The Curious Case of Jagging Variations

The slow start and variable speed of vaccinations in Scotland have been the subject of many questions during the First Minister's daily update on the Cover pandemic. She has normally blamed the slower rate than the rest of the UK by stressing that Scotland had focused on the Care Homes first. Whilst this has undoubtedly been better than England, it has not picked up the Care Homes for the Disabled including those for young people and it is certainly not at the 99.5% claimed by the First Minister, even medical experts acknowledge that it is difficult to get higher than 90%. The Scottish Government and media have also given great plaudits to the mass vaccination centres such as the Louisa Jordan centre at the SECC in Glasgow and others that have come on stream in Edinburgh and Aberdeen. 

The above table tells a different tale. It is the smaller Health Board areas that have performed considerably better. The health boards covering the three Island groups together with Dumfries and Galloway, Ayrshire, Borders and Highland all mainly serve sparsely populated rural communities. They depend on GPs and medical centres to deliver vaccinations with few additional facilities brought into play. They have managed to average 37% vaccination levels. 

The remaining 8 health boards covering the cities and major urban centres have commissioned larger buildings such as football stadia as well as hosting the mass vaccination centres. They have averaged a vaccination rate of 26.3%. This is almost 30% less than achieved by the rural health boards. So why is all the kudos going to the mass vaccination centres, is it because these are the visible evidence of Scottish Government intervention? After all, Louisa Jordan cost £70m and has a £2.4m contract for security with G4S. The GPs and local medical centres are not in the game of seeking glory, they are using existing facilities and it would appear that they are a lot better organised and efficient in delivering services and at the community level where patients have to travel less and are vaccinated by familiar faces. Now that achieves efficacy, efficiency and effectiveness and is sustainable, as we see every year when the flu vaccinations are rolled out.

Jagging for Victory

You would think from the headlines of the past couple of days that the UK had achieved the impossible. 15 million Covid vaccinations in 10 weeks! The PM and  Matt Hancock have been lapping up the kudos, wearing white coats and wide smiles as if they had personally administered the vaccines. Eventually, one of their promises has been realised and it was almost world-beating, only Israel and the United Arab Emirates were further ahead. But is it really such an achievement?

During the 2019/2020 winter before the lockdown, GP practices administered the vast majority of 15.3 million vaccinations to their patients: those over 65, those in clinical at-risk groups, pregnant women, and some children, whilst hospitals vaccinated some healthcare workers. The vaccinations usually take place from early October to early November in advance of winter flu, let's say over 5 weeks. They are carried out by community-based medical staff alongside all the other duties they perform with no fuss or celebration. Patients usually just pop into their local medical centre, or if housebound, they might be visited by a GP or one of the nurses at home. It makes you realise and appreciate the effectiveness of the NHS community-based GP practices.

The Covid vaccinations have benefitted from new vaccination centres, hospital vaccinations, drive-in centres, pharmacies and the army. Retired doctors and nurses were recruited to augment the operation. So when, as the weekend approached, we were told the target of 15 million vaccinations would be reached

By Friday soon, or Saturday noon
With Boris Johnson, Matt Hancock, Kate Bingham,
Chris Whitty, Simon Stevens, Dido Harding, 
Jonathan van tam as well as
Old Uncle Tom Cobley and all,

We were meant to be amazed.

And what have they done, well 15 million vaccinations in 10 weeks? The GPs were twice as fast with no need for patients to travel to distant centres, vaccines administered by medics you know and without any significant reduction to other services. And no need for Uncle Tom Cobley and all. Like so many government initiatives during the time of COVID, new initiatives emanating from central government have been more about them wanting to take control. Local practitioners have been sacrificed and the costs of responding to COVID have grown unnecessarily

To Impeach or Not Impeach

The Rise and Fall of American Presidents

The people -- the people -- are the rightful masters of both congresses, and courts -- not to overthrow the constitution, but to overthrow the men who pervert it. Abraham Lincoln

The impeachment trial in the American Senate had been playing out all week and, when I heard on the lunchtime news that a decision was imminent, I switched over to CNN to watch the vote on the impeachment of former President Trump. I had not seen much of the trial over the previous four days and wanted to see how the Senate conducted itself in taking such a momentous decision. Here was the chance to follow another of Lincoln's maxims. 'The ballot is stronger than the bullet.'

It was expected that the Senate would fail to get a two-thirds majority to impeach the President and therefore reject the evidence of the attack on Congress by the MAGA mob. I was surprised therefore to find that the Senate had voted to subpoena witnesses following a CNN report that a Republican Senator, Jaime Herrera Beutler, had released details of a heated conversation between the former President and the Republican Minority Leader, Kevin McCarthy. McCarthy had called then-President Trump on 6 January and asked him to call off the riot. Trump had replied that it was Antifa that had breached the Capitol and then contradicted himself by saying "Well. Kevin, I guess that these people are more upset about the election than you are." It seemed very likely that if Senator Beutler gave evidence the Republican Leader would have to confirm or otherwise the veracity of her description of events.

After a 2 hour break for negotiations between the parties to decide how to proceed, it was a travesty that the Democrats merely agreed to put this statement on record. They did not insist on hearing from any witnesses. The Presiding Officer, Senator Patrick Leahy, who had taken on the responsibility of chairing the trial after the Chief Justice declined to preside because Trump was no longer president, was perplexed and confused by the procedures. The five clerks advising him were like headless chickens and seemed unable to provide him with clear advice. The Democratic party managers had decided to throw in the towel rather than pursue a series of witness interrogations? These would undoubtedly have put Kevin McCarthy in the unenviable position of having to authenticate his conversation with ex-President Trump on 6 January.

Why was this, were they really so determined to get away on their week's holiday - apparently planes were already booked for the exodus? The other reason speculated was that it would take too much time to call and prepare witnesses and this would disrupt the Senate when it needed to focus on President Biden's agenda to get America moving again. Whatever had been the reason, it certainly wasn't a determination to unearth the real facts, admittedly a rare commodity in the time of Trump. 

The final act was to hear the summing up of the trial. The Democrat's Lead Manager, Jamie Rankin, and his team argued that Trump had incited the insurrection and had failed to care about the safety of Senators as was evident in the former President's words to Kevin McCarthy. Michael van der Veen made a preposterous defence, arguing that nothing Trump said "could ever be construed as encouraging or sanctioning an insurrection," and that it was part of an "unhinged pursuit of a long-standing political vendetta against Trump."

The vote for guilty was 57 to 43, well short of the two-thirds majority required for impeachment. Minority leader, Mitch McConnell, who had voted against impeachment then made a speech that accused former President Trump of "a disgraceful dereliction of duty." "There is no question that President Trump is practically and morally responsible for the events of that day." Too late Mitch, you had already hitched your wagon to the opposite view. The whole episode in the Senate seemed mired in hypocrisy. Here is the evidence of why the self-proclaimed "great" American Constitution has not been copied by any other democratic nation. 

It was left to Republican Senators Bill Cassidy and Susan Collins to remind fellow Senators that "the Constitution is more important than any one person" and that Trump had "incited an insurrection with the purpose of preventing the transfer of power from occurring." Abraham Lincoln would have approved of their summary but he would have been very disappointed in the decision of the Senate to deny the people the real facts.

I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis. The great point is to bring them the real facts. 

"I think Abraham Lincoln said that" Bob Dylan

Conic Hill

Conic Hill summit

11 February 2021

Ascent: 380 metres
Distance: 4 kilometres
Time: 1hr 21mins

Conic Hill          361m      42mins

Conic Hill on the shores of Loch Lomond is one of those popular micro hills that attract crowds from the Central belt at the weekends and during school lockdowns. It is perfect for families on sunny days when parents and children can compete for moans on the ascent or treats on the summit. Today was different, the overnight temperature had dropped to the lowest since 2010. Despite the bright sunshine, it was a finger-numbing -4°C as I arrived at the almost empty car park just before 10 a.m. There was only a Mountain Rescue vehicle that looked as if it had arrived shortly before me. It is almost 9 years to the day since I last climbed the hill during the first leg of a three-day walk of the West Highland Way.

The well-made paths through the forest at the start of the walk were covered in soft powder snow but after passing through the gate onto the open hillside, the strong north-easterly wind had cleared the powder snow from the path. There were patches of ice, easily negotiable, and the flights of steps were generally clear. It became more tricky alighting onto the grassy slopes above where the burn had overflowed and created a bit of an ice rink. The West Highland Way path climbs to the north of Conic Hill and it alternates between hard dry gravel and sections of ice requiring some careful footwork. I continued to the east and highest end of the series of peaks that make Conic Hill and climbed the last 50 metres up a steep snow slope until emerging on the pudding stone of the summit. Conic Hill is on the Highland Boundary fault and capped by this rock.

It was bitterly cold in the northeasterly but the views in all directions were sublime, The man from the Mountain Rescue had been about ten minutes ahead of me but he had ventured off, presumably making his way back by the series of diminishing peaks to the south-west. It seemed like a good idea and I decided to descend in that direction. Each of several mini ascents was easygoing, the wind had blown away the snow. Each descent was down a steep slope of hard snow, any slip would result in a rapid slide down and I had no axe or crampons but it was the landing pit of puddingstone that worried me. 

The route meanders down a grassy slope to join the main path at the top of the steps. I had met no one so far and on Conic Hill that is rare. Three tough-looking young men in outdoor work clothes, with no hats or gloves, were coming up the steps and having a laugh. I explained the route and hoped they had a good day. When I arrived back at the car park there was a white van advertising plastering and roughcasting.  The workers had obviously found it too cold to be mixing concrete or plaster and had given themselves a deserved outing on Conic Hill, I would guess that they had no difficulty.

Approaching the West Highland Way path

Across Loch Lomond to the Glen Luss hills

Ben Lomond

Conic Hill with Gualann behind

Loch Lomond islands on Highland boundary fault

The descending tops of Conic Hill

         

Conic Hill 361m 42mins

Day 322: Jags

Tuesday, 9 February 2021

After the first lockdown on 23 March 2020, we were told that the pandemic would not be over until a vaccine arrived and that this would not be before 2021. Unusually, progress was quicker than expected and the first vaccines became available in December 2020. By virtue of age, I was in the first four groups to be eligible for vaccination, after the NHS staff, care home staff and residents and over 80s. Today was the day for our first dose and we headed for the Medical Centre that has been closed all year owing to Covid. Any consultations have been largely restricted to telephone calls or NHS 24. The two practice nurses were on duty with the GP and a couple of the practice staff in attendance to supervise the vaccination of 200 baby boomers who were rattled through safely at 3-minute intervals. 

The imperative of being on time and an overnight fall of snow had meant that I had been harried into leaving home early, the mercury was still falling under the now clear skies. We arrived 25 minutes ahead of our appointed time so I took a 15-minute walk around the snowscaped paths in the village to kill some time and to compensate for the loss of my normal morning walk that was discouraged immediately after a vaccination.  

Linda is the practice nurse whom I have seen regularly for the past ten years, she is meticulous in everything she does. When I was prescribed warfarin after being diagnosed with atrial fibrillation, I had to visit her every week to monitor my blood count. We had become good friends as we announced new grandchildren and shared stories. It took the full three minutes as Linda repeated all the do's and don'ts of the Astra Zeneca vaccine and gave me the dates for the second dose in 12 weeks, the GPs were playing by the government guidance. I discovered that the practice was only doing vaccinations one day a week and that they were already ahead of schedule. Like many others we were disappointed that it was the Astra Zeneca vaccine, the published results of its efficacy are far below that of the Pfizer and Moderna vaccines. Questions about its suitability for the over 65s and questionable protection against the South African variant have not enhanced its popularity but most GPs do not have the storage facilities for the Pfizer vaccine that seems to have been largely used for health workers and those visiting the massive vaccination centres in the big cities..

The First Minister's persistent claim that Scotland was behind the rest of the UK in its vaccination rates because it was focusing on care homes first sounds like a lame excuse. The Medical Centre probably could have vaccinated its entire practice list by now if they had been allowed, and the vaccines had been made available earlier to the GP practices instead of restricted to hospitals and vaccination centres in the early weeks. Meanwhile, HC - One, the largest care home organisation in the UK and owner of many of the Scottish Care Homes that had the highest number of Covid deaths has said that 40% of its staff have yet to be vaccinated. Other care home providers have indicated that up to 20% of staff were refusing to be vaccinated. These figures do question the First Minister's much-repeated claim that Scotland had vaccinated 99.5% of those in care homes, I doubt it. It is worrying, apart from the unacceptable failure to protect care homes, I had largely trusted the First Minister in her handling of the pandemic but there is a tetchy defensiveness about some of her recent announcements.

We returned home and I joined four former colleagues to record a Zoom video for posterity on a website we have created to capture our experiences at the sharp end of local democracy. It was the fifteenth in a series of recordings but we were unhappy with the outcome. We decided we would have another go at it next week. We had had a paper published in the Herald last week on the need to reconsider holding the Scottish Parliament election on 6 May and discussed what else we should do on this score.

I decided to continue my prescribed rest by watching politics live, one of the best current affairs programmes chaired with great perspicacity and efficiency by Jo Coburn. What a contrast with the ponderous, heavy-handed pomposity of her predecessor, Andrew Neil, the Paisley pitbull. She creates an informality and stage for courteous debate between politicians of all persuasions, journalists and an occasional celebrity. Today we had the straight-talking sense of David Blunkett with two new Tory MPs and the excellent political editor of the Mirror, Pippa Crerar. They were joined briefly by Joanna Lumley who is trying to save the seabed from the explosion of wartime bombs when creating shelves for offshore wind turbines. The first rule of a debate with a national treasure is that you don't argue with them and even David Blunkett observed this obligation. 

By 3pm, I was getting frisky and with no repercussions from the vaccine, I took off for a quick walk up Lime Craig, my 20th visit this year. It was unusually quiet, the underfoot conditions were perfect with powder snow covering the frozen and in places icy base. The air was still and cold, ideal for thinking through how I would present my thoughts on producing a place plan for the community. Two of us had been asked to take a lead on this and we were reporting back to a Zoom meeting of the Community Trust in the evening. When I returned home I phoned Joyce, my colleague on this venture,  and we decided how to make the presentation. 

After watching the Scottish news and the start of the Channel 4 news, I joined the Zoom meeting. Conversations are strangely muted as you wait for others to arrive and there are always those who are really muted and have to be hand signalled in. Our 45-minute slot expanded to an hour and a half as the Trustees got themselves caught in a circular discussion about procedures. I think we eventually reached a decision but the balance of governance between control, transparency, ownership and action is always a precarious one.

And then there was just time to catch up on the night's football matches, the news and to watch Newsnight on the first day of the Trump impeachment trial in the Senate.

Austerity, Centralisation and Entitlement: the real Covid spreaders

As the press and media begin to celebrate the speed of the vaccination roll-out, there has been a marked decline in the reporting of the mistakes in the response to Covid-19 and the damage caused to people and businesses. Every day there are new stories spun about the wonderful progress being made to escape the confinement of Covid in the UK but little reporting of the actions taken by those countries that have managed the pandemic successfully. The government's long-held mantra that we shall have an inquiry later, once we have dealt with the present crisis, is barely mentioned by the government as they edge towards a reprise of an old war slogan "vaccinating for victory".

The evidence, however, is already in the public domain provided by those who have been closest to advising and watching the governments response. Two articles published in the last couple of weeks cover most of this ground. The BMJ view on the UK's poor record on Covid-19 is a failure of policy learning together with Professor Devi Sridhar's opinion piece, Five ways the government could have avoided 100,000 Covid deaths, are well-crafted summaries of what any inquiry will find. The UK has the highest number of Covid deaths in Europe whichever way you count it. No matter how quickly the vaccines are rolled out, they will not compensate for lives lost, the damage to children's education, the bankrupt businesses and the impact on mental and physical health. The scaling back of community medical and dental services and soaring hospital waiting lists have resulted in thousands of excess deaths over and above the direct result of Covid.

So whilst these are evident truths about how the UK got it wrong, it is not very apparent that the lessons have been learnt or that all the advice, whether it is partly, sage or time related has been heeded. What is less understood is how some underlying values have underpinned a decision-making regime that has been responsible for the failures. There are three prevailing government stances that have hindered the effective response to Covid-19: austerity, centralised decision making and the sense of entitlement that government ministers intrinsically support. These have been the real Covid spreaders.

Nine years of austerity had run down the NHS with fewer hospital beds and diminished community health provision, Councils had been starved of cash for community care and government investment in contingency planning was halted. Hence the warehouses full of outdated PPE, care homes that could not recruit staff and too few hospital beds to cope with a pandemic. What was called macho economics during George Osborne's time as Chancellor or "there is no money tree" by Theresa May had decimated public services and created a pool of outsourcing providers whose familiarity with their customers was incidental rather than fundamental. All the evidence shows that austerity has had the greatest impact on the poorest families and the ethnic minority communities and it is no surprise that they have been the most serious victims of Covid. 

Rishi Sunak, the new Chancellor in the time of Covid, earned high kudos as he turned on the funding for furloughing of staff, increasing universal credit and other measures. It wiped out the alleged benefits of George Osborne's austerity measures at a stroke but also provided some big wins for those businesses with an eye for the chance. Because of his desire to fire up the economy in the summer with every encouragement to the public to support the hospitality sector and travel industry, including the eat out to help out initiative, we were soon seeing second and third waves of Covid that have proved more enduring and costly in the winter months. Peak Sunak was reached in August, he is no longer the gilded member of a tarnished cabinet.

The second reason was the centralisation of decision making by the prime minister and his advisers . There was an absurd unwillingness of the UK government to mobilise and involve the devolved nations, regions and Councils in the planning or the delivery of responses to the pandemic was palpable as it struggled to take necessary but difficult decisions about lockdown or travel restraint. Even parliament was given a minimal and belated role in the scrutiny of decisions as the PM and his coterie of favoured ministers justified their inaction or spurious procurement practices behind the excuse that we are following the science. The UK's response was totally centralised with the BBC dragooned into a plot of mock transparency. 

The government was unwilling to engage Directors of Public Health or involve Councils to deliver Test and Trace. Top-down decisions on supporting care homes, travel, school closures, and business restrictions could all have benefitted from local knowledge. The simple expedient of trusting those who know their customers and localities to deliver the services was whitewashed as the government turned to its friends, the business savvy top feeders. They were given the chance to influence the shape of the response and then to pick up government contracts that were excluded from any objective tendering process. These decisions have been hugely costly to lives and the nation's finances as is most apparent in outsourcing, the Covid-19 windfall and £25.7bn according to the NAO on the Test and Trace programme.

The third reason for the government's devastating failure in responding to the pandemic is the presumption that entitlement allows certain groups and businesses to be exempt from the measures imposed on the general public. The entitlement is endemic in networks of the moneyed and privately educated elite that control the power in the highly polarised structure of society in the UK. As most of us obeyed the instructions to stay at home, only allowed ourselves an hour of exercise within walking distance of home and with no testing available, there were others whose lifestyles seemed untouched. Business people travelling abroad, royalty travelling between their various houses, celebrities jetting off to the sun, and premier football teams getting unrestricted testing and winter training camps in the Middle East. The most shameful example of exceptionalism was the failure of the PM and his cohorts to observe the guidelines as exemplified by Dominic Cumming's much-maligned trip to Durham. It merely confirmed that the government's exceptionalism has been also been a Covid spreader and that we should know our place.