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.

Can Contingency Plans Deliver?

Back in the long-forgotten days of the Millennium Bug, the DeliveryDemon was involved in a fair bit of contingency planning, basically identifying and documenting the actions which would be needed if a range of adverse occurrences came to pass. Even twenty years ago most large public bodies had pretty detailed contingency plans to draw on and adapt to suit the risks specific to the Millennium hype and scares.

 
Twenty years have passed and the concept of contingency planning is fairly mainstream. Mainstream means routine. Routine means a chore. Routine chores don’t get the same analytical thinking as do novel concepts. They get written, signed off, then put on a shelf and forgotten. It’s not clear to the DeliveryDemon if this has happened to public sector contingency plans. Having a Prime Minister making a maudlin announcement like a B-movie actor, – ‘Loved ones will die’ – does not engender confidence. If the contingency planning material exists, there should be facts to announce, even if those facts are only decision points. Instead we have constant statements which are quickly contradicted. And our irresponsible media love it – headlines galore, each scary enough to be clickbait.

 
What would the DeliveryDemon expect to see?

 
Obviously the NHS ought to have fairly hefty and well maintained plans, since they call on them every winter. Whether they have the resources is another matter, and not one which can be addressed quickly enough.

 
Logistics, as at the Millennium, is another key area. The UK, with its old and twisted road system is not an easy place to plan logistics. That is partially offset by the traffic reduction which has started already as people reduce their social contact. But a whole range of other factors come into play. Food and related goods have to come from somewhere and they are part of the infrastructure a country needs in order to function. That means a lot of HGVs going up and down motorways and through towns and trading estates.  But successive governments have abdicated responsibility for this and left it to ‘The Market’ – the range of competing companies which form the food supply chain – to manage the logistics of getting food to customers. It does not work. Retailers forever look for ways to cut costs, JIT (just in time) supply is the norm, there is cost in reducing expensive shop space to create more storage space. The retail model has little contingency in it and that drives the need for supply logistics.

 

Panic buying and hoarding are human nature, and totally distort the demand side of the equation. ‘The Market’ quite simply cannot control that, not without some sensible support from those who are supposed to be managing the country. Yes, the DeliveryDemon is talking about rationing, but not in the way it was applied during the World Wars of the twentieth century. So far, we are told that there is sufficient food in the supply chain and the problem is the speed with which is leaving the supermarket shelves. That’s a pretty clearly defined problem to solve.

 
Of course it’s not the only problem. Much of the UK’s food comes from abroad and the agriculture and fishing sectors haven’t figured high on government priorities for decades. Dr Tim Leunig, economic adviser to Chancellor Rishi Sunak, is understood to have said the food sector was “not critically important” to the country’s economy – and that agriculture and fisheries “certainly isn’t”. That’s looking like very bad advice now.

 
Already scarce items are appearing on Amazon – 16 rolls of Andrex for £49.99 anyone? Mothers relying on formula milk can no longer find it in the supermarket and the advice circulating is that it can be obtained from pharmacies but only on prescription – further demand on GPs and on NHS finances.

 
Of course, logistics needs people – to move, load, unload, deliver the goods. Two problems here. Those people are as prone as the rest of us to Covid-19 infections. And it’s in the nature of the job that they have contact with other people as well as the goods they deliver. The Army is well supplied with logistics expertise but it is certainly not an infinite resource and there will be a whole range of calls on its manpower.

 
Disruption of utilities and hygiene services has yet to be given much prominence. Households need power, water, sewage, more so when social isolation advice causes people to spend more time than usual at home. Hospital needs are even greater. As is the case for logistics, all these services depend on people, and people can get sick. So can their families and that means healthy people having to drop out.

 

One utility which has become much more critical in the last 20 years is communications. Today the internet is an integral part of most people’s lives. It’s a good way to disseminate news – and false news. It allows people to work easily from home. Social media enables people to keep in touch during periods of physical isolation. It’s also a channel for mass hysteria. That makes it important for the powers to be to have a trustworthy and informative presence through reliable media sources. That’s just not happening.

 

And underlying the need for good communications is a whole range of other functions. Telecomms companies provide the delivery mechanism – in this country still reliant on ancient copper wire technology for the critical last mile to houses. Internet service providers enable individuals to have internet access. Security companies provide all manner of protection for data, financial functions and the like. Banks use the internet to let people and companies manage their money. Online retailers abound – a great benefit to those confined to home. Email and social media create a venue for communication without the need for face to face contact. Content providers are a major source of entertainment when public gatherings in cinemas and at live events no longer happen.

 
In a well-run democracy, the government would have at its fingertips the management status of all these critical functions. Well-established plans would already have been activated to smooth over the most obvious disruptions. Serious consideration would already be given to the actions of other countries in the global economy, and the impact these actions have on this country. There is no sign that this is happening. All we’re getting is bombast and hyperbole and contradiction and obfuscation.

 
The DeliveryDemon has a message for our senior politicians. Think. Plan. Forget the vanity projects of a fortnight ago. Deal in facts, not spin. Drop the B-movie Churchillian speeches. Do the job. It’s hard? Tough shit, you could have thought it through when you went for the job. JFDI!!

Delivering Spurious Accuracy, Demanding Constant Attention

The DeliveryDemon did a double-take. The hospital receptionist had actually offered a follow-up appointment time of 8.48 a.m. Not 8.45, not 8.50, 8.48 precisely!

Great efforts were made to get the patient to hospital for the prescribed minute. As the seconds clicked by, the DeliveryDemon gazed at the white blocks on the bilious yellow screen, idly wondering whether the developers were aware that the inability to distinguish between yellow and white is a common form of colour blindness. The clock ticked over to 8.48…… Nothing happened! At 8.55 the appointment pinged up for its allotted 3 seconds then disappeared into the ether, never to re-appear.

There is a huge disconnect between the design of this system and practical reality. The underlying driver may well be a target of fitting 5 x 12 minute appointments into the hour, but that 12 minutes is an average. Pinning appointments to an exact minute means that overruns delay subsequent appointment, but nothing is gained if an appointment finishes early – an approach which increases the likelihood of targets being missed. It also invites mockery.

The mechanism for summoning patients is equally poorly conceived. It relies on the assumption that patients gaze non-stop at the single screen, waiting for their numbers to flash up for those 3 short seconds. In reality, pillars obscure the screen from some seats, and passers-by may obscure it from any position. The area, lacking sound absorption, is noisy, so any audio cue is lost. A patient with poor eyesight may need to move closer to the high-mounted screen to read it, and age or infirmity would make those 3 seconds of visibility completely inadequate. And of course real patients are chatting, reading newpapers, watching the world go by, as the clock edges beyond the allotted minutes of their appointments. That sickly yellow screen is by no means the cynosure of all eyes.

Part of the DeliveryDemon wanted to laugh at the absence of basic common sense in the design. The reason she is not still in giggling thrall to those ridiculous flaws is the context. This was an NHS hospital. Huge sums of taxpayers’ hard-earned money went into the creation of the system. The appalling design is unlikely to result in patient fatality, but the blatant absence of commonsense in a patient-facing system must call into question the quality of other systems which are life-critical.