The government must not be allowed to rewrite history on its failure to protect the NHS

The facts are these. On 9 December, HSJ reported admissions of covid patients had begun to rise from 4 December. It is really important to remember and stress this was not meant to be happening. The plan was that restrictions were meant to be dampening down infections ahead of the Christmas lockdown. 

HSJ was simply reporting a trend apparent from publicly available data which refers to the position three days previously (in this case 6 December). Rises in infections and hospital admissions obviously came even earlier than the increases in bed occupancy.

The senior NHS executives and government representatives attending the daily national incident response board had known, discussed and expressed concern about the trend since at least the start of the month. Two senior figures who are participants in these calls have both told HSJ that even if the government did not know the exact cause of the problem, it certainly knew there was a big one.

Yet still the tiered restrictions and Christmas plans remained unchanged and shoppers thronged the streets and stores. The cautionary principle observed by other European states seeing upticks in infections was seen as pure pessimism.

On 11 December, HSJ reported “36 trusts had seen covid admissions rise by 20 per cent plus in a week”. On 14 December, we reported covid admissions were again on the rise slowly in the North, and explosively in the South.

Later that Monday, the health and social care secretary Matt Hancock first publicly mentioned the new variant and fears that it could spread faster. It later became clear the variant had been first identified in September.

On 15 December, HSJ and the British Medical Journal called for the government to respond to the worsening situation by cancelling its plans to allow house-hold mixing over Christmas and tightening the tiered restrictions immediately.

On 16 December, Boris Johnson said such a move would be inhuman. Matt Hancock speaking privately to colleagues railed against mischief-making “newspapers” who knew it was too late for the government to change tack and whose opinion on this matter was worthless in any case.

The U-turn which followed on Saturday sent thousands of people onto crowded trains, exporting the new variant far and wide.

Speaking to HSJ after the decision, an exasperated senior Tory politician bemoaned his government’s chronic delay “on every single decision” that mattered to controlling the pandemic.

The end result — as forecast in HSJ’s 15 December editorial — is that, in the words of a national NHS leader speaking to HSJ this week: “The most likely scenario is that we’ll have more covid patients in our beds on 1 January than we did at the height of the first peak.”

Thank heaven the government did finally see the sense in changing its Christmas plans. But it should not be allowed to get away with claiming they were forced to do by a previously undetected threat — or that the situation facing the health service is anything other than an unmitigated and avoidable disaster.

The prime minister talked about “changing his mind” because the “facts have changed”. Well, as we have seen, the “facts” changed long before the government acted.

The vaccination programme

Truth be told, HSJ receives many reports of Mr Hancock being an energetic promoter of the NHS’ cause with Whitehall and Westminster. He and the senior medical/scientific advisers have usually managed to eventually persuade No 10 to take the right course of action.

Where Mr Hancock has undermined his reputation with the NHS (and, it should be noted, within his own party) is with his constant over promising and under-delivering.

This has been particularly brought to the fore in his predictions of how successful Test and Trace would prove to be. One senior T&T executive said dealing with expectations created by his constant boasts was “100 per cent the biggest issue in my working life”. When HSJ suggested to one of the programme’s leaders that they might ask the health secretary to be more cautious, they laughed hollowly and rolled their eyes.

Compare that scenario with the one surrounding the covid vaccination programme, led by NHS England.

In sharp contrast to Test & Trace, the approach has been strictly to boast of successes only once they have been achieved.

From a standing start at the start of the month, more than 500,000 people have received their first shot of the Pfizer vaccine. This has been achieved despite having to involve hundreds of NHS organisations, thousands of independent GP contractors and a myriad of IT systems.

The programme has not been without its teething troubles or its critics, but it has got off to a strong start and, crucially, seems to have established the public trust vital for all vaccination initiatives.

Of course, the programme must successfully accelerate in both scale and intensity if it is to hit Sir Simon’s ambition to have every at-risk person vaccinated by Easter. There will likely be pressure to go even faster. People’s relief that vaccination has begun will also soon start to be replaced by impatience that they have not yet had their shot.

It is also the case that when and in what quantity vaccine supplies arrive is out of NHSE’s hands. As is the approval of new vaccines, including the all-important one from AstraZenca/Oxford University. These are two other good reasons why NHSE has been very careful about what it has promised.

Finally, for the reasons explained in the first half of this editorial, some systems will have to deliver the vaccination programme while being overwhelmed by covid. Finding the staff and facilities needed to significantly increase and maintain the pace of vaccination in these areas will be a nightmare.

Merry Christmas and a better new year to all HSJ subscribers.