What Did Exercise Cygnus Deliver?

The UK carried out Exercise Cygnus – a pandemic drill – in 2016, and it highlighted all the issues we have seen this year, though the conclusions have never been made public. The Guardian has published a document labelled as the final version of the report and it does not make reassuring reading.

Conclusions from the report:

• There is no useful strategy in place, nor is there a useful implementation plan for what strategy there is
• The public reaction has not been considered
• Ethical aspects of decision making have not been considered
• It’s recognised that capacity is inadequate and one area where it is lacking is in subject matter experts

Lessons ‘LEARNED’ from the exercise:

• Organisations should ensure their Emergency Preparedness Resilience and Response training and exercising is consistent with best practice.
• Planning should be considered a multi agency responsibility. Specialist advice from all stakeholders needs to be available. Sector specific advice should be scaled up during a pandemic.
• During a reasonable worst case pandemic responders will struggle to maintain a response using the existing framework
• Meetings between the health ministers of the 4 nations should be considered best practice
• Consideration is needed of population based triage
• Work is required to consider surge arrangements. An NHS plan is being developed. Service plans need to be modelled for health, social care, and community support. A communications plan is needed. A clinical and ethical plan needs to be agreed. Mitigation plans are needed to ensure flexibility. Buy in is needed from those who will actually implement these plans.
• Strategy is needed for the use of antivirals – less relevant since there isn’t one for COVID
• Staff absence should be considered
• Health messaging at the national level was not effective. Procedures for getting the message out should be re-enforced (sic) and practiced. Local messaging was more effective.
• National attitudes to use of social media render their use of it ineffective
• Messaging needs to be consistent, avoid jargon, and consider that people want to make their own decisions. Trust in the message source is important
• Consideration needs to be made to using the voluntary sector
• There’s a need for a cross government group to make the response process effective
• The impact of school closures needs to be considered
• Overseas nationals should be considered
• MoD involvement should be considered
• Process for providing and presenting data to decision makers should be considered
• Social care and surge capacity should be considered
• Expansion of social care real estate and staffing capacity should be considered
• Thought should be given to using the capacity of the voluntary sector
• Capacity for managing excess deaths should be considered
• Work is needed to develop contingency plans and processes for prisons
• Future guidance and plans need to consider the potential response of the public

To all of the above unlearned lessons, the DeliveryDemon says NSS, all basic planning requirements. Such a shame that we have had generations of politicians who failed to consider that their job includes managing the country to the benefit of its population. Can there be any excuse for ignoring such a telling report? Maybe perhaps the astonishing claim made late in the document – ‘The healthcare framework to respond to a pandemic is robust’. Along with the minor bureaucrapic qualification that people need to be briefed of the plans for a similar exercise – seriously, the assumption for a disaster scenario is that there will be time for lots of cosy meetings.

We have seen the theory come up against reality. Will that make our politicians and bureaucraps treat disaster planning as something other than a fun exercise and a source of PR?

What Has Boris Delivered?

The DeliveryDemon actively dislikes listening to political pomposity. Let’s just get at the text and eliminate the waffle. If you didn’t listen to the PR persiflage, here it is edited to the bare factual bones, along with the DeliveryDemon’s thoughts (in italics) of what was said.

I will be setting out more details in Parliament tomorrow and taking questions from the public in the evening.

Given an offline Parliament there’s really no need to hold this info back

Because although we have a plan, it is a conditional plan.

Fair enough, but I’d expect to see a bit more about checkpoints

And since our priority is to protect the public and save lives, we cannot move forward unless we satisfy the five tests.

• We must protect our NHS. Pious wish, not a test
• We must see sustained falls in the death rate. Question as to how reliable that data is
• We must see sustained and considerable falls in the rate of infection. AFAIK criteria being used to determine infections is still pretty inadequate compared to the range of symptoms being reported so again a question as to how reliable the decision data is
• We must sort out our challenges in getting enough PPE to the people who need it, and yes, it is a global problem but we must fix it. Pious wish again, what actions are proposed?
• And last, we must make sure that any measures we take do not force the reproduction rate of the disease – the R – back up over one, so that we have the kind of exponential growth we were facing a few weeks ago. Pious wish again, what actions are proposed?

These are not tests, they are emotional PR.

And to chart our progress and to avoid going back to square one, we are establishing a new Covid Alert System run by a new Joint Biosecurity Centre. What is this Joint Biosecurity Centre? Sound like the renaming of an existing committee. What’s its remit? Who are the members and what are their qualifications?

And that Covid Alert Level will be determined primarily by R and the number of coronavirus cases.

And in turn that Covid Alert Level will tell us how tough we have to be in our social distancing measures – the lower the level the fewer the measures.This actually contradicts what he said earlier about conditionality. For basic risk management, it makes sense to monitor the effect before confirming a reduction in level.

The higher the level, the tougher and stricter we will have to be.

There will be five alert levels.

Level One means the disease is no longer present in the UK and Level Five is the most critical – the kind of situation we could have had if the NHS had been overwhelmed.

Over the period of the lockdown we have been in Level Four, and it is thanks to your sacrifice we are now in a position to begin to move in steps to Level Three.

And if we are to control this virus, then we must have a world-beating system for testing potential victims, and for tracing their contacts. Forget world beating, it’s not a competition. It needs to be effective. The UK carried out Exercise Cygnus – a pandemic drill – in 2016, and it highlighted all the issues we have seen this year, though the conclusions have never been made public. The Guardian has published a document labelled as the final version of the report and it does not make reassuring reading. It is clear from this that the lessons ‘learned’ use a different understanding of the word ‘learned’ from that understood by most people. The DeliveryDemon has summarised the document in a separate post.

And yet when I look at where we are tonight, we have the R below one, between 0.5 and 0.9 – but potentially only just below one. That’s quite a range for a non-linear variable. Just how many people will understand that distinction?

We now need to stress that anyone who can’t work from home, for instance those in construction or manufacturing, should be actively encouraged to go to work. Not all workplaces are equal in their ability to provide a safe environment. What protection is there for those whose employers are not providing a safe workspace?

And we want it to be safe for you to get to work. So you should avoid public transport if at all possible – because we must and will maintain social distancing, and capacity will therefore be limited. May not be an issue initially but as more sectors are expected to return, just what proportion of the working population work in major centres and / or at a distance from work? Are we expecting gridlock and a pollution hike from car usage? Where will all the parking spaces come from? Travel distance and weather will make walking / cycling impractical for many.

So work from home if you can, but you should go to work if you can’t work from home.

And to ensure you are safe at work we have been working to establish new guidance for employers to make workplaces COVID-secure. Guidelines are fine, enforcement is another matter and whistleblowers tend to suffer.

And when you do go to work, if possible do so by car or even better by walking or bicycle. But just as with workplaces, public transport operators will also be following COVID-secure standards. Enforcement?

And from this Wednesday, we want to encourage people to take more and even unlimited amounts of outdoor exercise.

You can sit in the sun in your local park, you can drive to other destinations, you can even play sports but only with members of your own household. How far is an acceptable drive? What guidelines will police have? How will more isolated communities react to an influx?

You must obey the rules on social distancing and to enforce those rules we will increase the fines for the small minority who break them.

In step two – at the earliest by June 1 – after half term – we believe we may be in a position to begin the phased reopening of shops and to get primary pupils back into schools, in stages, beginning with reception, Year 1 and Year 6. No consideration of country-specific differences in school term dates.

Our ambition is that secondary pupils facing exams next year will get at least some time with their teachers before the holidays. And we will shortly be setting out detailed guidance on how to make it work in schools and shops and on transport.

And step three – at the earliest by July – and subject to all these conditions and further scientific advice; if and only if the numbers support it, we will hope to re-open at least some of the hospitality industry and other public places, provided they are safe and enforce social distancing. Fair enough, but it would have been more sensible to state conditions rather than a date – the date is now firmly implanted in people’s minds.

We are going to be driven by the science, the data and public health. It has long been accepted that ethics have a place in this sort of decision making. Why is it excluded here?

And I must stress again that all of this is conditional, it all depends on a series of big Ifs. It depends on all of us – the entire country – to follow the advice, to observe social distancing, and to keep that R down.

And to prevent re-infection from abroad, I am serving notice that it will soon be the time – with transmission significantly lower – to impose quarantine on people coming into this country by air. NSS. But why just air? And why so late?

And of course we will be monitoring our progress locally, regionally, and nationally and if there are outbreaks, if there are problems, we will not hesitate to put on the brakes. Fair enough but a bit awkward after setting so many dates in people’s minds.

The DeliveryDemon has yet to be persuaded that we have a political class which is capable of managing this country in the interests of its population. After decades of hiding behind the excuses of the market and of the EU, there isn’t the will, the culture, or the competency to make that change.

DELIVERING FUTURE PLANS

In a crisis there has to be a constant balancing between the urgent and the important, and the primary focus has to be on items which are both. These activities get priority, they get publicity, and they get resource. That is often at the expense of activities whose importance is as great, or even greater, but whose urgency is less.

 

The resource issue is an interesting one. Throwing money at a problem doesn’t guarantee success though it can be essential to remove barriers to finding a solution. Throwing people at a problem can, beyond certain limits, become counter-productive. Come a crisis, effective resource management is critical. The right quantity of the right resource has to be directed to the right activities. When this is applied to the public sector priorities for dealing with the COVID-19 pandemic, there are some clear priorities, and resource needs to be directed to these. But what happens to the people not involved? The people not involved in the high-profile new roles? For some, the existing role cannot be abandoned – it may even become more demanding as the effects of the pandemic spread across the population.

 

That leaves a group of varying degrees of seniority, whose work, quite frankly, cannot be justified. Should they simply be put on gardening leave and treated as a reserve until such time as it becomes appropriate to redeploy them to fill gaps in the essential services? Or can some of them spend the time preparing for the day when the world emerges from lockdown?

 

With this in mind, the DeliveryDemon is about to talk rubbish.

 

We don’t know how long the pandemic will last. We don’t know what the world will look like when it comes to an end, or under control. One of the very few things we do know is that it will have generated one hell of a lot of rubbish, and that rubbish will need to be dealt with to prevent it choking the entire global environment. The earlier governments can start thinking how to handle this predictable problem, the more quickly it can be addressed.

 

Where is all the rubbish coming from:

• Even with inadequate supplies of protective and medical equipment, there will be a massive quantity of infective waste to be disposed of. Incineration may be an appropriate resource, but barely 18 months ago it became clear that the UK did not have sufficient capacity for business as usual operation. There is no evidence of substantial capacity increase. This waste is a predictable problem.
• A substantial increase in the demand for home delivery by supermarkets will more than offset the efforts of the past few years to reduce the number of single-use plastic bags. Picking and packing under pressure doesn’t allow the luxury of maximising the number of items per bag. And the bags are essential to minimise the level of contact between the delivery driver and customers.
• Fear of infection predisposes food shoppers to prefer wrapped goods to loose, whether shopping in person or on line.
• Working from home, limiting time away from home, home-schooling of children, all these create a degree of boredom and tension and the easy solution can be treats – an instant source of soft drink containers, wine and beer bottles and cans, wrappings from sweets and biscuits and other snacks. In one way this can be offset against the reduced waste due to reduced footfall in business centres and the closing of some of the big chains of fast food outlets. In another way it’s a shift from the commercial waste disposal route to the domestic one. Logistics and commercial agreements become as much of an issue as waste volume.
• Panic-buying has already had a noticeable effect on waste volumes, with bin crews finding fuller bins and obvious disposal of just out of date perishable foods.
• Tips have been closed at a time when people are forced to spend more time at home. Even those who can work from home will have more time on their hands to notice all the DIY jobs they never quite had time to do. That’s more waste being generated and it has nowhere to go till the tips open again. It won’t just be swallowed up by the newly opened tips either, they are not designed to cope with several months of waste arriving in a week or two.
• Fly tipping has been an increasing problem for some time as local authorities applied more and more limitations to the usage of tips. It is in fact a growing organised crime. It is also becoming less socially unacceptable at the lower end of activity. As outdoor footfall reduces, and tracing resource is reduced or redirected to other activities, the risk of a flytipper being caught reduces from an already fairly low level. After a few months there will be a lot of rubbish to be cleared from countryside, wasteground, farmland, and parks.
• And there’s the obvious point that legitimate waste disposal is as likely to be affected by resource problems as any other activity, where employees may themselves become ill or be required to isolate because of contact with others who become ill.

 

When we are able to look beyond the pandemic, when we are able to go freely from our homes into the natural environment, the DeliveryDemon expects that environment to look very different, and not entirely in a good way. We will not be able to ignore the aftermath of the lifestyles adopted of necessity during lockdown. It would be reassuring to see, as a secondary line of activity, some thought being given to helping our environment recover from what we have done to protect ourselves.

Delivering Sports Participation

The DeliveryDemon isn’t hugely fascinated by the 2012 Olympics. She didn’t bother with the ticket allocation fiasco. She hopes she won’t be in London, or near one of the few non-London venues during the event. She has no intention of going anywhere to peer through crowds at anyone trotting along with a badly designed bit of metalwork, which is the nearest many Brits will get to the Olympics. She certainly won’t be watching the Olympics on television, as she still hasn’t found a good reason to go out and buy one.

According to BBC talking heads, this means that the DeliveryDemon is not interested in sport. No matter that she walks for miles in the mountains and across country – that doesn’t count. Nor does bodyflying, an activity which tests muscles most people never get round to using. As soon as she finishes rehab from last year’s skydiving accident, she aims to be back flowriding and doing the occasional bit of running. But she’s not interested in sport. The DeliveryDemon was delighted when recovery reached a point that allowed her back in the gym and the pool – but that’s not sport. She’s looking forward to being able to take winter holidays with ice climbing and snowshoeing and cross country skiing and dog sledging – but according to those in the know, she’s not a sporty person. Obviously not, since she isn’t inclined to sit on the couch, munching and drinking, while watching others do something which may be active – or which may be as inactive as darts or snooker or angling or even poker, all of which are skilled, none of which contribute much to the body’s need for physical activity.

There’s a lot of justification of Olympic costs on the grounds that the fact of the Olympics will increase sports participation. It’s a pity that those who made the decisions to spend shed loads of public money didn’t do some realistic thinking:

• What does participation actually mean?
• How can you demonstrate that it’s happening?

Since the powers that spend our taxes clearly haven’t done this thinking, please allow the DeliveryDemon to suggest a few actions and measures.

Work is spread throughout the country so that people don’t have to spend so much time commuting that there’s no weekday time for anything else and no weekend time because weekends are used up with recovering from the week’s commute and doing all the chores there wasn’t time for during the week.

School offer a range of activities within the timetable with sufficient variety so that all children can particpate without feeling useless or stupid, and sufficient competition to give the competitive a way of measuring their success.

Sports funding includes reasonable support for public facilities which provide ready access for the public at times when people want to use them.

Bylaws and bureaucrats do not use health and safety as an excuse to prevent popular and emerging sports like inline skating and skateboarding and freerunning in public places.

Planning decisions require provision of public open spaces including green space, and sports facilties, with properly thought out arrangements for their long term upkeep.

That’s just for starters. The Olympics will long be remembered for the white elephant developments it leaves behind, but any effect it has on sports participation will be as transient as the annual blip  in tennis court use around the time of Wimbledon – but without Wimbledon’s annual influence. If the powers that be seriously want to influence public health for the better, they need to think more pragmatically than low usage monolithic development and nanny state pronouncements.

The 3 Layers of an Organisation’s Processes

Look at the processes in any organisation and they can be split quite neatly into 3 layers.

1. Operations. These processes are the lifeblood of the organisation. Each and every one of them contributes directly to delivering goods / services to the organisation’s customers. The people operating these processes are the organisation’s front line, and woe betide the organisation which doesn’t recognise this.
2. Infrastructure. Any organisation has to be managed, so it needs management processes. Think of Finance, HR, IT, Facilities…. The processes behind these functions are not directly customer facing but they are still essential to the business.
3. Change. The invisible layer, but a particularly important one as change and innovation becomes an increasingly important factor in the survivial of an organisation. Think of the 3 Ps – projects, programmes and portfolios. These activities bring change and these activities need to be managed. Any organisation undergoing change has a need for change processes.

It seems to the DeliveryDemon that many organisations struggle to optimise their change processes. Change activities are often tied to the business unit undergoing change, with limited links to the broader business, and little if any coherent attention to the change processes themselves. Strategic planning activity gives rise to change in both Operational and Infrastructure processes, but many organisations give little thought to the Change processes which form the bridge between strategy and delivery.

The Carnegie Mellon Software Engineering Institute’ Capability Maturity Model has been around for some time http://www.sei.cmu.edu/cmmi/. Although its roots are in software development it is in fact a widely applicable model. It classifies processes as:

1. Initial
2. Repeatable
3. Defined
4. Managed
5. Optimizing

CMMI Models are a good foundation for assessing whether Change and other processes operate reliably and consistently. What they don’t provide is a model of good practice for the processes being assessed.

As change and innovation become ever more important to the success of commercial organisations, the DeliveryDemon is watching to see which organisations are leading the thinking when it comes to optimising change management in order to deliver strategy effectively.