity will be deep and long-lived.

We can also be sure that this will not be the last virus. In a year or two there will be another, and because of the poor handling of this one, reactions by society and the markets will be even more panicky, and we may take more economic hits. We may take generations to get back to ‘normality’.

Summary

Whichever angle you look at it, lockdown is the wrong solution. It has high mental health costs, it saves fewer lives than freeing everyone, and costs more per life than almost any other way of saving them. And it comes with very high social and political costs.

Whether you look at it from an economic angle, a pragmstic angle or are trying to be compassionate, it still makes no sense.

It should end soon.

 

 

Achieving fair representation in the new UK Parliament

Now the election is over, we have a parliament with very unequal representation of voters, with some parties getting far more and some far less than their share of the vote would suggest. Rather than just banking the advantage, the new government should recognize the unfairness of the current system and apply a short term fix so that people are represented fairly. Call it handicaps, weightings, scaled votes, block votes, or some other name. But a fairer democracy would smell sweeter.

This chart should be self-explanatory, voting could be scaled according to the number of votes for that party and the number of MPs seated:Scaled vote

Some cut and paste from a recent blog about longer term fixes:

We have a new problem, well new for the UK, which is that we’ve gone from a 2 party system to having numerous significant parties. The number of seats each will get in parliament will bear little correlation to the proportion of the national vote they win. That’s because some parties are thinly spread across the whole country so will get very few seats indeed, whereas others are heavily concentrated in particular areas, so will get far more than their fair share. With each seat decided by whichever gets the largest vote in that area, it’s obvious why having widespread support is a disadvantage compared to representing purely local interests.

Option 1: block or scaled voting

I recently suggested a block vote mechanism to fix it:

https://timeguide.wordpress.com/2015/03/05/better-representational-democracy/

to save you reading it, it allows continuation of the existing system, with greatly unrepresentative number of MPs, but then adjusts the weighting of the vote of each according to their party’s proportion of the national vote. So if a party gets 1% of the seats but won 15% of the vote, each of those MP’s votes would be worth 15 times as much as the vote of a party that received a fair number. If the party gets 5% of the seats with 1% of the vote, each of their’s would be scaled down to 0.2 x normal.

Option 2: split house

In a country with 650 seats, that is far more than is needed to provide both local representation and national. Suppose 250 seats were allocated to larger local constituencies, leaving 400 to be filled according to party support. 250 is easily enough to make sure that local issues can be raised. On the other hand, most people have no idea who their local MP is and don’t care anyway (I have never felt any need or desire to contact my local MP). All most people care about is which party is in control. This split system would fill 250 seats in the normal way and the voting mechanism would be unaffected. That would over-represent some parties and under-represent others. The 400 seats left would be divided up between all the parties to make the total proportions correct. Each party would simply fill their extra seats with the candidates they want. I think that balance would solve the problem nicely while retaining the advantage of the current system.

A variant of this would be to have two separate houses, one to debate regional issues and one for national. A dual vote would allow someone to pick a local candidate to represent their local area and a second vote for a party to represent them on national issues.

Option 3: various PR systems

There are hundreds of proportional representation systems and they all have particular merits and weaknesses. I don’t need to write on these since they are well covered elsewhere and I don’t favor any of the conventional solutions. The best that can be said for PR is that it isn’t quite as bad as the status quo.

Option 4: Administrative and Values houses

Pretty much everyone wants a health service that works, good defence, good infrastructure, sensible business regulation, clean water supply, healthy environment and so on. People disagree profoundly on many other issues, such as how much to spend and how to spend it in areas such as welfare, pensions, even education. So why not have 2 sets of MPs, one selected for competence in particular administrative areas and the other chosen to represent people’s value differences? I often feel that an MP from a party whose values I don’t support does a better job in a specific role than an alternative from the party I voted for.

I am out of ideas for further significant options, but there must be many other workable possibilities that would give us a better system than what we have now. UK democracy is broken, but not beyond repair and we really ought to fix it before serious trouble results from poor maintenance.

The future of parliamentary corruption

Some MPs are fine upstanding people who are a credit to our nation and deserve nothing but our thanks and praise. However, it seems that some have been found with their greedy snouts  still firmly in the trough. When they were caught stealing by The Telegraph a few years ago, they tried to hide behind secrecy, then pretended it was a OK because it was ‘within the rules’, and when that didn’t work, that it was ‘a mistake’. Many MPs were shown up, hardly worthy of titles like ‘the honourable…’. The leaders promised to clean the expenses system up, but didn’t, as has now become clear. Once again, dirty deeds and corruption have been exposed, and once again they have tried to hide behind secrecy, then behind ‘the rules’ and presumably some soon will admit to ‘mistakes’.

The party leaders are not helpless and are only showing that they are also unfit for office by not acting. Rules are irrelevant, the principle is very simple. Only those of the highest calibre of behaviour should be permitted to make laws that must be followed by everyone else. MPs should behave in the decent and honest manner expected by (and of) their electors. If they see gaps in the rules, they should be closing them, not trying their best to squeeze through them to feather their nests. MPs should not be doing their best to steal from the taxpayer. Using loopholes to take money to which they know they are not truly entitled is theft. The letter of the law should not be an issue. We have a right to expect our lawmakers to obey its intent.

So, what could be done?

Firstly, it is very much harder to find loopholes in general principles than in detailed regulations. A good start would be for the party leaders to say that everyone in a party must behave in a dignified and honest manner, with integrity and honour. Ordinary people are perfectly able to understand what that means, and much of the current behaviour that has been covered falls far outside any sensible interpretation of it. Those MPs found guilty should be expelled from the party to which they have brought shame, and no candidate should be accepted without fully signing up to that principle. This should be done by all the party leaders. Much as staff in industry are exposed to an annual appraisal where they are assessed against common standards and their performance graded accordingly, so MPs could be assessed by their party leaders. If they are later exposed as corrupt, those leaders would have to shoulder some of the blame. No party should allow its members to exploit the taxpayer, and certainly should not allow any of its MPs to climb to cabinet level while behaving badly. MPs are very generously paid, and very well treated, and have no excuse for playing greedy games.

Secondly, MPs should not be able to hide their affairs on spurious grounds of security, as some are being permitted to at the moment. If there is any argument or even a just reason to hide them from the general public, then a committee of truly independent ‘good men and true’, perhaps including some from the Taxpayers’ Alliance should subject them to an even more intense scrutiny and the results should be made public. In fact, the TA should be part of any committee set up to agree expenses, to avoid repeats of the recent farce surrounding the IPSA. Only a zero tolerance approach will get rid of corruption.

Thirdly, there seems to be an attitude among those guilty that they are somehow better than other people, that they should be above the law, or entitled to more, and this is likely the root cause of the abuses. This attitude needs to be purged. An MP is elected to represent the views of the members of their constituency. At base level, it is essentially a secretarial job. In some committees it may be elevated to a management job and at cabinet level it could reasonably be equated to senior management or professional work. There is no justification in treating MPs differently from management or professional groups in industry. They should claim expenses on the same basis and with the same restrictions and administrative hassles that anyone in private industry does.  

In particular, being an elected representative is not at all the same as being a leader or a king, and to discourage self serving, the role should come without privilege. MPs are not our leaders, merely servants. They should be expected to commute the same as everyone, not to take it as a right to live close to parliament in expensive apartments or to travel first class. If it is cheaper to buy an apartment than to pay rent, then some apartments should be bought by government and rented out at fair rates to those that need them. Any MP with any home within reasonable commute distance of parliament should not be entitled to any subsidy or paid rent to acquire one any closer.

So I don’t think it is difficult to find solutions to the problems we see. You may not like my suggestions, but that is all they are, and wiser or greater people should be able to come with solutions at least as good, but they certainly cannot suggest that it can’t be solved.

But that is just for now anyway. In the longer term we really should consider going right back to the fundamental purpose of MPs, i.e. representing our views, and consider whether we should really replace most of them with AIs to acts as a filtered form of direct democracy. We ought always to keep final decisions vetted by humans, for fairly obvious reasons, but that could be a very small panel, and could work a bit like the upper house does today, pushing stuff back for a rethink if it looks bad, or like the Supreme Court, or another system TBA. Eliminating most of the humans eliminates most of the potential for corruption and restores fuller accountability and transparency.